Today, October 10th, is World Mental Health Day. It is a day when everyone is raising awareness to mental health disorders and mental wellbeing, and I am sick and tired of that.
Mental health and psychiatry are still relying mostly on disease classifications based on the early 20th century. It is based on observation of non-exclusive symptom groups, defining it with a name and avoiding any clear biomarkers (biological signs — brain mechanisms, protein expressions, genetics etc.).
Psychiatrists today have low certainty when they make a diagnosis and even lower certainty when they prescribe medications. For example, one of the most prescribed medications in the field, SSRIs (Selective Serotonin Reuptake Inhibitors) are used to treat depression. This group of drugs has low efficacy (below 50% for the first drug you will try) and while it is called SSRI, no one is really sure of the biological mechanism that is making it effective. As an anecdote, if it was actually serotonin, SSRI should have had an effect in the first 24–48 hours of taking them. In reality, when effective, SSRIs take a couple of weeks to show initial effect.
People SHOULD feel sad, worried and anxious. It is a natural mechanism that helps protecting us. It is only when it impairs our life for a lengthy period of time and in a debilitating manner that it requires aggressive interventions.
When we raise awareness for mental health, for all the good reasons, we are dismantling resilience to its core. We, as a society, and the media are encouraging people to define disorders for themselves, removing any accountability for situations that maybe saddening, worrying or just wrong. It’s ok to be sad, it’s ok to be worried, it’s ok to be scared. When you have 3 kids, a mortgage and 10 hours a day job, you are allowed to be anxious and stressed. It’s not a disorder. It’s life.
By raising a blanket awareness for mental health, calling everyone to get diagnosed for the sake of reducing the stigma, we are hurting those that do need help — The people around us that spiral in agonizing depression regardless to the reality around them.
We tell teenagers that they are depressed, anxious or suffering from ADHD, while in honest sincerity, being a teenager today is a stressful job. BUT IT IS OK TO BE STRESSED.
How do we solve it? How do we move towards a solution? Well, we first have to define the problem. Dr. Thomas Insel was the first director of the NIMH to enforce RDoC, a framework that encourages the discovery of biomarkers and unbiased behavioural markers for mental health disorders. Unless we have a clear marker to show when sadness becomes depression, when “healthy” anxiety becomes a chronic condition, we won’t be able to treat it. The next step is to raise awareness for resilience. Empower people to handle their mental wellness. This next example is going to be hurtful, but it is meant for the demonstration of a principle: If a child is being bullied at school and that upsets her or him, empower them to act, to report. Don’t encourage them to call it a mental disorder like depression or anxiety. By doing that you are disassociating the child from the situation, harming their resilience and creating a disorder that shouldn’t have been there to begin with.
The tl;dr of this short note is: 1.) Shift to clear unbiased markers to reclassify mental health disorders in a more accurate way. 2.) Change world’s mental health day to world resilience day.
To end it all, I did not believe I would ever quote Beyonce, but here it is, resilience, crystalize in a song:
“Now, I just fell in love
And I just quit my job
I’m gonna find new drive
Damn, they work me so damn hard
Work by nine
Then off past five
And they work my nerves
That’s why I cannot sleep at night
I’m lookin’ for motivation
I’m lookin’ for a new foundation, yeah
And I’m on that new vibration
I’m buildin’ my own foundation, yeah
Hold up, oh, baby, baby
You won’t break my soul (Na, na)” Break My Soul, Beyonce