One day, out of nowhere…
About twenty years ago, apparently out of nowhere, on a normal Saturday morning I woke up with the most frightening tachycardia, soon followed by a feeling of oppression, cramps on my left harm, and a mounting fear for my life, as I truly believed I was having a heart attack.
I ended up at the E.R. and fifteen minutes later I was diagnosed with ‘generalised anxiety’. I was given a tranquilliser and dismissed with a prescription for the same drug, which I quickly became addicted to, and could only quit two years later.
Since then, I have managed to heal, but I have seen a lot of anxiety and mental health issues around me, with friends, with family, and at work. Today there is more awareness of mental health, more information and support available, and less stigma. But there is also a lot of conflicting opinions and proposed recipes, and certainly what we are doing is not nearly enough. This might have something to do with my decision to graduate in Psychology and train in Mental Health First Aid years later, to understand what science really has to say about this topic.
‘Science’ is a plural noun
Here is what I quickly realised: psychologists, social scientists, psychiatrists and other scientists and practitioners have very different theories and beliefs about how to go about studying and dealing with mental health. They look for causes and consequences in different places, and use very different methods to gather and interpret data. As a consequence, their research often points to different possible factors influencing the growth of anxiety.
This reflects the complexity of the issue of understanding people’s minds and wellbeing, but it can be confusing.
For example, the bio-medical account of mental health disorders seeks the root causes in the individual’s faulty biology and neurology. This is the standard approach of GPs, psychiatrists, nurses, and pharmaceutical companies. Here, the diagnosis of a disorder is based on manualised symptom checklists, and individual symptoms are mostly treated with medication, with or without psychotherapy.
Some of the theories of anxiety focus on the individuals’ inner world: their thoughts, emotions and beliefs, and what they routinely do. Perhaps the most popular approach of this kind is the cognitive-behavioural model. Here, root causes are sought in the individual’s faulty ways of thinking and cognitions. Psychologists, counsellors, and nurses, as well as health organisations promote this approach because it appears fast and efficient, and it mainly deals with the present thougths and behaviours to be fixed with talking therapies like evidence-based Cognitive Behavioural Therapy (CBT).
These types of approaches can work in a number of individual situations. However, they don’t question the larger social and contextual conditions. For example, if one individual suffers from mental health problems because they are unemployed and struggle to find a home, or because they are neglected, bullied, exploited or persecuted, is medication or changing how they think about their reality really the best solution?
An alternative account, the social model of mental health, considers anxiety as a possible product of the pressure individuals receive from a materialistic and individualistic culture, as projected by media, politics and education, and of the growing inequality in many countries. Individual life events and experiences of difficulty and trauma are seen as linked with structural social and material conditions of distress, and these are understood as the root causes. In this approach, individuals can find sources of strength to address their own problems by correctly locating the structural causes of their suffering (e.g. society pressure, inequality, etc.) with support from talking therapy, for example. However, social and economical conditions must be also addressed.
We all need to take responsibility
Talking about mental health to raise awareness, destigmatise it and provide access to support and treatments for individuals is fantastic. For example, a non-judgmental genuine conversation with someone experiencing difficulties in life really helps a lot.
But it’s not nearly enough.
What we understand as anxiety is a complex blend of subjective emotions that are heavily influenced by the environment, culture, power and society. This means, helping people with their wellbeing is not as simple as training them with mindfulness programmes, providing more talking therapies, or prescribing pills. That can help some, but we can only hope to reduce the epidemic stress and anxiety by fundamentally rethinking our values, policies and power structures towards more just and inclusive societies.
Just telling individuals to take responsibility for their mental and physical wellbeing, and providing simplistic solutions for such complex problems isn’t enough. And it’s not fair.
We need to change the narrative from the individual to the collective responsibility. It’s on us all together to take responsibility. With our teams and co-workers. With our families, friends and communities. And with our societies.