Underlying problems with attitudes towards people with a mental illness and mental health issues – Some brief thoughts

I have had this on my mind for a number of years and it is a topic that is close to home, given my own long-term depression and other mental health issues, as well as my being on the spectrum. As a society, we currently give lip service to spreading awareness about mental illness, presumably to compensate, in lacklustre fashion, to the cuts that mental health services have sustained due to the government’s fanatic desire to adhere to neoliberal economic policy by reducing spending on public services and increase the role of private sector in the management of people’s health (but we won’t get into that here). Despite the so-called increase in awareness of those with mental health issues, the ways in which people talk about people who have, for example, suffered long-term depression is, quite frankly. insulting and contradictory.

People with mental health issues are encouraged to exercise their own responsibility in talking about their depression or other mental health problems; this has been specifically aimed at men because it is assumed that men hide their poor mental health behind machismo bravado. Regardless of gender, the current discussion concerning mental health conditions has been that in order to tackle mental health those with mental health conditions are personally responsible in declaring to others that they are in poor mental health. After all, how can they be helped if they don’t exercise they don’t exercise their personal responsibility in admitting that their poor mental health is having a negative effect on their lives?

Although the point above sounds like a reasonable one, it is fraught with unseen problems because of the emphasis on personal responsibility. For someone with a mental illness/mental health issues to be told that they are personally responsible in disclosing that they have, for example, depression it is particularly difficult, for the following reasons:

  1. The current discussions of people’s mental health is predominantly focused on people’s lifestyle choices rather than the structural or institutional causes (larger and embedded social problems within society). This means that, as we discussed above, people’s discussion around mental health is consistently centred on personal maintenance and strategies in personally maintaining their own well-being, such as positive self-talk and mindfulness. While these personalistic exercises aim to alleviate symptoms of mental illness they don’t eliminate the structural causes (the rise in food banks, insecure and precarious work and so on).

2. The person with a mental illness/mental health issues may not even be aware, particularly if they have lived with poor mental health for most of their lives (e.g. because of long-term social isolation) that they have a problem. Thus, they cannot be held personally responsible in disclosing that they have a problem because they are desensitised or numb to their mental illness, as well as the conditions that have played a significant part in creating their poor mental health in the first place. The fact that the sufferer may be unaware of their poor mental health and the conditions that have given rise to it means that someone else has the personal responsibility or duty to acknowledge that this person faces difficulties. However, in the case that the sufferer is unaware of their own mental ill health, it is likely that within the current system that they will not receive the proper care because they are treated as autonomous, self-aware individuals that are responsible for the maintenance of their own mental health, just as they are presumed to be economically responsible for everything they do. After all, a reactionary  observer in , say, the DWP may think “if they have managed this far in generally horrendous conditions and poor mental health, why would I feel obligated to help them?”

3. We live in a society with a set of social norms that enforces an artificial sense of upbeatness inherent within the field of positive psychology, which Barbara Ehrenreich has pointed out in her book Smile or Die, as well as Bright-sided: How positive thinking is undermining America. In living in a society that coerces us to be artificially happy, the relationships we have with people in society are equally artificial because they are based around not talking about our true feelings and ideas and, as a result, lacking in meaningfulness. The consequences of this are evident in Ehrenreich’s point that the institutional coercion for mandatory positivity contributed to the financial crisis because those who warned of the housing crisis were dismissed as being needlessly negative.

4. This connects to 3. and 1. but is equally important. In living in a culture that still dismisses people as being negative, from being honest about the poor condition of their mental health to talking about ideas that they have, people that face this understandably continue to face stigma. For example, if Ben expressed that they are depressed there is a chance that Ben would be treated as a whiner by Jen who isn’t taking things into their own hands to improve themselves in a predatory environment that treats mental illness as being caused by individual thought processes and behaviour rather than wider social structural problems within society. After all, Jen may well be depressed herself but she has “coped” so why should Ben be any different? In actuality, Jen may be motivated by resentment towards Ben because she is perpetuating the same indifference that she has faced from others regarding her own mental illness. As a result, both can be considered victims of the wider attitude that people with a mental illness should claw their way of their own problem.

5. While people like to talk about respecting that people with mental health differences and increasing mental health awareness, they continue to advocate the same uniform positive psychology techniques that we have already established. The emphasis positive psychology places upon the individual well-being only serves to increase the pressure on the individual to improve their own mental health. As a result, if these “techniques” and “strategies” only risk producing feelings of self-blame if they do not successfully improve a person’s mental health. Again, these strategies such as mindfulness through meditation are based on the premise that people can actively improve their depression solely by the exertion their own willpower alone. This only serves to treat depression as a “problem with the individual” rather than a “problem with society”. The latter seems to be considered a taboo that is rarely discussed in any detail by the media and especially psychologists within the field of positive psychology. Thus is is preferable to identify mental illness as a problem that is isolated individual rather than connected to deeper societal and social problems.

 

It is strange that the discussion about spreading awareness of mental health is still stuck in a kind of archaic time warp in terms of it’s attitudes and ideas about tackling the problem. Again, this is probably due to the preoccupation with minimising symptoms through various behavioural techniques rather than eliminating the social conditions that cause mental illness in the first place. Loneliness and social isolation undoubtedly plays a role in creating mental ill health but does this mean that someone who has little or no friends brings it on themselves? Underlying this belief is the assumption that there clearly must be something wrong with this lonely person which creates a kind of witch hunt atmosphere towards that person. Additionally, the lonely person is most likely assumed to be not trying hard enough to make friends, creating the the added self-blame on the isolated/lonely person. Thus, it is little surprise why mental illnesses are becoming more common as the second biggest cause of disability, as the WHO and a study in the PLOS medicine journal (https://www.bbc.co.uk/news/health-24818048).

While there is some recognition that depression is a disability, it is not sufficiently taken seriously by the social security system in the UK. Nor are the Work Capability Assessments effective in providing a basic social safety net that provides the vulnerable with the freedom to avoid poverty which was what the social security system was partly designed for. Instead, it seems that the emphasis on  short-term plasters such as cognitive behavioural “strategies” that revolve around personal responsibility in tackling one’s own mental health issue prevails over any attempt to see the connections that mental illness and mental health issues have to wider social issues.  If the emphasis isn’t placed on the social conditions that given rise to mental ill health, we will live in an increasingly socially atomised system where “society” will have little meaning.

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