Today I’m talking to Matthias Schwannauer about why the first things which spring to mind when we hear the word ‘illness’ are chicken pox and flu rather than depression or schizophrenia, and how we should be talking about mental health.
Why are mental illness and physical illnesses not perceived in the same way?
I think there are three main dimensions to this question.
Firstly, responsibility and autonomy; we often make an assumption that we are less responsible for our physical health than our mental health and there are more essentialist assumptions about our mental health than physical health. Physical health conditions mostly – and erroneously – are attributed to an external cause, an accident, circumstance, or if internal (like metabolism, organ failure, weakness of the heart) than they are often attributed to something unavoidable. The language is also mostly passive, something that has happened to you! Mental health on the other hand is seen as being more closely associated with our character and personality and is often seen as a weakness, lack of resilience to cope with life’s perils. Correspondingly the language is more active, someone going mad, etc.
Secondly, there is a scientific and philosophical reason, mental health and illness is more complex, located in the brain, and our neural systems, and less likely to be able to be directly observed. One of the main reasons why neuroscience and other biological models of our minds offer such a great attraction.
Thirdly, societal stigma in relation to mental health and illness is significant. This applies to both perception by others and by ourselves when suffering from mental illness – the effects and consequences of mental health stigma can be as significant as the effects of a mental illness itself and are wide reaching, affecting education, work, personal and family life.
How does this affect the way they are talked about and dealt with?
There is a lack of parity of esteem in relation to mental health, as said above it is almost seen as something very personal and weak that is not talked about easily. So rather than talking about certain conditions we tend to talk about individuals. Marked by misinformation and prejudice it is difficult to admit to and seek help for mental health problems and most find it difficult to share with others that they may be suffering from such difficulties. Lack of effective treatments and supportive infra structures also make it difficult for health and social care professionals to offer appropriate support and there is an air of neglect around the available provisions.
How should we be talking about mental illness?
I suggest that we largely get rid of the mental illness label but focus on coping and responding to stressors and challenges in our lives and environments – as the title suggests all of us are familiar with emotional difficulties and problems, most transient, but occasionally affecting the way we progress and deal with life. It seems like societal acceptance and normalisation of most mental health difficulties would go a long way to remedy its key problems. Where we can reliably isolate treatable conditions or symptoms we may focus on these rather than making wider assumptions about their implications or future outlook. E.g. individuals can learn to cope with and adapt to even severe so called symptoms like hearing voices etc. without that necessarily getting in the way of heir lives.
How will this lead to improvements for patients?
Reduced societal stigma and parity of esteem within health and social care services would reduce most so called secondary problems of mental health problems. If we could seek help without the fear of stigmatisation or discrimination if treatments were generally acceptable without huge personal cost of harm and impairments and if places of work and education would be set up to cater for the variations in emotional lives and expressions mental health we would find ourselves in a fairer and more just society.