Opinion | We Have Reached Peak ‘Mental Health’

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By Huw Green

Mr. Green is a clinical psychologist.

A few months ago I received a referral for a new patient with a history of depression who’d made a serious suicide attempt. Perhaps unsure how to describe these episodes, the referring clinician wrote vaguely that the person had a “history of mental health.”

Ordinarily, the word “health” implies an absence of illness. That is no longer how the term “mental health” gets used. The idea of mental illness, or mental disorder — both terms that have been subjected to their own intractable debates — has come to be supplanted by a broader umbrella notion, “mental health,” which somehow, confusingly, gets used to refer to states of both wellness and distress. Some awareness campaigners have even adopted the slogan “We all have mental health,” which seems on the face of it to be a stigma-busting, solidarity-building mantra. On closer examination, however, it manages a double exclusion. It fails to actually name any mental health problems — those about which we ought to be raising awareness — and it also makes a claim that is sadly untrue; there are many people who, at least some of the time, do not have mental health.

We are talking more and more about our mental health, and this has been enormously positive. It is no longer unusual to see celebrities or politicians referencing the concept. The rise of social media has introduced a generation of clinicians who have been adept at using it to communicate. In the United States, Dr. Emily Anhalt produces elegant aphorisms and promotes the virtues of psychodynamic psychotherapy on Twitter. In Britain, Dr. Julie Smith has turned her well-crafted TikTok advice videos into a best-selling book of practical psychology.

The focus of most of these discussions is improved mental health for all, rather than focusing on a particular group or condition. But language can be slippery.

The term “mental health” is a euphemism, and euphemisms are what we use when we want to obscure something. This language — in contrast to “mental illness” — encourages us to focus on the regulation of more or less transient states, and on the maintenance of something we supposedly all have. “Mental health” conjures phenomena that are, more or less, relatable: anxiety and depression. But who is being excluded as a result? The change in language was supposed to address stigma. But it has simply moved our attention away from the very people who face the most stigma — those with diagnoses of schizophrenia, for example, or symptoms that do not allow ready participation in the mental health curriculum.

This shift also cuts in another direction. An emphasis on health and equilibrium, with accompanying “advice” and “techniques” for self-regulation, has resulted in the term “mental health” undergoing a kind of mission creep: from providing increased awareness of specific difficulties to offering a broad set of prescriptions about how we should live.

The way we talk about mental health as a motivator for so many of our activities risks becoming a substitute for more broadly grounded discussions of how we should act. Consider the relatively recent notion of a mental health day. We absolutely need to take days off work for our mental health sometimes, and it is important that employers recognize our needs. But people also need — deserve — days away from their work without justification. They should then be free to spend those days doing whatever they like. Is a day off less valid if it isn’t spent engaged in something that has been approved by one of the many websites that now offer mental health day advice?

When mental health is given as a principal motivator for our choices, we are prioritizing our own experiences. As a result, there is less room for moral or ethical considerations for our behavior, and also less room for motivations that have to do with social, community or familial commitments, or doing something for its own sake. There are probably lots of things we should do in spite of our mental health: helping others, forming deep emotional ties that may then need to be painfully broken, becoming immersed in sometimes maddening, at times obsessive political or creative projects. These are choices that need deep rational, ethical and personal engagement.

I work in a hospital with people who have experienced acquired brain injuries; it’s a setting that inescapably involves loss and despair. Although my professional life is organized around reducing suffering, and although I think some emotional experiences represent clear illnesses, I also understand that many forms of misery are bound up with the experience of being a person. Distressing or extreme states can at times be part of what makes for a life worth living. There are feelings that are unavoidable, purposeful or morally significant.

The shift toward prioritizing mental health might be benign if it were only one way of reframing the question of what our priorities should be. But it comes with the imprimatur of clinical authority. As a result, therapists increasingly stray into a broader ethical arena while appearing to remain within their own zones of expertise.

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