By Candice Louisa Daquin
The wish to laugh and shrug off differences that create unhappiness and wars is a universal one. The majority of us want to avoid unhappiness at any cost. There is however, a downside to trying to avoid unhappiness by being too open about unhappiness. When we begin to pathologize everything as a disorder, we may inadvertently neglect our ability to generate better mental health.
Before mental illness was discussed en mass, it was private and considered shameful. This had obvious detrimental effects on those suffering, but one could also argue there was a benefit to not making everything so extremely public. Like with any argument, there are pros and cons to how far we publicize mental health. The extreme of ignoring it, didn’t work. But does the extreme of talking about it to death, really help people as much as we think?
In the second half of the 20th century, owing in part to a neglect of, and a need for; improved mental health care, societies began to shift from encouraging suppression of emotion to a recognition of psychological distress and its impact. Institutes and then the de-institutionalisation movement, became ways of coping with people who struggled to function in society. But these people didn’t choose to be unhappy. Whilst it’s obvious this shift to publishing mental health instead of hiding it, has been highly beneficial in some regards; we should also consider its far reaching ramifications.
“(Historically) Many cultures have viewed mental illness as a form of religious punishment or demonic possession. In ancient Egyptian, Indian, Greek, and Roman writings, mental illness was categorised as a religious or personal problem. In the 5th century B.C., Hippocrates was a pioneer in treating mentally ill people with techniques not rooted in religion or superstition; instead, he focused on changing a mentally ill patient’s environment or occupation or administering certain substances as medications. During the Middle Ages, the mentally ill were believed to be possessed or in need of religion. Negative attitudes towards mental illness persisted into the 18th century in the United States, leading to stigmatisation of mental illness, and unhygienic (and often degrading) confinement of mentally ill individuals,” states an article on this issue.
By publicising everything, in reaction to the days when mental health was viewed with more stigma, we have not improved suicide statistics or mental illness numbers like we’d logically assume. When something is freed of stigma and shame, more people admit to suffering from mental illness than ever before, which will make it seem like more people have mental illness, when it could simply be that they are more willing to admit to having it. On the other hand, there is an observed phenomena of things becoming socially contagious.
How can we be sure we’re not increasing mental health numbers by making it so acceptable to be mentally ill? By over-emphasising it on social media? Publicising the struggle to avoid stigma, is positive, but the degree to which we discuss mental illness may be so open, as to increase numbers or over-diagnose people. For example, everyone gets sad sometimes, that doesn’t mean everyone suffers from clinical depression. Everyone gets anxious sometimes but that doesn’t mean everyone suffers from anxiety. The distinction is: Is it a disorder or a feeling? Do clinicians spend enough time considering this when they give patients a life-long diagnosis? And what is the effect of such a diagnosis?
When psychiatrists diagnose mass numbers of people, especially easily influenced teenagers, with serious life-changing mental illnesses, that immediately means the reported numbers swell. Who is to say they would be that large if diagnosis weren’t so open ended? Nebulous? Open to outside influence? Or even, the pressure of pharmaceutical companies and desperate doctors wanting quick fixes? What of parents who don’t know how to handle their rebellious teen? Is that mental illness or just life? If they demand treatment and the teen is labeled mentally ill, do they fulfil that prophecy? And if they hadn’t been diagnosed, would their reaction and outcome be different?
Our innate ability to laugh and shrug things off, comes from the challenges in life that were so terrible we had no choice if we wanted to go forward. If we remove those challenges, are we teaching our kids how to cope with hard things or wrapping them in cotton wool and medicating them? When a family of ten children ended up with eight routinely dying, how else could families cope with such tragedy but to have that coping mechanism of laughter and the ability to shrug off despair and horror? It did not mean anyone was less caring, or feeling, but that sensitivity had to be weighed against our ability to endure. We could argue we endure less pain now than ever before, as we are less likely to lose a great number of people we know, die due to disease and famine and other historical reasons for early death. Many will never even see the body of a dead relative, so how can they process that loss?
The modern world brings with it, its own attendant risks and stressors. People growing up in 1850 may not have had to worry in the same way, about looking young to keep a job, or trying to ‘do it all.’ On the other hand, they might have had to worry about not having a society that helped them if they lost a job, or how to stop their families from starving or their village from being raided. They had fewer social cushions in that sense and more of a risky day-to-day. This was starkly true when we compare the recent pandemic outbreak with say the plagues of earlier centuries. People died in the street and were left to rot, whereas now, even as we struggled and many died, we had a modicum of order. For all our terrors with Covid 19, it could have been far, far worse and has been. I say this from a position of privilege where I lived in a society that had access to medical care, and I’m fully aware many still do not, but nevertheless if we directly compare the experience of the Black Death with Covid-19, we can see tangible improvement in what those suffering, could access.
This means whether we believe it or not, appreciate it or not, we have over-all an improved quality of life than even 50 years ago. At the same time, we may have swapped some deficits for others. It may seem a minor consolation for the myriad of modern-day woes, but we are better off than our grandparents who were called ‘The Silent Generation’. They grew up learning to not speak of their struggles but cope with them silently. These days we have outlets. And in other ways, we are more alone, it is a strange mixture of progress and back-tracking. Some would argue our grandparents had a simpler, healthier life. But if average life expectancy is anything to go by, we are growing older because for the majority, our access to medical care and over-all nutrition, are improved. On the other hand, more grow old but sick-old, which is not perhaps, something to aspire to.
When we consider how badly many eat, and in truth, we do ourselves no favour when so many of us are obese and suffering from diseases of modern living such as lack of exercise, heavy drinking, lack of sleep and eating fast-food. It might be most accurate to say we have swapped some deficits such as dying due to curable diseases, and dying from malnutrition or lack of access to care and antibiotics, with modern deficits like increasing cancer rates and increasing auto immune disorders, all of which are increasing with the swell of the modern world and its life-style.
What it comes down to is this; through the wars of the past, people stood next to each other in trenches whilst their friends were blown to pieces or died in agony. They had PTSD[1] then, they suffered from depression and anxiety, but they also had no choice but to carry on. For some, the only way out was suicide or AWOL[2], while for many, they stuffed their feelings down and didn’t speak of it. Clinicians thought this way of coping caused illness and it led along with other reasons, to an improved mental health system.
But, now, in 2022, you might be forgiven for thinking EVERYTHING was a disease, and EVERYONE suffered from something, and you might find yourself wondering if some of this perceived increase was the direct result of going from one extreme to the other. Initially, nobody was mentally ill. Nowadays, who isn’t? Is this a better model?
Having worked with mentally ill people for years as a psychotherapist, I can attest that mental illness is a reality for many. I knew it was before I ever worked in the field, and it was one reason I chose that field. I wanted to help others because I saw viscerally what happened to those who did not receive help. Despite this I came to see the value of sometimes putting aside all the labels and diagnosis and medications and treatments and trying to just get on with the process of living. If we tell someone they are mentally ill and medicate them and coddle them and tell them they don’t need to try because they are so sick, then it doesn’t give them much motivation to see what else they can do.
True, for many, they are too sick to do anything but survive and that in of itself is a big achievement. So, when we talk about the need to motivate ourselves beyond labels, we’re talking about those who we’d call high functioning. People who may suffer from depression, or anxiety, but are very able to do a lot of things despite that. Does medication and therapy and labeling them, really help them make the most of their lives? Is putting them on disability for years without reviewing if things could or have changed, help? Can they learn something from our ancestors who had to just laugh and get on with it, no matter how tough things got?
It may seem a very old-fashioned approach to consider ‘toughing it out’ and having come to America and seen how much onus they put on toughing it out, I have mixed feelings about the value of doing so. The idea of being tough enough means there is always the reverse (not being tough enough) and that feels judgmental. Being judgmental, I think, has no place in recovery.
What does have a place in recovery, is doing the best you can and not letting labels define or defeat you. In this sense, I see a lot of commonalities with those struggling today and those who struggled 150 years ago. Maybe we can all learn from them and combine that with some modern prescriptivism that give us more chance to laugh and thrive, rather than fall under the yoke of a diagnosis and its self-fulfilling prophecy?
I have had many clients who felt their diagnosis disincentivized them from any other course of action than being a patient. The medication route alone is fraught with ignorance. For so long SSRIs[3] and other anti-depressants were heralded as lifesavers for depressed people, but what proof existed for this aside the hope a cure had been found? Years later studies showed only 30% of people seemed to respond to anti-depressants versus placebo.
Then second and third generation drugs were created, all the while charging exorbitant prices, and patients routinely took 2/3/4 medications for one ‘illness.’ Aside the expense and physical toll taking that much medication can do, there was a mental cost. Patients felt over-medicated, but not happier, not ‘better.’ By tputing their faith in drugs, they lost their faith in other ways of getting ‘better’ and some spiraled downward. The reality is we are all different and we process life differently. Some of us are more forward-focused, others, through imitation, genes or experience, may not be. It isn’t a deficit or illness, it’s a personality, that can change somewhat but should also be understood as the diversity of how humans cope.
Treatment Resistant Depression became the new diagnosis when modern medication failed, and new drugs were considered in tangent with current drugs, but this led to people taking more drugs, for longer periods of time, often with little improvement. How much of this is due to a negligent approach to treatment that only saw drugs as the answer? Meanwhile therapy was cut-back or became prohibitively expensive, cutting off other options for treatment. It’s logical that therapy can help avoid feeling isolated, but when the system prefers to medicate than provide therapy, there are so many taking medicines for years, that were only meant as stopgaps.
Should the media or your general physician, be the one telling you what drugs you should be taking, if at all? Preying on the desperation families by the introduction of for-profit medication, muddies the waters further. The disparity of information means no one source can be trusted, especially as information is ever-changing. More recently a study showed that anti-depressants may not work at all it was commonly held clinical depression was caused by a chemical imbalance and studies show correcting that imbalance does not improve depression as was once thought.
This shows us that psychiatry still has a long way to go, and when they claim things as facts, they rarely are. It contends we should not blindly trust what has become a profit led industry, where many of its practitioners see patients for a short time but somehow still diagnose them with serious mental disorders. Surely, we should consider equally, the importance of conservative diagnoses and recognise that normal variants are not necessarily disorders. In many cases, it may be that under diagnosing rather than over-diagnosing could work better.
For example, I know of many (too many) patients who told me they were diagnosed with bipolar disorder, before the age of 21 by a regular non-mental health doctor, or by a psychiatrist. Their subsequent mistrust of the system is understandable with that experience. How can someone tell you that you have bipolar disorder at 17 years of age, from a 20-minute conversation?
Even the diagnostic criteria for bipolar 1 or 2 in the DSM (Psychiatric Diagnostic and Statistical Manual), is flawed, because it’s too generalised and only highly trained professionals would be able to understand the nuance. Most are not that trained and therefore take at face value, when a diagnostic tool says someone has bipolar if they experience an episode of mania. But firstly, are they defining mania correctly? Is the patient describing mania correctly or being led? Were there mitigating factors?
If you diagnose a child with a serious mental disorder and medicate them, how can you be sure their brains aren’t affected by taking that strong medication before they have reached full development? How can you be sure they are not becoming what they are told they are? Too often, people spend years under the cloud of medication, only to emerge and realize that what was a discrete episode of depression, was medicated for decades, robbing them of the ability to recover? Doesn’t a label make it likely that some will feel helpless?
Moreover, how much power does a label have on our sub-conscious? If we are told, we are (will not be able to do something, why would we even try? If we believe we are depressed, are we less or more likely to fight against it? Isn’t some fighting a good thing? Likewise, diagnosing older people with a disease like Bipolar (a disease that occurs after puberty), shows the mistakes of the psychiatric world. How can a 70-year-old man ‘suddenly’ be Bipolar unless he has a brain-tumour or otherwise? Dementia is often misdiagnosed as Bipolar because badly trained doctors seek answers for aberrant behavior, without considering the whole story, such as how can someone of 70 develop a disease that affects those around the age of 18? Sure, some can slip through the gaps, but often, it’s the frustration of the family or doctor colouring the diagnosis. Such life-long labels should not be given lightly.
What if we treat mental illness depending upon its severity, in a different way? Consider the value of improving real-world ways of copying despite it, instead of relying on medications that were only ever meant as a stop gap and not developed to be taken for years on end? Nor over-medicating without due cause. Nor medicating young people based on very loose diagnostic expectations. Or assuming everyone who says they feel depressed or anxious, is clinically depressed or anxious, or that medication is their only solution?
Organisations that take vulnerable teens who often have co-morbid diagnosis of drug-or-alcohol abuse alongside mental illness, into the wilds, seem to be a real-world way of encouraging those young people to find coping mechanisms outside of addiction and reliance upon medication. Equally, when a young person (or anyone really) is productively employed in something they feel has meaning, this is one way anxiety and depression can improve.
We’ve seen this with Covid-19 and the necessary isolation of so many school children. Whilst it was unavoidable, the rates of depression spiked, in part because studies show people need interaction with each other. This is why online learning has a poorer outcome than classroom learning, this is why older people are less at risk of dementia if they socialise. We are social animals, we feed off each other and we empower each other. Finding your place in the world is always in relation to others to some extent.
We may never avoid war completely or our human tendency for strife, but we also have a powerful other side that urges people to do good, to help each other, to laugh and shrug off the differences that divide us. What good does’ division ever do? Unhappiness is unavoidable at times, but sometimes it’s a choice. We can choose to recognise something is hard and actively pursue ways of improving it. We can struggle through and feel good about the struggle and the effort we put in. if we take that all away and don’t encourage people to try, we give them no way out. Sometimes there is no way out of suffering or mental illness, but often we cannot know that unless we have tried.
Many years ago, people valued older people because they were considered wise and able to impart valuable life lessons to impetuous youth. Nowadays, the elderly are not respected and are often siphoned off into homes before their time, because people find them an inconvenience. There is a theory that humans became grandparents because grandparents were an intrinsic part of the family make-up. This explained why humans were among the only mammals to live long after menopause. Most animals die shortly after menopause, nature believing once your reproductive years are behind you, you have no value. But humans were distinct because they live long after menopause. The grandparent theory supports this by demonstrating the value of grandparents, and we can learn a lot from what nature already knows. It is never too late to have value, it is never too late to learn and grow, and it is never too late to laugh and come together, setting differences aside.
Those who achieve that, may well be happier and live healthier lives, as laughter is shown to be a great anti-ager as well as an improvement on our overall mental and physical health. Of course, what we can learn from the extremism found in the cult of positivity, illustrates there must be balance and we cannot expect to be happy all the time or unaffected by tragedy when it occurs. But staying there, and not attempting to move beyond it, to reclaim ourselves and our futures, seems to be a way to avoid going down that dark tunnel of no return.
Experience shows, we are what we think. We don’t have to be positive 24/7. To some extent any extreme sets us up for burnout and puts too much pressure on us to be ‘up’ all the time, when it’s natural to have down times. But striving for happiness, or contentment, or just finding ways to shrug off the smaller things and come together, those are things most of us wish for. So, it does no harm to direct our energies accordingly and prioritise our ability to cope. Perhaps our differences are less important sometimes, than what we have in common, and what we can do to make this world a more livable place.
[1] Post-traumatic Stress Disorder
[2] Absent without Official Leave
[3] Selective Serotonin Reuptake Inhibitors
Candice Louisa Daquin is a Psychotherapist and Editor, having worked in Europe, Canada and the USA. Daquins own work is also published widely, she has written five books of poetry, the last published by Finishing Line Press called Pinch the Lock. Her website is www thefeatheredsleep.com
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