Some thoughts on our mental health crisis

Another interesting extended article in the Globe today, this one by British psychiatrist Sami Timimi, who specializes in treating children and teens. It seems to some extent to fly in the face of the conventional wisdom and zeitgeist on mental health.

Timimi seems skeptical of the reported levels of mental health problems in Western society, and particularly of the anecdotal reports and claims of individuals. It seems like everyone knows someone who has "mental health issues" these days, whether it be depression, anxiety, autism, ADHD, PTSD, or sometimes combinations of several of these. Like me, Mr. Timimi is questioning the validity of some of these claims, self-diagnoses and even professional diagnoses.

It's almost cool among young people (and their parents) these days to have a mental health condition or two. Even younger children (and certainly their parents) are well-versed in psychological lingo, and sprinkle their conversations with phrases like "the spectrum", "masking", "neurodiversity", "chemical imbalance", etc, with gay abandon. The ease of self-diagnosis using Dr. Google doesn't help, nor does the well-intentioned empathy and compassion about mental health in modern Western society.

Timimi sees this as evidence, not so much of psychological liberation and literacy, as of the tentacles of what he calls the Mental Health Industrial Complex worming its way into the minds of the masses. 

It seems indisputable that the prevalence of diagnosed conditions like depression, anxiety, autism and other mental health conditions, particularly in youth, has snowballed in recent years, and studies reveal a much greater number who see their mental health as "poor" or just "fair" compared to a few years ago. But, at the same time, investment in mental health treatment and research has also surged, and the stigmatization of mental health conditions reduced so mcuh that it is almost considered glamourous amongst some cohorts (like teenage girls). 

So, is the increased attention paid to mental health just not helping, or is it actually making things worse in some respects? Mr. Timimi has his suspicions that the latter may be happening, something he calls the "Treatment Prevalence Paradox". It's a brave move to say so openly, and he risks being ostracized by his own profession. 

He even goes so far as to suggest that the diagnosis of mental health issues, even by trained professionals, is so subjective as to be next to useless. For example, if he tells a patient that "depression is the presence of persistent low mood and negative thinking", that is little better than saying that a pain the head is cause by a headache.  And, unlike with other aspects of healthcare, even once a diagnosis is arrived at, there is rarely a causal agent that can be objectively identified, or even an obvious path of treatment to follow. His frustration with his own profession is palpable.

As for the battery of treatments and drugs offered by the Mental Health Industrial Complex, Mr. Timimi is equally scathing. Rather than rushing for a psychological assessment and medication, he has these thoughts: 

• Don't rush. Being able to tolerate, live through, and even find meaning in, low mood or anxiety is maybe a sign of resilence, not a marker of a disorder. So, don't jump into panic mode and look for an immediate professional diagnosis.
• Don't try too hard. Try not to critically compare your children with others and put pressure on them to conform. They may just be different.
• Don't fear emotions. Expressing (sometimes extreme) emotions and changing emotions is part of the process of growing up, and not a sign of psychological imbalance.
• Don't be controlling. Instead of looking for things that distress you about your child, try looking for things that you like instead.
• Don't obsess about concepts. Constantly using psych-speak like "meltdown" and "masking", and engaging in amateur diagnosis, might just increase your anxiety (and theirs!) about your child's mental health.

Brave and thought-provoking stuff. Mr. Timimi is saying, yes, arm yourself with knowledge, but don't obsess too much about your child's mental health. Sometimes they are just sad or worried; they don't necessarily have depression or clinical anxiety, and they don't necessarily need intervention or treatment.