Mental health is being talked about more than ever. We are reducing stigma a little bit at a time. Self care and Wellness are concepts that are taking hold in many parts of our culture and even in many workplaces. Access to information about various mental illnesses and treatment are widely available. We need these things. Many of these resources and tools have helped to save lives, and increase the wellbeing of people who have struggled for a long time. But, like all good things, these things can be misused and cause real harm.
Wellness
Self care, meditation, mindfulness, yoga are all things that can bring elements of health and happiness to the lives of people who might otherwise be unable to find peace. Wellness is promoted everywhere by companies, friends, family, social media and government funded campaigns. We can all benefit from wellbeing. But the wellness industry can also be used against us. When companies do not support their employees, denying vacation and sick time, pressuring overtime, understaffing and avoiding provision of full time employment, and instead offer mindfulness workshops, the message is clear: “Any stress you feel is your own fault. We do not intend to change anything we are doing that you feel impacts you negatively.” This takes employers off the hook for fair and humane work expectations. Many places end up creating a culture of “toughness,” implying that working less than overtime, taking sick days when actually sick or taking vacation time, which employees have a right to, in order to invest in one’s family means you are not committed and may be passed up for promotion. Using wellness lingo and trainings to promote an unbalanced and unwell work/life relationship is a distorted use of wellbeing practice.
If you are an employer or are in a workplace that is wanting to use more wellness strategies, make sure that your strategy is looking at the big picture. This includes reasonable productivity expectations, fair wages, limited overtime, guaranteed holidays and well defined policies and procedures to address workplace concerns. These things should take priority over things like mediation, social clubs or yoga groups, etc. but of course, can be in addition to them.
Also check out this interview with author, Ronald Puser about his book “McMindfulness: How Mindfulness Became the New Capitalist Spirituality.”
Couples do similar things to each other when they ignore the requests for addressing issues in the relationship and insist that the other just needs to take better care of themselves in order to resolve issues. Again, for sure people benefit from taking care of themselves and absolutely need to be responsible for doing so, but this is not a substitute for deflect responsibility for issues within the relationship that may need to be addressed by all involved.
Check out What do You Really Need? – A 6 Step Complete Self-Care Assessment Guide
Self Help
Struggling with parenting, your relationship, your mood, or your sense of direction in life? There is a book for that …and a podcast …and a blog …and a video series …and a course. I love all of these things and feel like I live in a golden era where there is endless access to information and strategies, research and inspiration.
With self help, the danger comes with the contradictory information and the lack of context that this information exists in. These authors don’t know you personally, who you are, your history or your context, and their advice, which many be useful to many may not be appropriate to your situation. When things don’t work out, despite our best efforts to do it all right, we assume that it is just us and clearly we are the ones who are ineffectual. Then we give up.
The shame that comes from what feels like a parenting, relationship, or life failure keeps us from talking to others we know who may have experienced the same thing or who might be able to give more specific and appreciate advice for our situation.
The other problem is that people tend to stop trusting their own instincts and rely primarily on distant expert outsiders. Again, these outsiders can be super helpful and I would never say that people shouldn’t look to outside resources (I refer people to these often) but don’t assume that the author know all about you. Try stuff out, if it doesn’t work, consider the possibility that there is more to your context than what the advice addresses and don’t hesitate to talk to others you trust about their life experience in this area and know that there is likely no “one right way” to address an issue.
Mental Health
Diagnosis
One of my concerns about diagnosing mental illnesses is it’s presumption that the particular symptoms listed are somehow a sign of an internal problem, as opposed to being a response to an external problem. Of course, a good diagnostician will screen for outside issues, but even the most thorough assessment guide doesn’t always see the bigger picture. I see uses for diagnosis and understand how they can work in peoples favour (giving meaning to what is happening, directing appropriate therapeutic interventions, and allowing for access to funding) but we need, as mental health professionals, and friends and families of loved ones who are struggling with their mental health, to watch out for ways that we might be inadvertently contributing to the problem by ignoring and not addressing context within relationships and society.
Check out On Getting a Mental Health Diagnosis
And Mental Illness & Diagnosis – Saving Normal
Personality Disorders
Most people have heard of Freud, “the father of psychotherapy” who famously reported that many of his patients had been victims of sexual abuse by their fathers or other men, and that the symptoms they were presenting with were a response to this abuse. He backtracked when pressured by a large group of physicians who insisted that these allegations must have been fabricated by women who actually wished that this had happened to them. Freud then attributed his clients’ symptoms to a condition called “Hysteria” a result of women’s “wandering womb” which caused them to behave in erratic ways. He went on to develop theories about the innate desire for children to want to be sexually intimate with the parent of the opposite gender, to further explain what he was hearing from his patients.
These days we scoff at many of Freud’s ideas, on one hand, and then diagnoses victims of sexual abuse and other traumas with personality disorders which are, at times, used as code for “difficult” people. With this diagnosis we forget, erase, or ignore the fact that the symptoms being witnessed are natural human responses to developmental trauma, and instead hold clients solely responsible for what they are experiencing in their minds and bodies. At the same time, we as a society, consistently let off perpetrators of sexual abuse, or assault, insisting that victims are making things up and really wanted the abuse they received and that bringing these things to light is a form of abuse towards the perpetrators. We have not come very far from the Victorian ideas of Freud’s time.
For more on this check out Borderline Personality Disorder (BPD) – The New Hysteria and Borderline Personality Disorder (BPD) – The New Hysteria
Depression
I’m not sure if any statistics have been done on this, but anecdotally, I have seen very few people in the mental health system, or in private therapy practice who experience depression and have not experienced loss, trauma or extreme stress within their lifetime. These days, with Epigenetic research growing, we are learning more about the impacts of historical trauma on DNA. When we tell people that depression is “all in their head” we insinuate that they alone are the problem, that their depression is a choice.
As mental health practitioners, we give, what can be very good advice: things like challenging negative thinking and self care strategies, like getting outside and exercising (I give this type of advice almost daily), but if we do not acknowledge the things in peoples lives and in the world around us which are actually disheartening and which challenge hope, we risk a form of psychological abuse where we try to convince people that everything is great, and that it’s just their perspective that’s the problem. The fact that we are experiencing depression in the light of all that is currently happening in our society and our planet, not to mention day to day stressors, interpersonal conflicts, etc, is more a sign that we are healthy and human, in our responses to these things that that we hold individual, internalized pathologies.
Also check out Depression Vs Grief – When You’re Down and Climate Grief
Anxiety
Like depression, when we look at the state of the planet combined with the insistent pressure of social media, with it’s never ending conflictual messages about how great we are, versus how much we are fucking up, versus what we need to do to be better, then anxiety seems like a foregone conclusion, a pretty normal reaction to a hostile and inhumane environment.
Again, it is about naming the reality in order to be clear about how much control people really do have over their circumstances and environment and how they can manage the parts they can control, to the best of their ability. Strategies and tools to manage depression and anxiety are useful and beneficial when we acknowledge all the part of the problem and don’t give people the impression that they alone hold the key to their own happiness. In my experience, when we tell people that they hold ALL responsibility for their wellbeing, then people feel overwhelmed and paralyzed by the weight of it all and less able to take responsibility for what they actually can change. When we tell people they are not able to address ANY part of their wellbeing, this is also paralyzing.
Another fallacy is the belief that, with the same tools, every person can address the same symptoms. If we do not account for context, history, and other barriers that individuals face, we risk setting people up for failure. The idea of “resistance” in therapy is, fortunately, losing ground. Therapists are beginning to acknowledge that people do what they do, or what they don’t do, for very good reasons, not because they are fundamentally lazy, bad, selfish, etc. and that change is most likely to come when we acknowledge the purpose people’s behaviour has in their lives, without judgement or assumptions.
Check out A Good Time to Panic and “Headline Distress Disorder”
Medication
It is far easier to get medication for symptoms of mental health (even undiagnosed illnesses) than to obtain counselling or any form of therapy for it. This is a choice on the part of all of us who vote for governments that limit what our health care system will cover, and on the part of insurance companies who do the same. Medication is only one part, and often only one of several options, for effective treatment of mental illness. The benefits of medication are mixed, the side effects varied, and the long term effects not often discussed. I believe that there is definitely a time and place for medication (see Mental Health & Medication). But the assumption that it is a cure all for what ails you is naive and ignores each person’s context, history, and coping skills. In my experience the reasons for prescribing versus withholding medication also seem to be random, based on what appears, at times, to be biases and whims of doctors who make assumptions about patients that they may, or may not know at all.
I was once offered my choice of three different types of opioids by an emergency room doctor, within minutes of our meeting “because,” he stated, “you don’t seem like an addictive type.” I’ve seen clients who have suffered for years with debilitating PTSD and anxiety symptoms, unable to function on a day to day level and are denied medication that might provide relief for fear that they will develop an addiction.
We can all contribute to a more well, mentally healthy, and caring society. Mental Health Care professionals, those who promote wellbeing and self help, and those of us who utilize these things on a daily basis can do so if we don’t forget the bigger picture. When we acknowledge the global, social, organizational and business contexts, when we acknowledge cultural, family and personal histories we will do better in promoting healing and not harming. When we acknowledge what we can and cannot control, what are reasonable and human responses to what is happening around us, and understand that each of us are unique in our needs and abilities, then we can promote wellbeing and mental health in ourselves and those around us.
Also check out How your Job can Damage your Mental Health (and what to do about it)
And How Social Norms, the Media & Gender can make Sobriety Difficult
And Finding Hope in the Climate Crisis
It's Not Just You 