Have you ever stopped to ask whether distressed people actually need a psychiatric diagnosis? For example, in Kenya many people claim the next challenge after Covid-19 will be a national mental emergency because of how the pandemic has negatively impacted the country’s mental health. However, becoming more anxious in response to Covid-19 is a normal reaction if you are mentally healthy and actually a sign of illness if you’re not. When one faces exceptional circumstances, everyone can be expected to feel levels of fear, sadness and irritability well above their usual baseline.
So rather than asking ‘What is wrong with you?’ to understand how to heal someone suffering emotional distress during this crisis period, the question should actually be: “What has happened to you?” Emotional distress is a real human response to adversity. In ordinary times, there are those who struggle with anxiety and depression and because of the mainstream views of mental illness as an intrinsic, biological defect of individuals. However, what should be at issue is whether our distress should be pathologised.
What we are rarely told is that the dominant explanations for these experiences – that they are ‘symptoms’ of an ‘illness’ caused by a ‘chemical imbalance’ which psychiatric drugs will rectify - has never had any evidence to support it. This will feel to many a controversial viewpoint in a world where the ‘biomedical model’ of distress has taken such a hold of public consciousness and become the accepted system for mental health. Yet, as levels of distress seem to be increasing in our society, especially now due to Covid-19, medical prescriptions have also risen. The biomedical model appears the only solution on offer.
A depression diagnosis gives people an identity formed around having a disease. It pathologises a normal human reaction to distress and this diverts resources from where they might be needed. There is no blood test or other biological test to prove the chemical imbalance. Imagine how much less depression there would be if people weren’t worried about school fees, health care, affordable quality housing and were given support to grieve their losses be it death of a loved one, loss of a job, marriage or a dream. These things are not improved because you take Prozac (a drug used to treat depression).
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Sadly, there appears to be a strong inclination towards use of medicine to treat our emotional/mental challenges instead of working with the person experiencing such issues to seek the root cause of their problems. Drugs will not solve our mental health issues. Instead, they raid our wallets and often leave us worse off. In the US, an estimated 1 out of 6 adults takes a psychiatric drug, with over 80 per cent reporting long-term use. In the last decade as mental health awareness has increased, so has prescription drugs as a solution. Many see a direct link between the pharmaceutical companies and the diagnosis of disorders. While statistics in Kenya are lower, this is where we are headed if we do not challenge the bio-medical model of wellbeing. Why are we blindly adopting a model clearly not working in the West?
Critiquing the medical model of mental illness means rejecting the limited way we are taught to view “mental illness.” But it does not mean someone’s experience is not real and not deeply distressing to her and the people around her. When bad things happen in people’s lives, it damages them, and they may go on to harm themselves and/or others. We need to normalise people’s feelings of distress and exhaustion and meaninglessness, not because they are weak or not up to the job. It is a natural response to adversity, abuse and pain.
We need a new narrative of shared distress to replace the failed one of individual disorders. We need human connection and mutual support. I believe Covid-19 and climate change will help us start to shift the conversation in Africa and beyond.
-Dr Angi Yoder Maina is Executive Director, Green String Network, Nairobi.