Have you recently been able to concentrate on what you’re doing? Have you recently felt constantly under strain? Have you recently been able to enjoy your normal everyday activities? Have you recently felt that you were playing a useful part in things?
More importantly do you know anyone who wouldn’t answer “Hell, no,” to every one of these questions right now? Except perhaps a medical professional or a shelf-stacker who’s absolutely playing a useful part in things, but probably hasn’t slept well in a fortnight.
The questions are from a standardised mental health screening tool called the GHQ 12. It’s used in surveys all across the world to get a sense of how many people are struggling with mental health problems at any one time. To qualify as having a “diagnosable mental health problem” you need to score 12 points or more.
Every “Hell, no” gets you three points. And if you didn’t score your full 12 with the questions I started with, don’t worry, you have eight more questions to complete. Eight more chances to qualify as struggling with your mental health.
In other words: yes, we are all a little bit crazy right now.
Of course, you might argue that this kind of mental distress doesn’t count as mental illness, or that it should be classified differently from conditions that occur spontaneously. Depression that creeps up on you for no reason and takes over your life is certainly different from what so many of us are experiencing: feeling shit because life is shit. And that’s especially true when we know that life is probably going to get back to normal-ish in a few months.
But we must not be complacent. It is true that mental health problems can come from ‘nowhere’, but it’s also true that they can be caused by poverty, trauma, pain and turmoil, and all too often are. What follows is a huge oversimplification of what little is understood about the reasons for the strong links between life experiences and mental health problems. But I hope it helps make sense of what’s going on.
When bad things happen to us, our thought patterns change. Run out of money and get into debt: you start to feel anxious. Stuck in an abusive relationship with someone who might hit you if you upset them: you become hyper cautious. Witness violence: you worry for your own safety. Lose a loved one: you shut down emotions that might overwhelm you.
These thought patterns become a “diagnosable mental health problem” when they affect your ability to live well. That might be because the problems don’t go away: debt doesn’t fix itself and abusive partners don’t turn into Prince Charming. But it might also be because you get stuck in those cycles of thinking even after the problems have gone away. The mental pain that started as a response became self-sustaining.
In normal circumstances most of us can bounce back from difficult experiences. But not everyone can, and not everyone does. And the longer our trauma lasts, or the sharper it is, the harder it is to get back to how we were before.
That means that there will be a huge and lasting impact on our collective mental health from what we live through over the coming months. We have to prepare ourselves for it.
Before you point out that we’ve lived through worse: I know, we have. Of course we have. We could list examples of collective trauma from human history for as long as this quarantine lasts, and we wouldn’t reach the end. But sanities were shattered by those experiences. For most of history, what we now call post-traumatic stress disorder was the standard form of our existence. When most mothers lost children; when most men witnessed war: these were not times for human flourishing. Most of us will have a living or remembered relative who can barely speak about their life in war. We humans can survive almost anything. But the conditions for our thriving are utterly different. Those conditions are what is under threat.
Early studies from Italy confirm the truth of this. In a recent study of nearly 3,500 people, not one said they weren’t anxious. People with health problems and women in particular are riddled by anxiety. Middle-aged people — those with both parents and children to worry about — are reporting the highest levels of worry.
So how do we respond? Well, despite my personal despair at the impossible standards expected of us by the fitness guru Joe Wicks, keeping us all healthy and active in this lockdown time is going to be vital. Keeping us on top of our finances is probably next on the list — and if the “money saving expert” Martin Lewis isn’t offered a knighthood, a dukedom or the monarchy by the end of this, then our honours system needs a serious overhaul.
Everyone’s talking about home education, but it isn’t just the children who should be logging on. People who keep learning are the most likely to stay resilient in the face of mental health problems. Keep learning and you will keep well. So this really is the time to take up cooking, or the piano, or to grow your own vegetables — just expect yourself to be bad at the start, and never get further than mediocre.
But there’s one thing we mustn’t do, and that’s catastrophise. Donald Trump has started arguing against his own public health experts by saying that the shutdown should end soon, because a recession will “cause” suicides in the thousands. That is reckless, wrong, and downright dangerous.
Suicide rates do tend to rise during recessions. But that is not inevitable. Most importantly, public messaging about suicide will have a dramatic effect on the number of people who try to take their lives.
Every suicide is a tragedy. But it is also a rarity. Every year 5.4% of 16- to 74-year-olds have suicidal thoughts; 0.7% of us make an attempt to end our lives. And only 0.01% complete a suicide attempt. Another way of thinking about this is that the vast, vast majority of people survive suicidal thoughts.
If you’re feeling at the end of despair, and you hear your leader confirm that suicide is normal, it will do nothing to bring you back. It is the worst message to send. Suicide is not normal. Suicidal thoughts are survivable. Most people live through the worst of thoughts. Most people find purpose and meaning in life again. Or as the Sufi poets have it: this too shall pass.
We are all struggling right now. Struggling for purpose. Struggling for coherence. Struggling to understand. We have to acknowledge the difficulty if we are to have a hope of conquering it. But we must tell ourselves the truth, too, that conquering things is what we humans do. We have lived through worse. And we will live through this.
It is the act of saying this that makes it true.