“… the unfortunate reality is that the topic of mental health is an unwieldy, untamable beast.”
Introduction
The aim of this article is to highlight contemporary psychological discourse. By that, I mean what is issued by specialists, doctors, or psychologists, specifically on mental health, whether written or spoken. I will touch further on the contents, i.e., topics that I think are important to reflect on. The topics chosen here are merely the result of my own observations. Putting them forward does not mean that they are the most important, or that my perception and the shortcomings I mention regarding them are the final decision on it. On the contrary, I hope that it will spark more discussion – regarding this topic and other topics as well – and that it will shed light on other relevant aspects that I have omitted here. Following that, I will look at two other concepts that I think should be considered when it comes to the study of mental health.
Some examples on the topics of this article
– Mental health awareness is not always useful or beneficial
Mental health awareness has a major attraction, as it has become a common practice globally, regionally, and locally. We find that many initiatives dedicated to this have grown significantly with the availability of social networking sites, with the aim of spreading psychological knowledge, addressing psychological stigma and stereotypes of mental disorders, and encouraging those who suffer to talk about their suffering and seek help. It may be surprising to raise talk about such efforts and initiatives, whose importance and nobility of purpose may not be disputed. However, psychological education is not as easy as we imagine. In other words, we may need to repeatedly rethink our belief in its absolute positivity. Let me elaborate on the issue a bit.
How do we spread awareness as mental health professionals? This is a question that is always on my mind, even though it is clear. How do we meaningfully simplify information and knowledge related to mental health? I do not find this to be an easy matter, nor do the professionals. Perhaps, because some people see this as just a matter of gathering information related to any disorder, objections to its content have emerged. It is also noted that most of them lack contextualization of mental health information.
Here, we are dealing with recipients who have a range of disparities. They have differences in their perceptions of mental health, in their trust towards the professional, in their social and economic conditions, their personal psychological suffering or the suffering of those around them, as well as their experiences of seeking and receiving mental health care. I think that scientific writing about many mental disorders in university science textbooks have been continuously under criticism, to be modified and reviewed for research errors, biases, or the usage of phrasing that is disrespectful of humanity and those who suffer from such conditions. So, what about the content that is directed to the community at large, which is often not subject to careful review?
Another important thing to note is a phrase that we often see being repeated in mental health awareness campaigns, which is “the solution to the issue lies in talking, not suffering alone, and asking for help without hesitation.” Superficially, these statements seem logical and justified. However, once again, simplifying the issue in this way is dishonest to how these issues manifest, and it can be painful for those who are suffering. These statements may be useful for some, but to others, they are inappropriate, difficult, and insensitive. This reminds me of what the British psychiatrist Sir Simon Wessely said back in 2017 in an interview, “Every time we have a mental health awareness week my spirits sinks; we do not need people to be more aware. We cannot deal with the ones who already are aware.” Here, Wesley talks about the British health institutions’ failure to provide psychological services to their patients; he expresses his concern about awareness and the continuous action of raising awareness, without matching the number with mental health workers, nor providing better conditions and support. This applies to many countries where access to mental health services is not always available, and not just the United Kingdom, due to the high financial cost, or the long waiting period of up to several months in government public hospitals.
Another issue is that in a broad view, the psychological education provided does not portray mental health conditions as being on the spectrum, which requires greater accuracy and effort in spreading awareness. Many mental health campaigns portray our psychological experiences as either healthy or unhealthy, while ignoring the broad spectrum between mental health and psychopathy, causing errors such as pathologizing natural and transient psychological experiences, or the recipients’ awareness that such experiences are pathological and require psychotherapy. On the other hand, some campaigns promote ideas such as self-care, talking to a trustworthy, practicing meditation and relaxation, etc., which often involve underestimating those who have severe psychological suffering, or are the result of compelling social conditions.
Another interesting hypothesis can be found in a more recent scientific research paper which was released in April of 2023. This paper raises the question of whether mental health awareness efforts contribute to the rise of mental health problems. This assumption was based on logical arguments, starting with that awareness efforts may lead to an exaggeration of psychological symptoms; some individuals may begin to perceive mild psychological distress and negative emotions as psychological problems that need to be diagnosed and treated. Paradoxically, in these situations, this may create or exacerbate mental health problems. Mental health awareness campaigns often portray mental suffering as something that is admirable and courageous, which unintentionally glorifies mental health problems, or romanticizes them, contributing to the phenomenon of exaggerating the interpretation of psychological symptoms. Moreover, describing normal psychological experiences as psychological problems or disorders can create self-fulfilling prophecy, in which an individual changes his beliefs or behaviors to fit a psychological diagnosis. Then, those around him begin to treat him differently in line with the psychological description and diagnosis in question, which may lead to this individual actually experiencing psychological disorders as a result. This hypothesis has not yet been tested in research, but I think it deserves attention and research.
Though of course what I mentioned does not mean that mental health awareness should be stopped, or that there are no important benefits of mental health education, I merely wanted to highlight some important aspects that are often absent in these efforts and bring them into reality. The problem lies in assuming that mental health education is always useful, regardless of its content and approach.
– Adopting a unilateral interpretive model for mental health
Mental health is a complex phenomenon, and it cannot be reduced or explained by a single factor. Psychological theories of reductionist mental health disorders have been criticized for focusing on the individual alone as a source of disorder, ignoring the role of social and cultural factors, or even siding with biological explanations. Such criticisms resulted in the emergence of corrective and integrative trends to understand and interpret mental health in all its aspects. Unfortunately, this has not prevented the re-emergence of discourses that explicitly promote and advocate for understanding and interpreting mental illnesses from a unilateral perspective, which sometimes seems to me to be a violent and extreme reaction to the biological and medical explanation.
For example, we can see how this is illustrated in a report issued by the British Psychological Society/ Clinical Psychology in 2020 under the title Understanding Depression. This article starts off by saying that it is better to think about depression as an experience, or a set of trials, rather than calling it a disease. The fact that illness of any kind is also an experience that we go through is an idea that puzzled me. So, what prevents depression from being treated as a traumatic experience and as an illness simultaneously? The report then goes on to criticize Electroconvulsive Therapy and Pharmacotherapy.
It is generally understood from the report that depression is a common and understandable reaction to certain life circumstances, and what blinds us from noticing it is the psychiatric diagnosis of it as a disease. I will limit myself to what I have mentioned here, as there is not enough space to review all the contents of the report. I wish the authors of this report had stated that this was their perspective on depression. Also, I wish that it included other explanatory models and references to this perspective. This article reflects a unilateral and certain view, which I find exaggerated, of a complex situation, much of which we still do not know. If depression is an experience, as the report prefers to say, then why have the experiences of those who benefited from pharmacotherapy, and found it to be lifesaving been marginalized? And what about the experiences of those who suffer from severe chronic depression, could you imagine telling them that depression is just an experience?
In The Empire of Depression: A New History, Jonathan Sadowsky writes: “The biology of depression is not fully known, and much of it may always remain a mystery. But I think that the whole idea of depression is unconvincing. So is the idea of depression being entirely biological. This dichotomy itself is the problem.” We can simply highlight and emphasize the role of social, economic, and cultural factors in understanding mental disorders, while not eliminating the role and effectiveness of medications in at least some cases. We can criticize the history of psychiatry and some of its practices, which are worthy of criticism, without ignoring its role in improving the quality of life of many individuals.
– Psychiatric diagnosis of mental disorders
When it comes to psychiatric diagnosis, it is seen as one of the most controversial topics these days. On one hand, a good number of psychologists and even some psychiatrists criticize psychiatric diagnosis, though some exaggerate in its criticism – or more precisely, they attack it –, describing the diagnosis as harmful and oppressive. Many critics of psychiatric diagnosis believe that everything that psychiatry does – or mental health services that use psychiatric diagnosis – is just a stereotyping of a person’s complaints and placing him/her under certain category.
The problem here lies in the superficial and reductionist approach to a complex topic, such as the diagnosis of mental disorders. John Sadler, a professor of psychiatry, points out that diagnosis is used as a denotation and a process in daily clinical practices. Diagnosis as a categorical denotation is part of the story, and perhaps a simple part of it. So, I think that such a reduction of diagnosis along with demonizing it and demonizing its practitioners – by some – and ignoring its context, is very problematic.
The direct and simple question here is: Is the diagnosis useful or harmful? Well, it could be both. Diagnosis is a tool of clinical practice, and it depends on the method of use and dealing with the diagnostic outcomes. At least, this is what a 2018 research review indicates. It dove into the experiences of psychiatric care recipients, caregivers of people diagnosed with a psychiatric disorder, and psychiatric care providers. The study revealed that having a diagnosis was very useful for some participants (patients), the problem for them was that it was not given early enough. While for others it was regarded as an oppressive tool. In addition, this review emphasized the essentiality of the context in which the diagnosis is presented; if the diagnosis is presented carefully and accurately, discussed, and the person is provided with clear information, the diagnostic experience is likely to be positive overall. Therefore, it is often difficult to take an absolute position –for or against – towards the psychiatric diagnosis itself, and to take those who hold such a position seriously.
Surely, this does not disregard that the existing diagnostic evidence is imperfect and varies in accuracy. It is also important to criticize the expansion of psychiatric diagnosis (although this is a controversial issue in determining what is considered an expansion or not, but this article will not address it), and the negative and erroneous practices related to the use of diagnosis.
The Relationship Between the Author and the Recipients
– Double hermeneutic
Mental health specialists and researchers need to pay attention and think about how people use concepts related to mental health, and how these concepts can change people’s perception and awareness of them. One approach to this issue is the so-called double hermeneutics and it refers to theories and practices of interpretation, as interpretation involves understanding that lies in justification. Anthony Giddens, a British sociologist, introduced the concept to the academic circles. He states that specialists in natural sciences like physics and chemistry have a shared understanding and discourse when it comes to the researched natural phenomena, and they have no doubts that discourse about these phenomena is bound to change their perception and understanding. They do not need to explain their knowledge of their (non-human) research samples, because they are irrational and will not absorb and interact with this knowledge or change its nature. However, the situation is completely different from that in the humanities, when the observer is a human being who uses this concept and interacts with it. Concepts and theories developed by scientists to explain behavioral phenomena are circulated among individuals, and they explain them in ways that may sometimes not coincide with their basic scientific explanations. Thus, a precise separation between knower or self and known or apparent is no longer possible.
For example, in 2020, a research paper was published to address and interpret the psychological classifications of young people (15 years old), specifically depression and anxiety. Through 51 interviews, it was revealed that they saw such classifications as reflecting hollow individuality. What is interesting here is that they give it another meaning by transforming it from diagnostic categories to cultural categories. They stressed the key role that cultural and social factors play in understanding the mental health of young people. Moreover, they separated these classifications from their clinical foundations. Instead of considering them problems in the minds of individuals, they moved their scope to the social structural context of school administration, their social relations, community norms and ideals, and peers.
Hence, many complex implications for mental health followed, in terms of its concepts, philosophy, and theories. Which topics should specialists raise awareness of in society in general?
– Looping effects
The looping effect is another concept that specialists should develop when talking about the concepts of mental health and the associated diagnoses of mental disorder. Ian Hacking, the Canadian philosopher who specializes in the Philosophy of Science, published a series of high-impact papers, showing that concepts in the social and behavioral sciences refuse to remain unchanged. We find that even established concepts are changing, as new ones emerge, and the set of perceptions and classifications by which people name/understand their experiences is constantly shifting.
In terms of mental health, the concept of the looping effect highlights the process of interaction between classifications and types of targeted individuals, which are supposed to share traits and behavior. In other words, categorical practices provoke reactions in individuals. For example, when a person is diagnosed either by a specialist or by himself, he begins to shape his behavior, experiences, and self-understanding according to this diagnosis.
In fact, this is one of the hypotheses based on the paper cited earlier, which hypothesizes that psychological education efforts may have contributed to an increase in mental health problems. Do not forget that the presence of a large part of these efforts on social media makes it easier to imagine how recurrent mutual influence might occur. A person makes a diagnosis a starting point for his self-understanding and awareness of his behaviors, and even goes beyond that, and becomes more problematic when it becomes his identity.
In general, I believe that these two concepts would make specialists think carefully about the content of the speech presented, how the recipient receives it, and the outcomes of this reception. When health-related concepts and classifications are launched and circulated, they will not remain the same, and will affect individuals’ self-perception, which contributes to making the formulation of the discourse and the follow-up of its outcomes a more challenging task, requiring a lot of deliberation and continuous review.
What is next?
All the above are just reflections and assumptions, which have not yet been researched in our Arab world. So, we urgently need research that investigates and revises our contemporary psychological discourse. While quite a few such research is found in Western societies, unfortunately it is almost absent from the Arab world, including KSA. Likewise, research measures the impact of mental health awareness efforts on community members.
Conclusion
Mental health discourse has its own temptations, appeal, authority, impact, and unexpected outcomes. All of this is worthy of contemplation, during the production of the discourse (the process of formulation) and after it (the process of investigating its outputs and impact).
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