When I went through my first episode of anxiety, all I could think about was fixing myself. I was obsessed with the idea that something was wrong with me, and it was not until much later that I realized this feeling was what was keeping me stuck. Many people suffering from mental health crises share this problem of self-doubt and self-criticism, through which detrimental states of mind sustain themselves. But what is the root of such personal dissatisfaction? How does our discourse and narrative surrounding mental health contribute to this self-destructive frame of mind?
The stigma surrounding mental health crises is slowly fading. These days, mental health disorders are more often classified as biological or chemical conditions as opposed to personal failings. This shift represents society moving away from the idea that mental illness should be overcome through force of will and encourages attending to emotional problems instead of repressing them. Certainly our changing societal conceptions around mental health represents progress in some form, but the emerging narrative is not without its shortcomings.
Our new approach suggests that mental health crises are caused by an imbalance in brain chemistry and that they are in a sense incidental, implying that they are not caused by the sufferer’s actions. This narrative is designed in part to prevent people from blaming themselves for their mental health issues, but it nevertheless still frames a mental health crisis as a problem to be fixed. Approaching most emotional issues as nothing but impediments to our lives still leads to the self-criticism that is damaging and counter to a sense of well-being. To evaluate whether there is a better way to conceive of mental health problems that avoids this, let’s first take a look at how mental health crises work.
I can only speak to my experience with anxiety, but as I understand it, there are basic similarities between all anxious episodes, and there is considerable overlap with depression as well. The nature of an episode of anxiety or depression as I see it is the inability to control our emotions and recurring thought patterns. Someone who has not gone through a mental health crisis may wonder how thoughts and feelings could ever become uncontrollable, and the answer, quite simply, is habit. Thought loops don’t begin as debilitating, but if we circle within a particular train of thought, we cannot easily remember any other way to think after enough time has passed. At this point, it can become extremely hard to break the cycle of thoughts and feelings that feed on each other, and intensive therapy and medication is needed to retrain our brains.
The reason we get trapped in these cycles is fear. Fear acts as a trigger — when it arises, we spiral into unwanted thought loops as an automatic and misguided attempt to alleviate it. Clearly fear can come from any number of different places, but an almost universal source of fear is the notion that we are somehow not good enough — a thought intimately tied to societal expectations. This means the ethics of a society can have a direct impact on perpetuating mental health crises, and in the case of our society, the foremost social expectation is continual productivity in the market.
In America, most people only take their mental and emotional health seriously when it begins interfering with what is considered to be “valued work,” and our notion of value is conceived rather narrowly. “Hustle culture” defines grinding and economic success as paramount, and as such, the most productive activities are generally considered to be those that have a direct or indirect impact on our economic output. But this calls into question activities like exercising or socializing, which are considered productive even though they aren’t economically valuable at first glance. In general, activities considered to be “healthy,” like exercise, are seen as more productive than unhealthy ones, like watching TV. Regardless of the increasing weight put on “self-care,” it is still undoubtedly seen as secondary to one’s work and contribution to the economy.
This should not come as a surprise, but what is perhaps surprising is why healthy activities are seen as productive at all, although admittedly less so than work. In following market logic, we see that healthy activities are considered productive not because of any intrinsic value placed on health, but only because they ensure our continued ability to work. This has huge implications for our mental health.
In the event of a mental health crisis, we become essentially unable to focus on work. The common wisdom is that in order to feel better, it’s important to fill the void with other productive activities, such as socializing and exercising. These activities considerably improve peoples’ mood and outlook, with qualitative as well as quantitative evidence showing measured increases in serotonin and dopamine, neurotransmitters closely associated with mental well-being. While diet, exercise, sleep, and socializing undeniably help with mental health, they are not a silver bullet. Even with these strategies, many still feel overwhelmingly anxious and depressed, due in part, as previously discussed, to fear-induced cycles of self-critical thought. In fact, one reason why diet, exercise, and socializing are recommended is because they are known to improve self-image.
But very rarely does anyone ask why these activities make us feel good about ourselves. I would argue that in our society, it is not so much the intrinsic qualities of these activities that leads to self-confidence, but instead their connection to our ingrained market-based ethic. As I have shown, “healthy” activities are considered productive because they aid one’s ability to work, which must come first according to our society’s values. Because we are implanted with the idea that we are only valuable if we are working, it doesn’t make sense for doctors to ask people suffering from emotional problems to put health first and work second.
So, if pursuing healthy activities won’t help mental health, then what will? The answer is, increasingly, medication. Mental healthcare has become enfolded into the umbrella of Western medicine and is increasingly being addressed with diagnoses and medication, just like other health problems. This comes with some advantages, including a growing availability of treatment and a forthcoming social acceptance of it.
But framing emotional problems medically also comes with its own generally close-minded attitude and an unwillingness to acknowledge alternative treatments, such as talk therapy or other forms of holistic healing. Psychiatry, far from a holistic practice, has instead become cold and calculated; it’s an analytical science that identifies symptoms, classifies people into boxes, and prescribes medication designed to address those symptoms instead of trying to solve problems at their source. Psychological problems often have their root in a traumatic experience, unresolved fear, or a misunderstanding of one’s own feelings, and these issues cannot be resolved simply by addressing the anxiety or depression they may cause. In fact, even though the administration of psychiatric drugs has increased significantly over the last twenty years, the prevalence of mental health disorders has not.
As opposed to psychiatry, which involves scarcely more than taking a tiny pill each morning, talk therapy oftentimes requires intensely painful and prolonged emotional work. Therefore, when people weigh their options, committing to therapy understandably seems like an onerous prospect because of its high costs — many who want therapy are unable to afford it, and even for those who can, it represents a huge investment of time and attention.
This brings us back to the idea that in our society, productivity and mental well-being are at odds. Although therapy is designed to help us find the root of our problems and ultimately become happier and more fulfilled, it’s hard to be working a job when you must at the same time be doing the exhausting emotional labor that therapy entails. As a result, the system does not make room for it. In the mainstream, emotional growth is not a valued economic activity, and it is therefore highly preferable for people to use medication to curb emotional issues or to simply do nothing at all.
I am not advocating for the dismantling of the structures we have built to help people who are suffering from mental health crises. Psychiatry has its shortcomings, but its straightforward approach can nevertheless be a source of great comfort for people. For me, it was an immense relief to know that a licensed professional was addressing my issue using clinically proven methods, and that my condition was essentially guaranteed to improve. Up until I had sought psychiatric treatment, I was relying wholly on myself to fix what I had identified as an emergent fatal flaw, and psychiatry took some of the responsibility of “repairing” myself out of my hands. Since being on medication I’ve achieved more control over my mind, and as a result talk therapy has become an effective tool for making more holistic emotional progress. For this reason, psychiatry should be seen as just one of many useful tools in combating mental illness, as opposed to both the start and end of treatment.
However, it is evident that in order to truly improve our collective mental health, expectations about how to be a member of society must change. This goes deeper than just eliminating the stigma around mental health crises or medication. Even if people are becoming okay with the idea of being in a mental health crisis (due in part to the shift in narrative), they are still not okay with the consequences of it — the loss of conventional productivity. We must ease the expectation of universal and sustained economic productivity that drives people to hate themselves en masse. We need to change the way we define value. People must be made to feel okay with taking time for themselves and using time as they wish.
This means dismantling the idea of work as the end-all be-all of life. It may be a tired sentiment, but we should be working to live, not living to work.
In my own case, the pressure I put on myself to meet expectations was what fueled my mental health crisis. The event that initiated my anxious episode eventually became irrelevant, as the anxiety became entirely self-perpetuating — I was afraid of the fear itself, and stuck on the idea that the fear would keep me from ever being valuable again. It is far too easy for people to feel like they are broken in this world. The truth is that there is no way for a person to be broken — there is no wrong way for a person to be.