Individualism and Mental Health
Here are three recent quotes from the world of mental health care. First, the British Association of Counsellors and Psychotherapists 'maybe this is about moving from a place of treating everyone the same to treating everyone as different, unique and wanting to understand their place of difference, rather than pretend it isn't there’.[1] Then The Lancet 'The aim of reducing the effect of mental illness generally is certainly laudable, but society must also accept that not all individuals with mental disorders can achieve mental health and that wellbeing should encompass living with mental illness. Recognising and accepting difference is the core of ending stigma and discrimination.'[2] Lastly, the ‘Millennial Parent Whisperer’, Dr Becky: “You will not see me recommend time-outs, sticker charts, punishments, rewards, or ignoring as a response to challenging behaviours. What do I recommend? An understanding that behaviours are only the tip of the iceberg, and that below the surface is a child’s entire internal world, just begging to be understood.” [3] There’s nothing unusual about these quotes, they are entirely representative of mainstream thinking in mental healthcare; you’ll read the same ideas expressed again and again in any literature on mental health.
The first thing to notice here is that none of these ideas are based on evidence. They are based on clinical experience, which is valuable; they represent the conclusions of professionals involved in the subject. But a clinician’s experience is a highly subjective thing: if you could take a dozen different clinicians through the same clinical experience, you’d be likely to have a dozen different accounts of what was going on and how to respond.[4] Psychological science is extraordinarily flaky, very little stands up to any degree of serious scrutiny,[5] but it’s important to recognise that here, there isn’t even a claim of scientific backing (and it’s important to notice that because it’s very seldom supplied as an explicit disclaimer). These views represent philosophical positions, merely ideological maybe. People are saying ‘I’m an expert, I know’ and that’s an approach that has been seen to fail countless times in every field of study.
In themselves, there’s nothing wrong with these ideas; they’re very easy to agree with. That’s part of the problem: they represent a fast, easy route to a settled position on a subject which is complicated and difficult to think about. And a position which allows people to feel generous minded and compassionate and good about themselves. These ideas are definitely part of the picture, the problem is what they are used to push out of view.
Everybody likes feeling understood, that’s true, but it’s not really the point. Feeling understood isn’t essential to well-being and happiness; not living with shame and guilt and self-hatred is. It is vitally important to people to feel competent enough in themselves and in their relationships with other people. Understanding is more important than being understood. You can feel understood and still despise yourself.
We are all different, that's true, but we are also pretty similar; we are the same animal. And, if you take the time to listen to people who are suffering from mental health issues, it is striking how similar are the ideas affecting whatever form the mental illness takes. One of the key elements is the idea of worthlessness, being uniquely different, worse than other people.[6] That’s a very difficult idea: it leads to anxiety and aggression and feelings of alienation and isolation. And people who feel isolated and unhappy become very self-centred, taken up with their problems and their predicaments. It gets harder for other people to be fully present or real to them. The idea of different always involves the idea of worse (in the mind of the person feeling different). The idea of difference needs care; simply celebrating difference is a risky strategy.
The drive to destigmatise mental illness is itself an attempt to override the idea of ‘worseness’ (which only tends to become more entrenched with a diagnosis). It doesn’t work because the idea of incompetence, the sense of a personal handicap, an imbalance between you and other people, is at the heart of mental illness; that’s what mental illness is - not crushing low mood and being unable to get out of bed for 24 hours, or alcoholism or an eating disorder; those are just some of the ways the illness expresses itself. Difference feels defective, difference feels worse, simply trying to dismiss ideas of inadequacy and telling people their difference should feel OK isn’t going to change much.
It is striking how much of therapy, and this is particularly true of the elements that find their way out into the mainstream, is highly individualistic in nature. Telling people to maintain their boundaries, to say ‘No’, to take care of themselves before they can take care of others, “No One is You And That Is Your Power” on a million coffee mugs, tea towels and blogs, assertiveness training, loving yourself, claiming your anger. It’s all very defensive and focussed on what’s being done to you. And those ideas of unfairness, grievance and resentment and exaggerated concerns with strength and power (also key themes you find when you talk to people suffering from mental health issues) just betray how weak and vulnerable people are feeling.
It’s curious that Psych flirts quite so enthusiastically with ideas of grievance and assertion and anger as a super-power because the traditional psychological strengths have always been regarded as adaptability, suppleness and resilience. And poor affect regulation and neuroticism (predisposition to irritability and complaint) have been powerfully associated with a whole range of mental disorders (depression, anxiety, oppositional defiance disorder, ADHD, eating disorders, substance abuse) and a range of physical conditions too.[7]
A lot of the problems that become mental health issues are to do with misunderstanding, with people’s unrealistic expectations of themselves and the world, a difficulty in meeting what’s outside them half-way. That translates into difficulty with negotiating competent feeling relationships with what’s going on around them, leading to anxiety, aggression and self-hate. That pattern finds an expression in claims of privilege, in hyper-sensitivity in demands for special treatment. The belief that other people HAVE to care about your unhappiness is itself likely to be a significant ingredient in many peoples’ mental health difficulties. Individualism, exceptionalism are always a problem, they always cuts both ways: assertions of exceptionalism reveal deep anxiety about being worse than other people, being defective.
That belief in inner wrongness, the low self-worth and the feelings of inadequacy are inescapable. Encouraging clinicians to ask not ‘what’s wrong with you?’ but ‘what happened to you? is unlikely to help. There’s not enough there on the ideas and behaviour which are the real roots of people’s self-dissatisfaction and negative emotion. The most productive experience in therapy isn’t self-love or self-compassion, it’s remorse from people seeing their own anxiety, weakness and capacity for shittyness and causing trouble to themselves and harm to others.[8] And, crucially, wanting to do better, wanting to be good. The title of Dr Becky’s book is ‘Good Inside’.
We’re living in an epidemic of disconnection and loneliness. Psych has been talking about this for years, many psychologists regard it as the single most serious mental health issue[9] but, in mental healthcare, Psych keeps propagating these notions of individualism and difference: everyone’s different and everyone deserves their uniqueness. So, when we treat mental illness, we usher people who are already suffering from acute self-consciousness into a dimly lit room in the company of someone who is required to pretend to be much ‘healthier’ than they really are, and subject them to a protracted process of intense self-scrutiny. When part of what could help them is, precisely, a better awareness of other peoples’ predicaments and experiences and, in particular, insight into how much of what troubles them most about themselves (and, in particular, those ideas at the bottom of it all about self-worth which have hurt them so badly) is affecting everyone else too.
There are superficially appealing secondary gains to ideas of individualism and difference: an element of a free pass (be yourself, express your difference), threads of superiority and triumphalism, but only at the price of the constant idea of difference as defectiveness. The idea of difference is part of what puts people into mental healthcare and it’s part of what keeps them there. That quote from The Lancet is misguided: the way to overcome self-stigma isn't some strained, faked attempt by everyone to embrace alarming degrees of otherness, its recognising common humanity in situations, it’s seeing similarity and shared predicaments.
Mental health is about the relationship with the self. And ideas about the self are driven by ideas about other people. So mental health is all about the self and other people. Psych leaves out other people almost entirely. That’s half the story.
[1] Therapy Today 16 April 2022
[2] Recognising the right to be different https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00344-3/fulltext
[3] Dr Becky Kennedy – Good Inside: Harper Collins 2022
[4] Famously, this was imperfectly attempted in the 1960s in the Gloria films (
) in which three leading psychotherapists were each filmed in one session conducted with the same client. Their approaches were strikingly different. Comments from later life indicate that the client was fairly disenchanted with each of them and with psychotherapy in general
and https://jonathancoppin.substack.com/p/self-esteem-and-mental-health
[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5428182/#__ffn_sectitle
[8] Melanie Klein – Love, Guilt and Reparation: The Hogarth Press 1975
[9] John T. Cacioppo and William Patrick – Loneliness: Human Nature and the Need for Social Connection: Norton 2008