Today is World Mental Health Day, launched in 1996 by the UN—at the urging of the World Mental Health Federation and with support from the WHO—to raise awareness about one of the most misunderstood but increasingly problematic issues facing humanity.
Even the concept of mental health is fairy new in human history. What we now call mental illnesses were known, studied, and treated by the ancient Mesopotamians, Egyptians, Greeks, Romans, Chinese, and Indians. Some were called “hysteria” and “melancholy” by the Egyptians, and certain Hindu texts describe symptoms associated with anxiety, depression, and schizophrenia. The Greeks coined the term “psychosis”, meaning “principle of life/animation”, in reference to the condition of the soul.
In virtually every society up until the 18th century, mental health was associated with moral, supernatural, magical and/or religious causes, usually with the victim at fault in some way. The Islamic world came closest to developing something like a mental health institution, with “bimaristans” (hospitals) as early as the ninth century having wards dedicated to the mentally ill. The term “crazy” (from Middle English meaning “cracked”) and insane (from Latin insanus meaning “unhealthy”) came to mean mental disorder in Medieval Europe.
In the mid 19th century, American doctor William Sweester coined the term “mental hygiene” as a conceptual precursor to mental health. Advances in medicine, both technologically and philosophically, quickly found the connection between mental and physical health while minimizing the idea of moral or spiritual flaws being the cause (the Greeks did come close to this, namely Hippocrates, who linked syphilis to a physical cause).
But the dark takeaway from this was the so called “social hygiene movement“, which saw eugenics, forced sterilization, and harsh experimental treatments as the solutions to mental and physical disabilities or divergences. Though the Nazis were the ultimate manifestation of this odious idea, their propaganda and policies cited most of the Western world, including the U.S., as standing with them in their efforts to cleanse populations. (In fact, the term mental health was devised after the Second World War partly to replace the now-poisoned idea of mental “hygiene”.)
While we have come a long way towards realizing the evils and horrors of how we treat mental illness—from ancient times to very recent history—abuses, misunderstandings, and neglect remain worldwide problems.
Hence I also want to take today to thank everyone throughout my life who has been so understanding, supportive, and affirming with respect to my own mental health struggles. I would never have broken through my anxiety or depression induced barriers without a loving and compassionate social support structure along the way (to say nothing of my relative socioeconomic privileges, which unfortunately remains the most common barrier to mental health treatment in the U.S.).
I am certainly luckier than most. Mental illnesses are more common in the U.S. than cancer, diabetes, or heart disease, which are far better known and addressed. Over a quarter of all Americans over the age of 18 meet the criteria for having a mental illness. Youth mental health has become especially dire, with 13% reporting a major depressive episode just over the past year, of whom only 28% get treatment. And over 90% of Americans with a substance abuse issue (which is usually tied to mental health) receive no treatment.
Worldwide, one out of four humans endure a mental health episode in their lifetimes. Depressive disorders are already the fourth leading cause of the global disease burden, and will likely rank second by the end of 2020, behind only ischemic heart disease. According to the World Health Organization (WHO), the global cost of mental illness—in terms of treatment, lost productivity, etc.—was nearly $2.5 trillion in 2010, with a projected increase to over $6 trillion by 2030.
Tragically, most mental health issues can be treated with relative ease: 80% of people with schizophrenia can be free of relapses following one year of treatment with antipsychotic drugs combined with family intervention. Up to 60% of people with depression can recover with a proper combination of antidepressant drugs and psychotherapy. And up to 70% of people with epilepsy can be seizure free with simple, inexpensive anticonvulsants. Even changing one’s diet could have an effect.
But over 40% of countries have no mental health policy, over 30% have no mental health programs, and around 25% have no mental health legislation. Nearly a third of countries allocate less than 1% of their total health budgets to mental health, while another third spend just 1% of their budgets on mental health. (The U.S. spent about 7.6% in 2001.)
In his book, Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions, Johann Hari explores the environmental and socioeconomic factors that contribute to poor mental health, and how these are often neglected in discussions and approaches to depression and anxiety.
Someone could meditate, think positively, or pursue therapy all they want, but if they are rationing insulin to stay alive, cannot find affordable housing, struggle to find a well paying job, and are otherwise at the mercy of external forces that leave them fundamentally deprived, such treatments—however effective and beneficial in many contexts—can only go so far.
He illustrates this perfectly with the following account:
In the early days of the 21st century, a South African psychiatrist named Derek Summerfeld went to Cambodia, at a time when antidepressants were first being introduced there. He began to explain the concept to the doctors he met. They listened patiently and then told him they didn’t need these new antidepressants, because they already had antidepressants that work. He assumed they were talking about some kind of herbal remedy.
He asked them to explain, and they told him about a rice farmer they knew whose left leg was blown off by a landmine. He was fitted with a new limb, but he felt constantly anxious about the future, and was filled with despair. The doctors sat with him, and talked through his troubles. They realised that even with his new artificial limb, his old job—working in the rice paddies—was leaving him constantly stressed and in physical pain, and that was making him want to just stop living. So they had an idea. They believed that if he became a dairy farmer, he could live differently. So they bought him a cow. In the months and years that followed, his life changed. His depression—which had been profound—went away. ‘You see, doctor,’ they told him, the cow was an ‘antidepressant’.
To them, finding an antidepressant didn’t mean finding a way to change your brain chemistry. It meant finding a way to solve the problem that was causing the depression in the first place. We can do the same. Some of these solutions are things we can do as individuals, in our private lives. Some require bigger social shifts, which we can only achieve together, as citizens. But all of them require us to change our understanding of what depression and anxiety really are.
This is radical, but it is not, I discovered, a maverick position. In its official statement for World Health Day in 2017, the United Nations reviewed the best evidence and concluded that ‘the dominant biomedical narrative of depression’ is based on ‘biased and selective use of research outcomes’ that ‘must be abandoned’. We need to move from ‘focusing on ‘chemical imbalances’, they said, to focusing more on ‘power imbalances’.
I can only hope that as mental health becomes less stigmatized—less a matter of superstition, genetic inferiority, or moral and individual failing—we can work towards building fairer and more just societies that promote human flourishing, physically, mentally, and spiritually.