By Bart Magee, Ph.D.
In my previous two posts, I examined our failure as a society to truly address the mental illness/wellness crisis in our midst. The evidence and consequences of this failure are everywhere as rates of mental illness rise along with related social problems, trillions of dollars in costs, widespread suffering, and death. Another consequence of continuing to marginalize psychological and emotional problems is that we perpetuate a myth that the causes of depression, anxiety and other forms of severe emotional distress aren’t well understood and don’t have effective treatments. For the latter half of the 20th century and continuing today, the dominant thinking about mental illness has privileged biomedical causes and technical interventions like medications and behavioral therapies. However, because biological factors are only one of a number of contributors to emotional problems, basing treatments solely on them has led to narrow and disappointing results. This is a well-established fact. But rather than rectifying a misguided approach, there has been a doubling down on the search for brain-based causes and treatments. Much of this is wasted energy and it diverts our attention and obscures the truth. We do know the fundamental causes of serious mental illness and we already have excellent treatments and other remedies at hand. We are continuing to expand our knowledge of the mind, but what we need more than greater knowledge is a new approach to the problem. That’s how we solve mental illness.
In my first post I discussed the fractured, method we’ve taken throughout history, a sort of blind-man-feeling-the-elephant process, to conceptualizing human mental life and its related maladies, one destined to come up short. If we’d employed the same strategy to the goal of landing on the moon we’d still be staring at the white board. And as it goes with space travel, understanding the mind and its relation to experience is a vastly complex enterprise. When approaching any complex problem the first thing you need is a comprehensive theory to work from. While there have been efforts to integrate approaches to mental illness, we have yet to build a theory that incorporates the four basic formulations (the somatic, psychological, spiritual, and social) and ground them in contemporary research and understanding. Such an all-inclusive theory is vital as we need to replace the worn out biological/medical theory (that illness is caused by bad genes or poor wiring in the brain) as well as the moral explanation (that it’s caused by a weak character) both of which have impeded our efforts to address the issue. A comprehensive theory of mental health will be grounded in human development incorporating psychological, social, environmental, and spiritual factors along with biological drivers of health and wellness. That’s the foundation we need.
An April 2019 report from the Human Rights Council of the United Nations supported this direction, stating: “Narrow conceptions of determinants, together with an over-reliance on biomedical explanations of emotional distress and mental health conditions, deflect political attention away from rights-based policies and actions that promote health. This grossly neglected human rights issue requires urgent action.” A restricted, medicalized approach not only makes it impossible to really see the problem in its complexity, but also contributes to avoidance of the more fundamental social and political changes necessary to create a culture where prevention and healing can truly thrive.
What actions and changes (social, political, cultural) could we start to implement today? First, psychological development is integral to human development. We know that half of all mental illness manifests before age 14 and three-quarters before age 24. In addition, abuse, neglect and other traumas experienced during the formative, childhood years are a major contributor to adult mental (and physical) illness. This means that the biggest changes we could make immediately would be to invest heavily in prevention, education and early intervention. Prevention and education programs would be implemented at all levels of society taking what we know about child development and sharing it broadly. This would mean advocating for a fundamental shift in how we raise and respond to children from one favoring discipline and punishment (Authoritarian child-rearing) permissiveness, or neglect, to one based on attachment, empathy, mutual responsibility, and respect (Authoritative child-rearing). Prevention also means teaching everyone (parents, teachers, medical professionals) how to recognize and respond to signs of emotional problems in children and giving them tools to help. This would mean providing vastly more support for families that struggle economically so they have the financial, emotional, and practical resources necessary to care for their children. And finally, it would mean fully implementing parity for mental health and substance dependence treatment to stop insurance companies from discriminating against patients.
We know that being socially connected is linked to mental and emotional wellness, no surprise as humans are fundamentally social animals. Social isolation, loneliness, dissociation, and alienation, have all been increasing over the past century. Today, only 25% of Americans report having someone in their lives to who they can turn to share private struggles or thoughts. Seventy percent say that when sharing with a co-worker, friend, or romantic partner, they tend hold back their true feelings. At the same time a noxious perfectionism is on the rise and along with that increased feelings of insecurity and disconnection from social groups. Fewer people know or feel they can rely on their neighbors than ever before. And social trust is on the decline. People report troubling feelings of detachment and wanting to get more involved in their communities, but don’t know where to turn. All of these factors contribute to mental illness. We know this from studying individuals, social groups and whole nations. In societies where there is greater connection to community and greater social involvement there is less mental illness. This tells us that we must rebuild our social norms and institutions. Starting at the neighborhood level, we can create more opportunities for people to get involved in recreation, spiritual pursuits, volunteering and organizing for community development. This is already starting to happen and can increase through vigorous partnerships among businesses, schools, community groups, and local governments. And as we create and develop these institutions we infuse them with norms and values that support mental and emotional wellness. Values like empathy, kindness, cooperation, mutual recognition and respect, all the ones that foster connections among people and support their emotional needs.
These two investments, in prevention/early intervention and in rebuilding social institutions and norms could start immediately, yielding significant impacts by addressing many of the drivers of mental distress at once. They would also set the stage for fundamental changes to our political and economic system also necessary to promote psychological wellness. The more people feel that their work is meaningful and that they can rely on safe and secure futures the less likely they are to experience mental illness. Unfortunately, the changes in the economy over the last century, and accelerating recently, favor acquisition over contribution, disruption over economic security, technical innovation over meaning, and have placed large segments of the working population in precarious places, where people lack confidence that they will have a decent quality of life in the future. At the same time, the politics of the country have favored cutting the social safety net programs like public housing, food stamps, and unemployment benefits.
Finally, just as the social environment matters to mental health, so too does the natural one and there is a growing recognition that our relationship with the natural environment and the planet is profoundly unbalanced and unsustainable. At least 10,000 species are going extinct every year, the soil we rely on for our food is being depleted, we are running out of fresh water, and the planet is warming. The psychological impact of this degradation contributes to anxiety and depression as does the disconnection from nature that contemporary urban living entails. On the positive side, the evidence suggests that there is a clear relationship between having routine interactions with nature and greater psychological well-being, and that those effects can be supported, literally, by a walk in the park.
Obviously, reversing all of these trends and building an emotionally-supportive society will take a massive and sustained movement for change. Connecting all of the social, economic and policy changes I’ve outlined to the outcome of improved mental health and enhanced quality of life will help to provide motivation and focus to our efforts. We need to send (and repeat) the message that mental illness is solvable and that all the efforts we make toward that goal will have immediate positive effects resulting in vast improvement to how we live, how we relate to ourselves and to each other. We have a choice, continue on the current path and stand by as human suffering and misery continue to deepen or we change our framework from seeing mental problems as individual ones, like broken minds or characters, to viewing them as a symptoms of a society and culture failing to meet the basic emotional and psychological needs of its citizens. As we correct that imbalance, we solve mental illness.