A Critique of the Genre of ‘Mental Health Writing’ | Part One
Though my mental health problems conveniently coincided with disorientating puberty, I was actually lucky in the sense that I was part of the generation that grew up ‘online’. I was perplexed by my diagnosis, and a painfully repressed teen stereotype, so it was fortunate that I didn’t have to risk alarming anyone by asking — or feeling mortified in asking — why I was feeling so desperately unhappy, or how I should be dealing with it, when I could just ask Google. By my teen years, blogging had already transitioned from a fringe internet activity into a widespread phenomenon, which meant I could readily find other unhappy people — people who weren’t talking to me and didn’t know nor care that I was listening — sharing their stories. I often wonder how much more bewildering that time would have been if I’d relied solely on the pamphlets snatched from GPs’ waiting rooms.
As a result, I trawled page after page on the subject, poring over “What it’s like to have…” posts and letting their “When you have … you [do] …” descriptions inform perceptions of myself and my condition to an alarming degree. Not only did I rationalise a lot of the symptoms and behavioural traits (lack of appetite, for example), but I inadvertently fostered them. While I’d previously acknowledged my diet and weight to be being a health concern, I now excused it as a by-product of my mental health. Similarly, inertia, the desire to stay in bed and do nothing for long periods of time, all the while feeling awful about doing that consuming nothing. Worse still, I think I fell into habits that hadn’t previously been mine until reading about them in connection to my condition.
Without wanting to be flippant, I noticed a parallel in the way I reacted to how I had upon discovering my dyspraxia (a disorder which affects your co-ordination and motor skills, and in my case, very mildly.) From previously finding it bizarrely difficult to use scissors, now the dyspraxia was confirmed, I couldn’t use scissors. Where I could just about mangle an onion into smaller chunks before, it suddenly became impossible to make any incision. While this inhibiting sense of futility over my dyspraxia really only meant my handwriting remained ‘spidery’ and I attempted fewer spag bols, it had a far more serious effect on my mental health. I stopped feeling as if I could prevent behaviours that would make me utterly miserable; that my mental health ‘made me do it’; that I had no autonomy over how I felt and that my defining characteristic was my condition.
It largely took rejecting these feelings of impotent helplessness for me to learn to cope with them; to prevent the desperate, deteriorating thoughts I found myself gripped by the longer I felt submissive to ‘my mental health’; and to live without feeling constantly condemned by ‘my condition’.
‘Mental Health Writing’
It would be similarly dismissive and unhelpful to attribute the fatalist mindset I’d adopted solely to what I will, from now on, loosely definite as ‘mental health writing’. However, I don’t think the adverse way I let what I inferred from reading inform me is particularly uncommon, and there are aspects within dominant ‘mental health writing’ which I feel — through inadvertent carelessness rather than maliciousness — compound and contribute to negative effects on the psyche and irresponsibly encourage the reader to take an uncritical and oversimplified view of their mental state.
My main objections are with what I perceive have become the generally accepted frameworks in which someone might talk about mental health; where individual experience is extrapolated to mean universal; where disparate conditions have been clumsily (and arguably, dangerously) united under the broad-church banner of ‘depression’ — a term which seems to be applied increasingly ambiguously and crudely; where language is deployed irresponsibly; and where prevailing axioms about the way “you should” deal with your mental health have almost become incontrovertible. I believe the way in which certain writing encourages the reader to view their psyche is not only unhealthy, but in some cases, utterly counteractive to coping. I feel it’s necessary to challenge what I find jarring with my own experience, and what I believe negatively impacted me as someone who grew up with psychiatric problems.
I do have reservations about writing this. To a degree, it does seem counter-productive to criticise any form of writing on mental health that might contribute to understanding or comforting, and I absolutely would not want to discourage anyone from doing that. I will stress that I know ‘mental health writing’ encompasses a great deal, and treating it as uniform would be to commit a very similar double standard to the fixed way a lot of writing presents experience that I will criticise later on. It would also be false of me not to acknowledge that I have found (and continue to find) what would obviously be defined as ‘mental health writing’ immensely helpful.
Limitations Of Language
To their credit, mainstream publications increasingly carry disclaimers recognising individuality and diversity in experience, and that the accounts they present might not accurately represent the reader’s own. However, failure to acknowledge this is still rife, though often unintentional. Here I will argue that limitations and misuses of language should shoulder a large degree of responsibility.
The Collective ‘You’
For some reason, an overwhelming majority of mental health writing is done in the second person. (“When you have depression, you…”, “We need to…” This ‘you’ is sometimes just implied; “Depression is debilitating. Eating becomes a chore.”) When discussing something as cold and medical as mental health, I recognise that ‘you’ is humanising and inclusive; but there is extrapolation of the writer’s opinion as universally shared experience. This mode is so pervasive that even after expressly setting out to condemn it (this essay pretty much grew out of my frustration of it), I’ve still had to go through and remove numerous instances where I’d done it myself. There are almost certainly instances I’ve missed. To avoid this devolving into one long exercise in contradiction and apology, please caveat any stance expressed hereafter with “I believe that…” The ‘observations’ I have made of others — whether it’s through accounts I’ve read, discussions I’ve had or purely what I’ve intuited from their behaviour — are still fundamentally flawed in that they are only as true as I believe them to be. I cannot claim any authority or expertise in understanding anyone’s mental health but my own, and even that still regularly baffles me.
I believe individual experience, though vitally important in discussions of mental health, is almost painfully limited. The feeling of perceived isolation from others is often discussed with regards to mental health. I have certainly felt great relief in reading accounts with often uncannily similar experiences and ordeals to mine — especially initially. I think my over-eagerness to relate to those I believed shared my sadness meant I would often disregard their sometimes wildly differing causes and triggers of pain. Over time, the differences in these accounts gradually became harder to ignore, until this snowballed into an overall disconnect, and I felt more alone.
I think the function I wanted these accounts to fulfill — purely comforting, something that ‘understood’ me — wasn’t achievable, at least not to the accuracy I was demanding of them. I still occasionally feel a pang when I read something that rings true to me, but overall I now find accounts most helpful in their differences. I find making a clear enough distinction between these accounts and ‘myself’ invaluable in constructing a sense of my own identity as ‘someone with mental health problems’. The more I manage to avoid projecting ‘myself’ onto these accounts (how I would feel if I was in their situation, what I would do etc.), the easier I find it to comprehend and empathise with them — and consequently better apply only what is useful in relation to my own psyche. That being said, this erasure of the self can occasionally feel impossible and the differences too pronounced. Sometimes I’m not sure it helps at all.
The desire to reach others, to make them feel less alone, seems to be the objective of most. However, reaching a wide audience while still ‘connecting with’ them requires a negation of sorts. The writer must sacrifice specificity of experience in favour of generalisation, while also forming this generalisation from their own idiosyncratic experience. To reach as many medically sad people as possible, the entire spectrum of ‘mental health’ is often irresponsibly condensed into ‘depression’ as a catch-all. There is a fair amount of crossover in traits and symptoms between conditions, but too often, the main (and sometimes only) unifier is in the deep unhappiness the sufferers feel.
‘Universal’ Advice and ‘Talking’
Anecdotal accounts will regularly carry advice that isn’t so much suggestion (“This helped me, it might help you”) as instruction (“You need to do this if you are depressed. It helped me — a depressed person — and it will help you.”) This creates false expectation if the advice contained within these accounts fails to work, which can be dispiriting and alienating. In my case, it was the instruction to ‘talk’.
The modern adage “We need to talk about mental health” has dual meaning. The first — that mental health should be discussed openly and widely, until the taboos still surrounding it cease to exist and we develop a better, more informed understanding of it collectively — I fully agree with. The second — that those who suffer from mental problems need to open up about them, as if this act is in itself vital to coping with their condition, and may even ‘cure’ it — on a personal level, I can’t.
Talking — professionally to therapists or to helplines, or privately to friends and family — seems revelatory for those it’s helped; allowing them to better comprehend their condition, reducing the ‘burden’ of mental health — feelings of isolation, shame and helplessness. It can positively inform the personal relationships around the sufferer, gaining them the necessary support and understanding from the people they need it from most. I certainly wouldn’t want to dissuade anyone who has somehow read this far and thinks it might help them. It just hasn’t for me.
At some point, I had convinced myself that I needed to talk, but almost without exception, every time I attempted to do so, it would be an extremely stressful, anxiety-inducing experience. I’d hoped it would bring the relief I’d read about so often, and it crushingly never did.
There is a big line in current mental health writing about the ‘crisis of masculinity’. Men, with their obsolete conceptions of mental strength, are too proud (stupid) to realise they need to talk. They are cartoonish, primitive oafs, so inhibited by their immature sense of pride that they can only express emotion during sport and after sex. If only they would stop being so silly in clinging onto their fragile egos, they could be cured.
I think there is certainly truth in the notion that (with men in particular) mental health problems are perceived as a form of weakness — that there is strength in silence and ‘cowardice’ in suicide. However, I believe perception of the self is more complex than a simple, misguided desire to appear ‘strong’ as opposed to ‘weak’ at some shallow — and therefore — easily disposable level. Though I know basic notions of weakness to be of no value, I’ve still internalised and attached a great deal of shame with regards to my own mental health. After constructing these ideas of self-worth, it’s very difficult to just reject them. I feel it is under-acknowledged how these ideas might affect any interactions — during and after — that it’s presupposed entering into a discussion means they immediately dissolve. Though I didn’t feel particularly invested in the idea of stoicism, the act of making myself necessarily vulnerable by talking was incredibly unpleasant, and then in turn, I felt pathetic for feeling this way.
For a long time I assumed that my inability to feel some sense of placation or catharsis through talking meant beyond help and repair, and that it was my fault. Eventually, I discovered that there were plenty of things that helped me cope and that I (and what I was reading) had put far too much emphasis on ‘talking.’
What the notion that we need to talk about mental health also presupposes is that the sufferer has a burning desire to say something to someone else, but won’t. For me, it was more that I didn’t really want to tell anyone anything, and couldn’t. Whenever I found the courage to speak, I couldn’t find the words.
I find one of the most inhibiting things in talking about mental health is that ‘talking’ itself is a flawed process. Words often seem a very restrictive and dissatisfactory way to convey experience, emotion and thought. They are abstractions; incomplete and partial representations of what they refer to; too rigid and imprecise in what they symbolise. I can find it immensely difficult to internally grasp what I’m feeling in troubled times of intense unhappiness, and so trying to distill and elucidate to someone else through insufficient words can feel like a futile exercise.
When these emotions feel stronger than simple statements (“I feel sad,” “I am deeply unhappy”, “sorrow”, “anguish”, “pain” etc), we turn to analogy, but I’m not sure how sufficiently emotion can truly be articulated in this way. As a quick digression, if we take analogies for love and callously reduce them to their basic expression, the overwhelming majority are simply comparing love to the extremes of beauty, size and longevity — purity, intensity and dedication. Because so many of these expressions have been worn to triteness, there is a competitive element in trying to prove one’s love by further advancing these extremes. These mawkish metaphors are grandiose and hollow, evocative of very little due to the contrived gap between sentiment and statement. I have felt intense love, but never vicariously through any written description of it. Perhaps I simply do not have the felicity or capacity for expression, but I often think how much better art, music, performance and film seem at evoking the ineffable.
Mental Health As External Metaphor
Analogy is similarly — and more dangerously — applied to expressions of mental health. When “I feel intensely sad” doesn’t seem to accurately convey distress and psychic pain, it’s understandable that many become figurative. There is a competitive element here, too. (“What it’s really like to have depression…”)
To articulate the sheer awfulness of the feeling (and more accurately than the last speaker) your mental health has to be made to seem as torturous and galling as imaginable. (“It’s like falling down a never-ending stairwell, in a sack full of glass shards, and every time you think you’re getting to your feet, you plunge further down again”, “It feels like your brain is stabbing your soul, on a loop” etc.) I think these constructions of mental health encourage the writer — and other sufferers — to view their own mental health in as grotesquely daunting terms as possible, to the extent that it becomes insurmountable.
I found it very difficult to relate to these tormenting ‘demons’ — as my own mental health has always felt dull and tedious, characterised by anhedonia; a lack of want and desire. Because it felt boring rather than fantastical, I couldn’t articulate much beyond “I am sad and don’t want to do anything” to people. As this comes across as moody recalcitrance (which, to an extent, it is), I rarely said anything.
In analogy, the experience of mental health is related as some external trauma that is done to the sufferer (‘the black dog’.) This idea — of constructing mental pain as separate to the self — is a vague notion I’d been unable to articulate until my pal Oisin sent me his excellent dissertation in which he presents the argument that psychiatric patients are encouraged to adopt a schizoid relationship with their mental health.
When the sufferer sees mental health as something that happens to them, they subordinate themselves to ‘it’. Here, I believe there can be a crucial loss of autonomy and agency. Though many thought processes emanate from within, the sufferer is prevented from recognising the causations, triggers and behaviours which might cause spiralling, episodes and other collapses in mood. Their mental health is happening to them. They are in complete thrall to their condition.
For me, what I will term ‘depression cartoons’ are one of the stranger manifestations of this. So often pushed as ‘getting’ mental health, for the most part, they are infantile depictions of tormenting monsters (‘This artist drew what depression looks like’) which serve to solidify crises of mental health as externalised and unassailable.
I appreciate that for many, the unfathomable nature of mental health is frightening, and there’s something abating in seeing it rendered in a childlike medium; reducing the glum seriousness by making it seem absurd. Perhaps also dissociating problems of the psyche from the self helps people feel less guilty, less responsible for their dark moods, in a way which is conducive to reducing self-loathing. Or else this splintering helps those see their affliction as a malady with a finite end — a cause for hope. I would argue that externalising seems, in some way, a repressive and debilitating in the long term, creating a very fragile defence mechanism built on enforced naivety.
Mental Health As ‘Inexplicable’
The sustained effort to render mental health as purely inexplicable is relevant here. Far too often, the assertion is made that issues of mental health defy any rational explanation and are thus completely without cause or aggravation. I have certainly felt unexplainable sadness; of feeling a gnawing despair or vague malaise and not knowing why, or of being able to identify some mitigating factor, but also feeling that my emotional response is disproportionate.
In mental health writing, this inexplicable is often attributed to ‘chemical imbalances’ in the brain, with mood explained by some deficiency or overabundance of monoamines (serotonin, dopamine and norepinephrine) or misfiring neurotransmitters. The ‘chemical imbalance’ hypothesis is highly scrutinised within psychiatry as one lacking evidence or proof, yet is one readily purported uncritically and as fact within mental health writing. This article (among others) draws a direct link between the theory’s promotion and the desires of the pharmaceutical industry in pushing certain antidepressants which claim to fix these imbalances.
Having only a hobbyist interest in psychiatry, I claim no expertise on the scientific specifics of mental health, and want to acknowledge that there could well be some biological explanation for sorrow that lies in my ignorance and beyond my comprehension. However, I want to talk about the erosion of autonomy and how this results in denial of ability to deal with the inexplicable.
I would apportion an amount of blame to the failures of language stated earlier. I feel that this failure to identify a root cause of a mood can be — and has been, in my case — a result of an inability to explain or articulate it precisely, both verbally and internally. For a long time, I wholly accepted the idea that my emotions were inexplicable, and therefore there was no course of action to deal with them — beyond medication.
Over time, I have developed a degree of mindfulness — reflexively observing certain mitigating factors for my moods. This has required some level of separation (‘getting out of my head’) — seeing myself objectively from my emotional state, and trying to apply a degree of rational deconstruction to what was troubling me; why I had so much investment in these factors and whether there was anything that could be done about them. Sometimes there is no obvious course of action (some gnawing dissatisfaction with my present situation; anxiety around my financial state; loneliness and so on), but every now and then, I notice how considerably something as innocuous as a personal slight had affected me — a crushing remark leading to a spiraling of the self-esteem. I found holding this factor to scrutiny and examining whether it had merit to be helpful. In the case of the slight, if I thought it stung because it contained some element of truth, then there was some galvanising effect in knowing I could work towards making it untrue. If it merely hurt because hearing unkind words just hurts, but was otherwise unfair, I could dismiss it — or else further examine any behaviour which might have provoked it. In these cases, it could be reasonably argued that what was afflicting me was not necessarily a direct issue of mental health (though might have been exacerbated by), but before this reflexivity, I would not have made such a distinction.
There is some degree of externalising here, of regarding myself as though an impartial observer. However, in doing this, I feel more present in of myself. In rejecting the construction of my mental health as an outside agent and cross-examining my emotional response as candidly and directly as possible, I feel less submissive to my moods and more in control of coping with them. I am not ‘my mental health’, it is not my personality. I have had far fewer periods of sustained anxiety that I have been unable to account for as a result. This critical function is often performed by a psychiatrist or counsellor, and I have sometimes heard to great success (though it hasn’t worked for me — counselling felt cold and medical, a blank faced professional assessing and consigning me like a mind MOT), but as such professional help often comes at a not-inconsiderable cost, I wish there was more encouragement within mental health writing toward people developing their own ability to be self-analytical.
Privatising Stress, Decontextualising Disorder and Denying Pain
In Capitalist Realism, Mark Fisher describes the ‘privatisation of stress’; that the sufferer is encouraged to ignore — or not even consider — that there may be various mitigating and compounding factors to their distress beyond the chemicals in their mind, their traumas or their personal problems. Fisher discusses how this benefits — and is encouraged by — capitalist systems, who can better exploit their workforce if they are conditioned to dissociate work stresses from their mental health. As the ability to deal with the anxieties of ‘work’ defines the worker as a ‘good employee’ within a capitalist system, a worker will do best not to acknowledge any adverse effects their job has on their mental health for the good of their career.
To me, this is further enabled by the inexplicable. This article, by Professor Richard Bentall, is very good on what he calls the ‘decontextualising of psychiatric disorders’. Work, financial, health and social anxieties — which can all contribute, exacerbate and compound to a dramatic worsening of the mental state — are diminished or completely disregarded whenever it’s asserted that there is ‘no explanation’ for mental illness.
I certainly found my mental state far more debilitating in times of unemployment or economic instability, but did not acknowledge any correlation at the time. Instead, I remember finding it infuriating that my mental state seemed to have deteriorated when I needed it to least, and chastising myself for failing to cope with the pressures of adult life. Though there is no directly achievable course of action in these situations in which I have little or no control, I’ve found it important to recognise that a worsened mental state is an entirely natural response. This seems obvious, but through dissociation, I had denied this justification of psychic pain to myself, I had denied my ability to manage how it was affecting me.
“The biomedical model of mental illness… makes it all too easy to believe that humans belong to two sub-species: the mentally well and the mentally ill.”
I have observed this denial of pain in others numerous times, particularly those who see themselves as insufficiently ‘ill’ — relative to what they’ve understood a mental disorder should be — and therefore do not consider seeking help or courses of action to deal with their psychological pain. In some ways, I think ‘illness’ is a somewhat unhelpful term in this regard, given how difficult it is to see one’s own behaviour as anything other than normative. I would contend that presenting tormenting ‘demons’ as an attribute inherent in mental disorder likely results in many undiagnosed sufferers overlooking the possibility that they might be mentally unwell, finding these ‘demons’ (or some manifest separation between the self and disorder)— apparently a symptom — absent in their own condition.
What effect do these deficiencies in how mental health is described have on the ability to communicate around the subject? If mental health is presented as solely irrational, or in the ambiguous, abstract terms of analogy and allegory, it becomes so much more difficult to communicate psychic pain, despite the emphasis placed on doing just this. I don’t think it’s a stretch to suggest this has a massively detrimental effect on the ability to empathise. When the significance of compounding factors is reduced, or a sufferer is conditioned not to recognise them, it becomes harder to address them with practical advice. Mental health is, in these ways, rendered unknowable, unmanageable and inescapable.