The first quarter of the present century will be marked by the steep rise in poor mental health diagnoses. At every turn, there seems to be another report, or statistic, or warning about Australia’s “silent” problem of poor mental health. Except that it is not so silent. For the last decade, governments around the globe have thrown well-intentioned taxpayer funds towards psychoeducation, namely early intervention and prevention programs, to slow the rate of mental health diagnoses. Instead, the reporting seems so bleak about the current state of the human mind that it appears that we are losing both the battle and the war. With one in five Australians experiencing a mental or behavioural condition each year according to the Bureau of Statistics, young people (aged 16–34) account for almost double the reporting of mental distress than the elderly (aged 65–85).
History is a storyboard for the vastness and complexity of the human experience. Shakespeare’s portrayal of the human condition drew richly from a palette dripping with love, hate, vengeance, pride, and depression. Contemporary novelists and filmmakers like Jhumpa Lahiri, John Updike, and Joan Didion explore similar themes. Negative emotions and distress are a constant in the human experience. Why is it, then, that we have begun champing at the bit to write them off as medical conditions?
Older generations have always lamented the fragility of youth, hearkening back to their own glory days of true grit and resilience. Perhaps the difference now is that we have not only armed the next generation with the language for self-diagnosis but have also stripped them of individual empowerment to look within and create meaningful change.
The noble roots of the journey in Australia towards educating the layperson about mental health conditions began to appear in the 1990s when the very first murmurings of reducing the stigma around anxiety and depression were voiced. As momentum grew, a crusade to “normalise” seeking help when struggling emotionally morphed into an emphasis on early intervention and the inclusion of psychology services in the national Medicare scheme. But somewhere along the line, we have turned from promoting acceptance of poor mental health conditions to the normalisation of the very diagnoses themselves.
Do we really want to live in a society where poor mental health is considered “normal”? Furthermore, if it is the norm, then surely that calls for a recalibration by the medical fraternity of what we regard as a disorder or pathology.
Through the National Mental Health and Suicide Prevention Plan, the Australian Federal Government invested an eye-watering A$2.3 billion in the 2021–22 Budget. This money has been thrown around to various initiatives including Beyond Blue, headspace, Lifeline, and multiple school-based programs. These well-intentioned initiatives are often run by qualified mental health clinicians delivering high-quality interventions in the form of school-based education, individual and family therapy, case coordination, and crisis support. But what are the measures we use to assess the efficacy of these programs? Perhaps their legacy is the increased detection of mental illness that already exists in the community, but surely we can’t measure their success based simply on increased rates of diagnosis?
Still, supporters of mental health awareness campaigns in our education system insist that the issue is “silenced” and argue that we must continue to have “the conversation” with very young children about mental health, insisting that it will encourage them to speak up about and seek help with issues that they are experiencing. The problem with that is, as the American psychologist Abraham Maslow stated, “If all you have is a hammer, everything looks like a nail.”
In that regard, there must be more in our toolkit than the language and mechanisms for self-diagnosis. Even the children’s television show institution Sesame Street aired an episode in which the word of the day was “Anxious” and offered up suggestions (prompts) for situations that may elicit worry in their viewers. We need to reflect on the balance between creating a space for the inflicted to confidently step forward without fear of judgement and not encasing the “emotionally well” with a sensitive instrument that allows them to view the trials and tribulations of their lives as medical disorders outside of their control.
We also live in a society where inclusiveness is next to godliness and, in some perverted way, the initial ambition of acceptance of an outlier, or those suffering ailments, has turned into the vehicle through which many young people now identify and connect with each other. This phenomenon has been able to easily take root and flourish due to the explosion of technology, moulding a generation that wants an instant hit in the form of a label and an answer to their feelings of discomfort.
The teenage years are marked by a drive to move away from parental control and authority and seek acceptance and inclusion from peers. For this reason, the movement of mental health education has provided a fertile ground in which struggling adolescents can identify, connect, and lament together their hardships and adversities. Compounding this is the sound-bite nature of social media, with its insidious and persistent messaging providing children with vindications of their emotions and struggles. With a natural and innate drive to “fit in,” young people will have a tendency to self-analyse, self-flagellate, and, ultimately, identify as mentally unwell, reinforcing not only their belonging to a community but also their own deficiencies.
Pushing our relationship with poor mental health further than mere acceptance, in recent years we have seen sportspeople, celebrities, and “influencers” praised for outing their own diagnoses. In mid-2021, the world watched and was divided over the decision by American gymnast Simone Biles to pull out mid-event at the Tokyo Olympics, citing the need to put her mental health first. Accolades came in instantly from people around the world who applauded her bravery in such an act, establishing her as the poster child for how we should all approach the adversities in life that push us to our limits and beyond. Concurrently, there were unfavourable whispers that Biles’s actions demonstrated a lack of resilience and the egotism typical of her generation.
Perhaps it was the revelation of real vulnerability in a cult-like sports hero that, disappointingly, brought her back to being just a fallible human. But the Biles affair also pushes us to question which message we are now supposed to be imparting to young children. Is the characteristic of persistence more important than quitting? Or should the message be that signs of emotional fragility are to be prioritised and that quitting is both essential and admirable?
In the weeks immediately prior to Biles’s action dividing the sporting world, tennis star Naomi Osaka withdrew from the French Open to focus on her mental health. These close events appeared to signal a decisive shift from the days of Michael Jordan, who is commonly known to have said that “If you quit once, it becomes a habit,” to an embracing of vulnerability and fault, letting fans know that it is okay to not be okay.
Humans have always needed to categorise and label the world around them. Categorisation is a well-documented short-cut phenomenon employed to reduce the complexity of our experiences and environment to a simplistic form to conserve cognitive resources. In this manner, the potential over-labelling of undesirable childhood behaviours in the classroom has, for some time, been increasing exponentially in parallel with the rise in emotional neuroses.
Five-year-old Australian children with an inability to sit still, attend, and respond appropriately to instruction as required have resulted in an explosion of paediatric assessments and “therapy.” Defiance, like melancholy or stress, presents with a slippery slope for a quick diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) or, worse, Oppositional Defiant Disorder (ODD), to explain away any obstacles faced by children and their parents and teachers. In a similar vein to the mental health movement, the noble objective to de-stigmatise neurological conditions that impact functioning in the classroom has created a hyperalert environment in which no child will fall through the cracks and all difficulties are seen through the lens of a potentially undetected diagnosis.
One of the many problems associated with this medicalisation of broader human presentations is a watering-down of serious neurological disorders which, at best, can impact some element of daily functioning and, at worst, can be lifelong and debilitating. One such diagnosis is Complex Trauma, which is said to develop after a person has been repeatedly exposed to a situation that elicits feelings of anxiety, fear, hopelessness, or powerlessness. The difficulty in such a theory is that young people are increasingly identifying and reporting such feelings during seemingly “normal” but challenging periods of their life, such as end-of-school exams and navigating their first jobs. When they are given a formal diagnosis of trauma, the young person is not only validated in their experience but also stripped of an opportunity to look at their situation with a fresh perspective and uncover their own faculty to bring about change.
The steep rise in youth mental health diagnoses undoubtedly reaches its peak among the middle classes. They are the children of the educated whose parents have been flooded with messages of early detection, the need for constant communication, and the dangers of not seeking help early—the youth self-harm rate alone is enough to frighten any helicopter parent. The latest figures from the Australian Institute of Family Studies (AIFS) reveal that 30 percent of young people aged 14 to 17 had considered intentional self-injury and 18 percent had engaged in actual self-harm. Parents are armed with an overabundance of knowledge to ensure that their child has well-developed self-esteem, a worthy emotional IQ, an ability for self-reflection, and a toolbox of self-care strategies at their disposal.
This is all before they even begin to consider nurturing concepts of gender and identity. Of course, this demographic also has the most access to mental health services, which usually confirm and entrench their self-diagnosed ailments. Amongst these middle-class students there is an obvious growth in disability provisions awarded for mental health reasons during exam periods. These usually consist of regular breaks, extra time, and smaller rooms for those students who cannot cope with the ordeal of the standard examination experience.
As a psychologist, I applaud our acceptance of those that are suffering from mental health conditions and believe that we still have work to do to ensure the message is loud and clear—seeking help in times of need is not a weakness. Poor mental health should be an accepted medical condition along with physical ailments, and the path to treatment unobstructed and without persecution.
However, a society that wallows in a culture of self-flagellation and diagnosis of emotional neurosis should never be held up as an ideal, just as we should not strive to normalize poor physical health. Mislabelling many of these emotions as mental illnesses may serve to ignore the great resilience and problem-solving ability humans have within themselves for overcoming adversity, and that can only be both a shame and loss to future generations.