It is thirty years since I spent my 17th birthday at the Royal Children's Hospital as an anorexic weighing 32 kilograms, being surreptitiously medicated with anti-depressants. So much has changed in the intervening years about our approach to mental illness. There have been some improvements in attitudes and understanding about mental health problems. Yet other problematic approaches have taken hold.
From its status as a hidden embarrassment, we have now have the disturbing situation where suffering from a mental illness, and declaring it publically, has become a badge of honour. We read stories about the latest celebrity declaring their mental health diagnosis and being called brave and courageous. Some of those, three months later, are on the speaking circuit, suddenly experts on mental illness, as if it is a short-term inconvenience.
The romanticising, oversimplification and sanitising of mental illness in the public sphere disguises its capacity to impair functioning over decades. The stories of mental illness you will never read about are not blips on the path to fame but debilitating complicated lifelong illnesses.
Our current approach to mental illness reduces it to a simple condition that can be resolved by the use of pharmaceuticals. The medicalisation of the human condition has far-reaching effects, including that the 'problem', and the mental health diagnosis attached to it, is often situated solely within the individual's biology rather than society at large. Researcher Mardie Townsend has found a strong link between mental health conditions such as depression and anxiety, and a lack of access to outdoor green spaces. Yet how often do we hear advocacy for parks as a valid approach to improving mental health?
Our well-meaning desire to reduce the stigmatisation of severe mental health conditions, has led to the problematic tendency to diagnose common patterns of behaviour as illnesses. The fact that such conditions, with names like Intermittent Explosive Disorder and Oppositional Defiant Disorder, respond to drugs, serves to confirm the belief that they are diseases. Yet the fact that mood-elevating substances elevate mood is not an indicative of disease. Ask anyone who feels better after a glass of wine.
Situating the problem of mental illness outside the responsibility of both the individual and society and in biology instead discourages us from looking critically at the circumstances that affect mental health: working conditions, having a satisfying and productive life, being connected to friends and community, having quality leisure time, adequate sleep and exercise, meaningful and supportive relationships, good nutrition, the opportunity to be creative.
Factors detrimental to mental health need attention too, like misogyny, discrimination, abuse, and lack of autonomy. As Townsend found, being worried about climate change feeds anxiety in some people.
An article in The Age last year cited the figure of 3 million Australians currently having an anxiety condition. This is a huge proportion of the population to be diagnosed with just one of hundreds of mental illnesses. The boundaries circumscribing illness have been widened so that people once deemed 'average' now fall within the bounds of mental illness. Placing a disease label upon individuals is very easy to do and can have a disabling effect, as well as over-burdening the medical system. Such conditions require an approach that delves beyond the biological to the familial and social context. It is more time-consuming, and demands more insight than filling a script, but ultimately holds more promise.
The distinction between minor and major illness has been watered down, with serious repercussions. More diagnoses mean more prescriptions (with their accompanying side effects) and a windfall for drug manufacturers. Antidepressants are now prescribed widely for mild cases of depression, even though the evidence of their effectiveness in such cases is weak and the evidence of harm is growing. Depression awareness programmes exacerbate the problems of inappropriate and over-prescribing. Prescription drugs, such as those commonly used to treat anxiety, can have fatal consequences, with more Victorians now dying from overdoses of prescription drugs than are killed in road accidents.
Grief, sorrow, anger and frustration are all normal human emotions. We can gain coping skills but we also need to have realistic expectations about life. Despite the impressions given by our celebrity-sated culture that ultimate happiness is within our grasp if we just want it enough and try harder, it is not true. Giving up on the quest for the ideal life and instead doing our best in life with all its ups and downs is both more modest, realistic and beneficial for our well-being.
The liberal-individualist ideology that is threatening both our politics and our health system needs to be challenged by a more radical approach that reinstates the social contexts of policy formation - and challenges the sound bites and slogans that are cultivating our approach to mental health.
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