So many of us are struggling right now. Lockdown feels never-ending. Maybe you haven’t slept well for weeks. Maybe your appetite has completely gone (or you’re eating everything in sight). Maybe you haven’t left the house for days. Maybe you’re heartbroken, unable to grieve loved ones who have died. Maybe you’re thinking about death much more than usual because it is all around us. Maybe you’re lashing out at the people you’re in lockdown with. Maybe you’re not speaking to or seeing anyone at all.
Against this backdrop, perhaps every Zoom interaction is leaving you in a paralytic hole of self-analysis. You may be questioning whether you said something weird, wondering if everyone hates you and are you fundamentally an unlovable person? You may even be asking yourself questions like: Am I depressed? Do I have a personality disorder? Is there something wrong with me? Your best mate or your mum might even suggest you give the GP a ring.
As a psychologist and someone who has been through mental health services myself, this is a plea from me to you: don’t be too quick to give yourself a diagnosis. I say this because suffering of the mind, body and spirit is a completely understandable response to a traumatising world at any given time, let alone during a pandemic. Suffering shows up for all of us in completely different ways but however it manifests, there is nothing wrong with you.
All around, headlines are telling us that ‘serious mental illness’ and antidepressant use has gone through the roof, and that ‘mental health problems’ are higher in young people who experience racism compared to white children. But what do we actually mean by ‘mental illness’? And are we really becoming more ‘mentally unwell’ or is the world around us becoming harder to bear?
Suffering of the mind, body and spirit is a completely understandable response to a traumatising world at any given time, let alone during a pandemic.
When we’re suffering, we’re quick to think there is something ‘wrong’ with us and that we need to get ‘better’. We go to our GPs because well-intended destigmatisation campaigns have convinced us that ‘mental illness’ is an ‘illness like any other’. We’ve been encouraged to equate mental health with physical health, comparing depression to a broken leg when the two are nothing alike.
Few people realise how misleading these comparisons are. Fellow clinical psychologist Dr Lucy Johnstone explains: “Physical health problems are diagnosed by looking for signs and symptoms in the body, such as rashes or abnormal blood tests. But despite what you may have been told, there is no evidence for the equivalent in mental distress, such as a chemical imbalance.“
Questioning this model is definitely deemed controversial in my profession. Especially as we have only just begun talking about mental health as a means of acknowledging the ways we suffer. We must not undermine people’s distress, which is very real. Nor should we ignore the respite from suffering that psychiatric drug interventions can bring. But we do need to look at whether this medical model is truly serving our understanding of what is happening to us. Lucy continues: “By telling someone they have a ‘mental illness’ called depression or anxiety, we are locating the problem and the solution in the individual, despite the overwhelming amount of evidence telling us that distress arises from people’s relationships and sociopolitical contexts.”
Blaming brain chemistry for our suffering may be a well-intended attempt to reduce deep-rooted social stigma but it risks obscuring the sociopolitical causes of our suffering and may plant disempowering messages within us about the possibilities of overcoming them. By this I mean that we cannot medicate away injustice or racial trauma, just as we cannot diagnose away the disempowerment caused by the pandemic or the impact of living on benefits which were cut under austerity in a country where the cost of living has been rising. As clinical psychologist Dr Tarek Younis says: “When a building is on fire, we shouldn’t say people have a ‘breathing crisis’, but focus on the fire and try to understand its causes.”
None of this is to diminish the role that psychiatric drugs or diagnosis may serve as a tool for survival. Currently, a mental health diagnosis is often a requirement to be able to access therapy or benefits when we need time off work. A diagnosis may seem to offer an explanation of our pain and the affirmation that we are not alone in our distress. It is also understandable that we might take medication when it feels like the only option to offer some relief for the ways that pain shows up. We are all doing our best to survive with the tools and resources that we’re able to access, and that’s okay.
What if we look differently at our unwanted symptoms, as necessary expressions of our despair and an invitation to feel through our suffering? Can we envision a culture which welcomes us and supports us to feel and express our pain, no matter how it shows up? As Black feminist bell hooks wisely reminds us: “The presence of pain in our lives is not an indicator of dysfunction.” We can choose to stop believing and retelling the lie that there is something wrong with us for suffering and, instead, recognise our misery as a survival response to a painful world. We only need to look at the history of so-called ‘mental disorders’ to understand why we should be cautious in believing otherwise.
By telling someone they have a ‘mental illness’ called depression or anxiety, we are locating the problem and the solution in the individual, despite the overwhelming amount of evidence telling us that distress arises from people’s relationships and sociopolitical contexts.
Dr Lucy Johnstone
The concept of diagnosis was created in the 1800s. We now have approximately 541 ‘disorders’ which attempt to order our complex emotional worlds into boxes and labels. History shows us how ‘disorders’ and ‘illness’ have been given to people who have dwelled on the margins of society or resisted societal norms. After all, a ‘disorder’ only exists in relation to what is supposedly morally or socially ‘ordered’ in a capitalist society.
In 1247 London, Bethlehem (later abbreviated to ‘Bedlam’) Hospital was the first mental asylum built to contain the ‘mad’. The supposedly ‘mad’ included poor people, sex workers, queer people, unmarried pregnant women and people with physical disabilities or epilepsy. Homosexuality was considered a mental illness until 1973 and it was only in 2019 that the World Health Organization acknowledged that being transgender is not a mental disorder.
For people racialised as Black, the historical use of medicalisation and diagnosis as a political tool of oppression is also undeniable. In 1851, the diagnosis ‘drapetomania’ was applied to Black people who ran away from plantations where they were enslaved. The criteria for ‘schizophrenia’ shifted during the late ’60s US civil rights movement, where ‘negro schizophrenia’ was a diagnosis commonly given to Black men involved in the Detroit riots, with symptoms including hostility and aggression.
In a systemically racist society, how can Black people safely express their understandable rage and distress without it being deemed ‘dangerous’? Today in the UK, Black men are disproportionately diagnosed with schizophrenia, medicated and more likely to be sectioned in the mental health system, often through criminal justice pathways. They are also more likely to be restrained and, terrifyingly, more likely to be killed by restraint in state detention. Alongside that, we have research which proves that if your skin is dark, your risk of ‘schizophrenia’ rises as your neighbourhood whitens.
When we look at trends in diagnosis throughout history, we can see two things: that diagnosis has been used as a political tool and that distress is inextricably connected to experiences of power and powerlessness, rather than arising from some kind of fault in our brains. In the UK, Dr Lucy Johnstone, alongside a group of psychologists and former users of psychiatric services, has developed a new framework for understanding the experiences we call mental health ‘problems’. She explains: “The Power Threat Meaning Framework shows how the abuse of power at all levels lies at the root of distress and despair. The way forward is to recognise the ways in which we struggle to survive these threats, reclaim our own narratives and our own sources of power, and ultimately, to create a fairer, more equal society for all of us.” The UK also has a lot to learn from organisations like Mariwala Health Initiative in India, whose work centres the redistribution of power and movement building in healing marginalised communities. Their collective social justice-informed approach, alongside recent drug-free support in Norway, is a radical form of resistance to the globalised medical model.
Fifty years ago we would never have questioned the need for asylums. Could it be that in 50 years’ time, we look back on individual psychiatric diagnoses as a tool to obscure and deny structural trauma, inequality and our collective suffering?
The best collective therapy would be transforming the structures in society that induce our so-called ‘sickness’. But how can we survive in the immediate term, when we just need to make it through another day? We can reclaim our immense personal power by re-authoring the day-to-day truths we tell about our suffering and experiences of oppression. We can start by naming and feeling into the ways our pain is showing up and its causes, rather than moving away from it with the language of diagnosis.
One way of doing this is by asking “What’s happened to you?” instead of “What’s wrong with you?” You have been experiencing racism at work? Of course you’re feeling anxious and rageful – maybe it’s showing up as insomnia or hearing voices that other people can’t. You’re trying to make ends meet but can’t cover your bills because you lost your job? Of course you’re experiencing shame and isolation – maybe you’re even thinking about ending your own life.
We are also still learning about the powerful force of social injustice and how complex trauma translates into interpersonal relationships and can be passed on. South Asian families are still carrying the trauma of the violent legacy of the India-Pakistan partition that was imposed by Britain during its colonial rule of the country, compounded by generations of racism experienced by those living in the UK. Similarly, the Windrush scandal has impacted the children and grandchildren of the generation who emigrated from the Caribbean to the UK between 1948 and 1971.
Interdependence is another key ingredient for survival. As a psychologist, most of my job requires simply being present with a person in pain, meeting their suffering with compassion, recognising how it links to injustice and trauma in the world around them, and reminding them of their divine power. Yes, there may be circumstances where professional support is needed, like when we really are a risk to ourselves or others and there is no one else around to help. But can we also create a culture where we can turn to each other when we’re suffering?
It is the role of the government to care for and support its people, and free access to talking therapies is important (although in reality, hard to access). However, too often I fear the reliance on state-funded health services and doctors has become an act of sending people and their pain away, out of society’s sight. There is deeper healing in the government redistributing funding and resources into community healing spaces to help us build a greater culture of interdependence. Black feminist and psychotherapist Foluke Taylor says: “We may need to call on support from a whole village to care for someone in misery, and we may need time for respite too.” Psychiatrist Dr Sami Timimi advocates for the creation of ‘emotional wellness services’ that centre community wellbeing rather than individualised crisis management.
Healing does not occur in isolation but being with each other’s suffering is not easy; just being with our own distress can feel intolerable. Both the medical model and our cultural obsession with ‘wellness’ and quick fixes can be seen as a denial of life’s inevitable pain. We have internalised a sense of being unworthy for suffering, mired in shame which only further disconnects and isolates us. As we give ourselves permission to feel pain rather than moving to ‘fix’ it, and compassionately bear witness to our own suffering, this opens us up to meeting others with the same compassion.
Are we suffering more in the pandemic? Yes, of course we are. Our lives have drastically changed and we are feeling powerless. Marginalised people are being significantly more harmed by government negligence. But how we understand and relate to the suffering caused during this pandemic has the power to change the way we meet our pain beyond it. Fifty years ago we would never have questioned the need for asylums. Could it be that in 50 years’ time, we look back on individual psychiatric diagnoses as a tool to obscure and deny structural trauma, inequality and our collective suffering? It serves us all to imagine that there might be a much bigger toolbox beyond diagnosing an individual ‘illness’, not only to help us survive and cope but to transform the aspects of our society currently causing us pain.
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