All mental health advocacy is political

This post was originally published at Huffington Post.

Equating mental health issues with physical illness is fashionable amongst health commentators. From analogies associating mental health issues with a broken leg or cancer, to calls for parity of esteem, the inference is that mental illness and physical illness ought to be considered in the same way. But while the message may have served a purpose in recent years, it’s also a simplistic and increasingly misleading interpretation of mental health, and we owe it to our society and to the millions struggling with mental health issues to do better.

In the aftermath of the general elections last month, New Statesman journalist Laurie Penny wrote an impassioned article that linked the election result with depression. Social media backlash quickly followed, accusing the author of being insensitive and naive about the seriousness of mental illness.

A political commentator lacking insight into mental health might have been inclined to admit error, even if only to avoid confrontation. But Penny is no stranger to the subject of mental health. Quite the opposite. One of her first roles in journalism was writing for One in Four, a magazine whose raison d’etre was to provide a voice for those with mental health issues.

What Penny knows, and what we perhaps all need to remind ourselves of, is that mental health and sociopolitical factors are deeply intertwined. Not least of which is the economy, with studies showing dramatic rises in suicide during periods of recession and high unemployment.

There is also a strong relationship between inequality and mental illness. And an underlying risk factor for poor mental health is a perceived lack of control over our lives – something that almost every political decision could be said to have an influence on. Interpreting mental health with a strictly medical model precludes all of this.

None of this is to say that mental illness doesn’t also have a biological basis. Of course it does. Medical interventions can help. And a medical interpretation of mental illness can reduce blame associated with those who are suffering. But a denial of social and environmental factors can also leave us feeling helpless and insensitive to what’s going on around us.

Studies have also indicated that a narrow, brain-based interpretation of mental illness may increase pessimism about recovery, reduce confidence in psychotherapies, and actually increase aspects of stigma.

The solution, needless to say, is with an integration of biological and sociopolitical factors. That may be difficult and uncomfortable to do in our dualist, western society with its love of clear definitions and boundaries, but only when it happens will we be on the right path. Not just for the benefit of those with mental illness but also for those with mental health. (Yes, I mean everyone.)

Mental health advocates have a tendency to lose sight of this. While some campaigners delighted in political parties putting mental health service funding in their 2015 election manifestos – others were skeptical in light of the government’s rhetoric-defying NHS cuts.

Irrespective, rises in mental illness and suicide should not only prompt an increase in medical service provision – which is a given – but also an examination and reversal of social and political contributors. Like the canary dying in the coal-mine, it should be seen as a sign that something is not right.

The onus to point this out shouldn’t only fall on the mental health community. It should fall on the political ‘left’. If the left is lacking direction, as some have claimed, it would do well to reflect on its attitude towards mental health, and its neglect of the social sciences. The Conservative government has mined the area, with its‘behavioural insights’ and ‘wellbeing index’. Why has the left not done the same, and used the the abundance of social sciences literature that inherently supports its position?

Were it to do so, it wouldn’t refer to the rise in mental health issues only in terms of health services, but in terms of a need for broad social and political reform. Reform that starts by recognising that the association between recession and suicide is a symptom of a society failing to do enough to protect its people from the downsides of misfortune, whether economic or otherwise.

There is no biological reason for why economic depression should lead to clinical depression. It’s entirely social and political. We’re all affected, and we need more public figures to be talking about it.

The rise of 'hapitalism', and what can be done

Hapitalism (hap-i-tal-ism)
noun (portmanteau of ‘happy’ and ‘capitalism’)
An economic system based on a state measuring collective happiness in a way that encourages a level of individual competition and inequality typical of unregulated, free-market capitalism.

Yesterday, I wrote something for the Huffington Post exploring the correlation between happiness and suicide rates in US states (and nations). In it, I raise concerns over a developing ‘hapitalism’ in which average happiness levels are raised by sacrificing the happiness, and, in some cases, lives, of a minority.

A central principle behind capitalism is that free markets allow for economic growth and that this benefits all of us on condition that interventions such as taxation and public services exist. In the same way, happiness advocates argue that an increase in gross national happiness will benefit us all. The problem is that, as the happiness-suicide correlate indicates, conditionals are also needed to ensure that a rise in GNH benefits all. I’ll look more at these conditionals shortly.

The importance of conditionals in a happiness economy risks being overlooked due to happiness being seen as an intrinsic moral good. On the surface, an increase in the happiness of a group seems like a good thing, but the problem is that an increase in average happiness can be attained even if one member of the group has come to find themselves in extreme suffering. The tendency to assume that we can draw conclusions about individuals from the condition of a group is known as an ecological fallacy.

The appropriateness of equating a capitalist economy with a happiness (‘hapitalist’?) economy depends on the way in which individual ‘growth’ occurs in the two types of economy.  In my blog post, I explore the idea that the happiness of some may be directly enhanced by the suffering of others, and that those who are suffering may feel worse by comparing themselves to happy people (hence a correlation between happiness and suicide)*. If this is an accurate description, then, just as capitalist societies tend to favour the wealthy and may widen inequalities of wealth and income, a happiness economy may widen the wellbeing gap between the happy and unhappy unless interventions are in place to help encourage the reverse.

Interventions

1. Improving happiness indicators
For happiness indicators to be a measure of the wellbeing of all, they need to focus on more than just aggregating individual happiness. The economist Sagar Shah suggests that this might be done by also looking at the ‘features of a society’, or by giving higher weight to those with ‘lower well-being’. Discrediting simplistic aggregated measures of happiness may also be an important step.

2. Improving communication
Those writing, speaking and teaching about happiness ought to appreciate the degree to which suffering is unavoidable, and to be mindful of the impact of their words on those who are suffering. Proponents of positive psychology tend to use Martin Seligman’s theories of learned helplessness and learned optimism to argue that we all have influence over our wellbeing. This can be a message of hope and encouragement to some, but it may also dishearten those with poor wellbeing. Whilst our perception of suffering may influence our ability to move on from the situation, the presence of suffering is often a normal and healthy reaction to adverse stimuli. (Try being happy when you’re repeatedly being subjected to electric shocks.) If we deny this, we risk stigmatising something that we will all experience at some point in our lives.

3. Improving policymaking
All official happiness policy should factor in public health principles, and any messages or interventions designed to boost collective happiness should consider implications for mental health and suicide-prevention. Economists and policymakers should be liaising with public health professionals — and also vice versa; as the World Health Organisation reminds us, “Health is created and lived by people within the settings of their everyday life; where they learn, work, play, and love.”

 

*This may only be the case for people, communities and societies that are driven by competition and comparison. In fact, research from Japan suggests that happier people are kinder.