We Need to Walk the Talk

by Dr. Teresa Graham

The other day, my four year old grand-niece announced: ‘I have anxiety about going to school’. This remark brought into sharp focus for me a concern that has been growing steadily over the past few years.


It is apparent that, in contemporary Western society at any rate, a narrative has been gaining traction about ‘mental health’. The first element in this narrative is that ‘mental health’ is now a synonym for ‘mental illness’. This lack of precision in language is really annoying for me as one who likes words to say what they mean – exactly, but more importantly, because language when adopted into popular idiom influences belief, attitudes and behaviour.


As Kelly (2022) points out, there is not a dichotomy between mental health and mental illness. It is much more useful to see them as a continuum, we are all somewhere on that continuum, and there is a point somewhere along that continuum when a diagnosis is appropriate. Contrary to popular belief (and the narrative I am complaining about) making such a diagnosis is not straightforward, and is, in fact a very contested and complicated area. A lot of the time there are no clear-cut, objective signs that someone is mentally ill (Barry and Yuill, 2002); clinicians are mostly relying on a cluster of symptoms reported by the client and the same clinicians are not always correct. For a great critique of how the DSM is compiled read Paula Caplan (1996: They say you’re crazy) and when you have digested that research ‘The Anti-psychiatry movement’ (www.psychologytoday.com) makes for some worrying reflection.


‘Ah but’, I hear you shout, ‘what about all the advances in neuropsychology?’ Yes, there have been new welcome discoveries in this field, but it could be argued, along with Thomas Szasz (2010) that if a disorder is caused by a lack or surplus of a hormone or other chemical in the body or brain, then it is a physical disorder and not a ‘mental’ one. The point I am making is that there are many disputes about diagnosis of mental illness and about the naming or creation of new disorders – too many to go into here.


To get back to the contemporary narrative I started off with, it is very common to hear in ordinary conversation that someone is ‘OCD’, ‘on the spectrum’, ‘depressed’, ‘narcissistic’ or has ‘PTSD’.  A lot or the time -most of the time I suggest - this casual use of language is ascribing psychiatric disorders to people who are displaying some behaviour that is annoying somebody else, but not mentally ill.


I would hazard a guess that most people who use these terms in this off-hand way have no idea what having a psychiatric disorder might mean. Apart from the genuine suffering of the person, being diagnosed with such an illness may cause a person to lose a job, be forcibly hospitalised (in extreme cases), lose custody of their children or be made a ward of court and lose autonomy to make financial decisions. So, we need to be careful about ascribing psychiatric disorders to people.


The strength of the narrative has become especially apparent in social media but has permeated traditional media as well. It is almost inevitably accompanied by ‘we need to talk about ..’ or ‘awareness should be raised about …’. Many times, it is celebrities who are telling the story and it seems to be a compulsory trait of celebrity nowadays to be suffering, or have recovered from, ‘mental health’.


I am not suggesting for a moment that the removal of the stigma once attached to mental illness is not a good thing. What I am saying is that one effect of labelling the ordinary ‘problems in living’ is that is detracts from those who are genuinely mentally ill and also trivialises their genuine distress. Mahony (2019) quotes Sir Simon Wessley who campaigns for more services for those who are mentally ill: “Every time we have a mental health awareness week my spirits sink. We don’t need people to be more aware. We can’t deal with the ones who already are aware ..’ Mahony (2019) says a psychiatrist friend of his feels that people with serious chronic mental illnesses such as schizophrenia are real losers in this atmosphere. He feels that it is easy to hitch on to a popular band wagon, talk endlessly about ‘mental health’ and not pressurise those in power to actually do something to provide the services which those who are genuinely mentally ill need, and which are woefully lacking.    


So maybe we now need to walk the talk.


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