In the last few years, the delicate subject of mental health has become a battleground in the culture wars. The reaction to the Duchess of Sussex’s recent claims that her poor state of mind was ignored by the Royal Family reflects the division. Has mental health become a calling card for an attention-seeking, over-emotional youth? Or are sufferers still stigmatised and brushed off when they present their genuine mental distress to authority figures?
The provocative title of Lucy Foulkes’s Losing Our Minds: What Mental Illness Really Is—and What It Isn’t, suggests she has taken a sceptical stance. But in fact this is a broad and refreshingly non-political survey of mental health and how we talk about it. Though she offers no easy answers, her grounding in academic psychology as a UCL lecturer and personal empathy for those afflicted (she suffered from depression in her early twenties) highlight several difficult truths about the reality of mental illness.
Foulkes describes how in a short space of time society has become very aware of mental illness and its associated language, not least because of various charity campaigns and the openness of celebrities. But with this generally positive development, Foulkes argues, the language of mental health has become somewhat diluted.
Foulkes carefully lays out what we know about the prevalence of mental illness. Some of her findings are surprising. Yes, mental disorders are on the rise, but among adolescents (the “snowflake generation”) the rate is only slightly up. Some specific indicators are more worrying: the proportion of females aged 16-24 who have self-harmed increased from 6.5 per cent in 2000 to 19.7 per cent in 2014. But the overall UK suicide rate increased only slightly from 2018 to 2019 after five years of decline.
The difficulty in diagnosing mental illness is that its symptoms almost always exist on a continuum with normal behaviours, yet “depression” is still a technical term rather than the vague feeling of being down. The determinants of illness are chronicity, severity, disruption (to daily life) and control (how a person is able to manage their symptoms).
One thing that has changed is a broadening of the circumstances when these determinants are thought to indicate a mental disorder. Take “trauma.” Previously it was understood to develop after exposure to an incident like a serious accident or violent crime; now, it can mean indirect exposure to such an incident. This flattening led one study to find that a quarter of one group of American college students had “probable PTSD” regarding the election of Donald Trump. Foulkes in this case blames the researchers rather than the students for looking for PTSD in what, for most Americans at least, was a stressful but non-traumatic presidency.
Jonathan Haidt and Greg Lukianoff’s The Coddling of the American Mind, which drew upon the research of Jean Twenge’s book iGen, partially blamed depression and anxiety among modern adolescents on screen time and social media. Foulkes is sceptical. Twenge’s data was not assessed over time, and British studies which have taken this approach find only a small link.
Still, there is greater evidence to suggest that those who use social media sites like Instagram do suffer from an increase in “self-objectification” (the extent to which your self-worth relies on body and appearance). And for those who are already suffering from mental distress, the dark corners of the internet can serve as a distorting mirror to exacerbate their troubles. But Foulkes reminds us that an obsession with the internet forgets what mental illness actually is: a network of predispositions and environmental factors which interact to produce a particular condition. While the internet may amplify these factors, it is very difficult to ascertain what would have happened had these young people not spent so much time online.
New technologies have always been suspected of leading to mental distress—in the 19th century “neurasthenia,” a kind of mental distress, was originally linked to industrialisation, the invention of offset printing and the railways. What is more, it is easy to forget the positive social interactions that the internet can stimulate.
Unlike Haidt and Lukianoff, or their 19th-century predecessors, Foulkes is not interested in grand generational diagnoses. She argues that while everyone may suffer from the symptoms of mental distress, only a minority experience mental illness. This leads to her nuanced conclusion that we are “overdiagnosing mental illness, coating too many types of distress in psychiatric language, but the confusing thing is that we are also underdiagnosing some cases.”
She ends the book with a call for better treatment of mental illness at a clinical level, through a combination of antidepressants and therapy. But these services are underfunded. So she also sees it as the responsibility of everyone to look after each other (and themselves) by actively listening to those under stress, as well as finding time for sleep, exercise and relaxation.
Foulkes’s message is a cry for nuance and complexity. As she writes, “all forms of psychological distress are the price we pay for being alive.” While those who are seriously unwell have a right to professional attention, for the rest of us, an awareness of this truth may be just the treatment we need.
