As campaigners encourage the world to recognize mental illness as a biological, rather than moral, failing, we must be vigilant in not diminishing the significance of social and political factors.
The UK’s mental health campaigning is the envy of the world. In Time to Change we have the world’s largest campaign to tackle mental health stigma. With the likes of Mind and Rethink, we have some of the most influential mental health charities. The UK paves the way in teaching that mental illness does not infer moral baggage, and opposing views are rightly condemned as remnants of archaic bigotry.
Being at the front of the curve of public opinion isn’t easy. It means managing the tensions between narrative and truth; between popular ideas and the more subtle nuances of reality. Of late, the mental health narrative has tended towards the view that mental illness is biological and unavoidable, and whilst there is some truth in that, it’s not the whole truth.
Campaigners often liken mental illness to physical diseases such as cancer. The point they make is that, like cancer, mental illness isn’t a choice and isn’t a reflection on the character of the person who’s suffering. These statements are true, and awareness of them lifts the burden of responsibility off the individual. But, crucially, they also lift responsibility off communities and societies – something we need to be increasingly aware of. Because communities do have a responsibility, and I don’t just mean with the provision of mental health services.
The basis of mental health may be hard-wired, but it’s at the mercy of our social, political, and economic environment. Having our freedoms taken from us cannot cause cancer. Nor is there a direct link between debt and cancer, or social isolation and cancer. But these things can aggravate mental health problems and push us into depression, and they are conditions that communities, institutions and governments determine. We must not forget this.
Every time we compare mental illness to cancer, we do a good and a bad. We do good by dispelling the ‘moral myth’ of mental illness, but we are also implying that we are prisoners of neurochemistry. By implying that our environments are irrelevant, a message that starts as an attempt to give people more of a sense of control, paradoxically, accomplishes the reverse.
Control is at the heart of the relationship between mental health and politics. To the degree that politics is about exercising control over our situation, as Hunter S. Thompson once suggested, mental health is as much a matter of politics as it is biology. When we feel like we lack control over our situations, we are more susceptible to depression. If the situation persists, depression is an inevitability. Just as poison to the body, tear down the conditions that enable me to retain a sense of control and my mental health will suffer. But give me cause to hope for a better future and I can persist.
Those of us with concern for increasing rates of mental illness have a choice to make. We can continue to diminish social and political factors by attributing the rapidly increasing global burden of depression to the influence of chemicals in the water, or air pollution. Or we can make a point of acknowledging that our communities and institutions are not structured in a way that is conducive to psychological wellbeing and that we need to be prepared to push for radical political measures that address this.
The issue is one of social progress and evolution, and it starts with the way we talk about mental health. Attitudes towards mental health are constantly evolving, and a necessary part of this evolution is to go through a stage of seeing mental illness through a biological lens. Of course emotion and cognitive functioning is seated in the brain. And of course genetics and trauma can predispose or tip us into mental illness. But it doesn’t end there, and if the narrative fails to encompass a due recognition of social and political factors, then, individually and communally, we risk navigating into precisely the conditions most harmful to us.