Mental Health: More Assumptions
Last time, we explored the assumption that health is a natural state that gets knocked down by illness. Next assumption: there is an “I” separate from a “You.” This is a difficult concept to address. Many of us spend a lot of energy from around 2 years-old defining ourselves as separate. Implicit in definitions such having no illness is that mental health is an individually identifiable phenomenon. I am sick, you are well. However, this depends greatly on how you carve out what the problem is. If I fall and break my leg, it makes sense to see this as a problem for me. However, if I am then unable to work for the next month while I heal, it is also a problem for my workplace and the people I serve. If bees go extinct, this would be an enormous crisis for our ecosystem, not just for bees.
Mistakes in how we define the problem can be costly. Let’s say I meet with a young black American man, who feels anxious and threatened when around a police officer. If I label him “paranoid,” attributing this as an individual problem, I have now made myself part of the problem. I have caused the threat to grow. Takeaway: social context matters. Boundaries between you and me are unfixed and vary (though I will be angry if you break into my house and take my possessions).
Nuance and Color
A nice example of the importance of context is William H. Macy’s character in the movie, Pleasantville. For much of the film, Macy’s character seems very functional and healthy. He shows a strong work ethic and supports his community. He provides positive parenting for his children, and is respectful and loving towards his wife. No one would label him “ill.” However, within minutes of his wife leaving, he has an emotional collapse and becomes reduced to meals consisting of olives from a jar. Suddenly, many people might label him “ill.” Could he change that dramatically, that fast?
What we took as him was in fact way more than him. His wife’s journey to create her own growth revealed Pleasantville’s inflexibly imposed structure, including: men are “breadwinners,” women are “homemakers.” As members of the community learned more about themselves, the town awoke to find that for many people, perfect Pleasantville was their spiritual prison. The “illness” was primarily of the community as a whole.
What have we learned about Mental Health?
To review: we have eliminated simple definitions of mental health, based on transient, narrow states like “happy” or arbitrary and inadequate ideas like “normal.” These common errors have been summed up by the idea of “the assumption of healthy normality” (Hayes, Strosahl, and Wilson, 2003). We also pulled at linguistic strings to identify other assumptions: that mental health is a state we experience, and that it is a feature of an individual. What then?
I’ve been practicing psychology for nearly 15 years. It is somewhat embarrassing to admit that until recently, I had not come across a good definition. Often, the question gets side-stepped. Good clinicians know that these misguided definitions are quicksand. People spend a lot of time in therapy stopping the struggle with impossible standards so they can start to pull themselves out.
This year, however, I found a promising definition, from Dr. Na’im Akbar: “… mental illness should be defined as any behavior or ideas that threaten the survival of the group or collective self” (as described in Awosogba et al., 2023). This definition stands well: it is not linked to a particular state or person, and not held to a particular norm. By focusing on the level of behavior and ideas (presumably as expressed through words), there is also the potential to put dysfunction into context with function. Rather than an all-or-nothing state, a person or system can be healthy and unhealthy at the same time. There are certainly criticisms that can be raised (who decides what is a threat?) but that will be true of any definition. (Why is any definition needed?) In science, we try to use data to make improvements to our models of how things work.
We can then start to approach, together, a more sustainable, compassionate, and equitable society.