September 30, 2020

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’.

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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”.

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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’.

The huge rise in the diagnosis of depression, anxiety, and other slippery conditions among young people is often attributed on the Right to over-sensitivity. The ‘snowflake’ narrative suggests that these youngsters are either exaggerating their distress, or that it has been induced in them by a political ideology that discourages resilience. There is some truth to the idea of mental illness as status symbol, as we can see from the fashion for including one’s psychiatric diagnoses in one’s Twitter bio, frequently found alongside pronouns, an anime avatar, and rainbow and rose emojis. In a social hierarchy constructed around marginalised identities, identifying as mentally ill can certainly boost one’s victim status.

But for the many young people who really are sad, vocalising that sadness by ‘identifying as’ mentally ill also offers another advantage, and one that the critics of the ‘snowflake generation’ often miss. The clinical social worker and psychoanalyst Lisa Marchiano describes the appeal:

A  diagnosis carries with it a sense of absolution. It isn’t our fault that we have anxiety or depression. Forces beyond our control have conspired against us… when our diagnosis becomes an important part of who we are, we are encouraged to abdicate responsibility for our plight. We are adrift on life’s turbulent currents, without blame, but also without agency.

The psychiatrist Lewis Kirshner argues that while madness was once considered “an existential possibility present at the margins for every person”, in contemporary society we understand it as a sort of biological taint, present from birth, that will sooner or later announce itself in the form of symptoms. Thus the presence of this ‘identity’ is outside the individual’s control, they are (as Marchiano puts it) “adrift on life’s turbulent currents”, and temporary remission is available only through drugs or talking: publicly, in an effort towards destigmatisation, or privately, to a therapist. The trouble with this understanding of mental illness is that there now seems to be an awful lot of ‘biological taint’ present in the population since, according to Kirshner, approximately half of Americans meet the criteria for a major psychiatric disorder at some point in their lives. If fully half of us are irredeemably mad, maybe there’s something else going on?

A new book, The Lonely Century by Noreena Hertz, poses an interesting challenge to the ‘biological taint’ theory by suggesting that loneliness is both responsible for a huge amount of the emotional suffering that attracts psychiatric diagnoses, and that its prevalence is a consequence of recent historical trends: family breakdown, the rise in both domestic and international migration, the disintegration of civil society, and our increasing dependence on the internet, particularly social media. We are social animals, and loneliness makes us very, very sick. While the elderly are particularly vulnerable to it, the young are also suffering terribly. Those ‘snowflake’ young people on Twitter are telling the truth when they write about their profound unhappiness. It’s just that they’re using these feelings as evidence of their special, oppressed status, rather than seeing themselves as part of a lonely generation in need of better company.

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Perhaps the reluctance to face up to this peculiar sadness induced by 21st-century living is because the most reliable remedies to loneliness are disturbingly traditionalist: get married, have kids, live near your extended family, go to a weekly religious service. Hertz points, for instance, to the surprising longevity of the Haredim, an ultra-orthodox Israeli community who, despite being disproportionately poor, overweight, and sedentary, live significantly longer than their peers. “Community,” Hertz writes, “the value of which was so repudiated by neoliberal capitalism’s focus on individualism and self-interest, seems to have a health benefit of its very own. And for the Haredim, community is everything.”

If we accept Hertz’s diagnosis of what really ails us, then we should look differently at the unfortunate students locked away in their halls of residence, and indeed the many other people locked away from the world as a result of Covid-19. First, we should do away with the clinical language of ‘mental health’ and its false sense of legitimacy, and return to words with more emotional resonance, particularly the word ‘lonely’. Second, we should think of isolation, not as something that might aggravate the psychiatric symptoms only of those with a ‘biological taint’, but rather as an unbearable imposition on any person, given our deeply social natures.

So, instead of using phrases like “experiencing mental health issues”, we could instead be more straightforward: “I want to see my friends and family, and I can’t, and that makes me sad because I’m a person who needs affection and companionship, just like anyone else.” You don’t need to tick off a checklist in the DSM to know that people need company — it’s a need as fundamental as sunshine.

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  • October 4, 2020
    You would think, with the conditions and severely reduced teaching, that there'd be a corresponding reduction of the tuition fees. You would think: but you'd be wrong because they are greedy and disgusting people. Read more

  • October 4, 2020
    Greetings from America, the birth place of the Medical Industrial Complex. Let me build on the narrative, starting with "A diagnosis carries with it a sense of absolution. It isn’t our fault that we have anxiety or depression. Forces beyond our control have conspired against us…" One... Read more

  • October 4, 2020
    The author is spot-on about the fashionable pathologising of entirely normal states of mind such as being sad, lonely or worried, and 'the fashion for including one's psychiatric diagnoses in one's Twitter bio'. Also, 'In a social hierarchy constructed around marginalised identities, identifying as... Read more

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