Mental Illness as Societal Sickness

It’s Bell Canada’s annual “Let’s Talk” day, and I’d like to take the opportunity to dissect what we really mean when we talk about “mental health”. It seems straightforward, but the concept is also a tool for enforcing norms and controlling behaviour. As a person labelled mentally ill myself, I feel we need to fundamentally change the discourse — and Bell’s project isn’t up to the task.

The human mind is incredibly complex and nuanced. With ~8 billion individuals wandering around the planet, the diversity in styles of thinking and personality is nearly unimaginable. Culture both influences and is influenced by individuals, adding even more variables to the makeup of a person. Each culture has ideas about what is considered “normal” thinking and behaviour, and both formal and informal rules about how to deal with abnormalities.

In our culture, we tend to measure this normality by one’s ability to function in society: can you hold down a job, pay your bills, and cope with the challenges of everyday life? Most can, some struggle at times, while others are simply incapable. Whether by emotional incapacity, difficulties in processing reality, or cognitive deficit, many people are made outsiders to society by virtue of their difference. This difference is medicalized and pathologized, treated as a problem to solve, an aberration to be eliminated. The explicit goal of these treatments is to return the subject to a normal state, such that they can work, buy, consume, and conform.

But it’s not like this in every society. Premodern peoples and cultures without an overly rationalized view of psychic phenomena don’t generally seek to eliminate difference. Those who hear voices and receive visions are often perceived as special — granted the gift of prophecy, or a special connection with beings from the spirit realm. Those suffering from unpleasant or harmful conditions are treated in the same context — ritual healing ceremonies, and with the care and love of their families and communities. Of course it’s a mistake to overly idealize some abstract primitivism, but there are things we can learn from this approach.

Many of the common psychic pathologies in Western society are arguably actually social pathologies. Rates of anxiety and depression, addiction and related problems have risen steadily in the last few decades. Among marginalized peoples, the poor, and those with precarious living conditions, these issues are even more prevalent. In some communities, opiate addiction alone has become a public health crisis. The correlation between mental health and socioeconomic status, community integrity, and general life-stress suggests that the structure of our society and economy are partially to blame for these conditions.

So how do we solve this?

First, we should address how we’ve been managing thus far. The psychomedical model of mental health has dominated since the mid-20th century. Most people suffering mental illness are assigned a diagnosis by a medical professional, and treated with a combination of drugs and talk therapy. Cognitive behavioural therapy (CBT) stands as the gold standard of dialectical counseling, which can help to identify and address problematic thinking strategies. The majority of medications used act as some form of anesthetic — reducing unpleasant or unwanted sensations so that one can cope with their existence. Many people go on to live happier, more fulfilling lives as a result of these techniques — myself included — but this is only a partial solution.

While conditions have improved somewhat, access to care of this kind is still quite limited. Counselling is very expensive, and the wait time to see a psychiatrist is often measured in months. Drop-in centres and call-in crisis lines are available, but don’t address the need for ongoing and contiguous care. Sadly, many with treatment-resistant disorders eventually run out of medication options, or slip into hopeless resignation. Ultimately, without addressing the underlying socioeconomic and structural conditions, the prognosis for those on the margins is poor.

Bell’s stated purpose for facilitating this conversation is to reduce stigma about mental illness, and get people thinking about their own state of mind, which is great. But there’s an underlying instrumental goal: minimizing lost productivity. Bell is a telecom juggernaut, and one of Canada’s largest and most wealthy corporations. They employ thousands of people as technicians, customer service agents, and various bureaucrats. Each year, thousands of person-hours are lost to mental health-related absence and impaired functioning. It’s largely in the interest of recouping those losses that Bell (and other corporations) take action on this issue — not for its own sake. Bell’s policies with regard to mental health leave and work-life balance heavily encourage presenteeism, and what help they do provide is focused on functional mental health management.

If we really want to improve on mental health, a more fundamental change of approach is needed. Addressing the aforementioned social and economic problems is a crucial first step. Complying with the society-wide compulsion to full-time, 40-hour work weeks under threat of poverty is simply an unrealistic possibility for many, causing high levels of stress. Poverty and homelessness themselves are among the largest contributors to poor mental health. And yet we’re immersed in a constant flood of emotionally manipulative advertising, highlighting our insecurities and urging us to spend them away. This highly individualistic culture, with poor community solidarity and a severe lack of neighbourliness leaves us lonely and sad. Instead of fun, we’re sold entertainment; instead of feeling sad, we buckle down and sacrifice. Is it any wonder we’re all nuts?

A society designed for sanity would ensure that all persons are treated in a humane way. Rather than individualizing, medicalizing, and stigmatizing problems, we would provide understanding and holistic care. Instead of anesthetizing our pain away, we would address its cause. We would focus not on solving symptoms so we can get back to work, but on becoming our best selves. Essentially, we would view mental healthcare not as a means to an end, but as an end in itself.

Thinking about and discussing this topic is a good first step, but we need to break out of the confines of what’s considered realistic and normal. If we really care to solve this problem, outside-the-box thinking is required. New research suggests that spiritual practices, psychedelic drugs, and community living hold great promise for the future of psychic well-being. But these ideas carry as much — if not more — stigma in this hyper-rational, individualistic paradigm. Attitudes are changing, but we have a long way to go.

I hope this has been thought-provoking. For those of us who suffer under the current paradigm, your understanding means a lot. Here’s to our health!