Yesterday was October 10th, a day which was dubbed World Mental Health Day. As a mental healthcare professional I embrace this initiative – a special day to emphasize the importance of mental health and wellbeing -, particularly due to the fact it signifies the launch of various initiatives to promote the international mental health agenda. For instance, the WHO is using World Mental Health Day 2016 to launch a 1-year campaign targeting depression. The aim here is to ensure that people suffering from depression seek and receive the support and treatment they need and to break through the stigmas which still surround mental illness in general and depression in particular. The campaign will be concluded 1 year from now on World Mental Health Day 2017.
I do frequently feel and experience that recognition of the seriousness of mental illness is still not commonplace throughout society. Mental disorders are too often still unrightfully associated with and ascribed to a person’s lack of character, effort or persistence. This is also a subconscious ego-defense mechanism; the notion that people are in control of their own mental health status confirms our narcissistic tendency and urge to feel superior to others whilst reassuring us that we have the capacities to fend off such mental issues ourselves. People who cannot deal with their mental health issues are sometimes still seen as weak for not being able to properly handle what life throws at them. The stigma is furthermore strengthened by the fact that many forms of mental illness are not very tangible or visible to the outside world.
Another issue is that mental illness often strikes in crucial phases of one’s life. A severe anxiety, depressive or cognitive disorder in adolescence and early adulthood can easily entail failure or at least under-achieving in high school or college. If and when the mental health issues are eventually resolved, the effects they had on one’s personal development, academic track record, study choices and opportunities are often permanent and irreversible. And also here the tendency prevails within society to at least partly ascribe such failure or under-achieving to the individual (e.g. a child being labeled as lazy, unmotivated, indifferent or perhaps rebellious, instead of recognising the underlying psychopathology). Experts have appointed a severe episode of major depressive disorder an average disability weight of .658, which is an indication of the severity and impact of the disorder on someone’s life. This actually means that a severe depressive episode is seen by experts as one of the most impactful health ailments one could suffer from. For reference purposes, the average disability weight ascribed to a severe major depressive disorder exceeds the disability weight of metastatic or even terminal cancer. Of course, cancer is a horrible disease, and the usage of disability weights is debatable, but this comparison is simply meant to signify how big of an impact depression can have on the way someone functions.
With regard to depression, another vulnerable group are women of childbearing age, particularly following childbirth (the so-called postnatal or postpartum depression). The psychological damage caused by a postpartum depression to a baby’s neurocognitive and social development can easily be long-term or even permanent, due to the fact that the attachment to the mother is severely distorted and the depressed mother does not stimulate the baby in the same way a ‘healthy’ mother would. As for the mother, the changes in her diet, sleep and activity levels can result in her being less well nourished, exhausted and overly or less active than usual. Combined with ongoing depression and high levels of anxiety this will affect the body’s immunity and ability to fight infection. Eventually the emotional distress of depression and anxiety may be expressed in increasing physical symptoms that might be felt as pain, headaches, chest pain or difficulty breathing.
And while we focused mainly on depression in the aforementioned examples, the field of mental illness is unfortunately far more vast and complex. According to some, mental health should be seen as a delicate continuum rather than a dichotomous division between ‘sick’ and ‘healthy’. Everyone is faced with mental health challenges to some extent, and some of us are lucky enough to be able to adequately deal with these challenges on a day-to-day basis. There are many potential protective factors and risk factors which either positively or negatively affect our capacity to deal with these challenges, and as a society we should acknowledge that not everyone has the same tools at their disposal. True recognition, respect and the willingness to openly address and discuss mental health and mental illness would be a great step forward. In a European context this should also be reflected in the professional care and assistance available to people and the way this care is financed through collective arrangements; in other words, mental disorders should receive the same recognition as other medical disorders and similar financing mechanisms should be in place.