Society plays a huge role in managing, but also in creating, mental distress. Race, poverty and gender can all greatly influence our experience of mental health. The institutionalisation of young children by the state in Australia and New Zealand (particularly Maori and Aboriginal children) has had documented adverse affects on those children. There is evidence that the experience of racism itself can have profound detrimental psychological effects. Injustices that persist in society resonate in mental health.
This seems to contradict an arguably helpful message that mental health does not discriminate, that it can affect anyone, and therefore, we all have a role in managing it. It also challenges the more insidious assumptions that mental distress is a consequence of purely genetic, chemical discrepancies or even, personal failings. From what I have seen of others experiencing the mental health system, poverty in particular can sharpen the pain of mental distress.
Lack of resources (including, crucially, advocacy), as well as discrimination and other consequences of poverty, are part of the problem. But what strikes me most from observation is the disconnection that poverty can cause. I met people who not only lacked family support, but community support. Although they were often kind, intelligent and engaging, once outside of the hospital they were no longer included in my community – or, perhaps, in any community. They became outsiders – due to homelessness or criminality or simply because they presented their experience in a different way.
These are some of the ways in which society can impact on those it excludes. However, even those with all of the benefits of inclusion can experience disconnection from their communities. I am writing from a perspective of immense privilege. I have a family and a community of peers that appreciate and support me. Despite this, my experience of mental distress has been an isolating one.
Even where privilege exists, the effect of mental distress on your ability to participate in your community in traditional ways, for example through work, can lead to feelings of exclusion and unworthiness. The ability to work productively and contribute to one’s community through work is widely viewed as part of what of it means to be an engaged, functioning person. The World Health Organisation defines mental health “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” (my italics)
Unfortunately defining “productive work” and “contributions to society” is a task laden with centuries of preconceived notions about types of work and types of workers which advantage already privileged groups. Mental distress can have a dramatic impact on one’s ability to work within current systems. A mental health “consumer” might be told that they will never be able to work full time, or in shift work, or during late hours because of the impact of sleep or stress on their experience. They might get the impression that their dreams of being a lawyer or a rock star are impossible (despite evidence to the contrary). Furthermore, humans undeniably affirm themselves through comparison to others. Living on the disability benefit while you’re best friend studies, or works overseas in some amazing location, can be hard.
Another societal expectation of how we can contribute to society is through having a family. I have heard of mental health “consumers” being told by medical professionals that they should “buy a pot plant” instead of planning a family. The genetic nature of some mental distress, and the stress of parenthood, make choosing a family a difficult decision (if choice is involved) and one that deserves special sensitivity from partners, family and friends, as well as mental health professionals.
We need to stop defining “work”, “productivity” and “contributing to community” in such narrow, old-fashioned ways. Perhaps we need to create new narratives where, instead of simply encouraging those with experience of mental distress to lead “normal” lives, we value their unique experiences and find space for the special wisdom that these experiences can create. Instead of only encouraging those who many still define as mentally “ill” to change and “progress” towards predetermined, narrow versions of wellness, maybe we need to also encourage the communities and societies around them to change, creating space and placing value on the experience of difference.
Mental distress can affect our ability to contribute to society in another way: by impacting on how we form linkages and relationships. Stress and anxiety around social situations, and the impacts on self-esteem and faith in judgment that can result from experiences of mental distress can limit our ability to meet new friends. They can also impact our ability to manage and develop existing relationships.
Despite their best efforts to understand, some of the narratives that comfort my supporters differ from the ones that enable my healing. I think of the different narratives surrounding mental health and those that are “true” or useful. To complicate things, different narratives can be helpful at different times and contradictory narratives can be “true” simultaneously. My truth has changed over the years, now, as a 27 year old, my story differs from what I told myself as a 20 year old faced with my first diagnosis. Consequently, it differs from what even those with the best intentions believe about my mental health. This can result in stress and complicate how I have to manage relationships.
For example, the decision to refer to my experiences as “mental distress” instead of mental illness is one informed by time. I honestly believe that being diagnosed with a mental illness was helpful to me for a period. It allowed me to disassociate from my psychosis and from what I had done when I was experiencing distress. It enabled me to identify with others who were diagnosed similarly. It gave me a sense that there were ways of responding and those who had the knowledge to help. Describing myself as “ill” addressed some of the feelings of blame and shame I felt and how I reacted to stigma. One of the things I was often told was “You wouldn’t treat someone like that if they had a broken leg.”
However, as time went on I began to identify with alternative ways of articulating my experiences, such as seeing it as “mental distress”. Using this term addresses societal stigma by including a broader group then those with a diagnosis and distinguishing mental health from physical health, implying that we should have different approaches to their treatment. There are many implications of this change in language, but for me personally my reasons revolved around my sense of self and how much control I had in managing my mental health and my life. Talking about what happened as “experiences” rather than “illness”, allowed me to reclaim my story – these were things that had happened to me, rather than something I was infected with.
Referring to mental distress helped me take ownership of my role in managing my health. I experienced changes in mood, triggers from trauma, or the memory of trauma, and symptoms that I alone could recognise and report. This made me realise that I had knowledge and wisdom to draw on, as well as family, friends, art, music and writing to sympathise with and articulate what I was going through. It brought the management of my health back into my own hands and out of the hands of medical professionals alone. This is a change I try hard to live everyday, although sometimes I fail.
Ultimately society as a whole cannot decide what is best for individuals, but must play a role in supporting their own solutions. It is the site of much of the injustice that can cause and exacerbate mental distress, so it must have a part in addressing it. Maybe the solution lies in placing more value on the “truths” of those who experience mental health differently, in the wisdom they can offer which can contradict the status quo. Maybe we need to make space for other narratives and empower those experiencing mental distress to choose their own. This, at least, seems to be the first step.
 Tackling racism: urgent priorities for children out-of-home care and immigration detention, Published: July 16, 2014
 Franklin, Anderson J., Nancy Boyd-Franklin, and Shalonda Kelly. “Racism and invisibility: Race-related stress, emotional abuse and psychological trauma for people of color.” Journal of Emotional Abuse 6, no. 2-3 (2006): 9-30.