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A BBC documentary broadcast last year offers a case-study in this sort of muddled thinking. Most of Trust Me I’m a Doctor: Mental Health turned out not be about mental health at all but about stress, because that was what nearly half of 2,000 people interviewed said they were most concerned by. Various diets, exercise routines and sleeping patterns were recommended — all of them helpful for countering stress, no doubt, but nothing a doctor is likely to have more knowledge of than a nutritionist or personal trainer. The last part of the programme entered very different terrain, however, as a psychiatrist and a clinical psychologist were shown debating the pros and cons of taking medication for depression while we also saw a surgeon in a research laboratory discussing a new treatment for schizophrenia he is working on.

What is to be gained by grouping together such diverse phenomena as stress and schizophrenia and labelling them all “mental health” — or rather “mental health problems”? And why is it that some obviously mind-related conditions are seldom if ever categorised this way?

Take dementia, for example. Undoubtedly that affects the way a person thinks, feels and behaves. Yet it is generally seen as more like a neurological disease, one arising from clearly identifiable deficits in brain tissue or functioning. The same is true to some degree of autism. But this is complicated by the fact that many people who suffer from this don’t think of themselves as ill or deficient at all, preferring to be known as “atypical” or “neurodiverse”. A third area of contention is what now goes by the name of substance misuse, referring to severe drug or alcohol addiction. Interestingly, this is missing from the list of common mental health problems highlighted by Time to Change, even though “substance-related and addictive disorders” are a prominent category in the latest edition of the supposedly authoritative Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and even though far more people will have their lives seriously damaged if not destroyed by these than by anxiety or schizophrenia. But addiction still has a level of stigma attached to it in the way that mental health problems are not meant to nowadays — despite the position taken by many experts and interest groups that it is, in fact, a disease like any other.

There isn’t room here for me to discuss any of these classification controversies — there are dozens more — in greater detail. The point is that what constitutes mental health, or indeed a mental health problem, is nothing like as self-evident as we are led to believe. How then can we be sure that there is a crisis in mental health, as is so often asserted? Another advocacy organisation active in this area, the Mental Health Foundation, states confidently on its website that “the social challenge of our time is to reverse the growing level of mental ill health”. Apparently there have been great improvements in education and housing over the last 50 years, while our mental health “has not improved and, if anything, has declined” (bold in original). No evidence is offered in support of this claim. Then again, I don’t see how there could be, given that the way mental health problems were construed in 1978 bears little resemblance to how this is done today. The edition of the DSM in use then was a modest 134 pages long, whereas the current one weighs in at 970 pages.
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