posted 1st December 2022
A lot has changed since my first article about mental illness was published more than six years ago. My prefrontal cortex has finished developing, I've written and published a book of advice for struggling young people, and I've seen my own views of mental illness shift and transform.
Currently, I'm trying now to catch up with schools of thought that have existed for years, movements that seek the kind of social change that would secure safety and care for everyone, not just those suffering in the mildest and most palatable ways.
These movements tell us what is obvious to anyone who looks long enough: that the mental health conversation we're having remains worryingly incomplete, failing to move with the times or properly consider what is being said by the people who experience mental illness first-hand.
While we've taken some strides towards a better general understanding of mental health and increased compassion towards certain people with mental illness, we continue to see serious mental illness (otherwise known as severe mental illness or SMI) left out of conversations and campaigns entirely.
SMI refers to any disorder that greatly impairs a person's ability to carry out a normal life, e.g., remaining in consistent employment or education, regulating their own emotions, and rationally and clearly viewing the world around them. Episodes of psychosis, mania, paranoia, delusion or catatonic depression can be examples of this, often but not always existing alongside a doctor's diagnoses of schizophrenia, BPD, bipolar disorder or post-traumatic stress disorder.
SMI can also include anxiety disorders, depressive disorders, eating disorders and personality disorders if those disorders are sufficiently disruptive. (Note: a great many people are moving away from this medicalised, doctor-led model of understanding mental ill-health and psychiatric distress. I use these terms here for ease, but I'd highly recommend the work of Nathan Filer, who writes sensitively and powerfully about mental health and the limit of diagnostic labels. I'd also recommend Recovery in the Bin; a user-led group focused on "placing mental health within the context of social justice and a wider class struggle.")
By ignoring suffering and distress that presents in ways that aren't polite or meek or easy to understand, we also ignore all the ways that social ills such as poverty, racism, sexism and the ongoing environmental crisis contribute to our individual and collective well-being. In an attempt to raise awareness, we've universalised mental illness in a way that unhelpfully blurs distinctions. Because while it may be true that we all have mental health, we don't all have a mental illness, and of those who do have a mental illness, not all have experienced or will experience SMI.
SMI too, will be experienced and received differently across social and cultural groups. Many people living with SMI will experience multiple hospitalisations, traumatic encounters with police, alienation from support networks, and homelessness - often resulting in a disinclination to trust systems that claim to exist to help them despite consistently failing to do so. Though this might seem like nit-picking, these distinctions are crucially important as we try to push the needle forward for anyone in need of any level of psychiatric care.
Instead of addressing what needs altering structurally for all our basic needs to be met, the focus remains on what we can do for ourselves and for one another. Campaigns that centre on opening up may fail to touch on the reality that a lot of psychiatric distress has its roots in poverty, housing insecurity, and the tightening screw of late capitalism. Though sharing with friends can be a great relief, what is unjust remains unjust after the pints are finished, and the pub is closed.
Similarly, the phrase "it's okay not to be okay" will always ring a little false to anyone who has lived with an ongoing mental health issue. Many workers, for example, know very well that although it may be admissible to have a couple of days off here and there, most workplaces will not tolerate an illness that affects their bottom line or code of company compliance. For some people being ill can lead to a loss of crucial earnings or even be grounds for dismissal. Of course, the motivation for people repeating these phrases to one another is often caring and kind - an attempt to challenge the notion that these feelings are unusual or shameful - but without a real focus on worker and disability rights, they end up being truly useful (and truly true) to only a small slice of the population.
What is required is abundant funding, ongoing and uninterrupted care, properly tailored support, a focus on individual dignity, dynamic treatment plans and a thorough understanding of the social and cultural factors that contribute to worsening mental health. We must allow people to speak for themselves, truly listening when they tell us what's stigmatising, what's offensive and what's dangerous.
We can all commit to taking better care of one another, yes, but mental health advocacy has to begin and end with restoring health to systems that have been intentionally gutted and stretched and starved across decades.
