What to do about Mental Health Issues? Caution Required

We have been having some important conversations about mental health issues. It’s not an area I am deeply expert in, and so I have been doing some reading to try to get to a deeper understanding (and here I am indebted to James Shillabeer who got me thinking with this terrific reply to my previous post, which has deepened my thinking significantly).

The desire to help anyone in distress needs to be carefully calibrated against our understanding of their situation and our capacity to genuinely help.  Good intentions are not enough. 

James’ point is very close to my heart; that we need to have evidence and good thinking to support whatever we do – in this case, the costs of getting it wrong are too high to ‘just try things’ to see if they work. In these cases I tend to turn to experts. Alas (and here is where it turns into a TOK!) experts do not always agree. In a trenchant and powerful article, Tom Bennet warns against being swept along by popular sentiment, quoting Dr Stan Kutcher, one of Canada’s leading experts in young people’s mental health who has said We have the same proportion of mental illness in our society now that we had 40, 50, 60 years ago. There is no epidemic of illness, there is better recognition of illness, which is good but what we’re seeing now is an epidemic of ‘I think I have a mental disorder when I’m just really feeling unhappy,’ and that is a direct reflection of poor mental health literacy…Now depression happens in adolescents and depression is a serious disease and if you have depression you need the proper treatment for depression, but feeling unhappy, that’s not depression…So I think a lot of people have become confused with all the talk about mental health and mental illness without the literacy to understand what they’re talking about”.

At one level this seems sensible – that we always tend to react to things in the present as if they are unprecedented and unique (tech is a good example); the perspective a few years down the line tends to look quite different. So maybe the issue is not quite what is seems – perhaps even just reflecting our higher aspirations for a flourishing life.

But, on further digging I am not sure that mental health issues really are static. Martin Seligman’s data in The Optimistic Child suggest that when you look at lifetime prevalence of depression, you find a 10-fold increase between early and late 20th century; furthermore, that the victims are getting much younger. Statistically if you were born in the 30s and had a depressed relative, your own depression if you have one struck on average between the ages of 30 and 35. Those born in the 1950s tend to have first depressions between ages 20 and 25; these days it seems to be happening in schools. So what’s happening?

An obvious point here – along Kutcher’s lines – is that this explosion of depression might just be an artificial artifact of labeling. Seligman himself wonders maybe our grandmothers suffered as much as we do, but didn’t call it ‘depression’ they just called it life. Maybe the grinding misery that we call depression used to be acceptable inevitable part of the human condition. Now it has become a ‘disorder’. I find myself drawn to this explanation, but the research methodology tends to suggest it is too easy a response. The researchers did not ask ‘have you ever been depressed?’, but instead looked at indicators, “did you ever have a period in which you cried every day for two weeks?” “did you ever lose 20 pounds in a short time without dieting?” “did you ever try to kill yourself?” The answers are far more often ‘yes’ for younger folk, suggesting a genuinely different experience.

Another possible explanation occurred to me – that older people forget their symptoms from early in life; and hence the rise in depression is only apparent. Alas, the researchers were ahead of me again – it seems that older folk report youthful alcoholic or schizophrenic symptoms at a high rate, suggesting that memory is not to blame.

So what to make of this apparently robust data, and yet the genuine contradictory claims from experts such as Kutcher? There’s more thinking to be done, for sure; and I am looking for the evaluations of school-wide intervention programmes what have taken place over recent years around the world. Initial discussion here shows a real desire to make a difference, but a genuine puzzlement about the issue; about what is within schools’ control; and then what steps might be the right ones. Watch this space.

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1 Response

  1. On reflection, I think there is a great deal of hope in the fact that so many good people are trying to find ways to understand and treat mental health issues. Indeed, the very fact that as a principal you see great value in thinking about and addressing this topic speaks to the good of progress in this area. As you say, schools cannot be laboratories to test out a particular new theory, but they can definitely be beneficiaries of the push to understand and support young people in this area as understanding becomes solidified with verifiable evidence. I guess the seeming contradictions in findings are just illustrative of the fact that we are in the middle of a great unfolding of learning.

    One interesting meta-analysis of the data on mental health entitled "Challenging the Myth of an "Epidemic" of Common Mental Disorders" by Baxter et al argues just as the title suggests – no significant changes (measured over a 20 year period 1990-2010). As you rightly point out, there are contradictory claims and studies from experts and so one can find studies that swing the opposite way (Seligman’s claims in your article attest to this). There is also the argument that the increase in recognised diagnosable conditions has increased threefold in the latter half of the twentieth century (As per the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Assocication), perhaps explaining the perceived increase (in line with the labelling point you made)? This is something that feels as if it has filtered down – I notice how my students have a much deeper and more technical vocabulary for understanding their own mental wellbeing compared to the previous generation (and a greater openness towards getting help).. All these points are mentioned in the “Happiness” chapter of Pinker’s new book, in which he makes a strong, compelling argument for not falling into the trap of buying into a sense of “crisis” regarding mental health, but to be, as your thinking also suggests, careful, measured, and responsive to both the small and big data. The trick, the somewhat daunting trick, is discerning sound approaches out of it all for one’s specific school context, with a whole bunch of localised additional variables, and questions about how you gather data and measure success on the ground too. Your study of the evaluations of intervention programs around the world sounds like a great place to go next towards this end – I hope it is fruitful!

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