In 2000, a paper published by a group of Canadian psychologists deconstructed the classic children’s book character Winnie the Pooh and “diagnosed” him with Attention-Deficit Hyperactivity Disorder, Binge Eating Disorder, and Borderline Cognitive Functioning. The paper went on to analyze all the book’s characters, revealing each of them to suffer from some form of “mental illness.” The authors’ effort spotlights the rise of “mental health awareness,” a trend under which almost every form of behavior is scrutinized as some form of serious dysfunction.
However, at a time where 1 in 5 Americans are said to suffer from some form of mental illness and 1 in 25 are said to suffer from a severe mental health condition, we must ask: Is mental health some underlying problem ignored by society for thousands of years, discovered only recently, or has modern society diminished the condition of our minds?
A Chemical Imbalance?
People suffering from mental health problems have been prescribed drugs since the 1950s. However, research has yet to prove a conclusive link between poor mental health and a “chemical imbalance” in the brain. This has led the psy fields to adopt the so-called bio-psycho-social model of mental illness for understanding and treating such disturbances. However, if we are to follow the DSM-5 definition, a mental illness is one in which the cause must be biological, psychological, or developmental, and where a “clinically significant” disturbance in cognition, emotional regulation, or behavior occurs. However, there is a problem here: the loose definition of dysfunction. What is clinically significant? Philosophers have long argued for a clearer distinction between distress and disorder; due to the subjective nature of the definition itself, many forms of distress are described as clinical depression. And once one is diagnosed, symptoms are relieved with pharmaceutical drugs and/or psychotherapy, despite that the individual’s problem might actually be a social one.
Cultural critic Marc Fisher made a key point against the medicalization of “mental health,” pointing out that the current understanding of the term has immense benefits for capitalism. He argued that while mental illnesses may be neurologically instantiated, their underlying causes are social and political. This idea, along with Michel Foucault’s argument against the “medical gaze” — the way doctors see patients merely as their dysfunctional organs instead of as human beings — can be used to challenge “Neurobiological Eliminativism,” the belief that all mental states can be reduced to neurobiology. Indeed, Thomas Szasz, in his 1960 book The Myth of Mental Illness, argued that people facing mental health problems do not have a chemical imbalance in their lives, and therefore their problems need to be addressed using a psychosocial model.
Today, while the argument for a chemical imbalance remains largely unproven, even the psychosocial model cannot explain why people in Australia, Sweden, Finland, and Denmark take some of the highest daily dosages of antidepressants in the world — despite these countries’ ranking highest on the Human Development Index and even the World Bank’s Happiness Index. Not only do these countries use more antidepressants, but they also have above-median levels of depression, according to World Health Organization statistics. With no clear explanation available for this rise in depression rates, perhaps we need to identify the point when the incidence began to rise.
The Failure of Modern Society
According to the American Psychological Association, mental health issues among adolescents have sharply increased since 2011. However, neither a change in economic conditions nor a “chemical imbalance” can explain this phenomenon. Instead, it has been linked to various cultural trends: lack of sleep, increasing use of social media, the breakdown of the family and community, and easier access to drugs. Such rapidly changing social conditions may indeed explain the rise in mental disorders among teenagers.
Second, the rise in depression rates has also been linked to increased feelings of alienation. Karl Marx argued that the individual needs to see the fruits of their labor to gain a sense of satisfaction from their work. However, in the modern industrial system, a worker who only operates a small part of the entire task feels like a mere cog in the machine and becomes so detached from the final product that they feel alienated. Marx linked this feeling of alienation to boredom, detachment from work, and even increases in depression levels.
Third, modern society constantly imposes a concept of self-worth determined by external factors such as wealth, fame, success, relationships, and physical appearance. Such a mentality constantly undermines the individual’s self-esteem, encouraging them to focus on attaining external goals instead of personal ones.
While almost all of the deterioration in global mental health can be linked to social conditions, almost all interventions to alleviate the problem take place at the individual level. But as history shows, that wasn’t always the case.
Mental Health Before Psychiatry
The Epic of Gilgamesh dates back to 2100 B.C. and is the oldest surviving work of literature in the world. While the first half covers the battles King Gilgamesh fought, the second half focuses on his spiritual journey after the death of his friend Enkidu. This story highlights a key point: The moral and existential questions that trouble people in the modern world date back to the start of civilization. Religion, philosophy, and folktales like the Epic of Gilgamesh all have all been used to provide us with catharsis, a coping mechanism, and a way to add meaning to our otherwise pointless existence.
The concept and experience of “melancholia” dates back to ancient Greece, but only in 1920 was the single term replaced with two: “endogenous depression” and “reactive depression,” so coined by the German psychiatrist, Kurt Schneider. If the concept itself is not a new one, how was this “mental illness” treated for centuries before the existence of therapists and psychoanalysis?
We find one answer in the life of the sixth-century Roman statesman Boethius, imprisoned as the Emperor grew increasingly paranoid. As despair struck, Boethius consoled himself by writing. His The Consolations of Philosophy is now regarded as one of the greatest pieces of prison literature. He wrote: “While I was pondering this in silence, and using my pen to set down so tearful a complaint, there appeared standing over my head a woman’s form…” And so appears Lady Philosophy to secure Boethius’ “mental health.”
This use of philosophy as therapy is ancient. Socrates used to style himself as a doctor for the soul, and Buddha spoke about suffering, depression, and anxiety some 2,600 years ago. Moreover, many modern-day therapeutic exercises stem from the work of various philosophers and philosophical schools of thought: self-appraisal from Socrates, self-realization from Nietzsche, self-restriction from the Stoics, selflessness from Buddhism. Rational-emotive behavioral therapy is derived from Stoicism, while mindfulness-based cognitive therapy is derived from Buddhism.
One example of philosophy helping to sustain a person’s mental stability is in the case of psychological rigidity. Here, the person is unable to come to terms with their unfortunate reality nor to creatively adapt to a changing environment. Such rigidity has been identified as one of the key factors drastically increasing one’s chance of experiencing depression. If an individual focuses on a narrow range of sources for self-validation such as romantic love, achievement, and social status, the loss of any of these can easily lead them into despair. This is why the idea of impermanence enshrined in Buddhism, Hinduism, Stoicism, and other schools of philosophy — in which the individual is taught never to rely on anything external as a source of happiness and self-worth — acts as a safeguard against despair.
In the mid-20th century, the Holocaust survivor and existential psychiatrist Victor Frankl addressed depression as a problem of futility and meaninglessness. On the other hand, psychologist Abraham Maslow highlighted the failure to meet one’s need for “self-actualization” (realizing their full potential) as most damaging to mental health. Whatever their differences, philosophers have emphasized that life is essentially an internal struggle to answer questions about the meaning of life and our own role in it, and the need to face those challenges head-on. Thus the rapid rise in depression rates throughout the world could point to a certain lack of “life skills” in the modern individual.
The Philosophical Void
Why might this be so? Carl Jung, the famous 20th-century psychiatrist known for his focus on self-transformation, pointed to a spiritual crisis in modern society. This crisis began with the decline of the Catholic Church in the 19th century, when Christian values and teachings lost importance in the larger world. Soon, all religions faced the same problem, and society was left with a philosophical void. Religion and/or philosophy had provided individuals with established doctrine on how to cope with loss and provided an ethical framework for what to value and how to live one’s life. However, in modern society, the individual is left to figure out these various problems on their own.
Philosopher Friedrich Nietzsche highlighted the importance of finding a new system for values, morals, and ethics to replace the teachings of the church. He set this task upon the individual conscience: to become an “Ubermensch” (a person who breaks from the values, ethics, and morals imposed by society and, through the process of self-discovery, forges a new set of values for himself). However, the past values, morals, and ethics were soon replaced not by an Ubermensch but by political ideologies ranging from fascism to communism and capitalism. The existentialist Albert Camus saw such movements as a form of “nihilistic rebellion” in the face of the absurd that help to satisfy the spiritual need of the masses.
Today, while various other economic ideas have failed, capitalism still prevails. Social institutions that once gave us our morals and values — family, community, and the wisdom of elders — have been undermined and replaced by a monoculture cultivated through marketing a “happy meal” to society. Viewed from the perspective of Maslow’s hierarchy of needs, modern-day capitalism has focused primarily on the fulfillment of consumers’ lowest-level physiological needs with the assumption that this will, in turn, satisfy their higher-level psychological needs. Today’s mental health crisis can be traced to the failure of this model.
Since this new version of an ancient problem has emerged, various leaders and institutions have emerged to provide solutions. Spiritual celebrities, in particular, have taken advantage of the psychologically lost at the very time they are most vulnerable, accumulating enormous wealth by selling life advice and meditation tips largely derived from pre-existing religious and philosophical dogma. The main problem behind such “godmen” is that they are largely unregulated. Some gurus, such as Rajneesh movement founder Osho, have formed cults that are willing to break the law to spread their ideas. Others, such as the Reverend Jim Jones of Jamestown Massacre infamy, use outright violence.
Another popular solution is modern therapy. While therapists undergo systematic training and are often effective, the modern “mental health awareness” movement promotes the idea of “mental illness” as something that befalls us and is therefore out of our control. In this way, the concept of mental health is now used as a victimizing tool. Such a victimizing culture can also lead to the vicious cycle of self-victimization.
Moreover, the so-called stigma of “mental illness” arises due to two reasons. First, society has created the idea of happiness as the norm. Starting in the post-war era, advertisements have portrayed a certain socio-economic status as necessary for “the good life,” implicitly evoking a sense of obligation to be happy if you are rich. When such ideas fail and the rich find themselves in despair, a “mental health awareness” drive is needed to justify their spiritual void. Never mind that their satisfaction in life could never have been achieved through material success in the first place. (It is no surprise that most mental health awareness drives occur in the developed world.)
Second, while we used to turn to family, community, and religious/philosophical teachings to ease our despair, now we are expected to turn as soon as possible to psychiatrists and therapists. Thus an awareness drive is needed to change social attitudes to accept a less familiar solution to a very familiar problem.
Finally, the mental health awareness movement promotes the idea that we all need some form of therapy, as we all are sick to a certain extent. Such a claim focuses solely on the solution to rather than the cause of our woes, highlighting the modern trend of economizing our problems. Here, where a market exists, a business providing a service soon emerges. Meanwhile, the root causes of the problem to be “fixed” are not addressed, because to do so would undermine the business itself. The idea that depression, anxiety, and various other “mental disorders” are arbitrary ailments helps preserve this superstructure, even as it evades any criticism of the way society functions. Essentially, therapy for human despair is similar to an air purifier in heavily polluted Delhi: much needed, but not a real solution.
Toward a Culture of Mental Well-Being
With depression rates rising throughout the world and a clear philosophical void emerging in modern society, what steps should the state take to tackle this challenge? Those who advocate for an increase in the availability of psychological and psychiatric services focus merely on dealing with the problem once it has already emerged. This approach might be effective in the short run, but such a system of blindly increasing spending on such services provides no solution to the root causes of this epidemic in the long run. However, because modern medical practice tends to exploit the asymmetry of information between professionals and clients, some form of government intervention is needed.
One example of an appropriate, society-wide intervention is Buddhist economics, which attempts to redefine some of the ethical teachings of modern capitalism. Its goal is to find “a middle way between a purely mundane society and an immobile, conventional society,” as E.F. Schumacher, the approach’s founder, once put it. Buddhist economics aims to make individuals ethically mature, with a value system not completely dependent on material success, and examines the intersection of economic activity with psychological issues such as self-actualization. Philosopher Amartya Sen, a Nobel laureate in economics, has become one of the key proponents of such thinking.
Another promising ideology is Minimalism. Minimalism attempts to target the modern idea of always wanting more, leading one to never completely appreciate what they have or to feel unsuccessful because of what they lack. By encouraging people to live on the fewest number of material things possible, this approach not only supports environmental conservation but also has a positive psychological impact. People realize that they do not need all the things in the world to stay happy.
Last, let us consider the “Happiness Curriculum” now being taught in public schools in Delhi. The curriculum, launched by the Dalai Lama himself, includes meditation, mental exercises, and moral values education. It aims to enable students to deal with various societal challenges on a day-to-day basis while also improving their relationships with peers, family, and teachers as well as their ability to concentrate on their studies.
All such interventions have one thing in common: They enhance the individual’s capability to build a meaningful, satisfying, self-actualized life from the abundance of resources available.
My purpose here is not to advocate for the idea that a peaceful mind should remain peaceful in the face of adversity or should tolerate the injustices, poverty, and discrimination prevalent in the modern world. Rather, it is to highlight that mental well-being is essential to the definition of a good life. Thus policymakers, while focusing on the eradication of low wages, poor access to health care, and inferior education, should also prioritize their constituents’ mental well-being. That means implementing large-scale policy interventions instead of leaving these problems for the market — i.e., therapists and motivational gurus — to solve.
Eventually, the goal would be to instill the idea of mental well-being into the individual’s everyday life. Just as the idea of brushing one’s teeth every morning has become the norm, so too should taking care of one’s psychological needs.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.