The role of the body in mental Illness distress

Campaigns working to reduce stigma (whose aims I wholeheartedly support) have likened mental health problems to a broken arm, arguing that mental and physical health should be seen as equal. It’s a totally reasonable idea. However recovery from a physical injury is, often like the cause, a reasonably straight forward, individual, process. The same is not true of mental distress and so the analogy, while well intentioned, is not really accurate or helpful.

In every presentation of distress that I see as a psychologist, pain and suffering is in some part, a consequence of the systems we “survive” within. We must recognise the impact of these systems on our mental health because otherwise all emotional distress is understood as ours: a problem we own, to be fixed or left to worsen, best understood by doctors or experts who specialise in “mental illness”.

Many people who are experiencing mental distress feel further burdened by the fact that they have struggled to “get better”, taken as more evidence of their brokenness. Mental health professionals end up holding a huge amount of responsibility for making the “right” diagnosis and offering the “right” treatment, be it a medication, or some form of therapy. Often when change doesn’t come, or recovery is slow, all parties are left feeling impotent.

Emotional distress, unusual experiences, and many other forms of illness and behaviour that attracts attention from health and care services are almost always understandable when viewed in the context of someone’s relationships, life events, social circumstances and the standards and expectations we are all expected to live up to.

“We didn’t evolve in a competitive, aggressive, exploitive, unequal, relentlessly, manipulative, hyperactive, addiction ridden, distracting, possessed, misogynistic culture. The way we live now is abnormal”

Garbor Mate

This leaves many folk working in the mental health field with a tricky dilemma. In this complicated modern world which is so far from the one in which we are evolved to navigate, when is it right to offer individual treatments for psychological distress (or even advocate “self-healing” or “self-improvement”) when we’re become increasingly aware that mental health problems aren’t biological illnesses, and so the burden of responsibility should be shared by all, to create a world where everyone has a decent opportunity to live a fulfilling life. Does this individual focus perpetuate the myth of mental illness?

Finding balance

I believe that there is balance to be found. I am trained to treat individual mental distress. And I’m aware that most of the treatments I offer do very little to challenge structural and power inequalities endemic in Western Society, or seek to improve or create the kinds of environments where individuals, families and whole societies have their core needs for safety, connection, freedom of expression, control, justice and purpose met.

However I also recognise that those basic needs are much more easily accessed via a regulated state, from which we also have much more capacity to act. Human beings are organisms – animals whose prime focus is on safety and survival via connection. When we cannot access those core needs, we respond as if faced with threat (anxiety, fear, depression, obsession, avoidance……) These responses are survival strategies, which serve us in the short term, but in the longer term often lead to confusing, problematic consequences.

In mental health services, it is these very survival strategies which are labelled as psychiatric symptoms. So if we are to recognise that this threat detection process begins in our body – via our individual threat detection systems, and we make a decision that we want to respond with something other than a defensive strategy, first we must recognise this as a goal, and then choose if we want/ need to act in defence (sometimes the safest or necessary option?), or if we wish to learn to regulate the response and do something different.

As a regulated individual, I can rest and grow then learn and share through connection. 

As regulated groups we have access to our collective higher levels of functioning so that we can act together with focus and direction, with intelligence and compassion rather than in fear or defence.

This is why I believe the work on the self, via the body, to be so necessary and important, but that it should be entered with an understanding that we do not cause our own psychological pain. Mental illness is not a biological disease happening within the individual or in a vacuum.

Our bodies respond to terrible things happening, both on individual and collective levels, and while we are not to blame for these things, we can take some responsibility for how they manifest. And for how we care for ourselves and our communities.

It is my view that we should talk about mental distress in much more authentic ways. Drop labels and disorders, quit comparing it with discrete physical injury, and recognise the complex contributors to distress in our society. Rather than asking the individual “what’s wrong with you?” we should be asking:

  • ‘What has happened to you?’
  • ‘How did it affect you?’
  • ‘What sense did you make of it?’
  • ‘What did you have to do to survive?’
  • ‘What are your strengths?’
  • ‘What is your story?’

Read more about this approach in The Power Threat Meaning Framework. My favourite easy read intro is in A Straight Talking Introduction to The Power Threat Meaning Framework, an alternative to Psychiatric Diagnosis, by Mary Boyle and Lucy Johnstone.

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