Dr Colman Noctor: I fear that mental health has become the new gluten

The wellbeing narrative sometimes suggests we should never be worried or unhappy, but this undervalues our own coping skills

Picture: iStock 

We tend to discuss mental health as a binary entity, as something you ‘have’ or you ‘don’t have’, or is ‘good’ or ‘bad’. But mental health is far more nuanced and complex.

While running a marathon may have helped some people overcome their sadness, this may not be helpful to the severely depressed person in an acute hospital bed who cannot summon the energy to brush their teeth.

I was a vocal supporter of the move some years ago to challenge the stigma associated with mental illness. That movement rightly tackled the use of terms like ‘mental illness’ and ‘mental disorder’, saying it was stigmatising and posed a risk of pathologising almost every behaviour by giving it an unhelpful medicalised category. Building on this movement, we soon migrated to more palatable terms such as 'wellness' and ‘wellbeing’.

Just because we avoid the term mental illness does not mean we've eradicated it. Mental illness and disorder still exist. In our attempts to make the conversation about mental health more accessible, have we lost a grasp of the core defining features of mental distress? By including mental distress in a catch-all concept like ‘mental health’ we are in danger of creating the exact situation we were trying to avoid.

I fear that mental health has become the new gluten. We are now self-diagnosing as gluten intolerant and buying from a growing range of gluten-free products that we may not need.

Not all sadness is depression, not all worry is anxiety, and some degree of sadness and fear in our lives is inevitable and necessary. As we learn to overcome and process these feelings through the support of family and friends, we build robustness that allows us to learn how to cope. We develop frustration tolerance, failure survival and learn skills and strengths we did not know we had. The wellbeing narrative sometimes suggests we should never be worried or unhappy, and so our organic coping skill-sets get overlooked or under-valued.

Not everyone can walk it off

I have visited many primary schools pre-Covid, where some principals proudly showed me the work of their teachers' wellbeing committees. On occasion, I've been shown their Worry Wall, Worry Tree, Worry Bench or Worry Box. Each time I have thought of the child who may not worry. Is it possible they might think, 'There might be something wrong with me’?

So, while the slogan ‘it’s OK to not be OK’ makes sense, we could also do with an additional line that says, ‘And it’s OK to be OK too’.

It’s comforting to imagine that all mental distress can be resolved by taking a walk, meditating, or downloading a mindfulness app, but this does not apply to everyone. In some cases, far more intensive support is required.

Many of the strategies being promoted are aspects of maintaining ‘mental fitness’. These are important to help us stay mentally healthy, but they are not ‘catch-all treatments’ or interventions when significant mental distress is already present. Good sleep patterns, diet and exercise, are advised to minimise our risk of heart attack or cancer, but they are not the entirety of the treatment package.

So, what does the current mental health concept mean to children, who the consumers of this messaging? In an effort to widen the appeal of mental health services, I believe we created the ‘talk to someone and you’ll feel better’ idea. But this in not always the case.

The unpopular, but accurate, reality is that not all mental distress responds so neatly or dramatically by simply talking to someone.

Although, many will say ‘what is the harm?’, ‘at least people are talking about it', and ‘it’s all about starting the conversation’, the question is whether we are having the right conversation?

Terms and conditions apply

 If we use the term mental health treatment incorrectly, we will negatively affect people’s understanding of what mental health recovery entails and potentially damage their engagement in the treatments when they are offered.

It's not unusual for young people who attend my clinic to say after two sessions: ‘Colman, you are a nice guy, but this is not working’. My response is ‘You have to give it more time’. However, they often reply: ‘But the poster on my wall in school said if you talk to someone, you will feel better. I have talked to you twice now and I don’t feel better’.

It can be difficult to explain that experiences of bullying, bereavement or stress do not disappear after two sessions, contrary to what the poster on the wall says. Perhaps we need to include the words ‘terms and conditions apply’ at the end of those posters.

If we are to truly address the issue of mental health in children and young people, we need to start by addressing the societal and cultural norms that are creating an epidemic of anxiety, fear and pressure.

While the global pandemic of the past 18 months has in some ways taught us the value of family, connection and community, many young people have been negatively affected by the loss of crucial opportunities to develop social and emotional coping skills. If we re-enter the same world that existed pre-Covid, which was awash with expectation and pressure, with the added challenge of these developmental losses, we will face significant challenges.

Mental health is complex

 The ‘right conversation’ around mental health has to acknowledge its complexity. We need to stop describing mental health in simplistic binary terms as it can encourage extreme responses to distress where more nuanced responses may be more effective.

Currently, it seems our response to mental distress is either a referral to a child and adolescent mental health service, or to be given a wellness strategy such as mediation or exercise. The reality is that mental health challenges require far more options than these two approaches.

If we are to make a serious effort to address the mental health status of Irish young people, we need to acknowledge that mental distress is complex and we need to offer a far more extensive menu of solutions to young people who are experiencing them.

We also need to acknowledge that investing in the societal issues that contribute to mental distress may be more productive than simply developing more services. Renowned social worker Barbara Wooten once said: ‘It is easier to build a clinic that re-develop a slum’, suggesting that developing services without addressing origins is somewhat futile.

Of course, we need to develop our primary care services where mental distress can be identified early and given the support necessary to meet the person's needs at the time. But we also need to address the societal issues such as the exorbitant pressure and expectation culture that exist in the Leaving Cert points race, and the unregulated culture of social media use. And we need to examine how we can best respond to the management of bullying and exclusion and address the alcohol use culture in Irish teens.

These are issues that are significantly contributing to our mental health crisis and we may need more creative solutions than creating additional psychiatric services or promoting new wellness strategies.