The messy, sloppy, awkward dilemma of declaring a mental health pandemic

I’ve been feeling a bit like the guy whose favourite band finally hits it big. Happy because it’s objectively good for everyone involved, but a little bit jealous because it takes something away from my own sense of individuality.

This has taken a few years to solidify in my head, but it’s been there for as long as I’ve been dealing with mental health problems. It’s nuanced and fraught, but I’m convinced it’s something we need to talk about more: the difference between clinical mental health conditions that require a lifetime of treatment, and the rollercoaster ride of ups and downs that make up regular life.

I write about mental health over at stevenladurantaye.substack.com. If you like this, go take a look. And if you like the site, maybe subscribe?

I feel a bit gross even writing that down, because it’s not for me to decide who needs to take mind altering drugs and who should just sit down for a good cry. After years of encouraging people to talk about mental health and get help, I’m starting to wonder if we’re getting it all wrong.

The pandemic has accelerated the medicalization of sadness and mainstreamed pharmaceutical responses to anxiety. There is absolutely no doubt that people are under enormous strain — but almost all of the stories about deteriorating mental health and the need for additional services are based on surveys in which respondents essentially diagnose themselves.

• An April poll by Morneau Shepell said 50 per cent of Canadians said their mental health worsened during the pandemic. Forty per cent said they were worried or anxious.
• A University of British Columbia and Canadian Mental Health Association poll said 38 per cent of Canadians said their mental health got worse since the pandemic began. Those with less money and within the LGBT community reported higher rates of distress.
• Six per cent of respondents said they had considered suicide.

This all paints a bleak picture and has led to calls for greater mental health supports across the country. And obviously, obviously, obviously anyone who is in mental distress needs and deserves medical intervention.

But it also leads to an uncomfortable conversation about the way mental health campaigns over the last decade have destigmatized these conditions to the point that they are being used to medicalized edge cases that can be cured with the passing of time and a whole lot of vaccinations.

“There has been a huge push to destigmatize mental illness and talk openly about distress — spearheaded by government and charity campaigns with taglines such as “It’s OK to not be OK” and “Every mind matters,” Lucy Foulkes recently wrote in The Guardian (she could have added #BellLetsTalk). “Broadly, this is a good thing. But when you attempt to smooth down a vast and thorny landscape into punchy hashtags and ad-friendly slogans, nuance gets lots. And there has been some collateral damage.”

That sounds an awful lot like “You may think you enjoy The Smiths, but you couldn’t possibly appreciate the intricacies of Marr and Morrissey as much as those of us who have been listening for decades.”

But the point remains — there’s a difference between situation maladies that can be cured with time, therapy and/or light medical interventions and the more debilitating illnesses that often require a lifetime of drugs, with frequent hospitalizations and a disproportiately high suicide rate.

“We do need to encourage people with milder or more transient difficulties to talk: first because any form of distress is horrible to experience along, second because what seems mild may be the start of a more serious problem,” writes Foukes, a psychology lecturer at UCL and the author of Losing Our Minds: What Mental Illness Really Is and What It Isn’t.

“But we need to figure out a way to talk about these negative emotions without sending the message that there’s something dysfunctional about you for feeling that way.”

Which takes us back to the pandemic. While it’s true that it’s difficult to access high-level mental health services in practically any country, the most common route to care is the family doctor. Their care can be wonderful, but mental health isn’t their area of expertise.

The visit will likely go something like this:

• You’ll tell your doctor that you are depressed or anxious.
• The doctor will go through a checklist, asking you questions about if you’ve spent more time sleeping or lost the enthusiasm to do the things you once loved.
• Your answers will tend toward the depressed or anxious end of the spectrum, because you are indeed feeling bad and also you don’t want to waste the doctors time (and you probably did the checklist online and felt validated by the virtual diagnosis).
• The doctor will bang out a script for an anti-depressant/anti-anxiety medication (often the same thing) and ask you to come back in a few months when the process will repeat.

And that’s that — you are now a ward of the mental health system. The drugs may take the edge of situational problems, but they are also mind-altering and difficult to stop taking. There’s also research that suggests those with mild depression can become more depressed when a doctor slaps a defining label onto their brain.

Back to the sloppiness: while everyone needs and deserves everything the medical system has to offer, they don’t all need the same services. And the money that is being invested in front-line responses to situational conditions is money not being spent on the “hardcore crazies” whose conditions are chronic and life-threatening.

These people will not improve without a high level of medical intervention — time and reflection does about as much good for a schizophrenic or bipolar person as positive thinking does for a palliative patient.

It all leads to an Insanity Arms Race (I hope I invented that term), where diagnoses get adjectives to distinguish those with situational disorders from those with lifelong disorders.

“Many people talking about their mental disorders now feel compelled to use qualifiers such as “severe” depression and “extreme” PTSD, just to try and get heard,” Foulkes says.

“But true depression is severe; PTSD is extreme. This is the sad irony of these campaigns, which were surely originally designed to give voice to people with mental illness. The public conversation as it stands therefore seems to be undeserving people across the spectrum: some people unnecessarily label themselves as disordered, which can make them feel worse, while others who are seriously unwell are still not being heard.”

This matters more than ever, as news reports breathlessly warn of the “second pandemic” of mental health problems that will follow in the real pandemic’s wake.

A Toronto Star news story recently said “What remains clear is the pandemic’s undeniable, prolonged effect on our well-being” without any sort of citation or source. Reporters have taken it as gospel that society will descend into a state of permanent psychosis as a result of a difficult year.

Whether it does or not remains to be seen, and although news providers should know better it’s an irresistible hook for stories in a slow news cycle.

But here’s the thing: suicide rates don’t jump randomly in response to world events (they’ve stayed more or less steady over the last century in Canada) and everyone’s brain chemistry isn’t likely to change and push them into a permanent state of mania that needs to be treated for the rest of their lives.

None of that takes away from the very real challenges faced by millions of people around the world.

But if everyone is crazy, then nobody is crazy. And that is going to have devastating consequences for anyone struggling with deeper psychoses as policymakers turn their attention to milder forms of distress.

“We need to gain confidence in talking about mental health and illness not as a neat dichotomy but a messy, nuanced spectrum,” Foulkes says. “We all like simple categories and answers, but the sooner we recognize that mental health doesn’t play this game, the better.”

And in the meantime, stop listening to The Smiths.

They’re mine.