Fitter, Happier, More Productive

How the Dialogue About ‘Mental Health Days’ Falls Short

Image courtesy of Flickr user Philo Nordlun under the following Creative Commons license.

In the days after Madalyn Parker took time off to focus on her mental health, the subject of “mental health days” went viral (as it were). Her company’s CEO thanked Parker by email for serving as a “reminder of the importance of using sick days for mental health.” She tweeted a screencap of his message and subsequently inspired a national conversation about the stigmas associated with mental health and pressures facing the American workforce.

Too few people use their sick days, for mental health or otherwise. We power through colds and ignore flu symptoms. Perhaps it’s the draconian expectations of management or, simply, the need to earn an hourly wage. Regardless, this only puts coworkers at risk of catching whatever is traveling at speeds upwards of 35 miles an hour in our saliva. Which is to say, we have to ensure employees can and do take their sick days — whether that means changing work culture or government intervention.

But unlike the flu, mental illness is not contagious. (At least, not in a conventional epidemiological sense. In psychotherapy, we sometimes speak of transient episodes of emotional contagion, like paranoia or disorientation, resulting from interactions with our clients.) But then, I should be more specific. We’re talking about mental health, not mental illness.

As reported by USA Today, Parker “suffers from chronic depression and anxiety.” Many will immediately empathize with the crippling pain of either diagnosis. According to the World Health Organization, one in four worldwide will have or experience a mental or neurological disorder at some point in life. This is an astonishing number. That’s one lover on any double date, the drummer in every four-piece band, or a member of every nuclear family.

We medicate ourselves in equal measure. One in six Americans takes some form of psychiatric drug, whether a mood stabilizer or antipsychotic. And yet, Congress continues to debate how to reduce insurance regulations at the expense of mental health services.

Which brings us to the crux of the issue: mental illness costs us a lot of money. But the powerful, whether that’s our elected officials or CEOs, generally don’t want to be on the hook for the bill—despite the fact that research shows that happy employees are more productive. And we all know that increased productivity is good for any employer’s bottom line.

If this reminds you of Radiohead, it should.

In the email thread that Parker shared on Twitter, her boss praises her for being “an example” and for cutting “through the stigma so we can all bring our whole selves to work.” This line in particular struck me. I’m reminded of a previous job where I was likewise encouraged to bring my “whole self” to work.

The idea, though well intentioned, is absurd.

It brings to mind the ideas of pediatrician and psychoanalyst Donald Winnicott, who addressed the True and False Self. In his theory, the False Self can be like the real you but is a modified presentation for society’s benefit. This is the “me” that represents the compromises I make every day to interact in the real world — in other words, at work. Without this mask, I might just have told my former CEO how I really felt about her narcissism and greed.

By contrast, our True Self, in the words of Winnicott, is “an isolate, permanently non-communicating, permanently unknown, in fact unfound.” We all have a True Self deeply embedded under the complex system of language, affects, and habits that comprises the external presentation of our “self.” Most importantly, Winnicott believed we all have a compulsion to keep this True Self secret.

Some of us might have jobs that nurture this True Self. I suspect most don’t. Work, by definition, is often at odds with our deeper desires. For every company that pays your college tuition, holds an open soccer tournament, or covers your gender reassignment, there are countless workplaces where people struggle just to get enough hours on the schedule to pay the rent. The typical job is not a place where our True Self flourishes. And it’s unfair that any employer would expect this of us, let alone that we should expect it of ourselves.

Again, I have no doubt that Parker’s boss has good intentions. But the underlying idea of “mental health days” only highlights a more profound issue with this debate: it goes beyond mental health.

Our collective mental health is something to which we can all contribute and for which we all have a responsibility. We should be more mindful of our limits and vocal when we’ve surpassed them. Employers could be more sensitive to our needs. And government must intervene when big business fails at this responsibility.

In talking about the ever elusive cure, Freud is modest in defining the goal of psychoanalysis—as transforming “hysterical misery into common unhappiness.” His idea was that if one’s mental health was restored, he or she will be “better armed against that unhappiness.”

Extreme mental illness is more than exhaustion or stress. This isn’t to deny the influence of these factors on our wellbeing. But the social impact of severe mental illness is staggering. It affects a quarter of our nation’s homeless, a fifth of the prison population, and 70% of juvenile offenders. It should go without saying, but nearly 90% of children who commit suicide suffer from some form of mental illness.

In the early months of the Trump presidency, many decried his rampant narcissism (and continue to do so). A prominent psychiatrist argued against this armchair psychology. Though the president “may be a world-class narcissist,” he wrote, “this doesn’t make him mentally ill, because he does not suffer from the distress and impairment required to diagnose mental disorder.” Trump doesn’t need a sick day. In fact, he’s the most successful person in America (if we take being president as the measure).

I work with people who endure extreme mental illnesses, like schizoaffective and bipolar disorders. They can’t take “mental health days” because their conditions make it nearly impossible for them to hold down a steady job. And even if they did work a 40-hour week, they likely couldn’t afford to sacrifice the pay in taking a day off when they can’t get out of bed to face the world.

I’m heartened that this issue penetrated the national discourse. But the fact that it started and flourished on Twitter—and that Ms. Parker had a job to which she could return after a restful weekend—should not be overlooked. The class implications are more than just implied.

Yes, we’ve made progress. But we’re far from resolving the conversation about mental illness.