To have any kind of relationship with mental health, there must be conversations.
This year’s Mental Health Awareness Week has a theme of relationships. The importance of relationships and how they influence our mental health cannot be overstated enough in both treatment and prevention.
First, I don’t claim to be a psychiatrist or psychologist. My profession,as manager of an education provision that works to support people with a variety of difficulties, those who have offended, and those with mental health conditions; young people who cannot access the usual routes of education. No surprise of course that these multiple problems can be found in one single individual.
In my role I have pondered a number of things relating to mental health over the run up to this week, but I want to bring up three ‘conversations’ in particular. Firstly, how our understanding of “normality” will shape our recognition and further acceptance of mental health in the future; secondly, how advancements in neuroscience can mark both advancement and warrant concern; and finally, how current expectations placed on young people in school contributes to damaging their mental health.
So what do I mean by our understanding of “normality”, and how can it be a word we use to better our relationship with mental health?
In the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM) the long standing ‘bereavement exemption’ was removed. Prior to the amendment the exemption did not define those who had suffered bereavement as having major depression, despite similar symptoms, because the depression was, you guessed it, “normal”. The removal of this exemption sparked fierce debate among academics and practitioners, but it highlights an important question: if there is a good reason for a mental health condition, should it be defined as a mental illness at all?
The mental hell that comes after the death of a loved one is widely accepted as being a normal response. In fact it could be said that not having some form of depression in these times would be abnormal. We understand death’s effects and accept them, but is it not equally normal to be socially anxious if your mother tells you from birth that you were a mistake? Of course it is. Just because something is seen as a normal response doesn’t undermine the fact that it can damage mental wellbeing and cause long term problems if the individual is not supported. In this case the removal of the exemption sounds perfectly reasonable. Many get past the worst of bereavement with time and support, which is nearly always readily on offer, because people accept it as a difficult time in someone’s life. Why then do other mental health problems not get similarly wide understanding?
The reason seems to be that most mental health troubles don’t have universal backstories, and our empathy with them is not as deeply ingrained as bereavement. Normality then is really just another way of saying ‘I understand why you feel like this’. By furthering people’s understanding and creating a culture of communication and support, (like we do with people who experience bereavement), we take steps towards understanding the normality of certain conditions. Damaged mental health due to bereavement may be normal, but so too is social anxiety, we may just have to dig a little deeper for the reason.
Reasons are also being unearthed with the help of neuroscience, and I have no doubt that one day the time will pass in saving our ethereal concept of ‘mind’. We will have to pass at least the majority of the mystery regarding ourselves to the biology boffins to explain to us in simple matter-of-fact statements how ‘we’ come to be. We should now begin accepting the real possibility that one day, having monitored the brain through the course of a human life, and uncovered both the organic and environmental factors of various disorders, we will be able to tell a developmental story in which our at least a vast majority of our ‘selves’ emerge. However, as Benjamin Y. Fong states in his New York Times article for ‘The Stone’, the real problem is practical application of this knowledge:
The instrumental approach to the treatment of physiological and psychological diseases tends to be at odds with the traditional ways in which human being have addressed their problems: that is, by talking and working with one another to the end of greater personal self-realisation and social harmony.
By relying on neuroscience to explain the causes for mental health problems, we will get biological ‘causes’; perhaps a biological cure. The issue with relying on one field to determine causes for very complex conditions means we are in danger of missing the psychosocial influences of our environments. Most aspects of psychological well-being are influenced by social factors (such as gender, social class, race and ethnicity) and social institutions (such as employment sources, education, and interventional health care services).
For example, schizophrenia has been proved to have a higher risk of manifestation when someone is born into poverty, but the vast majority of research into schizophrenia is now carried out at a biological level looking for a biological basis for the condition, in order to create a biological remedy. We have discovered a new toy in neuroscience, and we only want to play with that one.
Neuroscience has the capacity to, by forcing us to look at organic causes for mental health problems, repress all that we know about the often unequal and frustrating world in which we live, and the harmful effects it can have on the psyche.
These states, where we hand control over to science, are uneasy times. It admits defeat at the social level, and instead looks to scientific advancements and diagnosis in order to save the day and provide us with knowledge. Such research will bear fruit of course, but attached to the dominance of this research in the field of mental health is the assumption that it is still easier to change the individual themselves rather than wider, far reaching catalysts for mental health conditions.
One such cause that is becoming more widely accepted as problematic is our education system.
The point of education for young people is simple: To gain qualifications that help them in later life, to promote a healthy attitude to learning, to engender an interest in the world, and to provide opportunities for young people to establish social cohesion with their peers and adults. No one ever got this from being force-fed tedious grammatical terms or being made to sit test after test to provide schools with that word that makes teachers and educational practitioners crawl up the walls: data.
In the organisation I work for, we do not focus solely on academic teaching, (certainly not as much as mainstream schools), because we accept that young people have far more going on that needs to be untangled before any self realisation and academic learning can take place. See Maslow!
The issue we have is we still have to measure progress. But how do you measure emotional progress with data? Schools need to be monitored of course, they need to be measured, but the only easy way to measure a school’s success currently is in the numerical value it can place on things. When you strive to improve numbers, you miss out trying to improve things that can’t be measured numerically. I can think of a great many things we want and respect in people that can’t have a numerical value easily assigned.
What do your numbers say about your worth, young lady?
When you start trying to push those numbers up, teachers are pressured to teach to exam papers in a factory style churning out of newly moulded minds, and young people are forced to improve regardless of the strain or impact on their mental health. Teachers don’t get into teaching to stress young people out. We have fantastic, educated women and men in our education system who set out to better young lives, and offer access to opportunities to as many as they can.
I should mention I love academic study. There is immense value in being informed, but what the education system currently fails to provide is balance and reasonable expectations on young people. And I don’t want to create the impression that I would prefer all children to dance around a maypole and throw flowers at each other while giggling and treating every problem in the world with liberal zeal. Nor do I expect all sessions to be amazingly inventive and curriculums to be changed every week, because that would be hilariously impractical.
There should instead be a culture of openness, discussion and access to support services. There should be learning about things that relate to real life. Not just a fleeting, casual mentions of such things in embarrassed superficial sessions, but real classes that engage not only in what young people are dealing with personally, but assign normality to topics such as sex, relationships, and especially mental health. Schools are perfect social hubs, and should be encouraging interaction and social time more with a view to guide young people in this intricate, challenging, but key skill of relationship building. This new focus should not be something that is seen that detracts from hard study and academic development, but instead a necessary part of young people’s education. Support within schools at an emotional level cannot be lionised enough.
These are not just ideological mutterings of utopian madness. I have recently had a young man referred to our provision, who has just left a 6 month stint in hospital due to severe mental health problems who is still being made to sit his GCSE exams because ‘everyone’ has to be entered. His tutor knows he will likely fail, and he thinks he will fail. How is this mentality protecting or developmental in anyway? Our Child Adolescent Mental Health services are stretched because we fail to re-evaluate, as adults, the pressures on young people and the importance of a more nurturing and balanced education system that does not put academic achievement before emotional and mental stability.
As mentioned at the beginning of this article, this year’s theme for Mental Health Awareness Week is ‘relationships’. These three conversations are just an example of the many discussions we should now be having around mental health to foster a good relationship with the disorders of the mind, but they also show the variety of discussions that we should be having surrounding mental health: philosophical, scientific, social, and practical. Conversations like the ones demonstrated are going on more and more in spaces such as this, but perhaps for the good of future generations, we should start having conversations like this with our young people now, and get their relationship with mental health off to a good start.
Ben Greenhalgh is the post-16 manager at Inclusion Hampshire: an independent charity that specialises in alternative education for those who, for a variety of reasons, cannot access the usual routes of education and development. Ben works specifically with those 16 and above, but the charity works predominantly with those within the age bands of secondary education.