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Anxiety and depression: mental illness or human distress?

Anxiety and depression: mental illness or human distress?

The longer I work as a therapist, the more convinced I am that seeing psychological pain as a mental disorder makes things worse rather than better. Yet discussions about serious unhappiness now almost always take place within a mental health framework.  Last week, as part of Mental Health Awareness Week, The Guardian ran some articles about anxiety. Its piece on 16th May stated that 'One-in-five Britons suffer from some form of anxiety disorder'. It advertised the article on the front page of G2 with the words 'Sick, Asphyxiating, Fearful'. According to its article on Saturday (21st May) 'How not to talk to someone with anxiety' one in three of us will suffer from an anxiety disorder at some point in our lives.

This seems frightening but is supposed to help educate people and attract resources for treatment. It's argued that the NHS treats people with physical health conditions and so should give equal weight to mental health conditions. Raising awareness about mental health issues is also supposed to get rid of stigma. Just as we don't blame someone for having a broken arm, we can't blame them for being depressed/anxious.

Of course people who are suffering psychologically should be supported and of course we should be kind and non-judgmental to people who are suffering, whether physically or psychologically. But I don't think treating psychological distress as a mental illness is the best way of doing this.

Although we're often told that mental illness is the same as physical illness, it's somehow difficult to accept. If depression is a mental illness like flu is a physical illness there's nothing we can really do about it. Like flu, distressing thoughts just settle on us with no connection to the circumstances of our lives.This is almost always untrue, even when we feel utterly hopeless and overwhelmed by psychological pain.

Feelings have a context

 In reality, feelings have a context. They involve us making sense of things that have happened to us, sometimes in the distant past, sometimes more recently, sometimes now.  These events might that seem objectively trivial or may be evidently very serious. They may be things we haven't really acknowledged as having impacted on us.

Here's an example. Someone who's been in a series of abusive relationships may feel despairing and unable to function. She might then be diagnosed with clinical depression. Her feelings of despair are way more serious than ordinary unhappiness, grumpiness, pessimism.  But this doesn't make her ill, just profoundly distressed. There are reasons why she's so unhappy and these will lie in the way she's made sense of what's happened to her. For example she may believe that she's unworthy of being treated kindly and that she'll never have a good relationship. At worst she may decide life's not worth living.

However profoundly distressed this person is, seeing her feelings as a depressive disorder may keep her stuck. It moves the focus away from how she's made sense of what’s happened to her onto her condition, something she can't really control.

But if this person talks to someone who listens warmly and openly, helping her understand the way that she's thinking, she might start to question her feelings of unworthiness.  She then has the possibility of becoming stronger and better able to choose more positive relationships.

The way we interpret symptoms can make us feel better or worse

Sometimes it might be difficult to think about the circumstances and ways of thinking that have triggered anxiety or depression. Even then, the way someone interprets their symptoms can make them feel better or worse. For example, someone with a buzzing feeling in their head might think 'I'm feeling anxious, it'll pass in a few minutes, I'll just focus on what I'm doing'. Alternatively, they might say to themselves 'this is a serious medical condition I've got that's running out of control, this is unbearable'. Thinking about anxiety as a serious medical condition is  likely to be make the person's suffering more serious and protracted than treating it is as something which will pass (as most feelings ultimately do).

Being compassionate

This is not to say that we shouldn't be compassionate towards ourselves and towards others when we're suffering. It's not to say that we should feel guilty if we're overwhelmed by anxiety or despair. I just don't think that calling this some kind of mental illness is helpful. It makes it into something scary partly because in the end illness is random and meaningless.

Better to use words that actually describe the emotional experience - hopelessness or intense anxiety for example. Then we can think of what these feelings relate to. We can also be kind to the person who's suffering because we all, as human beings, have the possibility of experiencing profound pain and unhappiness. We're less likely to become overwhelmed by these feelings (for extended periods of time) if we can make sense of them and others can be there for us as we do that.