果冻影院

Many years ago, in the fading hours of a house party, I sat outside in the garden with an old friend. From inside came the distant thud of music and pockets of laughter 鈥� a thousand miles from the conversation we were having. My friend鈥檚 relationship had ended a few weeks previously, and that night his heartbreak was palpable and raw. He told me how disconnected he felt from the people inside the house, from his life, and then he said something that made my heart sink. 鈥淲hen I look into the future,鈥� he said, avoiding eye contact, 鈥淚 can鈥檛 see anything ahead of me.鈥� At that moment 鈥� I thought 鈥� something became clear: he was clinically depressed.

Over the following days and weeks, I told my friend what I knew about the disorder, and the benefits of therapy and antidepressants, and encouraged him to go to the doctor. Even though he was reluctant, I was sure of how much he would benefit, so I persisted. But then, after about a month of checking in with him, something strange happened: he started to feel better, without any professional help at all. I distinctly remember the moment, a disintegration of what I thought I understood about mental health. Evidently, since my friend鈥檚 acute distress passed within a few weeks, he didn鈥檛 sit clearly in the territory of what we might call 鈥渕ental illness鈥�. But he certainly wasn鈥檛 mentally healthy for those weeks either. Instead, I realised, he sat somewhere in the vast grey plains between the two.

Everything we might think of as a 鈥渟ymptom鈥� of mental disorder 鈥� worry, low mood, binge eating, delusions 鈥� actually exists on a continuum throughout the population. For each symptom, we vary in terms of how often we experience it, how severe it is, how easily we can control it, and how much distress it causes. In the terrain of mental health, there is no objective border to cross that delineates the territory of disorder. On top of this, the thoughts, feelings and behaviours that appear temporarily as a natural response to hardship and stress 鈥� like when we鈥檙e heartbroken 鈥� exactly mimic those that, should they persist, are defining features of mental disorders. So blurry are these boundaries that some psychologists argue we shouldn鈥檛 use the terms 鈥渋llness鈥� or 鈥渄isorder鈥� at all, and should only view all of this as matters of degree.

But this messy truth is not part of the public conversation about mental health. In the last decade or so, there has been a huge push to destigmatise mental illness and talk more openly about our distress 鈥� spearheaded by government and charity campaigns with taglines such as 鈥淚t鈥檚 OK to not be OK鈥� and 鈥淓very mind matters鈥�. 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 lost 鈥� and there has been some collateral damage.

The current conversation can be summed up as follows: you should notice, scrutinise and seek help for negative psychological experiences. Of course, for some people, this message will be essential. For those who are suicidal, it can be lifesaving. But the message misfires when it implies that all negative states are problems, health problems 鈥� and things that can and should be fixed. That鈥檚 not how life works.

This is not to say people who fall below the threshold of a 鈥渄isorder鈥� should be silenced or ignored. I am vehemently opposed to the accusatory, dismissive language aimed at 鈥渟nowflakes鈥�. We do need to encourage people with milder or more transient difficulties to talk: first because any form of distress is horrible to experience alone, second because what seems mild may be the beginning of a more serious problem. But we need to figure out a way to talk about these negative emotions without sending the message that there鈥檚 something dysfunctional about you for feeling that way.

This means resisting the temptation to label all negative feelings with psychiatric terminology. When I was a psychology lecturer, I spoke to an undergraduate student about how she and her peers discussed their mental health, and she said that everyone in her year group 鈥� around 150 students 鈥� described themselves as having either depression or an anxiety disorder or both. From what we know from population-based studies, it鈥檚 nigh-on impossible that they all met criteria for these disorders. What seems more likely 鈥� in universities, but also in schools, online and in private conversations 鈥� is that individuals in more hospitable parts of the mental health terrain have started to co-opt terminology that really needs to be reserved for people trapped further in its depths.

This is no one鈥檚 fault. We all want language and labels to interpret our experiences, especially difficult ones, and thanks to the public conversation, psychiatric terms such as depression, post-traumatic stress disorder and social anxiety disorder are readily available. And they have power. Psychological distress, whatever its intensity, is hard, and diagnostic labels allow you to say: I鈥檓 suffering, my problem is real, and I need help.

But this framing, used inappropriately, can ironically compound people鈥檚 distress. Psychiatric labels provide meaning and legitimacy, but they can also be heavy and frightening, and can turn a fleeting problem into something bigger. Interpreting your low mood as a sign of depression, for example, can actually cause you to spiral into the very depression you鈥檙e worried about. We know this from research into mindfulness-based therapies for people with recurrent depression: learning to view low mood as 鈥渏ust鈥� that, rather than as a start of a new depressive episode, can help reduce risk of relapse.

It also doesn鈥檛 help the people who actually do have depression: a devastating disorder that hijacks body and mind, leaving people unable to live the life they want or, in some cases, any life at all. When you call all low moods 鈥渄epression鈥�, the term loses any meaning. Back in 2001, the psychiatrist Derek Summerfield wrote, 鈥淭o conflate normality and pathology devalues the currency of true illness鈥�. There was barely even a public discussion about mental health back then. His point is more important now than ever.

In fact, it seems that many people talking about their mental disorders now feel compelled to use qualifiers such as 鈥渟evere鈥� depression and 鈥渆xtreme鈥� PTSD, just to try and get heard. 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 underserving 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.

We need to recalibrate. None of this is to say we need to stop the public conversation: we just need to press pause, and slightly change direction. First, we need to tell more stories about individuals with severe and debilitating mental disorders, so we clearly understand what these disorders involve and what can help. Second, we need to promote the idea that a great number of distressing psychological experiences can be managed 鈥� sometimes with professional help 鈥� without needing to reach for the psychiatric dictionary. This is not meant to be critical but to empower, and reassure: don鈥檛 feel you have to take on a psychiatric diagnosis, or consider there鈥檚 something medically wrong with you, unless you really do find that framing helpful.

We need to gain confidence in talking about mental health and illness not as a neat dichotomy but a messy, nuanced spectrum. We all like simple categories and answers, but the sooner we recognise that mental health doesn鈥檛 play this game, the better. Remember those vast grey plains. The individuals who roam this space will still need care and support, and professional help might indeed be warranted 鈥� but the language of disorder might not be.

It鈥檚 a lesson I have had to teach myself. The next time one of my friends is heartbroken 鈥� which will happen, of course, as night follows day 鈥� I鈥檒l take a different approach. I鈥檒l still discuss the value of getting professional help; I鈥檒l still remember that relationship breakdowns can and do contribute to mental disorders and even suicide in some individuals. I鈥檒l still keep checking in, and being a good friend. But I鈥檒l also hold another possibility in mind: that with a bit of talking and time, their pain will pass on its own. That we may be in the realm not of psychiatric disorder, but rather in the tangled landscape of our rich and painful lives.

This article was originally published in听听on 29 March 2021.

Links

• Original article in听
• Dr Lucy Foulkes鈥� academic profile
• 果冻影院 Department of Clinical, Education & Health Psychology
• 果冻影院 Division of Psychology & Language Sciences
• 果冻影院 Faculty of Brain Sciences