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Mental health: Do we practice what we preach?

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In a recent piece for Healthline, editor Christal Yuen discusses how she used to worry about her irritability until she found out it was attributable depression. Without this revelation, she writes, “I would’ve believed the idea that my subconscious was inherently evil.” But with it, she came to understand that she was only ill.

In making this claim, Yuen showcases a problematic, yet common tactic used to destigmatize mental illness. We find biological explanations for abnormal behavior and tell the person that it’s not a reflection of who they really are. The problem with this approach, however, is that we rarely generalize our understanding to strangers or even acquaintances. If we see an unfamiliar person exhibiting the same behavior out in the world, we are very likely to judge them.

To illustrate that, I’ll examine two emotional tendencies that remain socially damning: neuroticism, an innate tendency to experience negative affect and anger. 

In many ways, these two traits are strikingly similar to accepted forms of mental illness. We find that people who are chronically angry or neurotic have great difficulty coping with pain and stress. The inability to cope has been the primary heuristic through which genetic research has understood depression. Likewise, irritability is a major feature of all three because it’s hard to be friendly and upbeat while inundated with cortisol.

Despite these similarities, the only one recognized as illness is depression. Neuroticism and anger, on the other hand, are seen as personality flaws, which is ironic given the amount of effort that goes into saying depression is not a personality flaw. The difference here is that we don’t apply scientific evidence to the former. 

When people show these traits, we dip fast. This is why, in a speech on chronic anger, psychologist Russell Kolts describes managing the condition as inherently isolating. He says that “someone who really struggles with anger can get very used to the sight of people walking away.” The same holds for neuroticism, which is one of the best predictors of instability in interpersonal relationships. For any individual who struggles with either disposition, these tendencies beget social issues, often to an extremely predictable extent.

However, beget is a strong word here. Abandonment does not simply follow from mental illness, as if it were a genetic phenomenon, but instead is socially enacted. 

A necessary implication of the data is that we run from people who are emotionally unhealthy. We’re willing to be tolerant of emotional problems in the abstract until they show up in real life. While we can send people with anxiety or depression to therapy (i.e. away from us), we cannot easily do the same for people who are neurotic or angry. So instead, we act like the only thing wrong with them is their moral fiber.

One practice that demonstrates this exceptionally well is our readiness to label and exclude those who we deem ‘toxic.’ The terms allow us to shamelessly classify people as morally bad. How? Identify someone who is “unhealthy emotionally — someone who basically brings you down more than up.” Call them toxic, and you have a pre-formed cultural narrative for leaving them on a whim. Calling them ‘neurotic’ works equally well.

We make this judgment based on how they make us feel, their presence like a poison or a drain. Yet we’d do well to think beyond our feelings. The neurotic person probably has it worse: that same person that vexes or annoys you is more subject to depression, death, abuse and interpersonal violence. It is fundamentally unfortunate to be like that. What results is a cascade in which those determined to be ‘toxic’ find unhealthy ways to cope with loneliness, often resorting to drugs or finding risky companions. 

It becomes incredibly hard to fit in again. Because these labels directly target a person’s character, they lead to deep exclusion. We thus find, on extremely reliable data, that behavioral phenomena such as loneliness, dysthymia and unhappiness, all of which are correlated with neuroticism, stay relegated to particular clusters of the population. We even find that neurotic people tend to be outcast within their own families. 

In hastily pushing these people out of our own lives, we show that there is a low upper limit on how much we care about mental health. We sympathize with those who are anxious or depressed because we recognize it’s unfair to look at them as the sum of their thoughts. Yet when someone who is neurotic or angry offloads their disproportionate emotional difficulty, we cut them off.

I understand that it’s hard to deal with people who bring you down — I really do. But the fact of the matter is that this behavior is fundamentally a trap and underlies a hard, short life. We at least have to do more than we do now to rehabilitate and reintegrate, even if that means reaching out to strangers who’ve already been outcast. To just leave people suspended is to invalidate our abstract sympathy for mental health. You can’t pass up on every opportunity to help and still claim you care. 

More to the point, you can’t condemn those hurting and talk elsewhere about mental health. I return to this definition of a ‘toxic’ person: someone who basically brings you down more than up. This definition is hopelessly unaware. All forms of suffering manifest distress that inevitably ‘brings you down.’ Obviously, there is an emotional cost to recognizing and fixing problems in the world. It’s just that in this case, we’re not willing to pay.

We’re more willing to be sympathetic towards those with anxiety or depression because we can send them away to a doctor. But we have no sympathy for those whose problems require anything of us. If you don’t believe me, it’s worth asking why almost all mental health discussion on campus has to do almost exclusively with Counseling & Psychological Services (CAPS) when we know so much about the importance of supportive, caring communities in promoting psychological well-being.

I know because, only weeks ago, I was sitting in a room of 30-plus opinions writers whose discussion of mental health reform was limited to CAPS and forced leaves of absence (with one or two comments about workload). No one seemed to have thought of the more obvious point that maybe we need to work on treating each other better; to do something more than argue about medical services and pretend we can’t help one another.

Why? We’re not as progressive or sympathetic as we say we are. We refuse to let our understanding of mental health extend to our personal lives, preferring instead an incredibly selective definition so as to preserve our own time and effort. It’s telling that we only prefer structural solutions that require no interaction on our part with those struggling.

Now, I’m not asking us to all be therapists. But what I will say is that mental illness is growing at a rate beyond what is feasibly treatable and that even when treatment works — what a therapist might call functional remission — people struggle deeply with finding acceptance. This suggests that a lack of care is not the whole problem. Yet even if it were, the complications that follow from emotional problems are immanently social. No one can seriously argue that the ways in which we relate aren’t vital to the prevention of mental illness or the mediation of its effects.

The problem is that this is exactly how we act. This is a stark contradiction in our professed sympathetic beliefs and it has to do with values, not efficacy. As the World Health Organization argues, if we take seriously the goal of improving mental well-being, “Action needs to be universal: across the whole of society.” That means we have to stop with the labeling and the neglect and to start building each other up. A veritable culture of well-being could never be so individualized as our own.

Of course, you could write a whole book on how to treat people better. But I think the first step is to not be obsessed with your own life that again, is a matter of value. If the thought of spending some of your time each week with people whom you’re not particularly fond of is really all that bad, then maybe we’re more materialistic than we think. We’ll drop good logic, scientific evidence and social justice in favor of flimsy blame. I simply refuse to believe that’s only a matter of pressure or overwork, as some students would claim. Rather, it seems like a prime example of bad faith.

Contact Noah Louis-Fernandez at nlouisfe ‘at’ stanford.edu.

Noah Louis-Ferdinand is a freshman from Bloomfield Hills, Michigan. He studies Human Biology and Anthropology. Noah is also an avid reader of philosophy and enjoys contemporary fiction. When not studying or writing, he loves to run trail races throughout the United States.