Towards a Better Understanding of Anxiety and Depression
Mental Health Week 2014 has now been and gone, and there has been a tremendous amount of support for the cause from many institutions. This has been phenomenal to observe, and I really hope a lot of people have been motivated to seek help or to ask friends, family members, or strangers if they need support.
Although the awareness and encouragement that has grown out of this movement is incredibly positive, a word has been used an awful lot that leaves me feeling more and more uncomfortable each time I hear it. The word is ‘illness’.
Anxiety and depression are the main focuses of most of the Mental Health Week dialogue, and I’d like to talk about the problems associated with using the word ‘illness’ to describe these problems. But before I do, I want to make it clear that I do not think anxiety, depression, or indeed any mental health issues are invalid concepts. Undoubtedly there are some mental health problems that can benefit from being conceptualised as illnesses, but I do not believe these include the majority of cases of clinical anxiety or depression. There are far more helpful ways of conceptualising these problems.
The ‘illness’-focussed coverage we’ve seen during Mental Health Week has been a strong reminder that we are still using a medical model to understand mental health. This model emphasises the treatment of dysfunction (or ‘illness’ as the model forces us to use the concept) through utilisation of external resources, such as doctors, psychologists, and counsellors. Before this model we’ve historically used many others, including the character-weakness model (i.e. anxiety and depression are just ‘in your head’ and are ultimately reflections of laziness), the moral-weakness model (i.e. you are having these problems because you are immoral and not living your life correctly), and, even earlier, the possession model (i.e. these problems stem from demonic or spiritual forces). The big advantage of the medical model over these archaic concepts is the relocation of blame. Under the medical model mental health problems are illnesses that someone is either born with or develops through forces that are largely outside of their control. This can be tremendously powerful for someone who hates him or herself for having anxiety or depression. All of a sudden they are told that their experiences are just symptoms of a disease, so they can rally their forces against this externalised threat. They are no longer an anxious person, they are now a person with anxiety.
As implied, however, there are some big drawbacks to this sort of conceptualisation of anxiety and depression.
Firstly, treatment is approached in a purely medical way, which we know from research has mixed results. Secondly, people can fall into the trap of labelling themselves with a diagnosis, which can become sort of like a self-fulfilling prophecy. Thirdly, people can be stigmatised by a diagnosis and this can have major impacts on their quality of life. For example, a recent study found that 2 in 5 Australian employers would not hire someone with a ‘mental illness’. Imagine how this would impact the mental health of an already depressed jobseeker.
And finally, and most importantly of all, feelings of anxiety and depression are normal and everyone experiences them to different degrees. When statistics are quoted like “1 in 4 Australians have anxiety” it can seem like anxiety is a selective disease, but what it really means is “1 in 4 Australians have had anxiety at some point that is so bad that it causes them enough distress to warrant significant external support, while the other 75% of Australians experience anxiety but have not been unlucky enough for it to be disabling, yet”. It’s a little bit of a mouthful, but it avoids labelling and stigmatising, and it acknowledges that anybody can experience anxiety.
Feelings of anxiety and depression are normal experiences and, at controllable levels, can even be useful. In a well-functioning person, treating these feelings like symptoms is unhealthy and can even lead to development of the feared disorders. For example, imagine that you are distressed by anxious thoughts. Every time you have an anxious thought, you beat yourself up about it and you anxiously avoid any situations that could lead to more anxious thoughts. This is the core of Generalised Anxiety Disorder. In another example, you could have a sad, depressive thought. You think to yourself, “only sad, depressed people have these thoughts. That means I’m sad and depressed. That’s bad, and that makes me a bad person.” Now there is nothing stopping you from having more self-hating depressive thoughts and feelings about all sorts of things, including the fact that you are having self-hating depressive thoughts. This may ultimately lead to a Major Depressive Episode. The more we think of anxiety and depression as concretely being symptoms of an illness, the more we lead ourselves into these traps that perpetuate mental health problems.
I know there may be people reading this who have been diagnosed with anxiety or depression and who have found solace and support in the illness model. I want to make it clear that I am not arguing against you or invalidating your experience. As someone who has studied and worked in the field of mental health, I want to look forward to a brighter future when we don’t have to use the word ‘illness’ to understand anxiety or depression. Wouldn't it be nice for our society to get to a point where we don't need to use the word. Where people understand the full range of psychological functioning, from languishing to flourishing. Where we are no longer dragging people out of the character-weakness model of mental health into the medical model, and we can instead help people transfer their understanding of anxiety and depression from a medical model into a psychological model. Where they understand that people who need help aren't weak and sick, they're just caught in a vicious cycle and they need someone outside of the cycle to help them through it. Where people don't need to use the analogy of physical illness to understand their own or others' problems in a non-stigmatising, empowering way. I wonder when that will be.