Mental Health is Invisible

Why is mental health so hard to talk about?

Despite progress and insights gained in the fields of cognitive- and neuroscience, the mainstreaming of practices like mindfulness, and the explosion of various brands of self-help and self-care, from bookstore shelves to TED Talk stages, mental health problems remain stigmatised. Deloitte’s 2020 report on mental health in the workplace cited survey findings that less than half of people are comfortable talking to their line manager about their mental health; another study said 82% of people who have a diagnosed mental health problem keep this information a secret from management. Nobody questions whether going to the gym regularly is a good idea for everyone, but broadly speaking, going to therapy is still only for people who have “issues”.  

I know there are cultural and gender-related norms and standards around how we seek support, how we display and deal with emotion, and generally how we show up as individuals and members of our communities, not to mention questions about resources. But structural and social acceptability concerns aside, and to take a more individual and philosophical perspective, it occurred to be that maybe one of the reasons mental health is so hard to talk about, let alone deal with, is that it’s mostly almost invisible to us. That is, not only is it not spoken about at a social and societal level, it’s often not even really noticed at an individual level.

Our mental problems are less visible to us than our other physical problems precisely because we’re in them. And you can’t treat what you can’t see.

Think of how we orient ourselves towards our own bodies. The head, ergo the mind (for we assume that’s where the mind, and hence “mission control”, lives), is proximal; the rest of the body is distal. Our ankles are further away from “us” than our shoulders. So, a fractured wrist or lower back pain or high blood pressure is something we have, whereas depression or anxiety is something we are. We operate from within our mind; therefore, if there’s something wrong with it, it’s a little harder to see because it’s so up-close. So close, you might almost say it’s behind us or “under the bonnet”, while “we” are in the driver’s seat. Or at least, that’s the way it seems.  

In short, when it comes to our minds and our thoughts, we don’t look at them, we look from them.  

As one analogy, consider this story. Two young fish are swimming along one day and they pass an older fish who greets them with: “Morning boys! How’s the water?” They nod politely and continue on their way, until the one turns to the other and says: “What the hell is water?” The author David Foster Wallace used this in his 2005 Commencement Address at Kenyon College (see a great animation of it here); his key message was that we need to become aware of what he called our “default setting” – the illusion that we (each one of us) are the centre of the universe – and then, having had this realisation, begin to actively choose how we see the world, rather than continue to run our programs of well-worn narratives, assumptions and biases.

Another analogy, used by neurologist Sam Harris, is that of a windowpane or even the lenses on a pair of glasses. You look through the clear glass to see the world outside, but occasionally your focus might shift and you see the glass itself. You might only be prompted to do this if there’s something obstructing your view, like a smudge or a crack. Or you might even catch a glimpse of yourself reflected back from the glass when the world outside is dark. But until those obstructions appear, you may not realise the glass is there at all.

What is this a metaphor for? The windowpane is our mind, our thoughts. Seeing the glass – seeing what you’re looking through – is conscious awareness. Our first problem, by implication, is that we don’t realise we’re thinking at all. We don’t even realise we have a mind: we are our minds. No wonder, when it comes to mental health, we can’t see the wood for the trees, or the glass we’re seeing through, or the water we’re swimming in.

What are we working on when we work on mental health?

If you have a leg injury, you can go to one of several specialists (physio, biokineticist, radiologist, orthopedic surgeon) to get a diagnosis. They ask you about your symptoms, they make assessments and observations, and you get a treatment plan (rehabilitation, exercises or surgery). They can tell you whether it’s worked or not, and more importantly, you can tell if it’s worked or not.

If you have a mental health problem, you can also go to one of several specialists (a GP, psychologist, psychiatrist, or even neurologist) to get a diagnosis. They ask about symptoms, they offer treatment, but do they make observations? Usually not. The diagnosis is normally based on self-reported symptoms and behaviours – unless you get a brain scan. But then the assumption is that the organ you’re dealing with, at the centre of any mental health problem, is the brain. And the question is: is this true? Brain scans are admittedly rare, but in any case: when they prescribe treatment, is it working on the brain or on the mind, and what is the difference?

“Where is my mind?”

The Pixies

Where is your mind? Is this the same question as “Where is your brain”? More importantly, is it the same as “Where is your consciousness?” Or even “where are you?”? For those interested in joining me further down this ontological rabbit hole, in future posts* I will go into the origins of this illusion that we are our minds, and reflections on what the mind and the self even mean.

For now, though, I think one practical question is this: Is it helpful to be able to almost dissociate from our brains and minds and treat them more like things we have – much the same way as we think of other body parts? Is this kinder on ourselves individually, and would it help us collectively to normalise mental health?  

These questions are not without further complications, because they invite us to consider whether we are in charge of our own minds, whether we are responsible for them, and even whether these are one and the same thing.

As a part-answer, or the start of one, here’s my story.

My story

I went through a depressive episode quite recently and, along with therapy, decided to try the drug route. The antidepressants worked (apparently I was lucky – some people have to try several types before finding one that does work), and because my circumstances subsequently changed, I’ve since been able to come off them. Question: Was it all because of me, or because of my circumstances?

If the pills worked, does it mean the problem was a chemical thing? A chemical thing in my head? If so, would that be “me” or “not me”?

I started this article by suggesting that we can’t easily identify our mental health problems because we’re so identified with our minds. But more accurately, when it comes down to it, it seems to me that we actually think we are above our own heads.

If we’re sitting back and ceding control to the doctors who are saying “Your brain chemistry is broken but don’t worry, we’ll fix it”, then there is a separate “Me” (ego, self, I) doing the watching and concluding that it’s the brain’s fault; hence, I (the thinker, the perceiver) am not responsible, I am cleared of blame. But what if this is just an illusion created by that brain to save face (as it were)? Because in that moment, even though in one sense I’m giving up control, I’m still retaining a sense of control in being able to hand my brain over.

Who’s the one saying: “Well, that didn’t work” or “Come on, you can do better than this” or “I’m sorry you felt this way, but don’t blame yourself, we’ll take better care from now on”? Who is the one who was suffering from depression and anxiety as a result of the brain’s misbehaving? Does the pain belong to somebody other than the body that produced it? Was my body suffering, or was “I” suffering?

An even scarier implication of all the above, of course, is that we’re not in control of our own brains or minds. What’s worse: being nothing more than a brain – a squishy puddle of grey matter; a bunch of “squirting chemicals”, in the words of roboticist Hans Morevec – or being above it, but out of control?

I believe we fabricate a sense of control by imagining a self that’s separate from the grey matter (and based on my research, which I’ll unpack in later posts, it’s not just me). A self that then takes ownership of the pain. A self that even takes ownership of externalities. Because here’s the thing: even if my depressive episode was entirely due to circumstances (and it’s likely that it was, at least in part, given that I now no longer need the pills), my mind still sees that as an indictment on me personally because I could have dealt with the situation differently, right? Put differently, am I better now, or just lucky right now?

Whether and how we take responsibility for and internalise the things that go wrong – be they internal or external, chemical or material, or both or indistinguishable – is, of course, part of the tangled mess of factors that make up mental health. They fall in the category of stuff that I’m not sure would show up on a brain scan, or what it might look like if it does, or even how it fits into this “black box” we call the mind. At the very least, these things may hopefully be experiences that we are able and willing to share.