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Why Mental Health is not the problem

Defining it is already part of the solution

By Niels Devisscher


Niels Devisscher is an artist, freelance creator, and communications strategist passionate about co-designing economic systems for regeneration and wellbeing. In his former role as Analyst and Content Strategist at a mental wellness impact investment fund, he helped change the way we think about and invest in mental wellness. Find more of his visual art, poetry and prose, and freelance work on nielsdevisscher.be.


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We are collectively bringing mental health out of the shadows. People no longer want to stay quiet about their inner lives. Although social media continues to perpetuate the false image that life is just a collection of holiday postcards with blue skies and sunshine, there is a cultural awakening taking place. We are slowly relearning that beneath the surface of glamour and fake positivity, there is a hidden depth to life that knows grief, sadness, and loneliness. But are we individually and collectively equipped to welcome these experiences and hold space to talk, make sense of, and process them? Looking at the surging rates of suicide, addiction, and depression, I would not say so.


But mental health is not the problem.


What is the problem?


When working as an analyst for a mental wellness impact fund that invests exclusively in mental health startups, I screened hundreds of mental health startups and talked to dozens over Zoom. Most founders I spoke with started a business either after having shone a light on their own darkest parts or having borne witness to the lived experiences of a friend or relative. Each of their stories was personal and beautiful, and they all speak to the human capacity to turn adversity into creation.


Almost unequivocally, they define the problem as follows: we are going through a mental health crisis. 1 in 5 people worldwide is set to develop a mental health condition in the course of their lifetime. The mental health crisis will cost the economy $16T by 2030 — or 4% of GDP. Millions of hours of work are lost every year because of mental health issues.


Is mental health really the problem? Even if you presume it is, does defining it in terms of lost productivity truly further the cause? I get it, those in finance tend to focus myopically on financials and quantifiable data. Productivity and efficiency are the axioms of their worldview. So I understand why startups make this argument. However, the financial story does not do justice to the reality it presumes to narrate. The goal of the capitalist economy is prioritized, and some people may conclude that mental well-being is a deficit that must be refilled like oil to get the economic machine running again. This framing creates the idea that those experiencing mental health issues are to blame for slowing down the economy, which can further exacerbate mental health stigma. Only if we solve mental health, the logic goes, can we return once again to the realm of hard-working, productive citizens operating in a functional world. Right?


It is worth asking ourselves if our economic system is the problem, not mental health conditions. Consider for a moment that how we have designed our social fabric is what is causing mental ill-health. As individuals, we are, after all, deeply interwoven with this fabric. And what we experience collectively manifests itself in the psyches of each of us individually. What we view as “mental illnesses” in individuals, then, are alarm bells of our subconscious, intended to shake us up from our collective paralysis. Mental illnesses are thermometers that make visible our cultural fever, in the same way that a fever activates our immune system's response to infections and viruses intruding into our body. This begs the question: what virus are we responding to? Or better, what infections are intruding on our collective body?


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Outside inwards


“People use drugs, legal and illegal, because their lives are intolerably painful or dull. They hate their work and find no rest in their leisure. They are estranged from their families and their neighbors. It should tell us something that in healthy societies drug use is celebrative, convivial, and occasional, whereas among us it is lonely, shameful, and addictive. We need drugs, apparently, because we have lost each other." ― Wendell Berry

It’s midnight in Berlin Neukölln as I walk through the underground station. Mice hurriedly crawl between black stones and shiny train tracks. A homeless person lies to rest on a metal bench. It’s freezing outside, but warm in here. A pungent smell of urine, beer, and crystal meth drifts across the platform, not unusual in this part of town. Sensing this cocktail of fighting fragrances, my brain knows it’s time to dissociate again. I hold my breath as I walk apace up the stairs toward the exit. A whipping gust of wind makes dozens of aluminum foil sheets flutter up, reflecting the bright TL lights like a dystopian rendering of autumn-colored leaves darting through the luminous sky. There are a few guys sitting in the corner smoking meth. For an instant, our eyes meet, and we exchange gazes. I thought I would receive a menacing look, but what I see is a face marked by pain and the past. I am reminded of the words of John O’Donohue: “The face always reveals who you are, and what life has done to you (68).”


Life in cities is very different from the life I enjoyed growing up in the countryside. Things like addiction were largely hidden then, but here in the city they’re clearly visible. Sometimes unwittingly, I may be quick to judge people experiencing substance misuse. How often do we denominate them as “dysfunctional” or “weak” or think that addiction is a choice, and people can quit whenever they want? But beyond our judgments and rationalizations lies fear and recognition of our collective indebtedness. When we’re honest with ourselves, we realize we’re afraid, for we know deep inside that we all carry pain within us. One day, we too may find ourselves unable to deal with that pain, and instead, resort to ways to numb and distract ourselves from it. How often do we consume stuff to feel better, or turn to alcohol to silence our critical inner voices? Stripped from all else, we’re deeply vulnerable beings.


Whether we consciously realize it, we carry an indebtedness, for together we make up society and maintain it through our values, ways of being, actions, and inactions. This felt sense of indebtedness creates a festering pain that settles on our souls and can close the curtains of our hearts. I believe it’s a form of moral injury, i.e. the suffering we experience when the actions we take individually or collectively transgress our values. Western psychology would be quick to diagnose and pathologize these experiences — in fact, moral injury is often misdiagnosed as PTSD — and prescribe psychoactive drugs for them. Aware of how antidepressants can disconnect us from ourselves and the world and even cause suicidal thoughts, is this really the best solution? What if this sense of moral injury is actually a testament to our ability for empathy — to feel and be sensitive to the troubles and sorrows that plague our world? “To live a life of soul means living with sensitivity to the plight of the planet (48)”, writes psychotherapist Francis Weller in The Wild Edge of Sorrow. What if it’s not about managing our feelings just so we can get back to normal — whatever normal means — but an invitation to get closer to the wound and stay with the trouble?


A confession


“What if my fatherhood is not about disciplining him [Bayo’s gifted son Abayomi who was diagnosed with Autism Spectrum Disorder] to walk the straight and narrow? What if it could be about the engorged possibilities, monstrously abundant, that are available in the things we often learn to pathologize? What if my so-called sanity has always been my prison, and that this messianic wound urges me to something different? Something incalculably stranger than anything we can come up with? “ — Bayo Akomolafe, Let’s meet at the crossroads

I am sick of the rhetoric that renders social and political issues into matters of personal responsibility and individual success or failure. I am sick of people being labeled with a disorder, their lived experiences seen as a deficit rather than a gift to be shared and learned from. I am sick of shareholders getting rich off tech companies that address symptoms, not root causes, by selling products and services under the guise of healing, and whose success depends on the retention and acquisition of ever more “patients”. I am sick of seeing the world burn; seals’ and fishes’ lungs perforated by microplastics and drowned in oil spills; dehydrated birds like deceased angels falling from dry skies. And then, in the midst of all this, being told by the DSM-5 that I may be suffering from “grief disorder”. Perhaps I need to be treated with CBT (Cognitive Behavioral Therapy), surely there’s something wrong with how I think about the world, “maladaptive thought patterns”, as they call it.


“Are you doing okay?”, I am fine, thanks for asking.


Now, don’t get me wrong, I am not a cynic. I haven’t lost all hope. Those who know me also know I am deeply hopeful. Yet, I don’t believe in the kind of hope that is contingent on outcomes. No, that’s the kind of hope that, to borrow from George Carlin, turns the greatest idealists into disappointed cynics. I rather consider myself an apprentice of Joanna Macy’s “Active Hope”, the kind of hope that wakes us up “to the beauty of life on whose behalf we can act.” I am inspired by people and organizations that aren’t just creating a shift in what we do, but more importantly, in how we do it. Those that proactively address the underlying degenerative systems and structures of our economy, rerouting approaches toward the community and the relational. Rooting our stories and structures in the principles of life. I am inspired by the weavers, artists, and storytellers, who make us see the world anew, liberate us from the entrenchments of the Old Story, and help us break free from the inhabited tentacles of hyper-individualism, neocolonialism, and capitalism.


You may wonder what all this has to do with mental health? Let’s consider two examples.


Thou Shalt Rise — obsessed with growth

I.

In their articleMeditation App Headspace Relieved Stress for Everyone but Its Own Employees, Say Former Staff” published in July 2022, Bloomberg looks at the workplace culture of the leading guided-meditation app Headspace. Employees depict “an intense and sometimes grueling work environment” and reported unmanageable workloads. In 2021, attrition at Headspace was 25% for the year, compared to the 16% tech-industry average. To rephrase Bloomberg: “This is the downside of monetizing meditation,” said Diana Winston, director of mindfulness education at the Mindful Awareness Research Center at the University of California, Los Angeles. “It’s not like we’re going to stop the forces of capitalism.”


Headspace was started with one mission: to improve the health and happiness of the world.


II.

Cerebral — the largest online mental health care provider in the world — recently faced allegations regarding its failing quality of care. In June 2022, The U.S. Department of Justice launched an investigation into Cerebral's prescribing practices.


Having raised more than $400 million since the start of the pandemic and pursuing hyper-growth, Cerebral’s management pushed for shorter and rushed patient visit times — nurses were allotted 30 minutes for intake visits and 15 minutes for follow-ups — and told prescribers to prescribe quickly and widely, in some instances leading to lethal drug doses and combinations. Dozens of leaked incidence reports “complain about patients with bipolar disorder being prescribed too many drugs, or the wrong drugs, or drugs at the wrong dosage”, writes Business Insider. One internal incident report quotes a patient complaint: “You're sending me powerful neurological modifiers in a happy-colored box filled with Easter egg grass without doing the due diligence required to make sure none of these agents could kill me.” 120 of the reports obtained by Business Insider describe Cerebral patients (Ed. or customers?) who ended up in the hospital, emergency department, or other inpatient care, such as psychiatric wards. One phone coordinator who quit her job last spring said that “It feels like a factory sometimes. We're just trying to churn people in and out”.


The authors continue that “Cerebral's explosive growth was built on the shaky foundation of temporary regulatory waivers triggered by the pandemic”.

"We can't sacrifice access for quality or vice versa”, says Dr. Anna Lembke, a professor of psychiatry and addiction medicine at Stanford University's school of medicine, “What telehealth allows is increased access. But it also allows for increased exploitation."


“We’re Cerebral. Our mission is to democratize access to high-quality mental health care for all.”


Systematic research by The Lancet Psychiatry found that mental health conditions increased by 48.1% between 1990 (654.8 million estimated cases) and 2019 (970.1 million estimated cases). In 2019, 14.6% of YLD — which represents the equivalent of one full year of healthy life lost due to disability or ill-health — was attributed to mental health conditions. High-income countries have the highest prevalence of individuals experiencing mental ill-health. At the same time, the prescription rate of antidepressants is increasing. Between 2015 and 2018, 13.2% of the US adult population used antidepressants in the last 30 days. 7% of Americans keep taking them for 5 years or longer, often because of debilitating withdraw symptoms. Why is it that despite decades of public investment in mental health services and millions of people being on medications, the number of people globally experiencing mental ill-health almost doubled — and continues to increase? Why are our societies not becoming healthier despite all efforts?


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Capitalism is a growth-dependent system, which means that if the economy doesn’t grow, we get into trouble (e.g. economic recessions and inflation are both design failures of capitalism). For capital to grow, we need a continuous increase in productivity and output. What we’re producing — whether it’s fossil fuels, baby diapers, or meditation apps— and whether it benefits human and planetary wellbeing is of little importance. Capitalism, after all, is concerned with exchange-value, not use-value. I’d like to note that profit is not the main problem, and you can have profit without capitalism. But to fuel the continuous growth and expansion of the economy, profit must be reinvested to make more profit, again and again. And to achieve economic growth year-on-year, we need more material throughput — more raw materials and other natural resources that need to be extracted and fed into the production process — which contributes to climate change and comes at the cost of human and planetary health[1].


Translated to the world of venture capitalists, the startups they invest in need to grow and expand quickly — investors commonly expect a 10x return on their investment. Again, net profit alone isn’t enough; it’s the yearly rate of profit that matters. “Move fast and break things” is at the heart of the startup ethos. Because of that, startups are forced to rapidly outcompete competitors, penetrate ever-greater markets, and retain customers as long as possible. As a result, tech companies often deploy aggressive marketing strategies, create ever more addictive algorithms to hold people’s attention, sell sensitive users’ data, and drive productivity — often at the cost of their own employees’ health and wellbeing. In Cerebral’s example, patient visits are shortened, salaries of prescribers are reduced to the bare minimum, and time-staking procedures such as patients’ medical background checks are ignored. As for Headspace, the growth imperative results in unmanageable workloads and unhealthy workplace cultures, leading to high employee turnover.


In a startup, what’s extracted is not so much natural resources, but the time and energy of founders and employees who make growth possible. A recent survey shows that 87% of startup employees in Europe said that working at a startup had negatively impacted their mental health. But it’s not just people working in startups who are impacted. A 2021 study of US workers found that nearly 3 in 5 employees reported negative impacts of work-related stress, and a third reported emotional exhaustion.


To be clear, there are people in finance changing the industry from the inside-out, and it’s not that your everyday investor or founder is at fault. Growth becomes a structural imperative, meaning that the system needs growth in order to maintain itself. Seen through this perspective, we are all cogs caught up in an economic machine that runs at exponential speed, demanding that we, too, run ever faster — and ever more consume what it produces. We’re dancing deeply out of tune with our natural rhythm, stuck listening to a cacophony of SUV exhausts, smartphone notifications, and the voices of people we never met, deafened to our own heartbeat.


The real problem is not mental health. Mental health conditions are but symptoms of a deeply-seated root cause; the by-product of systems that are disconnected from life and further disconnect us from ourselves, each other, and more-than-human ecologies.

The alternative to capitalism is not communism, nor is it some watered down euphemized version of capitalism like sustainable capitalism or green growth — those are just bad excuses to continue pursuing infinite growth on a finite planet. The real alternatives are already here: think non-for-profit business models and post-growth entrepreneurship, think-tanks and alliances such as Post-Growth Institute, Wellbeing Economy Alliance, and New Economics Foundation, who are creating the conditions for all to reimagine our economic system and redesign it according to regenerative principles. An economy that serves the well-being of all.


In spite of all systems change efforts, what is preventing us true transformation?


Pendulum swing: we are enough


The self-help industry tells us that buying their latest mental health product or service will help us lead happy and fulfilling lives. From this perspective, we are considered self-determined agents in control of our own wellbeing. Yet when it comes to influencing the patterns and structures of the larger systems we operate in, we are often told that we’re just a drop in the ocean; that our individual actions don’t really matter.

To be clear, there is real value in cultivating psychological and emotional capacities and resilience. I think Organizational Transformation Expert Nadjeschda Taranczewski explains it beautifully in her book Conscious You, “... If you feel disadvantaged or persecuted… [the message is not to] “just develop a different mindset and everything will be fine”. Rather, I postulate that a great deal becomes easier with self-awareness. When I know who I am, what has shaped me, and what I want, it becomes easier to defend myself against injustice and channel my anger constructively. And it is easier to develop creative solutions with other self-aware people than with those who are driven by diffuse fears and prejudices.” As I have written before, mental wellness is growing the resilience and inner capacities to navigate changes and challenges in our everyday lives. But I believe we have stretched the pendulum too far in favor of individualism. It is time to release our grip and let it sway until a more balanced position is reached.


A beautiful example to illustrate my point is found in psychotherapist Viktor Frankl’s Man’s Search for Meaning. He wrote: “When we are no longer able to change a situation, we are challenged to change ourselves.” Frankl survived the concentration camp of Auschwitz and experienced firsthand the indignity and injustice of the Holocaust. He reminds us that when everything is taken away from us and the world we inhabit is suffused with suffering, all we can do is change ourselves. Our chances of survival are reduced to our willpower and unwavering faith. Yet, what this quote also signifies to me is that we often do have the agency to change our situation.

While I recognize that agency is deeply contingent on privilege, modern western culture teaches us that the cause of our unhappiness, depression, or other possible forms of suffering, is our perception of a situation and not the situation itself. For example, Cognitive Behavioral Therapy (CBT), itself an evolutionary product of western (Stoic) philosophy, aims to correct unhelpful thought patterns, or what CBT practitioners call “cognitive restructuring”. As psychoanalyst Bradley Murray explains in his essay, CBT is based on the belief that psychological disorders are rooted in problems of thinking. According to this logic, the cause of our malaise lies not in our reality, but in our thinkingabout that reality. And while this may at times be true, it repudiates felt experience and the importance of emotional expression in healing. Take, for instance, people historically racialized and marginalized by society who faced centuries of institutionalized racism and oppression — carried on in the form of intergenerational trauma — or those who bear witness to a dying world, keeping their hearts open to biodiversity loss and disappearing ecosystems. To attribute psychological pain solely to maladaptive thinking on behalf of the individual not only takes out the relationality and subjectivity of our experience, but also renounces our very sense of agency that inspires us to change our situations — and our systems.


Similarly, this belief frequently shows up around resilience. Aware of the impact that mental ill-health has on employee performance and the potential return on investment to be gained, corporations spend millions each year on resiliency programs. As a quality of living systems, there’s nothing “wrong” with resilience. It helps us to return to equilibrium after having experienced adversity. However, we need to look more deeply at the object of our resilience. What are we building resilience against? And what if the situation or state of being we’re returning towards doesn’t truly serve us? As a Harvard Business Review article argues: “...too much resilience could make people overly tolerant of adversity. At work, this can translate into putting up with boring or demoralizing jobs — and particularly bad bosses — for longer than needed.” Resilience may turn into resistance to change systems that don’t truly serve us.


Going forward, going deeper


I hope to encourage everyone to think outside the prevailing paradigm that defines lived experiences as mental health conditions situated in the individual, which must be managed, controlled, and cured. What can non-western cultures teach us about mental crises, wellbeing, and healing? How else can we make sense of psychological experiences? Appreciate the gifts of those who may be neurologically different from you. Listening and being listened to nonjudgmentally is profoundly healing.


Our deepest wounds are relational. Solutions must therefore be relational, focusing on the space between us and healing collective trauma. What role does business play in addressing the broken relational fabric of our society? I see its potential in creating online spaces in which we can relearn and regain our collective capacity to hold space for grief, vulnerability, and heartfelt connection. To curate meaningful experiences within intentional spaces which people can then take to their physical groups and communities. After all, communities are the fertile ground for hope, resilience, and agency.


I believe that fundamentally how we measure organizational success will need to change. The most impactful companies will not be those with the longest user retention, because they aim for transformational change on behalf of their stakeholders, breaking outside traditional patterns of problem-solving and instead addressing root causes. They are the ones that take a critical look at themselves and transform the economical foundations on which they are built.


[1] For example, mines extracting raw materials for production of consumer technologies destroy natural ecosystems and displace indigenous communities who act on behalf of those ecosystems and to survive in this world. Capitalist logic goes that we need to earn the right to live — i.e. earning a living, by selling our labor. Millions of people around the world are one drought or flood away from falling into extreme poverty, as happened recently in Pakistan.

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