Mental health: from mocking to understanding

DURING 1985, in our Standard 9 year in the eastern Free State, Juliana Combrinck (not her real name) was suddenly absent from school for about four months. At first, few pupils noticed this, but after a few weeks the speculation started.

Her parents did not move away, she did not go to another school, and Ansie Gerber, who lived in the same street as Juliana, swore that she simply stayed at home. Some evenings, Ansie spied on the house from behind a bush and insisted she could often see movement through the lace curtains of Juliana's bedroom.

Juliana eventually returned to school, more timid and resigned than before. The term mental health was unknown to us, but one sensed that her absence was not due to a commonly known physical condition.

Her distant attitude after she rejoined classes was reminiscent of characters from One Flew Over the Cuckoo's Nest, which was one of our only sources of reference about how people with mental illnesses are supposed to behave. Her parents moved away after six months and she left the school unnoticed.

That was more than 30 years ago, and Juliana's withdrawal, a few references on radio or TV, and jokes about people who escaped from the “madhouse", were the sum total of our group of young people's understanding of mental health.

We were almost old enough to leave school, and words such as depression and phobia were simply not part of the general narrative.

In retrospect, the general approach to mental health at the time was black and white: you were either “normal", or there was something wrong with you that implied you were “abnormal", and possibly belonged in an institution for the mentally ill.

Stigmatisation and misperceptions

It wasn't only a few high school children in the eastern Free State who were uninformed. The term “mental health" might have existed in dictionaries at the time, but it was certainly not part of the collective consciousness in South Africa.

Globally, mental health was still stigmatised in the 1980s, which meant  large numbers of suffering individuals did not seek help or talk about their problem. In fact, it was common in many official and informal settings that individuals hampered by their minds were marginalised, teased or gossiped about, or they were considered weak and inadequate. Much like the way we used to think about Juliana.

Fast forward to the mid-1990s: political transition, unrest, and a new South Africa, but mental health was still low on the agenda. Here and there the high incidence of suicide and post-traumatic stress among police officers was mentioned, there was awareness of the psychological implications of gender violence and sexual molestation of children, and general crime and violence began to take on a collective narrative.

Misperceptions about mental health were still the order of the day, however, and anyone who had the poor taste to be anxious or depressed was still mostly marginalised in social and professional contexts.

Mental health becomes fashionable

The turn of the new century brought momentum to mental health awareness. The medical and financial implications of rapidly increasing symptoms — of anxiety-related conditions and depression, in particular — could no longer be ignored.

Sick leave for mind-related conditions became common, and employers were forced to accept it. And then, in the 15 years before Covid-19 struck, and especially during and after the epidemic, mental health became fashionable.

Suddenly, it has become acceptable to talk openly with friends about your depression or medication. People are no longer ashamed to park their vehicles outside a psychologist or psychiatrist's office, and in many social circles it is regarded as old-fashioned for parents not to take their children to psychotherapists.

Young working adults think nothing of taking a “mental health day". Teenagers talk openly about their therapists, and those who do not visit psychologists feel left out.

Psychologists and psychiatrists who have not been snatched up by European countries, where demand for their services is just as high, struggle to cope with overflowing waiting lists. 

Psychologists such as Jordan Peterson and Dr Phil (McGraw) are world-famous celebrities, and podcasts, seminars and courses are the order of the day. Awareness of mental health has became cool.

In less than two decades, how did we and most of the developing world get to the point where mental health has wormed its way into the same level of consciousness as physical exercise, diet and personal fulfilment?

How did we so quickly reach a point where it is widely accepted that most of the world's population experience mental health challenges?

The Dark Ages

The collective consciousness about mental health developed from a complicated historical background.

The period before the 19th century can rightly be described as the Dark Ages in this context. Communities throughout most of history have always dealt with mental illness harshly, and this period was the worst. Cruel treatment, the exorcism of “demons" and isolation have always been common, and social as well as official marginalisation has mostly been the fate of many people who did not think, feel or act as society expected.

Until late in the 1800s, people were still punished (mostly from a religious perspective) for behaviour that occurred outside the norm.

The beginning of the 19th century ushered in psychiatric institutions, and consequent institutionalisation, in the Western world. Although the main purpose of these institutions was to help people and improve their mental health, most of them became the source of horror stories. Treatment was still mostly inhumane and unscientific, institutions were overcrowded and unsanitary, and patients' fates were uncertain and precarious.

However, from this period onwards it was possible to develop psychiatry as a fully-fledged science — largely as a counter-reaction to the ineffective impact of mental institutions of that time. As the 19th century gave way to the 20th, Sigmund Freud and a few like-minded people paved the way for a humane and scientific approach.

The world wars further intensified the focus on mental health. Tens of thousands of soldiers displayed the same symptoms of war-related stress, or shellshock, later known as post-traumatic stress.

The second half of the 20th century brought rapid progress in scientific research. The focus shifted from institutionalising individuals with mental problems to the reintegration of individuals into society and the associated reduction of stigmatisation.

Rapid advances in empirically based research, the development of pharmacological treatments, as well as neurobiological studies and treatments, began to elevate psychology and psychiatry to prominence.

With the transition to the next (digital) century, celebrities, sports stars and other public figures have started to contribute to normalising conversations about mental health. Organisations and pressure groups with mental health as an agenda are making a wider impact on organisations and governments.

The role of technology

Technology has played a massive role in this development, and technological progress is increasingly a heavyweight player in the individual's dealings with mental health.

Smartphone apps such as Headspace, Talkspace and Calm provide easy access to methods of practical mental health management. Telemedicine, online psychotherapy and counselling give individuals easy access to interactions and discussions about their mental health.

Social media allows everyone to observe the consequences of catastrophic events worldwide, such as natural disasters, wars or pandemics, and to share the psychological impact of these events with other people internationally.

Generation Z

One would think that advances in mental health awareness and treatment would avert a crisis, but this does not seem to be the case.

Individuals from the so-called Generation Z (those born between 1995 and 2012) are generally considered to be the most independent, creative and technologically savvy generation to date. They also report more mental health problems than any other demographic group.

Recent studies show that up to 70% of Gen Zs feel mental health is their highest priority when it comes to caring for themselves.

Just a phase?

Bullshit, some say. Just another phase that will blow over, like yo-yos and the Rooi Gevaar. Not that simple, say the World Health Organisation  and many other institutions conducting research.

Psychiatric conditions are more common than cancer, heart problems and diabetes. It is estimated that about 450-million people worldwide experience some form of mental illness. Major depression is among the 10 conditions that cause the most disease, and is expected to be the leading cause of disease globally in less than six years.

It is conservatively estimated that the psychological functioning of about half the world's population is under pressure, with negative implications for relationships, work and general health.

More than a million people worldwide take their own lives every year. South Africa, where 23 people end their own lives daily, has one of the highest suicide rates. Meanwhile, only 5% of the national health budget is spent on mental health, one of the lowest proportions globally.

It would have been nice if our teachers at the time had handled the situation with Juliana Combrinck differently. Maybe told us that she was struggling with her feelings, but that she was normal. That we should talk to her and include her, rather than avoiding her or gossiping about her. That the way most of us felt on Sunday afternoons was the way she felt all the time.

Even though awareness of mental health is much better than it was 20 years ago, it is difficult not to think of it in crisis terms. Some of the risk factors are social and economic inequality, traumatic personal and world events, physical health, and discrimination accompanied by social exclusion.

The crisis is still far from averted. And only now are we beginning to fully understand it.

♦ VWB ♦

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