Mental health and being a wanker
One of the problems with mental health is that we have fallen into very set ways of thinking and talking about it. It is a very sensitive subject and over time strict rules have emerged on what’s allowed to be said.
Something that’s very much allowed to be said is that mental illness is caused by a chemical imbalance in the brain. It’s commonplace, you hear it all the time and the leading candidate for many years has been serotonin depletion. But a very well-known, widely cited paper in 2007 established conclusively that when you give people who are not suffering from depression a drug (called tryptophan) which reduces serotonin levels, they don’t get depression. [1]
That’s very straightforward – reduced serotonin does not equal becoming depressed - and it should have been the stake through the heart for the chemical imbalance theory, at least in that form.[2] But that idea is still very much alive in the mainstream and still influential in some areas of research. So much so that in July this year, it was necessary for a fresh academic review to revisit the evidence and conclude ‘the main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations’.[3]
So, anyone maintaining that depression is caused by reduced levels of serotonin or insisting that mental illness is a chemical imbalance in the brain, is doing it in the face of overwhelming evidence to the contrary. That’s a stupid thing to do. But you won’t get into trouble for it.
The unkillable nature of the chemical imbalance theory isn’t (as often argued) down to cynical marketing by Big Pharma – stimulating demand for more antidepressants. Companies aren’t smart or creative enough to manipulate us that much, they just take advantage of opportunities presented by the way people are. The reason for this idea’s enduring appeal (and what the drugs companies took advantage of) is it exonerates sufferers and their families.
Any form of unhappiness is, at some level, a difficulty in coming to terms with reality, with what happens. The extreme form of unhappiness which is mental illness is an extreme form of difficulty coming to terms with reality. It’s about seeing things wrong and getting it wrong: wrong values, wrong expectations, ‘wrong’ emotional reactions and wrong behaviour. In some important ways, that makes you a bit of wanker (and you know that). Since most of the values, assumptions and reactions that are causing you trouble were formed in childhood that means, at some level, your parents and family got it wrong bringing you up. That makes them wankers too (or it can feel like that). And since self-loathing is at the heart of mental health issues, that’s not an idea people suffering from mental health issues are good at managing and it’s an idea from which they, and their relatives, would like to stay far away.
And the fact of the matter is that people who are suffering from mental health issues are a pain in the arse quite a lot of the time. They are self-centred, taken up with themselves and their own issues – not in an enjoyable way (they dislike themselves) but it’s still the case that they struggle to relate to other people adequately and they often behave very badly. This is a conspicuous example of what you’re not allowed to say. Behind closed doors mental health professionals spend a great deal of time complaining about their patients: how mad and difficult they are. In public, it’s all about their suffering and fortitude and social neglect and lack of compassion and stigmatisation.
So, if mental illness is about people getting things wrong, seeing things wrong, behaving badly and despising themselves for it, the solution seems obvious - come to terms with reality more, see things more realistically, do better.
That may be obvious but it’s likely to be made quite a bit harder by the nature of the restrictions on what we’re allowed to say about mental health.
[1] https://www.nature.com/articles/4001949
[2] In fact, the same research also debunked the role of norepinephrine and dopamine in depression
[3] https://pubmed.ncbi.nlm.nih.gov/35854107/