I’ve experienced mental health struggles for most of my life. For me, like many of us, that means that I’ve had a high level of self-critical background noise a lot of the time: thoughts that I’ve done something terribly wrong, or that I will do, or that there’s something wrong with me. It often manifests as a low, heavy mood: a kind of grey fog over everything that makes it difficult to see things clearly, to make decisions, or to appreciate the beauty of the world around me. At its worst, it has tipped into extreme self-loathing and the urgent wish to eradicate the ‘bad’ parts of me in order to make myself acceptable.

Despite these experiences I’ve always been reluctant to label myself with the terms that might seem obvious when you read this description. I’ve probably ticked the boxes for several of the recognised ‘psychiatric disorders’ in my time, but I don’t feel comfortable identifying as a person with depression, as mentally ill, or as having a psychological problem. Equally I don’t feel comfortable identifying as sane, mentally well, or psychologically healthy. As with so much in life, I feel that the binary – in this case between ‘mad’ and ‘sane’ – is actually part of the problem.

The mad/sane binary is present in all of the mainstream messages that we receive about mental health. For example, high profile campaigns to end mental health discrimination have often centred around one, apparently game-changing, statistic: 1 in 4 people have a mental health problem. Celebrities like Stephen Fry and Ruby Wax have used the figure to speak bravely and openly about their experience of mental ill health, but the danger of that statistic is that it suggests that 75% of the population do not experience any mental health problems at all. Rather than seeing mental health as a continuum which we might all move up and down over the course of our lives, we’re forced to stake our identity on one or other side of a strict dividing line:

'Either ... I have a mental health problem – I need help – it’s not my fault
Or ... I don’t have a mental health problem – I don’t get help – it is my fault'

In this way we’re placed in a double bind, because accepting one side inevitably involves denying the other, and neither side promises a great outcome. If we’re seen as having a mental health problem we may well feel utterly disempowered, as if there’s nothing that we can do to improve our situation. If we’re seen as not having a mental health problem we might feel like we can’t admit to having any problems or get any support because we’re completely responsible for our own happiness and well being. The responsibility either rests entirely with other people, or entirely with ourselves, and either way that puts us in an untenable position.

Linked to this is the fact that both sides of the binary internalise suffering, seeing it as a purely individual thing, rather than a symptom of wider social issues. We are forced to view mental health problems as inborn, either caused by illness (perhaps a genetic vulnerability and/or brain chemistry issue) or by a personal deficiency (such as bad habits, faulty thinking, or lack of moral fibre). This can be very damaging because there’s strong evidence that all our human experiences are biopsychosocial: a complex interaction between the world around us, our personal experiences of it, and our bodies and brains, with all of those aspects influencing the others. We risk doing further damage to ourselves when we attempt to change our individual experience without recognising the role of social injustice or cultural messages in our suffering.

For example, it’s clear that structural oppression and social inequalities have a major role in mental health struggles because we see far higher rates of such difficulties in groups who are socially marginalised. One recent UK study found that women were 40% more likely to develop anxiety and depression than men, for example, another found that LGB people are twice as likely to be suicidal as straight people, and a further one that BAME people are six times more likely than white people to be admitted as in patients in mental health services. We need to recognise the role of intersecting marginalisations in mental health struggles, and the ways in which social experiences such as poverty, discrimination, and the experience of trauma are highly related to psychological distress.

We also live in a culture, which encourages the very kind of self-critical thinking that’s a feature of all the most common mental health problems. The French philosopher Michel Foucault famously used the analogy of the panopticon prison for our culture. In this prison there’s a single guard sitting at the top of a central tower in the middle who is able to see into all of the prison cells.  Prisoners end up monitoring their own behaviour all of the time, just in case they might currently be being watched.

Foucault argued that our culture works in this way through all of the pressure we’re under to self-improve, and to present a positive, successful self to the world. We’re made to feel fear that we might be lacking or failing in some way, and we’re sold products which claim to help us to allay those fears. Makeover shows, self-help books, and beauty products are some of the more obvious examples. Social media also encourages us to maintain the illusion of perfection online, leading to endless rounds of self-evaluation and comparison.

In a world where so many of us are struggling with very real social problems, it’s vitally important to acknowledge the cultural context we’re in and to resist individualising our suffering. The mad/sane binary is very effective in preventing challenges to toxic policies and practices because people are not aware of the social context of their struggles, and because there is a fear that if you do speak out you will be dismissed as ‘insane’.

We can see this at play in the recent moves to regard unemployment as a psychological problem and the insistence that those claiming benefits undergo cognitive behavioural therapy. The responsibility is placed on the individual rather than on wider societal problems, and resources are focused on psychological change rather than addressing economic inequalities. There’s a high risk that people are left in the same damaging situation, but with an even greater tendency to blame themselves for it.

The psychotherapist Winnicott famously said, of depression: “The capacity to become depressed […] is something that is not inborn nor is it an illness; it comes as an achievement of healthy emotional growth […] the fact is that life itself is difficult […] probably the greatest suffering in the human world is the suffering of normal or healthy or mature persons”. Perhaps we would do well to view the depression, anxiety, and other mental health struggles that most of us grapple with at some point as a sane response to an insane world. This would shift the emphasis for change away from the individual and towards the wider societal structures and cultural messages around us.

I know that what has helped me the most in this area has been to recognise the social and cultural aspects of my struggles. It’s a huge relief to allow the weight of total responsibility to lift, and to recognise the role of internalised self-criticism and social power dynamics in my experiences. This acknowledgement also allows me to engage critically with the mad/sane binary: resisting the sense that I’m completely responsible for my difficulties and the sense that I have no capacity at all to help myself. In this way I can cultivate a kinder relationship with myself, on the one hand, and feel more of a sense of kinship with all of the others who are in the same cultural boat. Such connections enable the possibility for collective resistance and for social activism, which feel like a much better focus for my energy than continually trying to change myself.

You can read more of Meg-John Barker’s thoughts on mental health on their blog, including their social mindfulness zine in the resources section. Strongly recommended is Richard Bentall’s work, including his recent response to the Stephen Fry documentary on depression, found here. This article is also an important overview of the current use of therapists in the benefits system.

Illustration by Pom Lette