"We shouldn't have to put the word 'mental' in front of the word 'illness'", says Dr. Barbara Mariposa
A guest essay from Dr Barbara Mariposa, doctor and organisational consultant, on how mental health needs a much richer story around it - aware of social systems as well as struggling selves.
AS a doctor, a guiding principle for me has always been, “First do no harm.”
And I’m now going to stick my neck out. I’m going to say that the current narrative around mental health is doing more harm than good.
First off, the very fact that in everyday parlance we talk about mental health when actually we are talking about illness is a euphemistic approach which does nothing to help and may even compound the stigma surrounding it. As my dad - a pragmatic Yorkshire lad - would have said, “call a spade a spade.”
Secondly, in the not too distant future I’m sure that we will drop the word “mental” altogether and look back on our current understanding, deeply engrained as it is the 20th century thinking generated by a bunch of Europeans, and later on Americans, who just happen to be mostly white and mostly male. We will say, “Silly us. Oh well. At least we know better now. “
Let’s just be bold and do it sooner rather than later. In fact, why not now?
Imagine going to work and saying, when asked why you were away for a few weeks, that you been ill. The health professional said it was a healthy, normal, psychomotor shutdown following a series of challenging events in your life in order to give you time to heal and grow. Or that your gut micro biome had been out of whack which had affected your mood and cognitive functioning.
In other words: to what extent is the narrative constructed around this whole “area” (what can I meaningfully call it now!) both a myth and a contributing factor to the apparent problem?
And this is my third and main point: we must transform the narrative.
A few years ago I came across a World Health Organisation report which predicted that depression would be the biggest source of global disease burden by 2020. And today, 350 million people worldwide are said to suffer from depression, a figure that rose by 20% between 2005 and 2015.
When I read this WHO prediction, I committed myself to proving it wrong.
After all, a century ago, scientists warned that “winning the vote would put such pressure on the challenged female brain there would be a 25% rise in female insanity.”
And in the 19th century, Thomas Malthus predicted that, if the population of England kept growing as it was, and given that the horse-drawn carriage was the predominant means of transport - we would all be knee deep in horse poo by the end of the century.
And we can see how those predictions turned out…right? We need to shift focus and spread another kind of narrative.
Don’t get me wrong. In recent years, fantastic initiatives have opened up and changed the landscape around mental illness in many countries. And yes, we need a zero tolerance of stigma, prejudices and discrimination of any kind, making it safe to speak about our distress.
But we need to be far more ambitious as a matter of urgency. We must spread the “how to do it” of wellbeing and full-on flourishing.
By all means educate about how to offer support to people in distress - offer first aid, if you will. But if we’re offering first aid, we’re already too late.
Think of it another way. In 2014, when increasing numbers of people in West Africa started dying from the Ebola virus, and it looked like it could become a global pandemic, WHO and other organizations mobilized resources not just to stop its spread and take care of the ill but also to develop a vaccine. Not just stop the epidemic but prevent it.
How can we talk about illness in one breath without talking in the next, or even the one before, about prevention? That’s like providing ambulances to attend road traffic accidents but not bothering about seat belts, speed limits, or drink-driving.
We must re-imagine our approach and ask different questions. Questions like, “What do we currently know about the ‘how to do it’ of healing, growing and flourishing?” The answer is “A lot!” So then, “How can we spread what we know far and wide?”
And this is where I’d like to pick up on my personal story.
* * *
Several years after being hospitalised, and still on medication, I’m sitting at the kitchen table with my three daughters and we’re laughing and bantering together. A thought occurred to me: “what would I do with my life if I were well?”
The answer was clear. “I’d do everything I can to help people not get ill, get well if they do, and live amazing lives.”
The funny thing was that it was simply asking the question, “what would I do with my life if I were well?” that seemed to catalyze a shift. My vision of my flourishing self and what I would be doing with my life, allowed that shift slowly to come into being.
Something profound had moved in the story I was telling myself and living out of. I’d refocused my internal narrative from one of being broken, with a label and a disability, to one of wholeness, able-ness and hope.
And narrative is incredibly powerful. Narratives create realities.
Imagine you’ve been invited to a book launch. You’re standing in the reception room with 39 other people, a wide cross section of the general public. Someone comes in and asks ten of you to stand in the far-right hand corner of the room. Somehow or other the group organises itself so that ten people are in the corner. “Ok, out of you 40 people, you ten will suffer a mental illness during your lifetime.”
How does this make you feel? Especially if you’re in the corner!
The scientist in me asks: “Is this a useful narrative in terms of reducing the incidence of what we currently refer to as mental illness?”Is this a message that empowers people to be well, or does it create a deep-seated unsettled feeling that “Golly, it could be me, maybe there’s something wrong with me that I don’t know about. Hope it’s not me, I better watch out.” That induces fear.
As Nobel Laureate Joseph Stiglitz said, “If we use the wrong measures, we will strive for the wrong things”.
Of course, in real life it’s far from random whether we would end up in that corner. Numerous socio-economic and educational factors play a huge role. In towns like Blackpool, levels of deprivation and antidepressant prescribing go hand in hand.
And this all too common association of poverty and mental illness has given rise to a phrase used privately among frustrated doctors, who diagonose what they call “Shit Life Syndrome”. Depression here is clearly not an individual’s failing but a normal reaction to a profound systems failure.
So what narrative would reverse the tide and prove that WHO prediction wrong?
* * *
It struck me that part of the problem is the “cult of individualism” that pervades modern western life. Let me illustrate.
We’re in Dakar, the capital city of Senegal, West Africa. A very hot, very dusty road. The heat is heavy and sweat rolls down every surface of my body. The chirping of cicadas provides a backdrop of sound and clouds of chatter float across the laden air. How is it possible to walk in this heat, let alone work?
I notice a young man. His gait is a bit shuffly and clothes seem a little haphazard. He’s wearing three wooly hats, one on top of the other, perched on which are three pairs of sunglasses, none of them over his eyes. A huge boombox on his shoulder blares out the powerful rhythms of Senegalese music, mbalax.
My “expert” medical gaze quickly decides he has probably been suffering from some kind of schizophrenic illness for a while. “What’s wrong with him?” I casually ask my Senegalese friend.
“Nothing,” he replies. “Actually he has a special ability to hear voices that others can’t hear. So we take extra special care of him because he doesn’t work.“ In other words, whilst my spot diagnosis may have been correct, the way in which the members of his community viewed him meant he was cared for, integrated and valued.
In this way, his experience of his illness was profoundly different than if he had been in England. No stigma. His sense of belonging and personal dignity intact. Living in a culture of connectedness.
I realised the extent to which our discontent, distress, dis-ease, or dis-order - our “suffering” - is shaped and added to by the way our society views it. A view that deeply and invisibly moulds us, like a giant hand pulling invisible strings.
There are strong societal and cultural forces at work that determine how we experience our suffering and whether we get ill.So what cultural and societal forces promote flourishing?
Books by wonderful people like Joseph Campbell document the stories told among communities spread wide across the globe and across the aeons of time.
These myths unite communities, build trust, and act as roadmaps for the difficulties, pain and distress that areinherentin life. By these means challenging times can be navigated productively, safely and successfully.
They ease distress and say that we are not broken, and are not defined as broken by others, when we are in pain. These myths provide a narrative of hope, healing and belonging.
We seem to have forgotten or be disenfranchising the deeper dimensions of our common humanity, dumbing down our potential, ignoring our profound need to have meaning in our lives, to have the feeling that we belong and that we make a difference.
And yet it is the very lack of these things that is causing so much distress at personal and global levels. Lack of belonging, lack of community, crisis in meaning. A state of global acedia.
There’s a link between inflammation in the body, meaning high levels of certain chemicals in the body called cytokines, and social isolation and depression. On the other hand,strong social relationships are a powerful protective factor against illness.
The source of our personal wellbeing has its heart in our communities, which are the embodiment of our shared humanity. The personal and the social are intertwined. What if we were to see this apparent epidemic as a symptom of a global systems failure not an individual’s failings?
I have realised that there is a perfection to it all that I hadn’t foreseen. Something deceptive in its simplicity.
Human beings feel best when behaving in ways that promote social cohesion. In other words, the very things that allow me to be well, create the conditions for you to be well, for us to flourish.
A shift from a “cult of individualism” to a “culture of connectedness”.
So now we’ve uncovered some important answers to the “how to do it”, we’re looking to prove that WHO prediction wrong. We have the ingredients for a new narrative.
We must spread this “how to do it” with the same degree of urgency that characterised the response to the possibility of an Ebola pandemic.
* * *
I’d like to end with a story I heard on a podcast. The head of a large recycling company in New York city was struggling with how to enforce their recycling objectives. How do we get people to put the soft plastic in one container, the hard plastic in another and bio-degradable waste in yet another? So he went to Denmark where they have been successfully recycling for decades.
“What do you do when people don’t recycle or put the wrong things in the wrong containers?” asked the company head. “How do you police it? How do you fine them?”
“What are you talking about?” the Dane asked. “Everybody just does it. Why on earth would they not?“ In other words: the values of community action are so deeply embedded they are invisible - it’s just the way it is.
Hope requires imagination. It stands in the present and invokes a better future.
We can start living that better future today, embedding values that mean that we no longer need to put the word ‘mental’ in front of the word ‘illness’. We have roadmaps to enable us to flourish, in a culture of belonging and connectedness where everyone cares, everyone is cared for, and everyone matters.
We must make freely available to all our citizens, from an early age, the educational means that bring us together and equip us with the “how to do it” of healing, growing and flourishing.
And if you think that’s crazy, let me take liberties with two quotes, from Steve Jobs and the Dalai Lama. I’m sure you can work out for yourselves which one is which!
“Whenever possible, be kind. It is always possible.“
“Those who are crazy enough to think they can change the world are the ones that do.”
In which case, kindly call me crazy.
Dr. Barbara Mariposa trained at the Royal Free Hospital, London. She has worked internationally, in general practice, psychiatry and public health. Whilst at medical school, she obtained a B.Sc in psychology and began a life-long enquiry into the interdependence of mind, emotion, and body. She is a thought leader in the field of workplace wellbeing, emotional intelligence, mindfulness, leadership, presence and the science that brings all these things together. Her most recent title is The Mindfulness Playbook