There is no student mental health crisis Depression and anxiety have become status symbols — while sadness and loneliness are taboo

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’.

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.

Perhaps the reluctance to face up to this peculiar sadness induced by 21^st-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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Louise Perry is a freelance writer and campaigner against sexual violence.

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