In an increasingly globalized and mediatized world, in which mental illness is one of society’s most discussed cultural artifacts, Colleen Patrick Goudreau’s words ring out: “If we don’t have time to be sick, then we have to make time to be healthy”.

With the prevalence of mental health problems, it is clear why. Mental health issues are one of the leading causes of the overall disease burden globally, according to the World Health Organisation. One study reported that mental health is the primary source of disability worldwide, causing over 40 million years of disability in 20 to 29-year-olds.

Compared to previous generations, mental illness is now said to surpass the effects of the Black Death. The root causes of the unprecedented rise in people directly affected by mental illness, and the cost of this, can be considered across at least three levels of analysis.

If we don’t have time to be sick, then we have to make time to be healthy. Colleen Patrick Goudreau

At the first level of analysis, the root cause of mental illness is an amalgamation of heredity, biology, environmental stressors, and psychological trauma.

Notions of specific genes being responsible for illness have been supplanted by those of genetic complexity, where various genes operate in concert with non-genetic factors to affect mental illness. That is, health-relevant biology and mental health impact each other in a complex interplay, which is inherently social.

Despite the importance of understanding the social underpinnings of biological risk factors for mental illness, there is a relative paucity of research investigating this topic. Research that does exist, is nevertheless engrossing. For example, one study, of many, found that social isolation leads to increased risk of coronary heart disease. Since low levels of social integration are related to higher levels of C-reactive protein, a marker of inflammation related to coronary heart disease, social integration is posited to be a biological link between social isolation and coronary heart disease.

Moreover, social support affects physical perception. In a landmark study, researchers demonstrated that people accompanied by a supportive friend or those who imagined a supportive friend, estimated a hill to be less steep when compared to people who were alone.

Mental health, like physical health, is more than the sum of functioning or malfunctioning parts.

At the second level of analysis, the complex bio-social interplay scaffolding mental illness points to the fundamentally chemical underpinnings of human thinking and emotion.

With recent advances in neuroscience like Clarity, we are now able to make the brain optically transparent, without having to section or reconstruct it, in order to examine the neuronal networks, subcellular structures, and more. In short, we can examine mental illness from a biological perspective.

The depth and complexity of the bio-social root of mental illness, however, paints a more nuanced picture than discussed thus far. With such pioneering work, there is an increasingly popular assumption that the brain is the most important level at which to analyze human behavior.

In this vein, mental illness perpetuates itself by virtue of the fact that people often consider it to be biologically determined. In turn, a ‘trait-like’ view of mental illness establishes a status quo of mental health stigma by reducing empathy. Such explanations overemphasize constant factors such as biology and underemphasize modulating factors such as the environment.

At the third level of analysis, the obsession with seeing mental health in terms of mental illness reveals the fallible assumption that mental health is simply the absence of mental disorder. However, the problematic landscape of mental health draws on a far wider set of working assumptions. That is, mental health, like physical health, is more than the sum of the functioning or malfunctioning parts. It is an overall well-being that must be considered in light of unique differences between physical health, cognition, and emotions, which can be lost in a solely global evaluation.

So, why do we as a society ponder solving mental illness, which should have been targeted long ago, far more than we consider improving mental health? In part, because when we think of mental health, we think of raising the mean positive mental health of a population, more than closing the implementation gap between prevention, promotion, and treatment.

Cumulatively, social environments are the lubricating oil to biological predispositions, which influence mental health, such that mental health and physical health should be considered holistically. In this vein, national mental health policies should not be solely concerned with mental disorders, to the detriment of mental health promotion.

It is worth considering how mental health issues can be targeted using proactive behavioral programs. To achieve this, it is pivotal to involve all relevant government sectors such as education, labor, justice, and welfare sectors.

In a diverse range of existing players, many nonprofits’, educational institutions’, and research groups’ efforts contribute to the solution landscape of mental health promotion. In Ireland, for example, schools have mental health promotional activities such as breathing exercises and anger management programs. Nonprofits around the world are increasingly seeing the value of community development programmes and capacity building (strengthening the skills of communities in so they can overcome the causes of their isolation). In addition, businesses are incorporating stress management into their office culture.

We think of raising the mean positive mental health of a population, more than closing the implementation gap between prevention, promotion and treatment.

The pursuit to empower people to help themselves joins up these social ventures to teach us that promoting mental health is optimized when it is preventative, occurring before mental illness emerges, and when it is linked to practical skills within a community. Furthermore, these social ventures exemplify how different types of efforts (government, nonprofit, business etc.) cater to different populations, from children to corporates.

While these social ventures bring hope to the future and underscore the importance of sustainable change, there are still too few programs effectively targeting people, who want to maximize already existent positive mental health not just to resolve or cope with mental health issues. If we continue to take such pride in our successful problem finding and solving of mental illness that we ignore mental illness prevention and mental health promotion, we are at risk of increasing the problem we are trying to solve.

References

Heffner, K., Waring, M., Roberts, M., Eaton, C., & Gramling, R. (2011). Social isolation, C-reactive protein, and coronary heart disease mortality among community-dwelling adults. Social Science & Medicine, 72(9), 1482-1488. doi: 10.1016/j.socscimed.2011.03.016

Lozano, R., Naghavi, M., Foreman, K., Lim, S., Shibuya, K., & Aboyans, V. et al. (2012). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380(9859), 2095-2128. doi: 10.1016/s0140-6736(12)61728-0

Schnall, S., Harber, K., Stefanucci, J., & Proffitt, D. (2008). Social support and the perception of geographical slant. Journal Of Experimental Social Psychology, 44(5), 1246-1255. doi: 10.1016/j.jesp.2008.04.011

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