Oxford Court student accommodation at Manchester Metropolitan University (Photo by PAUL ELLIS/AFP via Getty Images)
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Students in Manchester have been prevented from leaving their halls of residence by security guards, those in Scotland have been told not to go to pubs or restaurants, and the Health Secretary, Matt Hancock, has said he cannot rule out banning students from going home for Christmas. Shut in their dingy rooms, attending seminars only via Zoom, and all the while paying almost £10k in fees, some of these young people have taken to putting up sad little posters in their windows (‘Help’ and ‘Fuck Boris’ are popular themes).
The phrase ‘mental health’ appears in almost every news story about the new restrictions placed on students, and recurs in statements made by officials. Larissa Kennedy, President of the National Union of Students, said on BBC Radio 4’s PM that “we need to think carefully about the implications for mental health for students”, while the Scottish Liberal Democrat leader, Willie Rennie, insisted on BBC Radio Scotland that “mental health support” should be made available by universities. The students themselves echo this vocabulary, with freshers telling journalists of their “history of anxiety”, or using oddly clinical language to describe this unpleasant introduction to university life. One young woman, for instance, described how isolation had “unfortunately” led to her “experiencing mental health issues”.
We might expect an 18-year-old to use more prosaic words when she is far from home, living with strangers, banned from leaving her accommodation, and now facing the prospect of Christmas without her family. Words like ‘sad’, ‘angry’, ‘upset’, and ‘lonely’ spring to mind. But over the past several decades, these ordinary words have been crowded out by medicalised words that seem to give an aura of authority. This new discourse speaks not of ‘sadness’ but of ‘depression’, not of ‘worry’ but of ’anxiety’, and not of ‘happiness’ but of ‘mental health’.
There are several factors at play here. One is the steady expansion across the globe of American psychiatry — well documented in the book Crazy Like Us by Ethan Watters — which has led to both the medicalisation and the Americanisation of forms of emotional distress that in other times and places have been considered an expected part of the human condition.
The American Psychiatric Association publishes a diagnostic manual, the DSM (now in its fifth edition), that is used the world over as the bible of psychiatric diagnosis. The DSM sets out in cool, logical bulletpoints the steps by which a person’s dysfunction or distress becomes pathological. A diagnosis of depression, for instance, requires either a “depressed mood” or a “loss of interest or pleasure”, accompanied by three of the following: weight loss or gain, physical slowness, fatigue, feelings of guilt, poor concentration, or recurrent thoughts of death. Tick, tick, tick, tick: congratulations, you’re mad.
Tellingly, the so-called “bereavement exclusion” — which excluded a patient from a diagnosis of depression if he or she had been recently bereaved — was removed from the fifth edition of the DSM, meaning that ordinary grief is now technically considered a disease. Some forms of mental illness are easily distinguished from everyday experience, but others are not, meaning that ‘pathological’ can be distinguished from ‘normal’ only by drawing a line on the spectrum of severity, and that line can easily slip. Meaning that, as the outspoken critic of over-medicalisation Allen Frances puts it, “normality is an endangered species”.
There is a slightly conspiratorial, anti-capitalist way of framing this psychiatric concept creep, a framing that leans heavily on the role of Big Pharma. I won’t dismiss this theory, but nor do I believe that it tells the whole story. Yes, in a privatised healthcare system, doctors have an incentive to prescribe medication that patients don’t really need, but we also have to acknowledge that medication, effective or not, is often what patients desperately and loudly want. An old friend of mine who works in mental health services once told me that although she and most of her colleagues were signed up to the so-called social model of madness and distress — which understands mental illness as not just biomedical, but also as a product of the social environment — most of their patients didn’t want to hear it. They wanted to take a pill and feel better. They didn’t want to be told that they were suffering from what some medics darkly refer to as ‘Shit Life Syndrome’.
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