“I wake in the morning feeling down and not wanting to go to work.”

“I feel sad and disorientated after the death of a parent.”

“I have just started university and I feel anxious.”

Do these statements suggest a mental health issue?  Surely not, unless the problems become so serious that they severely effect the person’s life. Each of these examples could be considered an understandable, entirely predictable and ‘normal’ response to a stressful life event or even a stressful day; albeit distressing for the person. Of course, if they are refusing to go to work, or so disorientated by grief that they cannot function, or so anxious that they will not leave their room, we would have cause to worry and may well advise them to seek help.

This seems straightforward; however, complications may arise if the person starts to interpret the ‘symptoms’ as indications of a mental health disorder. Perhaps, because of previous experience or something they have read, the morning symptoms and the feelings of grief become signs of depression, the worried student has an ‘anxiety disorder’. The entirely human responses become a medical problem to be ‘treated’.

The discipline of health psychology developed the concept of ‘symptom perception’; the process through which we interpret the physical and psychological sensations that pass through us all the time. What if we are unwittingly encouraging, young people particularly, to interpret their experiences as mental health problems when they are within the range of normal human experience? Although recognising all the good work to challenge stigma, we wonder if it has led to an unexpected and unanticipated result, the interpretation of normal human feelings as a mental health problem.

If our concerns are valid, this may lead to four problems:

1. The tendency to ‘medicalise the human’ may create dependence on professional help and perhaps maintain a focus on the problem rather than on the social networks and resources that can help us through difficult times.
2. The use of medical terminology, whether medically or individually attributed, may have the effect of erasing the complexity of the person’s experience. An individual’s story often contains clues to how to address their problem. Reducing it to a diagnosis or label may obscure this, leaving the person feeling powerless to connect with their identity and change their life. You have to know yourself to care for yourself.
3. There is a risk that using psychiatric terminology may devalue the experience of those with very serious and distressing mental health problems. Severe depression or anxiety can be disabling and terrifying and require intensive help. There is a danger of conflating these with what are part of ‘normal’ human experience leading to the dismissal of these mental health states as ‘low level’.
4. If human distress is framed as a mental health problem, then the social and economic causes that may well have contributed to it are masked. Mental health becomes the problem not inequality, poverty, poor housing or even a lack of human connection.

A recent article by Helen Guldberg sounds this warning in relation to schools:

…by exaggerating the prevalence of mental disorders those who really do need help, who suffer from debilitating emotional or behavioural disorders, are increasingly losing out. If already sparse Child and Adolescent Mental Health Services (CAMHS) resources are diverted from more targeted intervention to an ever-increasing proportion of children, those children whose levels of difficulties substantially restrict their capacity to function socially may suffer further. https://schoolsweek.co.uk/stop-talking-about-a-mental-health-crisis-in-schools/)

While we do recognise the enormous value of the anti-stigma work carried out by Time to Change, Heads Together and others; in this piece we are, tentatively, wondering if the use of ‘mental health’ as a catch-all for the disruptions of human life may lead to problems which adversely impact on a person’s ability to navigate through the inevitable difficulties of living. We wonder if it is time to reflect and rebalance these perceptions and if this is a crucial part of addressing our current mental health crisis. In York, system partners across sectors have committed to a strategy and vision which will help us focus on the wider determinants of wellbeing and health and connect our city to explore the strengths we have in communities to keep us well.

Opinion piece by:
Jennie Cox, Senior Local Area Coordinator, City of York Council.
Sheila Fletcher, Commissioning – Mental Health and Vulnerable Adults, Vale of York CCG.
Dr Nick Rowe, Director of Converge, York St John University.
Dr Helen Ward, GP Registrar