You know, the good old days when men were men, and although life was harder, people just got on with it. They didn’t complain about their situation, and they certainly didn’t go and get themselves diagnosed with a mental illness, or rely on medication to get them through. They just stiffened their upper lip and carried on.
You don’t have to look too far to find sentiments like this expressed online. In fact some variant of this opinion tends to come up in pretty much any discussion involving mental health sooner or later. It seems to be a commonly held belief that mental health problems are over-diagnosed these days; that some of the supposed illnesses aren’t even real health issues at all, just people being lazy or weak; that people in the past were much stronger than today’s cry-babies; that we as a society are medicalising things that shouldn’t be medicalised; that drugs such as anti-depressants are prescribed much too freely to people who don’t actually need them at all.
In this piece I will argue that this way of thinking is misguided and, in fact, quite self-centred.
Actually, that’s not entirely true… there are a couple of points there that I sort of agree with. Firstly, the over-reliance on drugs: I do think there is too much reliance on anti-depressants for treating depression and related conditions, but not because I don’t think the recipients need treatment: rather, because I don’t think drugs are the right treatment for everyone, and tend to be prescribed a lot because they’re relatively cheap and simple (compared to, for example, long term talking therapy) rather than because they’re actually the most effective.
And secondly, I think it would be great if there was more tolerance at all levels of society of people who are different in some way, rather than immediately labelling someone as having a problem and needing treatment just because they don’t fit in with those around them. This would undoubtedly have a very positive effect on many people’s mental health, but it wouldn’t eliminate the problem completely.
The other points, though, are nonsense, and destructive nonsense at that.
For a start, let’s lay to rest any notion that today’s mental health problems didn’t exist back in the 1940s, or 50s, or Victorian times, or whenever this supposed golden age of stoicism is meant to have taken place. Of course we’re never really going to know for sure how many people were suffering from clinical depression, or social anxiety, or ADHD several decades ago, because there wasn’t really any awareness of those conditions back then. But what we do know for sure is that a lot of people ended up killing themselves, or turned to destructive coping strategies like alcohol or drugs, or spent their lives locked away in grim asylums. The same problems that we have today almost certainly existed, and wreaked the same havoc on people’s lives that they do today if left untreated. The only difference is that people back then didn’t talk about how they were feeling or have a name for it.
Of course, a lot of people did just “get on with it”. They didn’t have any other choice, because often their conditions weren’t well enough understood to be diagnosed, and even if they were there wouldn’t be any effective treatment available. A lot of those people would have lived pretty miserable lives, constantly battling demons in their own heads and getting no help or understanding from those around them. But is it reasonable to demand that people should do that now, just because that’s what people had to do in the past? The situation has, after all, changed dramatically. We understand mental illness a lot better than we did even a few decades ago, and there are treatments available that can relieve or even cure many conditions. To me, saying that the mentally ill shouldn’t get help now because their ancestors had to go without is as pointless and cruel as suggesting that people undergoing major surgery should do without anaesthetic, because that’s what people had to do before anaesthetic was discovered.
Even if there has been a genuine increase in the incidence of mental health problems in recent decades, it doesn’t follow that it must be because people now are somehow “weaker” than in the past. Whilst many aspects of life have undoubtedly got a lot easier and more comfortable in the past 50 or 100 years, that doesn’t automatically mean that everything is becoming more conducive to good mental health. The human brain evolved to live in small hunter-gatherer tribes, but that society has been turned upside down in a remarkably short timescale, the blink of an eye in evolutionary terms, and the pace of change shows no sign of slowing. Although most people would probably agree that the changes are largely for the better, if you look at the bigger picture we really haven’t had a lot of time to adapt – it doesn’t seem at all surprising that some people are struggling.
I think a lot of the antipathy I was describing at the start stems from people not really understanding how and why mental health problems are diagnosed. They’ll read a description of, for example, social anxiety and think “That’s just shyness! It’s ridiculous that people are being given therapy and medication just because they’re shy! They just need to get over it!”.
It’s true that social anxiety does have a lot in common with shyness… but the key deciding factor between the two is more about the impact on someone’s life and happiness rather than any innate biological difference. One person might be quite happy with being shy and mostly keeping to themselves, and in that case no-one is going to force them to label themselves as “clinically socially anxious” or to accept treatment for it. But another person might find their “shyness” to be seriously getting in the way of what they want to do with their life and causing them a lot of distress (like I did), and feel powerless to change it on their own, in which case they would probably welcome the chance to get some help. This seems entirely reasonable to me – I don’t understand why anyone, other than a terminally grouchy misanthrope, would object to someone getting treatment for a condition that’s massively impacting their quality of life, even if it’s not something that would have historically been considered a medical problem.
It’s true that the bar for a diagnosis of depression or social anxiety might be set lower than you’d expect: I’ve seen estimates that a full 7% of adults are suffering from clinical social anxiety at any one time, and 25% of adults will experience some form of mental health issue in any given year, which does sound a lot. But there’s a good reason for this, namely that even relatively mild cases of these disorders can cause a huge amount of disruption and distress to sufferers. As Dr David Burns says when talking about a scale for measuring levels of depression in his famous book Feeling Good, “Don’t be fooled by the term ‘moderate’. A score in this range can indicate pretty intense suffering”.
And I’ve always remembered something similar that was once said to me about social anxiety: “‘Mild’ social anxiety isn’t necessarily mild in terms of its impact on your life. It can mean, for example, no love life” – in fact, in my case that was exactly what it did mean. My social anxiety was “mild” compared to some people’s in the sense that I was able to leave the house and (mostly) function day-to-day, but even a mild case was enough to essentially close off an entire area of life (and, I think most people would agree, a pretty important and rewarding one) to me until I had treatment to bring it under control.
I find it quite disturbing that so many people seem to think they are qualified to decide whether others have mental health problems or not, whether they deserve treatment or not, despite having next to no knowledge or experience of the subject themselves. Personally I would rather trust the professionals who’ve dedicated their lives to studying and treating psychological disorders, and the direct experience of the people who live with such disorders every day, but it seems as if there is a growing distrust of experts in all sorts of fields lately (climate science being another big one just now). Thing is, it’s fine to be sceptical. It’s fine to research things yourself rather than just blindly believing whatever you’re told. And it’s fine to acknowledge that so-called “experts” have been spectacularly wrong sometimes in the past. But what’s not so fine is starting from a position of assuming that the experts must be wrong, assuming that they’re either incompetent or corrupt and that you know better, based on no evidence whatsoever, just because you don’t happen to like the implications of what they’re saying. Science may not be perfect, but it’s still far and away the best tool we have for understanding the world and making it a better place.
Ultimately, I think the people wishing we could go back to the “good old days” before mental illness existed are being very selfish. Because there never were any such days. What most of them really mean is “I wish we could go back to the good old days when I didn’t have to think about mental illness, when sufferers knew their place and kept their mouths shut, before they started getting all uppity and wanting to talk about their experiences, wanting people to understand and help them”.
Or, to put it another way, “I want ill people to suffer in silence so that I can maintain my comfortable illusion about how the world works”. Well I’m sorry, but it ain’t gonna happen.