Depersonalised conversations about mental health

As a therapist I’m happy to see the momentum that is gathering around conversations about mental health, particularly in the African and Caribbean communities, and also in wider society. As much as the stigma attached to mental health is being slowly eroded I feel the conversations are very 2 dimensional. Maybe our use of the words mental health is too encompassing and meshed to enable clear understanding to be had about cause and effect.

Mental health is used to describe enhancing one’s wellbeing; mental health is used to describe someone being mentally unwell like someone experiencing being run down, having a cold or flu; mental health is used to describe the capacity of cope with everyday stresses; mental health is used to describe someone experiencing mental illness known as psychosis which is at the extreme end of the continuum and requires medical intervention. Mental health is used to describe symptoms without asking what the cause is.

Currently there’s a sense that we are stuck in a situation where in conversations – medically oriented professionals and lay people like, the label is seen as the cause. In truth, depression, anxiety, stress, border personality disorder etc as descriptors is just that. They don’t actually tell you anything about the person’s experience and life story. Of course, if that’s the diagnosis then medically it indicates a certain treatment protocol will treat and cure the condition as though psychological injuries are akin to cancer cells to be eradicated and sent into remission. That may be the unconscious wish of many, which is to have their pain from past experiences permanently erased. The medical equivalent would be the removal of some brain tissue to stop the physical capacity to remember. Therapy or treatment can’t ever cure in the traditional sense that we think of and that’s something I feel needs to be more explicitly stated. Instead all work to do with mental health in its various forms involve providing the space to be heard and helping people to heal, live with, think different, change, accept or grow amongst other things. Granted this is more related to historical experiences leading to present day vulnerabilities.  This is where I feel the conversations can get a bit muddled. Mental health being discussed relative to present day situational difficulties versus unresolved/unprocessed historical life experiences. Then there’s the issue of how our past and present interact to cause health issues.  This is where people get wrapped up in the labels and depersonalise their lived experienced.

When it comes down to it, for me, the critical issue is, what’s the person’s story, who are they beyond the label? If the person has been “diagnosed” with depression, anxiety, as borderline etc, what have they been through that has left them feeling depressed or lead them to bottle up their feelings? If someone is suffering from excessive anxiety what is triggering the fear, threat, or lack of safety? No one wakes up one day mentally unwell unless they have been through something like a single event trauma i.e. natural disaster, a violent physical or sexual attack or an accident.  For the of majority people becoming mental unwell happens slowly overtime due to a combination of factors. That is where the complexity of the work lies and a reason why pharmacological treatment which is necessary for some people will be never be the cure by itself despite the ideological, political and economic motivations for pursuing this course of action. I remember seeing Dr. Bessel van der Kolk  in a lecture say something like the reason why we keep looking for biological solutions is because it means we avoid looking at the root causes of trauma in wider society. I couldn't agree more.

To reiterate, in the main, becoming mentally unwell doesn’t happen spontaneously or in vacuum. It tends to be an accumulative process thus the work needs to mirror that by addressing the multi layered factors. This may not be what people what to hear or are conditioned not to consider but this is part of the uncomfortable truth that needs to be part of the work to facilitate the healing, change and growth.