Suffer The Children
Oh dear. According to a Health Foundation funded report from the Resolution Foundation earlier this week, more people in their early 20s are out of work as a result of ill health than people in their early 40s.[i] That’s a ‘radically different’ picture from the past, when illness related unemployment increased with age and, the report said, young people now have the poorest mental health of any age group.
The Resolution Foundation is a think-tank focussed on improving living standards for people on low to middle incomes; the Health Foundation is a charity promoting better health and healthcare. They are two of dozens of different organisations in the UK who regularly provide commentary on mental health, and they have hundreds of counterparts in other countries.
And the universal conclusion around these commentaries (from organisations whose survival generally depends on other people providing them with money)[ii] is that what’s required is more money and resources for mental health. The BBC reporting of this story included quotes, from an online mental health platform, about ‘lack of funding’, a ‘spiral in mental wellbeing’ and a ‘mental health crisis’.
But there really isn’t very good evidence that spending more money on mental health would make things better. The NHS’ own figures show that only around 1 in 4 people suffering from the most ‘treatable’ forms of mental illness (anxiety and depression) recover when they receive treatment. A significant proportion of that recovery level is likely to be coincidental and the result of regression to the mean. Another significant proportion is likely to be attributable to the placebo effect – they would have experienced a similar outcome whatever treatment they received, just by receiving treatment. And other statistics suggest that up to 85% of people who are considered to have recovered will suffer a recurrence.
There’s no reason to believe that spending more money on what we’re doing now isn’t going to just result in 1:4 of a higher number in terms of treatment results. And the sharply increasing numbers of people reporting mental health problems and trying to access treatment suggests that all the money spent on mental health awareness campaigns hasn’t had any positive effect.
In fact, even within psychiatry and psychology, there are respected voices arguing that spending more money on mental health awareness might be making things worse – and everyone nods sagely and carries on what they’re doing. Certainly, the Resolution Foundation report above relied on young people self-reporting on their own mental health[iii] and there’s very consistent evidence of significant mismatches between people’s assessment of their own mental health, particularly the young, and the results of clinical assessment.
But however much people may be talking themselves into something here, if the result is that there are dramatic increases in the number of young people who can’t get work, or stay at work, because of their mental health, that’s clearly a very real problem. And that number is likely to be a small sub-set of the number whose ability to perform effectively at work is being undermined, and whose lives are being compromised in countless other ways, by their states of mind.
∞
Another way of looking at it, another way of saying the same thing as previous articles in this series, is that mental health is about managing your own aggression. ‘Hateful’ is a literal term, so… full of bile, a kind of acid reflux of the soul, and it feels as bad as its physical equivalent. Aggression is a form of unhappiness; it will make you unhappy. And you will hate yourself for your own vile emotions because you have to be with that person all day (and, even worse, night).
It's curious, everyone in prison is there because they got into a poor state of mind, involving aggression and hatefulness, and caused a particular kind of trouble. But so long as the kind of trouble people cause is confined to tormenting others in their relationships, letting colleagues down or sabotaging the workplace, it’s not just OK, it’s actually protected by law.[iv] It’s not immediately clear why: that kind of aggression is responsible for much more human misery than attacks on the bus or online bank fraud.
Mental illness is what happens to the human brain when it generates too much anxiety and aggression. And when things go wrong you become anxious and aggressive. So, it's important to take care of business. If you're in your 30s and you can't afford secure housing that's going to be a challenge to mental health.
But it's not just a matter of what happens to you. It's very much about how not getting what you want affects you. How much anxiety and aggression it generates. That’s going to depend on your perspective on yourself and other people; your expectations of how the world ought to treat you, how much responsibility you feel for what’s happened and how much things feel done to you. That's very much a matter of how you grew up and that's become more of a thing.
When I talk about seeing what you're up to and doing better, I'm not (just) talking about taking care of business, going to Oxford or getting a better job, I'm talking about getting better ideas about yourself and the world that will keep you further from the edge. That gets harder when we're all surrounded by stupid ideas about ourselves and other people and that's become a thing too: the proliferation of ideas (often expounded under the flag of mental healthcare) which are exquisitely calibrated to make people ill.
Everybody's problems are to do with the gap between how we think the world is going to be and how it is. It’s about (not) growing up; a failure to come to terms with the conditions of life. It’s not that some have it worse than you, so why are you so unable to cope (which is a common persecutory idea affecting people who suffer from mental health issues) or some are like you (the afflicted, the sensitive or weak) and everyone else is OK: everyone has everything that really matters to them pretty much the same. There are no fairy stories, that’s all wishful thinking and potentially very damaging.
∞
Mental healthcare is riven with different factions (and they’re often pretty aggressive, though they’d probably prefer ‘passionate’) fighting each other about the way forward: for or against medication, therapy, social change. They’re aggressive because they can’t get what they want: there's no evidence available that can prevail; no hope of resolution because experimental psychology is currently incapable of producing one. For all the billions spent on, and hundreds of thousands of people working in, mental healthcare they don’t even have the beginnings of a coherent picture of what mental illness is.
So, the debate is really just ideological, and it goes on and on. Yes, mental illness is a response to society; that’s true because it's a response to not getting what you want: expectations crumbled, perspective crashed, sense of reality challenged. But that misses the point - why is that happening so much more now?
Is it that it was always there: we've just got better at talking about it? No, it wasn't always there: we have contemporaneous records. People haven't been deluding themselves wholesale for thousands of years about how they feel: Sophocles to Dante to Shakespeare to Woolf, Thomas Mann, Joyce, Becket; lots of philosophical issues, happiness is hard to come by and fleeting but everyone in those accounts isn't struggling with their mental health.
Is it that society in the UK, Europe and the US has grown crueller, more restrictive, more likely to persecute the individual? No, think about the second world war and its aftermath. And racial, gender, sexual and class boundaries were much more rigid in the past than they are now. Liberal capitalism has its faults but really?
Is it really all the fault of Apple and Google? It seems unlikely that we’d reward these businesses by making them the largest companies in the world if they were just making everyone ill. But, in any event, they are the largest and fastest growing businesses in the world; they’re not going to stop doing what they’re doing, and, clearly, we don’t want them to. And if young people have really become so vulnerable to the content they’re accessing via these platforms, where has that come from? No-one’s (really) making them do anything, people are using this stuff the way they want to. What is that vulnerability, what’s made them like that?
And there’s the answer: people are incredibly suggestible, our experience of the world is malleable, it’s conditioned by the ideas we have about what’s happening to us. Specifically, we are affected the way we expect to be affected; we feel the way we expect to feel. Research coming out of psychology’s replication crisis[v] has shown just how pervasive and powerful this effect (originally best known in the form of the placebo effect) really is. [vi] But it’s not just a matter of having to radically overhaul the explanations behind the findings in a great deal of previous experimental psychology, this principle holds good in every aspect of life – belief predicts experience. If you believe you’ll feel crushed if slighted by someone you barely know on social media, you will; if you believe you won’t give a shit, you won’t.
So, your assumptions and expectations about yourself, and yourself and other people, and how the world ought to work, dictate how you experience things. That's not ‘just’ a matter of the medicalisation of ordinary human distress, of kids being talked into thinking they’re ill (which is commonly identified as a potential problem), it’s not even ‘only’ a matter of unrealistic ideas undermining their ability to function competently in the real word (and dooming them to anxiety and aggression and illness), it’s a matter of their expectations and beliefs transforming how they actually experience what happens to them.
One of the remarkable features of life in the developed west over the past 50 years or so has been the penetration into mainstream society of ideas from mental healthcare and the evolution of those ideas towards subjectivity of experience, vulnerability and personal autonomy.
Whilst everyone was busy getting on with their lives, there’s been a steady shift in the focus, in society, in the media, in politics, on difference, individuality, divergence and on unhappiness (what else is mental health if not unhappiness?) and complaint. Keynotes of frantic self-determination and complaint: a great self-centred bleat rising all around us.
This isn’t specifically about diversity or inclusion - it would be possible to navigate those issues in any number of ways. It is to do with a much deeper set of ideas about self and others - individualism, isolation, vulnerability and complaint - that do lead to culture wars, but which also impact on the way we think about and manage intimate relationships, our ability to find them and maintain them, and every other aspect of our lives.
Those ideas, and the emotional tone they lend to life, are all that the young people now reporting unprecedented levels of mental health problems have ever known. And it’s psychology and mental healthcare that have provided the authority and validation for them.
It’s the ideas they have in their heads that have made these children so vulnerable to social media. Adolescence and young adulthood are vulnerable times but the way these generations have used and reacted to social media is a product of how they have been brought up to see the world, and their problems go way beyond Instagram. Don’t blame Google, blame the stupid ideas we’ve given our children.
So, thanks for all the reports but more money to shovel stupid ideas at children in school and colleges and to fund more ineffective treatment, isn’t going to help.
It's you, bleaters. You've sabotaged your own lives and polluted everyone else’s, and you've made your children ill.
And you’re going to drone on, furiously working your ticket, tugging at the same lowest hanging fruit, clinging onto a bandwagon that’s taking us God knows where.
[i] https://www.bbc.co.uk/news/health-68399392
[ii] In terms of its immediate funding, the Mental Health Foundation is something of an exception since, ironically enough, it was created from a windfall endowment deriving from the sale of a private health insurance business, but it still exists in a sector devoted to raising funds and its mission statement is about giving and the provision of resources.
[iii] https://www.resolutionfoundation.org/publications/weve-only-just-begun/
[iv] Mental health is a protected characteristic under the Equality Act 2010
[v] https://www.theatlantic.com/science/archive/2018/11/psychologys-replication-crisis-real/576223/
[vi] https://www.theguardian.com/science/2023/jun/24/do-life-hacks-work-the-truth-is-well-never-know