Let me start off with the less serious mental conditions in which each one of us will certainly have found himself or herself some time. It is amazing how emotions and any type of pressure can play inexplicable tricks on our minds. For example, it is important to talk about the problem of depression. However, it is neither really a disease nor an epidemic and over-diagnosis and over-medication are serious issues. Yes, depression is a serious problem. That sense of hopelessness, exhaustion and alienation is dreadful. But let us not exaggerate its extent or severity or the relevance of medical intervention. It is not really a disease. Depression is better understood as a symptom, like fever or pain. Most people given the diagnosis are not mentally ill, they are responding to life’s stresses and difficulties. That is why it is more common during periods of economic turbulence or emergencies, as was the case during the peak period of the Covid-19 pandemic.
Sometimes I wonder whether the problem is one of over-diagnosis rather than an under-diagnosis of depression. The proposed vision for mental health in Malta is based on fostering policies and environments that are conducive to promoting mental health and well-being for everyone, preventing mental disorders among individuals at high risk and providing quality treatment and care to individuals with mental health problems. On paper, it sounds reassuring, but I think that our medical professionals will have to concentrate more on identifying people with complex depression who experience socio-economic disadvantage, abuse, physical morbidity or disability. These might well be pointing to consequences affecting mental health at the cost of missing or ignoring the whole cause of them all. We must act together with health and social care professionals and with our local communities to provide evidence-based interventions, including psychological therapies and collaborative care. We must avoid using the notion of a global depression crisis to ignore the grave social injustices that make people miserable.
If in these days and times, more than ever, any simple symptom of erratic behaviour alerts the attention of our mental health professionals, then, surely, we are all in this concealed pandemic without our knowing it. We are continually being bombarded with a mental health problem awareness campaign and to be on the lookout for the most common symptoms possibly indicative of a mental health issue. On the first least sign appearing we may easily self-diagnose as being affected with some kind of mental health problem and seeing us rushing to a psychiatrist, psychologist or psychotherapist.
We read and are told that common symptoms of mental illness in adults and adolescents can include excessive worrying or fear, feeling excessively sad or low, confused thinking or problems concentrating and learning and extreme mood changes, including uncontrollable “highs” or feelings of euphoria. Who of us has not had or demonstrated any of these symptoms? The reasons could be pathological, seasonal, temporary or simply imaginary. Today, there is an ever-growing list of mental illness types that we may not be totally spared during our lifetime. Enough to drive us insane!
In a different dimension, we cannot ignore redefining mental health in a social media world. With Facebook and Instagram active round the clock, we are commenting, sharing, posting and ultimately interacting with each other on just these two social media platforms every moment of every day. With such an unfathomable amount of connection at our fingertips, it seems like togetherness and belonging would be a logical outcome. But this sense of connection is actually a lot different than we may have expected. More and more studies are revealing that the way we use social media can significantly impact our mental and physical health – from increased anxiety and depression to decreased attention spans, memory, sleep, and even self-worth. Yes, we are all at risk, if not already impacted.
Covid-19 has caused a collective crash in our mental health that has drawn much public attention, but the menacing shadow of mental illness – stigma – can be even more devastating than the illness itself.
Years of public education on mental health have failed to remove the stigma – and actually made it worse. Only a recent change in how we talk about mental health is starting to make a positive impact. Stigma is hard to define and often oversimplified into a single, discrete entity, which it is not. There is stigma at the institutional level, at the societal level and at the individual level when people internalize negative and pessimistic messages.
Perhaps a silver lining of Covid-19 is that mental health is no longer out of sight. We cannot ignore that so many of us are struggling right now. Whether experiencing it ourselves or recognising it in our loved ones, we are all learning that there is no health without mental health. This is an opportunity to see how the complex storm we are in – of biological threat, political turmoil, social inequity, spiritual reckoning and historical trauma – come together to create mental health symptoms.
There has been no easier time to talk about mental health than during this pandemic because no one is a stranger to it anymore.
I found that with depression, one of the most important things you can realise is that you are not alone. You are not the first to go through it, you are not going to be the last to go through it. Once you start talking about experiencing a mental health struggle, you realise that actually, you are part of quite a big club.
Mental health problems do not define who you are. There is not anybody out there who does not have a mental health issue, whether it is depression, anxiety or how to cope with relationships. They are something you experience. You walk in the rain and you feel the rain, but, importantly, you are not the rain.
Dr Mark Said is an advocate