Published in the first week of what many are touting as “mental health awareness month”, New York Times staff reporter, Ellen Barry, asks, “Are We Talking Too Much About Mental Health”? In the era of “Mental Health First Aid” (MHFA), it’s a bold question to be asking. In some ways, her “answer” —that some experts now warn we might be over doing it—is even more bold. Yet, while this mostly unheard of perspective is compelling, the frame remains a bit askew as it more or less still rests on the assumption that medicalized interpretations of human distress are the foundation upon which to build. Or, at least largely fails to recognize the difference between programs that rest on such assumptions and those that do not.
Barry points to research on trials of mindfulness and Dialectical Behavior Therapy (DBT) skills in schools that have led to unchanged or worsening outcomes. Interestingly, while the researchers expected a backlash after reporting their results, they instead received quiet whispers of agreement from educational professionals who were afraid to challenge popular beliefs but were seeing similar things. Theories about why there were such poor outcomes from some of these studies included that focusing so much on ‘mental health’ can lead to “self-diagnosing” and encourage people to see themselves as less capable and resilient. The piece also acknowledges that no amount of ‘mental health awareness’ will change the harsh realities of poverty, racism and other traumatic conditions. (Note: Barry stops just short of naming that falsely being treated as if one has control over poor conditions in their life—basically a form of “victim blaming”— can itself dramatically increase feelings of hopelessness and isolation.)
As important as this article is in many ways, what seems most notably absent is fuller acknowledgement that the choices aren’t truly limited to what we’ve already been offered or nothing at all, and that re-evaluating our starting assumptions may be a critical next step. We need not exist solely in the realm of brain disease, and the “answer” may be found outside of the binary of “mental health” or throwing our hands up and doing nothing. Interestingly, Barry does report, “One problem with mental health awareness, some research suggests, is that it may not help to put a label to your symptoms.” Yet, she never quite gets to the point of questioning whether it might be because the labels themselves —along with the messages they carry— are part of the problem.
While Barry’s piece talks about the potential harms of trainings that can increase ‘self-diagnosis’, the author doesn’t seem to fully grasp the critical importance of included feedback from doctoral student, Isaac Ahuvia. Ahuvia found that students who self-labeled with depression also felt they had less control over it. Given that the medical model teaches relative helplessness and chronicity, this makes sense but there are already demonstrated ways to counter that. For example, Barry likely isn’t aware that—over in the Hearing Voices Movement (a decidedly non-medical and harm reduction approach) — people like Marius Romme, Sandra Escher and Patsy Hage have been talking for decades about how poor outcomes are more likely the less power someone feels they have over what’s going on. Yet, the Hearing Voices Movement’s response hasn’t been to give up so much as it has been to identify strategies that bring regaining a sense of personal agency to the forefront. Surely, she also hasn’t heard that the one of the most notable results from research on the Wildflower’s own “Alternatives to Suicide” approach is that it supports people to have a greater sense of control over their suicidal thoughts.
The article goes on to talk about how teaching kids to be endlessly “mindful” in the moment isn’t fun enough to keep young people engaged and may actually keep them more focused on ‘what’s wrong’ than is useful. But, it doesn’t really talk about how MHFA, DBT and other mainstream approaches neglect the importance of finding joy, meaning and a sense of belonging within culturally relevant communities. This mirrors the staggering frequency with which many people are chastised for not prioritizing relentless scrutiny of their pain in the name of “treatment”, even if they’re taking other steps to improve the quality of their lives.
At one point, Barry offers counter-evidence to the theme of her article, citing reportedly contradictory evidence from studies on “Social Emotional Learning” (SEL) programs that report better results. However, she leaves out the apparent fact that SEL programs appear to include focus (for example) on young people learning skills for conflict resolution and working in groups, a critical difference to strictly “mental health”-focused approaches. Do these apples truly belong int he same cart?
One of the most interesting (and disturbing) quotes comes from a psychiatrist toward the end of the piece: “Really, if you think about almost everything we do in schools, we don’t have great evidence for it working … That doesn’t mean we don’t do it. It just means that we’re constantly thinking about ways to improve it.” This somewhat terrifying sentiment —so commonplace in our systems— deserves to be scrutinized and condemned. But here, in the more neutral voice required in this type of reporting, it is simply presented as another perspective, laid out as if benign.
Barry did important work raising this question. But, when will we get to the point where the question “Are We Talking Too Much About Mental Health,” shift to, “Have We Defined ‘Mental Health’ In a Way That’s Causing More Harm Than Good?” It seems we still have a ways to go. At least this is a step in the right direction.
EN 
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