What will our ideas about mental health look like in 100 years?
If I allowed myself to dream I could imagine a different world some time in the future in which we understood ourselves in a different way. A world in which we didn’t see ourselves as just biological machines pushed and pulled by the circumstances and events in our lives. A world in which we recognised that our inner lives are coloured by our hopes, our aims, our attachments to people, places and ideas. A world in which we didn’t define any small ups and downs in our feelings as mental health problems.
In this world we would see it’s our thinking that shapes our experience. We would have a clear and sharp understanding that our here-and-now thinking is the source of our current emotions and feelings.
We would accept that much of our thinking is outside our immediate awareness; that it’s shaped by our assumptions, beliefs, and the cultural influences of our time and place. We would know it is hard to be aware of this thinking, but we would see becoming more aware of it as a main aim of living well.
We would accept that difficulty and distress are inevitable parts of our lives; that we cannot have hopes without fears, aims without disappointments, and attachments without loss.
We would see living well as an ongoing process of learning; one that frequently requires acceptance, adjustment to change and the making of new plans. We would see that the things we choose to want are the source of our energy and motivation but that they need to be tempered by reality and the interests of those around us. We would see our active appreciation as a source of pleasure and as an art to be cultivated. We would value contentment as much as striving.
In trying to live well we would recognise that we can be creatures of habit; that our habits make it easy to do things but once established they can be hard to break. We would patiently value the effort involved in learning new habits. We would know such learning can be a gradual and slow process. We would value small steps forward and not focus on what we still can’t do.
In this world our ideas about psychological problems would be very different. We would see our distress as arising from our reactions to the things around us; that it usually arises from dashed hopes, our fears, disappointments and loss. We would have more realistic expectations of how we could cope with sudden and unwanted changes. We would have a more tolerant understanding of how we can feel when distressed. We would not worry that our feelings meant there was something wrong with us or that we were different from other people or abnormal in some way; such worries simply heighten our distress.
We would not be so quick to label ourselves. We would also have more empathy for other people in distress. We would want to support them in their efforts to understand themselves and manage the changes and challenges in their lives. We would encourage them to pay attention to the way they were reacting and thinking; to understand how these things could be creating or adding to their distress. We would then support them in the often hard work of finding other ways of thinking and reacting.
In this world mental health professionals would be less concerned with their careers and protecting their reputations. They would be less interested in defining new conditions and disorders. They would not use obscure terms for ordinary things or describe what they do in technical terms. They would not describe what they do as ‘treatment’. Instead they would discuss how ordinary psychological processes are at the centre of our distress. They would help people explore the difficulties and possibilities of living well.
POST SCRIPT In the 45 years I have worked with people as a psychologist the drift of the culture has taken us further from my dream. More experiences have been labelled as conditions and disorders. It is far from clear the general public understand their distress any better or feel more able to solve their difficulties by themselves. On the contrary, many people think mainly in terms of what symptoms they have and whether these qualify for a diagnosis. More people see themselves as having problems and needing treatment. Professions have expanded. More ‘treatment’ approaches have been invented. More medications have been made available and prescription rates have generally spiralled. A dream cannot stop such a trend, unless, of course, it is shared by many.
Increasingly, like others who want to offer an alternative to this cultural drift, I spend my time trying to undo the baggage of this cultural mindset by helping people rediscover the vital psychology that is still available if we take the time to reflect on simple experiences that we all have in common.
“For as long as you live keep learning how to live.” Seneca