Essay

Going sane

Creative terminologies for challenging times

ON THE DAY of The Correspondent’s launch in September 2019, a reader who identified as manic-psychotic sent me an angry note. ‘I’m insulted by your use of the word sanity without even a mention of psychosis,’ he wrote. ‘Is this a joke? Is this supposed to be cute? Call yourself the mental health correspondent. Not the sanity correspondent.’

Here’s the thing. I don’t like the term mental health. I believe mental health has been hopelessly corrupted by big pharma, wellness snake-oil sellers and motivational Instagrammers. I like sanity because sanity is free from these associations.

The pursuit of sanity, which I imagine as a state of equilibrium, transcends the narrow ambit of healthcare. The best thing about sanity is that it has nothing to do with diagnosis – the centrepiece around which the orthodox practice of mental health revolves. You can be diagnosed with depression, mania or schizophrenia and still be entirely sane.

I have lived with depression, anxiety and suicidality all my life. I am thankful for modern medicine. But I am suspicious of any system that is rigidly wedded to diagnostic labels and reduces people to the sum total of their diagnoses.

All medicine is performing art. Cardiology’s prop is the perfectly designed heart; pulmonology has the impressive symmetry of the lungs. Psychiatry has no such prop. In a bid to emulate its sister disciplines, psychiatry grabs at slippery chemicals in the brain, trying desperately to hide that it is, at best, an inexact science.

In trying too hard to align itself with other medical disciplines that work on a physiological plane, psychiatry ends up situating too much responsibility for sickness as well as cure within the individual, in a putative serotonin imbalance, while neglecting the root cause of our suffering – violence, inequality, injustice, discrimination.

In this, there’s no difference between a lifestyle guru peddling the newest mindfulness trick and a psychiatrist extolling the latest wonder drug for depression. They both contribute to what the British cultural theorist Mark Fisher called the ‘privatisation of stress’. Before he died by suicide, Fisher had seen through how the interlocking webs of capitalism and healthcare trap us. We fall sick because we work too hard in a system obsessed with productivity. We are then sold antidepressants and baubles for self-care – meditation apps, goat yoga, or perhaps ‘tidying expert’ Marie Kondo’s ‘energy clarifying’ crystal ball and tuning fork – to heal ourselves so that we can be productive again.[i]

A friend of mine who lives in the UK had to wait for more than a year to see a psychiatrist. But hey, you can always talk to a chatbot.

As you can see, I hadn’t chosen the term ‘sanity’ over ‘mental health’ lightly. Sure, the PR appeal of launching the ‘world’s first sanity beat’ wasn’t insignificant, but my ultimate goal was to find a new language to deconstruct the ‘mental health epidemic’ the media claim we are facing and to do so by uncovering often ignored lived experiences.

The Correspondent was a new kind of newsroom fully funded by over 50,000 readers – we called them members – from 140 countries. It was positioned as a movement against breaking news and championed subjects that mainstream news media either had no patience for, such as the first 1,000 days of human life, or had run out of ways to cover with any degree of optimism, such as climate. It was gloriously free from dogma and afforded me the radical freedom to build something that didn’t previously exist.

Except, in my zeal, I had forgotten to sufficiently account for those who couldn’t afford to dismiss the old way as dogma. For the reader who rebuked me, ‘manic-psychotic, bipolar I’ was core to his identity. Maybe it was his only means to claim his rights and access services.

Of all the things I had expected to be challenged on, the name of my beat wasn’t one. But this reader made me conscious that what I saw as undermining the problematic language of mental health, others could experience as a threat to their very existence. It was an early reminder that there’s no one way of denying someone their lived reality.

 

WHILE PSYCHIATRY’S HISTORY is full of arbitrary diagnoses and forced incarceration of those dubbed ‘mad’ because they challenged the status quo – from ‘drapetomania’ in American slaves (a conjectured disease involving a supposed addiction to wandering off or running away) to ‘sluggish schizophrenia’ in political dissenters in the USSR – the other side is equally true: a lot of people who genuinely need help don’t receive it because the system doesn’t believe their problems are genuine.

In a July 2020 column for The Correspondent, Canadian writer Anne Thériault wrote about voluntarily checking into a hospital following a suicide attempt:

I was yelled at, accused of lying, left for hours on a bed in a public hallway. The tone adopted by most of the staff when speaking to me varied between condescension and animosity. One nurse told a doctor that I was probably a drug user because she had found a lighter when searching through my backpack. A psychiatrist kept repeating: ‘I don’t think you understand how serious what you’ve done is.’
The message, communicated to me by multiple staff members, said this: I wasn’t reliable when it came to telling or understanding my own experience.[ii]

There is a name for this unreliability: malingering, the practice of faking illness to avoid responsibilities or consequences of whatever sort. On 31 January 2021, British psychiatrist Derek Tracy tweeted that he had cancelled a planned lecture on malingering. ‘I reflected on the hurt [the topic] has caused, particularly for people who have personal experience of not being believed by mental health professionals or services,’ he said. ‘I am very sorry for this.’

As my angry reader would say, you can’t fight the establishment’s denial with your own brand of denial. To be an ally, you first need to listen.

 

IN MY TWELVE years as a business journalist in India before I joined The Correspondent, I became familiar with an industry catchphrase: ‘dial-a-quote’. It referred to a widespread practice where journalists kept a handful of experts – consultants and commentators with views on everything under the sun – on their speed dial and routinely went to the same people to churn out a quote for practically every story. The obsession with ‘breaking news’ left journalists with no time to cultivate new experts. Over time, this created an incestuous echo chamber and blocked original perspectives, especially from under-represented communities.

The Nigerian feminist writer OluTimehin Adegbeye, my friend and former colleague at The Correspondent, was fond of reminding us that until the hunted learn to write, every story will be written by the hunter. In mental health, the hunter is typically a white, male clinician-researcher-funder figure in Europe or North America. The hunted are people in poorer countries, older people, people with disabilities, women, LGBTQIA, children.

Doing journalism the old way and deferring to the hierarchy of the mental health ecosystem wasn’t going to change anything. The Correspondent’s way of tackling this grew from a principle called ‘memberful journalism’ – creating journalism with, and not just for, our readers.

This is what helped me develop one of my career’s most meaningful relationships. When I decided to write a series of articles on the importance of touch in the context of the coronavirus pandemic and announced this through a newsletter, one of the first people to respond was twenty-five-year-old Micaela from the US. Micaela has spinal muscular atrophy. She is in a wheelchair full time and can only move her arms enough to eat or type on her phone.

At the peak of the pandemic, the world was in a paroxysm of touch deprivation, and the media cranked out article after article on this exotic malaise. But there was nothing in this coverage about people with disabilities and their relationship with touch. Micaela told me she has a ‘love-hate relationship with touch’. ‘Unfortunately, most of the times I am touched are in the context of physical, not emotional care, so touch is often more of a practical thing than I want it to be,’ she explained.

Micaela led me to an area of human experience that was very real for millions of people around the world long before the pandemic. The high point of the exercise was when she agreed to come on board as an expert and answer questions from other members of The Correspondent.

I discovered Ida, the ninety-three-year-old American-born daughter of Russian and Central European immigrants, the same way. Ida and I became pen friends after she replied to an article where I described my experience of living with depression. ‘Depression has disrupted my life for seventy-five years,’ she wrote.

Over the next few days, as several other senior readers echoed her story, I was troubled by a question I had never considered before: where were all the old people in the swelling media coverage of depression?

If your only source of information on depression is the news or the standard-issue expert advice column, you’d think it is an exclusively young person’s disorder, characterised by too much Instagram and too little sleep. Older people are confined to stories on dementia, Alzheimer’s or Parkinson’s, sidelined from the critical conversation around the one mental health challenge that gets arguably the greatest share of public attention.

This isn’t an accident. Before COVID-19, the only three illnesses named on the homepage of the National Institute on Aging in the US were dementia, Alzheimer’s and Parkinson’s – evidence of their domination over the research and funding agenda.

The narrative is so entrenched that I was taken aback when I found out that according to the World Health Organization, depression is the single most common mental disorder in the sixty-plus age group.[iii] Ida was the expert who drove me to that discovery.

The story I wrote based on my research triggered a fervent reckoning on ageism in mental health among The Correspondent’s members. It also encouraged people like Pete, seventy-five and a Vietnam War veteran, to open up about their own lifelong struggle with mental health problems. It was a story that spoke to the kind of invisible structural truths dial-a-quote reporting would never have uncovered.

 

WRITING ABOUT THE worst kind of human suffering on a daily basis is nobody’s idea of a living. It sounds mawkish, but some of us don’t have a choice. I ran out of choices the day I decided to jump from our balcony, saved only by my two-year-old, who came running out of the house shouting ‘Papa!’ because he wanted to show me a new insect he had discovered.

If I were religious, I’d have called it a miracle. But the only epiphany I had that day was that pills and therapy were no longer enough to save me from myself. I had to engage with mental health full time, learn everything I could on how the human mind turns on itself, to really understand what I – we – were up against.

My country, India, has the world’s largest population of under-thirties, and is also the country where suicide is the biggest killer of young people. Low- and middle-income countries (LMIC) like mine account for 80 per cent of the world’s population but attract only 20 per cent of its share of mental health resources.[iv] More than 75 per cent of those identified with serious anxiety, mood, impulse control or substance use disorders in the LMICs receive no care at all. When I wrote a piece highlighting how the so-called global mental movement, meant to democratise the mental health conversation, had spectacularly failed, a Dutch public health researcher wrote back:

Thanks for this very relevant article! I will take this along in my teaching. And I will never read or understand the term ‘global’ with regard to mental health the same anymore.

You can’t be a mental health journalist without being an activist first. But classical newsrooms snigger at the idea of activism. You cannot be too attached to the story you want to tell, they insist, because it will mess with the holiest of holy tenets of the profession: neutrality. This shouldn’t really be news in 2021, but neutrality is fiction. In the post-pandemic world, everyone must become an activist, because we are all only as safe as the most vulnerable among us.

When I started at The Correspondent, mental health as a topic was already hot. By the end of 2020, a year when loneliness, loss and grief covered us, a booming mental health economy was upon us. By the third quarter of that year, venture capital funding in US mental health start-ups had reached $1.37 billion, more than quadrupling since 2015.[v] To borrow a phrase that spread like a rash towards the last phase of my earlier career in business journalism, mental health had firmly become the next big thing.

The rapid productisation of mental health is also evident in the mushrooming of columns, blogs, podcasts, webinars and ‘feel happy quick!’ schemes. Every other movie or series now has a main character grappling with psychosis or at least garden-variety anxiety. The therapist’s clinic (or Zoom room) is the new gym. ‘Mental health enthusiast’ is an au courant Twitter bio (just like ‘start-up enthusiast’ was in the halcyon days of Silicon Valley).

The work we started at The Correspondent is more urgent than ever, even though the pandemic felled the publication after a fantastic eighteen months, as it has felled so much else. I am now building my own independent platform on the politics, economics and culture of mental health. And yes, I am calling it Sanity.

Sanity is the knowledge that your mental health is a ping-pong match between your biology and your environment.

As economies collapse and jobs disappear, sanity is resistance against what Australian writer and journalist Gideon Haigh has described in this journal as ‘the demoralising sensations of infinite replaceability’.[vi]

Sanity is the right of the ill and their caregivers to scream at vote-seeking politicians: ‘Give us a better deal, or else.’

Sanity is investing in prevention rather than cure.

Sanity is driving out racism (‘depression is black’), sexism (‘don’t cry like a girl’) and ableism (‘crippled by anxiety’) from our language.

Sanity is justice. And that’s worth a few angry emails.

 

REFERENCES

[i] I have written extensively on why the multibillion-dollar ‘workplace happiness’ industry doesn’t create the results it tom-toms, because its ultimate goal is to enhance productivity - which is the prime culprit behind employee distress to begin with. See this article for instance: https://thecorrespondent.com/211/the-modern-workplace-is-toxic-we-need-to-overhaul-how-we-think-about-mental-health-at-work/27933040036-94c6b109

[ii] https://thecorrespondent.com/596/when-asking-questions-is-proof-youre-mad-the-problem-of-the-unreliable-narrator/78900909296-6584d6e8

[iii] https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults

[iv] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3432444/#R1

[v] https://pitchbook.com/news/articles/mental-health-startups-venture-capital-outpace-2019

[vi] https://www.griffithreview.com/articles/arbeit-macht-frei/

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