Raising awareness of mental health is all well and good, but the hows and whys are important too
It’s good that there are now many official campaigns dedicated to raising awareness of the fact that mental health can go wrong, but why is it so necessary, and often so difficult, to raise such awareness in the first place?
Yesterday, 10 October 2019 was World Mental Health day, an international day dedicated to promoting and raising awareness of mental health issues. It occurs during Mental Health Awareness week, which is essentially the same thing, and runs from 6-12 October.
That’s only in the United States, though. In the UK, 13-19 May was Mental Health Awareness Week in 2019. So, World Mental Health day is separate.
These shouldn’t be mistaken for World Bipolar Day. Or Children’s Mental Health Week. Or Stress Awareness Month. Or World Suicide Prevention day. Or any of the other calendar points dedicated to raising awareness of mental health matters.
Let’s be clear; it’s good that there are now many official campaigns dedicated to raising awareness of the fact that mental health can go wrong, regularly does go wrong, and that dealing with this is a serious problem for many.
However, there’s a question here that’s seldom asked. Namely, why is it so necessary, and often so difficult, to raise such awareness in the first place? A common statistic used by awareness campaigns is that 1 in 4 people worldwide are affected by mental health disorders, at some point in their lives. Even organisations like the World Health Organisation endorse this claim, so presumably it’s valid.
But this means that 25 per cent of the population have direct experience with mental health problems. In Britain, that’s 16.5 MILLION people who are intimately familiar with mental health disorders. And yet, mental health is still often stigmatised, dismissed, scorned, or just ignored.
I’d wager that far fewer than one in four people in the UK are fans of football. Is football scorned or ignored? No, it’s promoted in every newspaper and via multiple dedicated channels and sites. It’s a billion-pound industry.
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Why doesn’t mental health have the same prominence? Why don’t we have rolling coverage of the treatment stats of hospitals and crisis centres? Where aren’t we wearing t-shirts or drinking from mugs with top therapists’ faces on them, while hearing about how they’ve been appointed to another psychiatric department for a seven-figure sum?
Admittedly, I’m being facetious here. Football, or any sport, provides both a contest and a spectacle. Mental health therapies and interventions really shouldn’t do that.
But still, the central point stands; why is mental health awareness such an issue to begin with, when so many in the population have first-hand experience of how it can go awry?
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Part of it is down to the ‘intangible’ nature of mental health. With physical health, we all have a comprehensive idea of what the human body should look like, and what it should or shouldn’t be doing. So, if someone’s plastered with blisters, bleeding profusely, missing an arm, or has turned blue, anyone can look at them and say “that’s not right”.
No matter how common they may be, it’s much harder to do this with mental health problems. Because they’re largely intangible. When something unhelpful happens within someone’s mind or consciousness, it’s often difficult for they themselves to recognise it, let alone anyone observing from the outside.
True, there are often changes in behaviour associated with mental disorders, but unless you’re very familiar with the person in question, even these can be hard to pin down. Someone’s behaviour varies substantially from hour to hour, day to day, situation to situation. We laugh and applaud a best man’s speech, we categorically do not with a eulogy.
The thing is, if someone you know who’s usually upbeat and cheerful is suddenly all melancholy, are they experiencing a mood disorder? Or have they just got some really bad news, about the end of a relationship, or the passing of a relative? From the casual observer’s perspective, it could be either, it all looks the same. Hence, ‘awareness’ of mental health is harder to embed (and “armchair diagnosis” of someone you’ve seen on TV is a very suspect practice).
This is compounded by the various defence mechanisms, inherent in the human brain, which work to shield us from accepting uncomfortable truths or potential threats. There’s the just-world bias, where we assume the world is fair, and bad things only happen to those who deserve it. The idea of people enduring constant hardship, through no fault of their own, in hard-to-clarify ways? That doesn’t fit with the just-world bias, and the cognitive dissonance caused compels us to deny or dismiss the possibility.
Related is the attribution bias, where in order to protect our sense of safety and security, if something bad befalls someone we’ve a lot in common with, we instinctively pin the blame on them, and their actions/decisions, not bad luck of circumstance. Because if their problems aren’t their fault, that means they won’t happen to us, because we’re not them. This provides us with piece and mind, while also heaping blame, stigma and prejudice on the person dealing with their mental health problems. Which is the absolute last thing they need. But still, it happens.
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There are numerous other biases and hurdles that prevent mental health problems from being as acknowledged and accepted as they rightly should be. But what can be done about it?
The obvious answer is a huge increase in resources for vital mental healthcare and related educational programmes. However, judging by the current political climate, that’s a long way off. So, what else can be done?
The answers to this are many and varied, but my own approach is to try and move beyond the relatively simple message(s) of many mental health campaigns, which, despite the good intentions, regularly boil down to “Mental illness is real, pass it on”.
A valid statement sure, but if you don’t already agree, there’s no guarantee it’ll change your mind. There are millions of Christians worldwide who regularly insist that God is real. But atheists still exist.
But if we can go beyond the “what” of mental health, and spread word about the hows, and the whys, perhaps this would get more traction? Mental health may be intangible, but it’s the product of the human brain, which is a physical object. If we incorporate it, and the problems that occur within it, into the mental health discussion, perhaps the messages will end up more persuasive, more convincing?
For instance, everyone’s heard of the ‘chemical imbalance’ theory of depression; the idea that depression and similar ailments are caused by a loss of vital neurotransmitters in the brain. It’s officially known as the monoamine hypothesis, and stems from the discovery of antidepressants, which work by increasing levels of certain neurotransmitters (usually of the ‘monoamine’ class, hence the name of the hypothesis). If boosting levels of neurotransmitters relieves depression, then depression must be due to a lack of these transmitters. Basic logic.
Except, it’s not. The monoamine hypothesis has gradually declined in prominence as more recent evidence paints a more complex and nuanced picture of the neurological origins of depression and related issues.
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It’s not that antidepressants don’t increase transmitter levels, it’s just that this process seems to be one cog in an increasingly sophisticated machine. A lot of attention is now directed to the loss of neuroplasticity in depression, where important neurons can no longer respond or change in accordance with a situation. Mood disorders like depression aren’t about just feeling sad; the bigger problem is an inability to feel anything else. The neurons that allow you to change your mood and feelings being ‘fixed in place’ would help explain this.
Why would neurons lose their flexibility, though? One prominent theory is that constant activity caused by prolonged, potent stress essentially wears them out. The brain’s ability to regulate and suppress stress seemingly can be, and often is, overwhelmed, so the stress response becomes more potent and prolonged, leading to things like anxiety, which often goes hand in hand with depression.
This also includes many physical consequences like weight gain, high blood pressure, reduced immune response, and more. The fact that mental health problems do come with many serious physical symptoms due to the interactions between the brain and body, via stress chemicals like cortisol, is something that should be emphasised more, if you ask me.
And that’s without the indirect consequences, like a complete lack of motivation or constant social anxiety hampering your ability to exercise or go outside, which further impact on your health in ways that have nothing to do with ‘laziness’.
My point is, there are so many ways to tie mental health issues to real, tangible, physical aspects and properties. In my experience, as a lecturer, sometimes comedian, and neuroscientist specialising in memory formation, this is a much more effective way of communicating something and getting it to ‘sink in’, so to speak.
Insisting that mental health problems are real and very common is all well and good, but perhaps it would be more helpful and effective to start going the extra mile and telling people why.
Dean is a neuroscientist, author, blogger, occasional comedian and all-round ‘science guy’. He is the author of the the popular Guardian Science blog ‘Brain Flapping’ (now ‘Brain Yapping’ on the Cosmic Shambles Network with accompanying podcast), the bestselling books The Idiot Brain and The Happy Brain, and his first book aimed at teens, Why Your Parents Are Driving You Up the Wall and What To Do About It.
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