Thursday, August 22, 2019
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Mental health problems; the stigma must end


Mental health disease is swathed in myth and distrust. The bible tells of schizophrenia in the story of Lot, whilst ancient eastern religions proclaim ascendance in disconnection from thought. Ancient seers, zealots and oracles would often predict the future, with hallucinatory episodes commonly used as gospel. Mania was seen as genius and depression seen as possession. The demons of myth kept a tight grip on cultural beliefs.

With time we moved away from demons and fantasy, towards measurable phenomena. Jung and Freud attempted to explain disorders as a result of interruptions in psychosocial development during growth. Although nuance differed, both thinkers emphasised the importance of the interplay of different driving forces. Still conflict raged in the mind; the demons were given intent and measure.

The idea of a subconscious, characterised as inaccessible to the thinking mind, was coined as an explanation for the feelings of discomfort felt by patients of the time. Psychodynamic medicine evolved as a response to addressing the role of the subconscious in its undesirable effects. The idea of the id, ego and superego dominated western approaches to mental health treatment for a long time. Finally, the demons were given names.

As medical science developed, and our instruments of measurement improved, we began to see mental health issues in a more reductionist view. We would see imbalance of chemicals in the brain being responsible for disease. In this argument, the concentration of a specific chemical is linked to the likelihood of feeling an emotion or a reaction. This is the basis of pharmacological treatment of such disorders. The demons were replaced by chemistry.

Careful thought has been given to the evolutionary need for such problems. Many interesting theories have been put forward which suggest that anxiety, depression and other conditions confer a survival benefit. It is suggested that behaviours associated with mental health issues protect people. For example, one theory of depression is that the need for help generated stronger bonding relationships between groups. If only that were true in the modern day.

Whatever the reason, and as doctors we are not fully sure, we see mental health problems as a pervasive and growing problem. As treatments improve we see people living a higher quality of life. Celebrities the world over owe their success to the power they have gained fighting their affliction. Many speak out, and are proud to do so. This should be encouraged.

As a doctor it shocks me that in the 21st century we may hold anyone with a disease in a place of social disregard. A broken arm is met with interest, humour and empathy. Mental health problems are met with fear, distrust and isolation. Media myth, movies and popular culture stereotypes have created grossly emphasised caricatures of these conditions. Often these are demonic visages written to drag out old myth for the sake of entertainment.

The stigma of mental health problems lies in its history. The idea of demons is strong within culture and exists, concrete, within our global psyche. The human brain is conservative in its ideas and hypervigilant in its fears, and will quickly label the unfamiliar as threat. Throughout history those with mental health problems have been treated as wrong, evil or dangerous, and as a result this role is deeply ingrained in our social narrative.

These people are not evil, wrong, or dangerous. They are simply people whose thinking, for whatever reason, differs from the majority. Sometimes the extent of this difference makes life very difficult, and that is when they need help. Much like a limb that becomes worn out, minds break too. The cure to this social stigma will begin a greater march toward better management of these conditions and a better life for these patients. Minds mend.

We are of course limited by our brains, but more so by our beliefs. But by questioning myth and social ideals, we can begin to deconstruct our misconceptions. By treating mental health problems as part of the normal human experience we can remove the stigma and make a world that accepts and helps. The first step is education. I hope that these words can be the start of your own journey into knowledge. A journey that culminates in a greater understanding of an ailment that can affect us all. Let us shake the old demons.

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