I have written the title above as a psychologist whose livelihood stems from serving those who would adamantly disagree with that statement. And they should. When you are suffering from mental illness, you begin to realize how much everything we do is intimately connected with being “sane.” Or, as I like to think of it, living squarely in the fat part of a normal distribution. Yet what I have begun to notice here in North America is that after every public tragedy, the finger is pointed at poor mental health as a culprit. Media outlets tend to throw around words like “psychopath”, “schizophrenia”, and “bipolar disorder” to embellish high-contrast stories that stand out in black-and-white instead of the colours in which life is really painted. Perhaps it is another Pandoran love-child of the Enlightenment and Modernism wherein being human was reduced to being molecularly constructed “just so.” As a result, what we have now in the mental health field is the Medical Model that seeks to separate human suffering from human circumstances that includes socioeconomic divides, bigotry, misogyny, cultural and national history, and family systems. Yet I don’t necessarily blame establishments for doing so. The rabbit hole of the human condition is convoluted and very deep, and there are not many efficient ways of describing it. It is much easier, for the sake of paperwork that must be done for the sake of accountability to those who hold the pursestrings, to define causes of statistically abnormal behaviour as the result of a thing that can be treated or fixed. Very often, that treatment comes in the form of medication and psychotherapy– both of which I advocate as possibly helpful. Yet these are interventions, not prevention.
If one truly seeks the good of people as a whole and the health of a society, the root causes of poor mental health must be addressed. To be sure, there may be strong genetic influences in the development of one issue or another, but even these are heavily influenced by the environment one is exposed to. Our best estimate is that for genes account for roughly half of the development of mental illness. Even though that is a staggering proportion, the mystery of why some genes are turned on and why some remain “off” is part of the research that epigeneticists are undertaking. When I was a microbiology undergrad toiling over evil-smelling agar plates and burning my fingers on flamed test tube caps, the buzz in the scientific community was over the sequencing of the human genome. It was whispered (but perhaps not published) that achieving this would change “everything.” Yet the impact of now having a fully-sequenced human genome was not perhaps as great as we had thought. The great puzzle now is why some genes are expressed and others remain silent. Thus far, the answer appears to be environmental influences.
If we really care about mental health, a shift must take place in how we describe it. It has been expedient but harmful to push mental health solely into the realm of medicine. And, I think, even describing it as purely “mental” has not helped matters either. The Cartesian dualism that pervades the Western world leads to the understanding that since the mind is separable from the body (and hence the environment), those with an illness of the mind can be cured by addressing the mind alone. Yet as philosophers will tell you, even understanding what a “mind” is, is a difficult task indeed. Mental illness and mental health can’t be addressed by simply looking at people at their problems as disembodied brains gone awry.
If we truly want to understand mental health, it can’t simply be seen as the result of genetic causes that have purely medical solutions. Having worked in the public health system, I can say with some authority that psychiatrists don’t even see medications as cures. They generally prescribe them to help people calm down so that other work– psychotherapy– can be done. The general feeling amongst them is that they and the psychiatric social workers and nurses that work with these acute populations, are performing an intricate triage. When we sat in grand rounds discussing child psychiatric cases, the grimmest looks are for those who come from impoverished areas, foster or group home care, or have the very rare adolescent manifestation of hallucinations or delusions. Yet the factors that seem to lighten the mood of treatment teams because they boost the odds of reclaiming all round health are the ones that have little to do with genetics. Does the child have loving and attentive parents or a loving community? Is the child out of places or relationships where they have been abused? Is the child free of drugs and alcohol? If the answer to these is “yes”, there is a general sigh of relief from social workers and doctors alike because there is a fighting chance that they will never again see that child hospitalized for psychiatric reasons.
The question remains: what can be done about poor mental health? Short of gene therapy to prevent the expression of particular genes, what can be accomplished is to create environments that eliminate stressors that contribute to the manifestation of mental illness. Yet if you have made it this far into my little article, the latter sentence should seem absurd or at least unrealistic because it is. Even if we were to eliminate abuse and wean society of drugs and alcohol, “normal” stressors remain. Couples break up, friends turn on friends, exams and courses are failed, jobs are lost, and finances get tight. Furthermore, there are wars, random violence, poverty, accidents, unforeseen illnesses and deaths, micro and macroaggressions, and a host of “isms” that make life difficult for everyone, everywhere. The trouble is, these stresses are so “normal” that to think about getting rid of them requires huge turnarounds– dare I say “repentance”?– in the way our world works. As you perhaps can now see, the problem of mental illness from this perspective is so intractable that it is understandable why we prefer to think of mental health as a discrete problem for a few unlucky ones. No, we are all on a spectrum of health-unhealth where we are sometimes more or less healthy, and the factors that lead to one or the other are inextricable from the world we live in.
This is why it’s not all about mental illness or mental health. By continuing to address it as an isolated phenomenon that occurs in a vacuum away from the evil that besets us all, we shunt responsibility for it on the medical profession, which I daresay is not the best equipped for handling stuff that happens outside the examination room or hospital. Social workers are of some help, but even they only intervene once something has gone wrong. If we are serious about growing healthy people, the answer lies within the creation of healthy communities and relationships that help provide the kind of care and maturation that breeds resilience. Yet by its somewhat fuzzy nature, this is not an attractive option because in order to release the funds for these kinds of communities and help, measurable goals must always be put in place. It is far easier to get behind interventions (miracle drugs! miracle therapies!) that often come too late rather than address the things that contribute to the development of mental illness. But as this problem is unfathomably large, where change can begin is in the way we think and speak of mental health: not solely as the result of some chemical problem in our brains, but as the result of a confluence of factors that are not extraordinary to the cultures that we inhabit and that inhabit us.