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But thinking makes it so … Are we medicalising unhappiness?

4 Jun

happiness

Are we medicalising distress these days, as psychologist Dr Lucy Foulkes believes? In her book ‘Losing our minds: what mental illness really is and what it isn’t’, Foulkes argues that labelling a state of mind can be tantamount to pathologising it.   Tags can easily be internalised and become a badge of identity for the individual. ‘I’m a depressive.’ ‘I’m OCD.’ Our labels may come to define us, both to ourselves and to others.

Plain old grief is one of the examples cited by Foulkes. Most of us experience it at some point in our  lives. But it’s now set down as a mental illness. An emotion that arguably belongs to the better part of our human nature – our capacity to care for others and to miss them when they’re gone – is being  classed as an aberration, a problem (https://www.theguardian.com/commentisfree/2021/mar/29/conversation-mental-health-psychiatric-language-seriously-ill ).

Foulkes’ arguments make absolute sense to me. Encouraging people to think of themselves as mental invalids can’t possibly be healthy.

But there again, what about acceptance? It’s an important tenet of cognitive behavioural therapy, for example, that we acknowledge our anxiety and learn to accept it. We can flounder around thinking, Oh God, everything scares me, I’m totally useless. Or we can admit to ourselves that we’re anxious, and think of a few reasons why that might be happening to us. Acceptance creates a platform for coming to terms with the condition. Here, a label – identifying and naming the emotion – may actually be beneficial.

Confirmation that a bit of self-reflection might not go amiss in the fight against mental illness is provided by a ‘science of happiness’ course being taught at the University of Bristol. An academic appraisal of this course, the first of its kind in the UK, revealed that the first-year students who had taken it had significantly higher mental well-being than those in a control group (The Guardian, https://www.theguardian.com/education/2021/mar/24/bristol-university-happiness-course-students-found-to-be-more-upbeat ). The inference, that we can acquire happiness by studying it, is quite contrary to the advice offered by people like George Bernard Shaw, who believed that the key to a happy life is to be far too busy to even think about happiness (this blog, 9 January 2018).

Foulkes, I suspect, would say that all this is relative. ‘Everything we might think of as a “symptom” of mental disorder – worry, low mood, binge eating, delusions – actually exists on a continuum throughout the population. For each symptom, we vary in terms of how often we experience it, how severe it is, how easily we can control it, and how much distress it causes. In the terrain of mental health, there is no objective border to cross that delineates the territory of disorder.’

The boundaries are so blurry, she suggests,  that some psychologists argue that we shouldn’t use the terms “illness” or “disorder” at all, but instead view all these conditions as matters of degree. For some people of course seeking help for negative psychological experiences will be desperately important. ‘But the message misfires when it implies that all negative states are problems, health problems – and things that can and should be fixed. That’s not how life works.’

But there may well be points on the continuum where a label can be helpful. It’s a case of ‘nothing in excess’, as a wise Greek once wisely said. Or, as Foulkes writes,

‘Psychiatric labels provide meaning and legitimacy, but they can also be heavy and frightening, and can turn a fleeting problem into something bigger. Interpreting your low mood as a sign of depression, for example, can actually cause you to spiral into the very depression you’re worried about… Learning to view low mood as “just” that, rather than as a start of a new depressive episode, can help reduce risk of relapse.’

So we need to take unhappiness seriously, but we shouldn’t necessarily see it as a mental illness.