Mental illness is often reported to have reached epidemic proportions, particularly among adolescents and young people—and nothing has brought this into sharper focus than the COVID-19 pandemic and its ensuing disruption of our daily lives. Recent years have also seen a seismic shift in public perceptions of, and discourse around, mental illness. Celebrities, among many others, have openly shared their struggles with mental ill health, and campaigns encourage those who are suffering to seek help and open up to others.
But, according to author Lucy Foulkes, although public awareness of mental illness has increased, understanding of what constitutes mental illness—and, importantly, what does not—has not kept pace. In Losing Our Minds, the psychologist critically appraises the data behind the rise in mental ill health, providing much needed clarity and nuance to a subject mired in misinformation. Foulkes uncovers that, although studies show a small and significant increase of such problems in recent decades, we might not quite be experiencing the tsunami that we imagine. “We may yet face an increase in mental illness, brought on by the pandemic”, she explains, “but before that, we were not experiencing the crisis we might have thought”.
The reasons underlying the rise are also more nuanced and complex than they at first appear. Although the idea that younger generations have been exposed to greater amounts of stress than ever before—exacerbated by the universality of social media—might feel intuitive, Foulkes makes a convincing case that every generation has faced its own defining hardships and that social media can have a positive as well as a negative influence, providing previously unavailable information and support. In parallel, campaigns to combat stigma have influenced the ever-changing cultural framework through which we view mental illness, as well as the language we use to describe our experiences. “The upshot could be many more people saying (and believing) they have certain problems, when nothing has actually changed.”
Although Foulkes praises those who have spoken out about their mental health, even candidly sharing her own experiences with generalised anxiety disorder, she notes that campaigns that have aimed to destigmatise mental illness have also engendered some unintended consequences. Sharing of statistics about the incidence of mental illness in the absence of knowledge about what mental illness truly is has created a “vacuum that is filled by inaccuracies and half-truths”. Obsessive compulsive disorder, for example, has become common parlance for a tendency towards neatness, organisation, and cleanliness, with little awareness of the distressing intrusive thoughts and ritualistic behaviours that characterise the disorder. This is true of many other often misrepresented disorders, including bulimia and bipolar disorder. “These terms have been let loose into society, but without sufficient depth of information, they take on a life of their own”, she explains. Beyond this issue, in the bid to recognise everyone's struggles, “the language people are using to describe common, transient negative feelings has become caught up in the language we should be reserving for mental illness”. Sadness, grief, or worry, for example—unpleasant but completely natural responses to distressing life events—begin to merge with depression and anxiety.
At the root of the problem, mental health and mental illness exist on a continuum, with cutoffs that are difficult to define. “Even among the experts there is confusion, debate and disagreement over what counts as mental illness—and even…whether the terms ‘illness’ or ‘disorder’ should ever be used when describing psychological distress”, explains Foulkes. This continuum has also expanded over time, with definitions encapsulating a broader expanse of the human experience as well as becoming less stringent. When the DSM began in 1952, it listed 106 disorders; in the latest version, DSM-5, that number might, by the count of some researchers, be as high as 541.
Nevertheless, Foulkes believes these cutoffs are essential. Not only for practical purposes, such as deciding who should receive treatment and insurance coverage, but also in research, helping to distinguish which treatments work for which disorders. Not least of all, suggests Foulkes, we need to reserve some language for the most severely ill. “Calling everything anxiety and depression serves no one”, she argues—not only overmedicalising the suffering inherent to human existence, but also undermining those most in need of help.
Foulkes, whose approach is careful and sensitive, is clear that the issues she raises are not a criticism of the movement to destigmatise mental illness. In fact, more than anything, she believes we need to keep the conversation going. Although the first step is to create space and acceptance for the sadness and suffering that are part and parcel of the human condition, we also need to deepen our understanding of mental illness beyond alarming news reports and statistics. “We need to gain collective confidence to include in these conversations full-blown mental illness, in all its exhausting reality”, she writes, highlighting the importance of giving a voice, and actively listening, to those with the most stigmatised disorders. “Only by keeping the stories coming can we hope one day to have a conversation about schizophrenia or bulimia, say, and for everyone in the room to understand what it is we really mean.” In the face of such complexity, Foulkes' focus is unflinching, and her precision and balance in rendering Losing Our Minds are both provocative and accessible.
© 2021 Penguin