‘A Mental Problem!’ by Abheepsita Purkayastha (YIF’20)

It was a cold January afternoon and the hands of the clock seemed more sluggish than usual—it had been about ten minutes since the start of the lecture but it felt like an eternity. The dampness of the classroom made it even more unconducive to intellectual activity—yet my professor of research methods tried diligently to keep a firm grip on the class’s attention. I was particularly distracted that day—I had debate practice in half an hour, but the class was scheduled to go on for another hour. I had requested to be excused from debate practice too many times in the past and could not muster the courage to do this another time. I felt fidgety and kept unlocking my phone to see if my teammates had arrived for practice. The 12th NUJS Parliamentary Debate was in three days and no amount of practice would have been enough for one of Asia’s largest parliamentary debate tournaments that would see stalwarts coming from across the continent.

It was 2:48 pm and there was still no news from my second teammate. That day was our last day of practice, and missing it could prove to be detrimental to our performance in the tournament. At 2:53 pm my phone buzzed with a message from my teammate who wrote, “Guys, I’m having a bad mental health day today and don’t think I can make it for practice. Just not in the headspace to meet people right now. Can we reschedule this to tomorrow?” This was my second year of college and I hadn’t heard of anything like ‘bad mental health day’ before—in fact, the phrase ‘mental health’ was relatively new to me. I had frequently heard of phrases like ‘mental illness’, ‘psychological problems’, and ‘mental disorders’ in high school psychology classes but all of those were phenomena that required clinical intervention and those afflicted with them were generally referred to as ‘patients’. But the feeling that my friend described did not quite seem like something that required her to visit a doctor or be called a ‘patient’—what was it then? What does ‘mental health’ mean? In retrospect, this may seem ignorant and insensitive, but the 21-year old me was new to this term. I later found out that most of my friends too had learnt of this phrase very recently. Why had this phrase not entered our vocabulary in 21 years? Could it be a relatively new coinage then?

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According to the World Health Organisation’s Expert Committee on Mental Health, “mental health is a condition, subject to fluctuations due to biological and social factors, which enables the individual to achieve a satisfactory synthesis of his own potentially conflicting, instinctive drives; to form and maintain harmonious relations with others, and to participate in constructive changes in his social and physical environment” (Bertolote). Let’s break this rather complicated definition down. The mental health of a person is not constant—it changes due to social, temporal, and biological factors, and it is these changes that help an individual to attain a sense of balance among their conflicting feelings and maintain harmonious relations with those around them. It is not unusual to experience contradictory emotions, for different emotions, though distinct from one another in theory, are in their manifestation, fluid phenomena that cannot be contained in clear and discernible categories. For instance, while happiness and dejection may theoretically seem like opposing emotions that cannot be felt simultaneously by an individual, it isn’t hard for us to recall times when we have felt happy and content, but at the same time experienced a nagging sense of dejection and hopelessness. However, often when these contradictory feelings become perpetual, individuals find it difficult to effectively adjust and respond to their social and physical environment.

The reason the phrase ‘mental health’ had arrived relatively late in my vocabulary was that the phrase entered the English lexicon only in the late 1940s and even then, phrases like ‘bad mental health’ were used strictly to refer to illnesses of the mind that could be diagnosed, identified, and cured. The term ‘mental health’ was not used explicitly until 1946 when a Mental Health Association was established in London by the World Health Organisation. Before the twentieth century, a widely prevalent concept was that of ‘mental hygiene’ (Bertolote), which went on to become a movement concerned with enhancing the methods of care for those with mental disorders. This understanding of mental hygiene started as one which was related to the specific domain of psychiatry—mental ill-health could be alleviated and ‘cured’ by adopting specific preventive measures. The latter half of the 20th century, however, saw a swift shift in the discourse around ‘mental health’—individuals and psychiatric associations asserted that conversations around mental health needed to be distanced from hospitals and instead placed in communities; that is, preventive measures could not just be restricted to individuals but extended to the community at large. Instead of merely ‘treating’ those afflicted with mental disorders, it was imperative to empower the community in a way that aided their healing—policies needed to be created to break down the existing stigma and discrimination faced by those diagnosed with a poor mental state. Despite bouts of activism to normalise it, conversations around mental health remained stigmatised, primarily because the phrase’s association with medical set-ups could not be broken. This disassociation was perhaps hard to attain because, by the 1970s, most aspects of human life had become (over)medicalised—most human problems had entered ‘the jurisdiction of the medical profession’ (Conrad), and this had created the compelling need to define everything to a T – a person and their behaviour. Peter Conrad in his essay “Medicalization and Social Control” uses Max Weber’s concept of ‘rationalisation’ to argue that this shift to medicalisation was primarily caused by society moving further away from religion, the mysterious, and the unexplained. Interestingly, however, medicalisation of life was a phenomenon restricted mostly to the Western part of the world. Even as late as the mid-twentieth century, medicalisation had made only very minor dents in the common understanding of mental illness in most parts of the world. The majority of people continued to associate mental illnesses with the supernatural—oscillations in emotions were attributed to ‘possession by evil or demonic spirits, displeasure of gods, eclipses, planetary gravitation, curses, and sin’ (Farreras). Irrespective of whether mental health was medicalised or linked with the mystical and supernatural, it remained taboo.

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As opposed to the 20th century, the use of terms related to fluctuating mental health conditions were far less stigmatised in the 21st century and therefore used relatively frequently— albeit, often even flippantly. While the uninhibited use of such terms has helped destigmatise conversations around mental ill health, their sudden entry into the popular culture lexicon has led to several contradictory opinions within the mental health discourse. To understand the evolution of the discourse on mental health, we must explore the arguments put forward by those that have contributed to it. 

A section of people argues that the phrase ‘bad mental health’ must be understood as a spectrum ranging from simply ‘feeling bad’ to having a mental disorder/illness that requires medical intervention. In order for terms associated with mental health to be destigmatised and normalised, it needed to be reclaimed and used even in cases that did not necessarily qualify as an ‘illness’. Restricting the usage of this term to only cases that were ratified by a medical practitioner as one which needed curing, could potentially lead to pathologising the state and thereby stigmatising it further. 

This section argues that it is all right to use terms such as ‘depression’ and ‘anxiety’ in cases of momentary fluctuations in feelings that may lead to temporary imbalance and hinder functioning. That is, it is all right for an individual to say they are feeling ‘depressed’ when they are experiencing a fleeting moment of sadness. Poor mental well-being does not necessarily have to be diagnosed and labelled by a trained doctor for it to qualify as a valid issue and therefore be termed “bad mental health”. In fact, this branch of critique asserts that the very act of defining human beings and their mental illnesses is a show of power at play. Definitions are used to label individuals and segregate them into categories—medical terms are used to give legitimacy to some social norms and behaviour, and deviating from these norms are labelled as “abnormal’ and therefore in need of treatment. For instance, medical fraternities in several countries across the world continue to use the language of medicine to justify the view that conditions like homosexuality, transsexuality and hyperactivity are psychological aberrations that need healing. Labelling is therefore used as a potent tool to create the very foundation of institutions such as the asylum, as discussed by Michel Foucault in his seminal work Madness and Civilization. Individuals labelled and medically confirmed as being ‘mentally ill’ internalise their illness, accept that they are social deviants, and succumb to the medical surveillance that is administered to ‘rectify’ them. 

In my opinion, labelling and classifying individuals into categories that describe their mental state also reduces the individual to their mental illness. It denies them the right to view themselves as capable individuals who can live independently, creatively, and with dignity. The most immediate example of an individual who was doomed to being reduced to her mental illness is Virginia Woolf—throughout her literary career and long after her demise, her works were blemished with the term ‘manic depressive’. Ever since her diagnosis, it was almost as if critics, readers, and well-wishers had banished from their memory the erstwhile image of a Woolf pre-diagnosis. Authors Susan M. Kenney and Edwin J. Kenney, Jr in their essay “Virginia Woolf and the Art of Madness” point out how soon after her diagnosis, the lens with which Woolf’s life and literary works were viewed, was one of ‘madness’—the dominant image of her that emerges is of a ‘frail, pathetic invalid’ (Kenney and Kenney 162). The label ‘manic-depressive’ invisibilised the potential Woolf had to channelise, if not control her depression; though her mental distress occasionally debilitated her, she had the unique power to use it to cultivate her creative genius. As opposed to what was popularly conceived, Woolf was not a perpetual victim of her mental state—she had unique coping mechanisms, and fiction was the most potent of them. While having words that can give meaning to one’s feelings may feel empowering to some, there are some others who don’t find the language of diagnosis empowering. To the latter, labelling reduces them to powerless entities who constantly need assistance, a cure, and someone to control them.

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Another section of the mental health discourse argues that casually using terms related to poor mental well-being greatly undermines the severity of symptoms experienced by those who live with that condition. This is not to invalidate the realness of the feelings of imbalance that are felt in passing; proponents of this section push for creating a community that is more mindful of the impact words have on people. Frivolously using terms that describe mental illnesses, to refer to minor lapses in mood, does a grave disservice to those dealing with mental health disorders for it seems to them a trivialisation of the crippling feelings they face on a regular basis. As someone who was diagnosed with obsessive-compulsive disorder, depression, and anxiety, I often find myself feeling extremely uncomfortable when people around me unmindfully say things like, “I’m so OCD when it comes to keeping my desk clean,” or, “Can you straighten the painting on the wall; it’s making my OCD go wild!” It seems to me almost bizarre that the term has gone on to signify a particularness with cleanliness or being a ‘neat-freak’ as it is popularly called. I have for a long time experienced and continue to experience intrusive thoughts which often cause me to obsessively repeat certain actions like washing my hands and feet, counting from one to five, arranging and rearranging things around me when I feel anxious, etc. For me, the disorder also includes sexually intrusive thoughts, irrational fears, fear of doing harm to others, and having harm inflicted upon me. These thoughts often manifest in disturbing dreams which, on waking up, cause further discomfort and compel me to think about it all day and hence come back in my dream the next day again, and the cycle goes on and on and on …

“If you say kangaroo enough times, it stops being a furry animal with a pouch and becomes a sound” (Ewens), and such has been the case with words related to mental health disorders. They have for so long been used in casual conversation to refer to mild to moderate emotions, that the words have almost become diluted. Ewens, in this context, talks about ‘semantic satiation’—the study of repetition or “the psychological phenomenon in which the echoing of a word causes it to lose all meaning” (Ewens). She argues that for far too long words like ‘OCD’, ‘bipolar’, ‘depressed’, etc. have been used in contexts other than those of mental disorders and further added onto disorders being misunderstood and illness normalised. Ewens further argues that this rapidly increasing trend of decontextualising words related to mental illnesses leads to “either a total disconnect between language and meaning or a troubling symptom of self-diagnosis culture”. She elucidates this claim in her article, by citing Dr Zsófia Demjén, an expert in applied linguistics who studies the intersections of language, health, and mind, who asks, “How does someone who actually has depression describe his or her illness or how he or she feels? How can people differentiate the much more complex, much more intense thing they have from this thing everyone always claims ownership of?”

The social implications of such usage are several. Many argue that this collective flippancy reflects the pervasive ableist culture that appropriates terms that the mental health community attributes pathos to—words that carry extreme psychological, emotional, and social baggage for individuals struggling with ‘bad mental health’. What is interesting, is that terms related to physical illnesses aren’t used as throwaways— one wouldn’t casually use cancer to describe a feeling of transient laziness or weakness. But the invisibility of mental illness allows people to conflate anything and everything with it. This carefreeness in usage is aggravated by social media and its devouring meme culture that oversimplifies, trivialises, and makes a mockery of even the most serious things. While a positive change in the mental health discourse has been noticed, with individuals with mental illnesses coming out on social media and making jokes at the expense of their illness, it has also facilitated the trend of nonchalantly using terms like ‘anxious’, ‘retarded’, ‘manic’, etc. by those who are, say merely tired of studying for an upcoming examination or a snarky boss at work. 

We live at a time where fads start and end at a rapid pace and words take no time to enter and leave our vocabulary. Owing to social media and its ability to reach even the farthest corners of the world, language acquires new meanings and words enter our daily parlance with such swiftness that we do not even realise it. Words that once had pejorative connotations to them, can now mean something completely different and maybe even empower some. Therefore, there is nothing inherently wrong with the evolution of words. However, some words come with meanings that one community of relatively disadvantaged people attributes immense power and importance to, and when these words are appropriated by those who are relatively advantaged, the words become liberating and convenient for one but oppressive and tragic for another. But how do we determine if someone is appropriating these words or using them flippantly? Given that mental health constitutes a wide range of feelings and the validity of a fluctuating feeling is not contingent upon its degree, it is not only harsh but also insensitive to argue that someone’s momentary fluctuations are not intense enough for them to use certain words to describe their feelings. What is the solution to this lexical conundrum then?

To put it simply, we must exercise mindfulness when using words that may generate anguish in another. Just like the human mind and matters related to it, the discourse around mental health is intensely complex, nuanced, and for some, even personal. In my view, the very act of choosing one side of the discourse and dismissing the other defeats the very essence of the mental health movement that upholds consciousness, empathy, and sensitivity.