Not a day goes by where I don’t see someone mentioning mental health on social media. Then again, my sample is pretty biased – being a PhD student who is interested in mental health, with friends and colleagues who are in the same field – but it’s welcome nonetheless. Most days when I’m perusing my Facebook timeline, I see someone openly talking about their struggles with anxiety or I read an article advising how to help someone who has depression. It’s not weird to talk about your mental health anymore, which helps us all to connect and to create the culture of openness that will encourage others to do the same. One in six people in England report mental health difficulties in a given week (1). It’s a scary thing to deal with alone.
The problem I have is with people treating mental health difficulties as solely the result of biological processes, whether it be due to factors such as a genetic predisposition (2), a disruption in serotonin (3) or dysregulation of neural activity associated with emotional regulation (4). Although these play a part, our lives are too rich to be reduced to only these factors.
We are brains existing in a physical world, so mental health difficulties do have a biological basis, similar to other psychological processes such as learning or reasoning. I understand that people are trying to ‘legitimise’ mental health difficulties such as depression as a problem on par with other physical illnesses, such as heart disease or a fracture (see Robot Hugs’ comic for a commentary on this – 5). And it’s true that the structure and function of the brain can change following multiple episodes of depression (6). To some people, focusing on the biological basis of mental health difficulties may be empowering, as they are able to show to people that it isn’t just “all in their head” and that there is a physical basis for it.
But this leaves out a multitude of reasons why someone could be depressed, for example: family or work issues, a negative self-image, living life that does not align with one’s values or even small stressors that have built up over months. If someone simply treats their depression as a purely physical illness, it may be that they are less likely to tackle aspects of their lives which are perpetuating their distress. There are practical things a person with depression can do to alleviate their symptoms. But if we focus purely on the neurochemical side of it, they may feel that they are at the mercy of their biology, which can only be corrected with medication.
On the flip side, there are people who declare that a person does not “deserve” to be depressed based on their privileged life. A few weeks ago I came across a Twitter post that presented the following:
@renoomokri Sep 24
“Are you depressed? Ask yourself these questions:
* Do you have a home?
* Do you have food?
* Are you healthy?
* Do you have family?
It people who dont have these can be happy, then what reason do you have to be depressed? You are more blessed than half of humanity #RenosNuggets”
(* The tweet has since been removed from the account, but I do have a screenshot I could upload if anyone is interested.)
A person may have a seemingly perfect life – food, shelter, family – but they may have suffered a painful and traumatic event, or they may have a toxic relationship with their family and have no social support. Sometimes people may not know the reason themselves – they may just realise that something is not right; their life feels meaningless because the needs important to them aren’t being met. People’s reasons for depression vary greatly. Comparing and shaming people for their depression does no good and a whole lot of harm. There is evidence that the act of gratitude can help people who are feeling depressed and can increase social support (7), but the nature of the gratitude would be for the person to figure out for themselves, not thrust upon them through shame.
My point is that strictly prescribing to either ends of the nature or nurture debate is unhelpful in learning about a person as a whole. On one particular day, a person may be more sensitive to stressors or negative events. But that does not mean that they will definitely feel low, as that depends on the environment that day and how they conceptualise and interact with it. It’s not a one-way street – our social environment, thoughts, feelings and brain all interact both ways. Our brains can change according to experience, a phenomenon known as neuroplasticity (8).
Mental health clinicians often utilise the bio-psycho-social approach (integrating biological, psychological and social factors) to understanding and treating mental health difficulties and I believe the public discourse should adopt the same framework. It’s all about putting the whole person back into the focus of mental health difficulties. We are our brains, but in our day-to-day lives we live in a social and cognitive context where we can make choices. This may be more difficult for some people whose base level of mood is highly variable, but ultimately there is always something a person can do to help themselves. Sometimes it may only help a little or it may only help sometimes, but it’s better to do something. And it’s a better way to live than to do nothing.
Views and comments are encouraged and welcomed!