*Content warning: this article deals with mental illness and healthism.*
It was on another “mental health awareness” holiday, actually: Bell Let’s Talk Day 2021. Over the phone, I admitted to this person I’m often cynical about this type of initiative.
“I mean, we have another ‘mental health awareness’ day every few months: Bell Let’s Talk Day today, Men’s Mental Health Day in June, World Mental Health Day in October. But, one in five Canadians live with at least one mental illness. Anyone who knows at least four people knows someone – or is someone – who has one. Surely, most people are aware mental health is important.”
“I guess,” they said. “But don’t you think it’s good that these holidays remind people to practice self-care?”
“Of course. I don’t think mental health awareness holidays are designed in bad faith. I’m sure they truly help some people, and I would never try to take that away from them. But, still, I can’t shake the feeling that we’re… past raising awareness about mental health.”
“OK, so how would you acknowledge a mental health awareness holiday? You know, since you think we’re past raising awareness.”
“I can only speak for myself,” I said, “But, for me, I guess it comes down to action over awareness – you know, donating to an organization that provides accessible mental health services if I have a few dollars. Being extra kind to the people in my life who I know live with mental illnesses. Being extra kind to myself, since I live with mental illnesses.”
They didn’t skip a beat.
“You don’t live with mental illnesses.”
I almost couldn’t respond. This person has known me throughout the peaks and valleys of my experiences with mental illness. I’d spoken to them about being in therapy. They knew I used to take medication for my diagnoses. They even visited me when I was institutionalized. And, yet, because I don’t express obvious symptoms in my interactions with them anymore, they feigned ignorance to the fact that I live with mental illnesses at all.
Their tone tagged “mental illness” as a dirty term. It said, “Sure, you’ve gone through some stuff in the past, but that’s all behind you. You’re in school, and you wake up on time most days, and you have friends, so you’re fine. You don’t have mental illnesses; you have mental health. Today’s about face masks and yoga and meditation, not insomnia and compulsions and anxiety.”
They said, “You don’t live with mental illnesses,” And, suddenly, something else that bothered me about these awareness days – a subtlety I’d overlooked – became glaringly, abundantly, pie-in-your-face clear:
We always talk about mental health. Why do we refuse to talk about mental illness?
there is mental health and then there is mental illness. There is a difference – people love talking about yoga and self-care days, but get uncomfortable talking about blackouts, suicidal thoughts, manic episodes ect – and that’s the problem.
— Deborah Okenla (@deborahokenla) October 19, 2020
The same coin?
In part, it could be because these terms are often used interchangeably. But they’re not the same thing. “Mental health” describes the state of your mental well-being, while “mental illness” is patterns of thoughts, feelings or behaviours negatively impacting your mental health. In other words, you still have mental health even if you’re struggling with a mental illness – it’s just poorer mental health than someone without one.
It’s a small distinction, to be sure. And, you could argue the collective choice to focus on mental health over mental illness is nothing more than a framing device. But framing matters. The words we use matter. I think refusing to talk about mental illness, in favour of focusing on mental health, further stigmatizes the very people it claims to uplift.
Everyone’s a mental health advocate til it come to stuff like addiction – stuff that’s messy n u can’t just package up into pastel-coloured insta infographics
— Holly (@deidhaul5) April 13, 2021
The word “health” itself is neutral – it literally just describes the state of your well-being, flourishing or floundering. But, socially, it’s linked to positive overtones. When most people think of “mental health,” they think of “connection,” “confidence,” and “resilience.” Connotatively, health is good.
Yet, more than that, health is socially linked to morality through what Robert Crawford coined “healthism.” According to this predominant line of thought, not only is health good, it’s good to be healthy. You are good if you are healthy.
But when we deem something “good,” we insinuate the opposite is bad. You are good if you are healthy, you’re bad if you’re not.
Since it came into the public sphere in 1980, healthism has mostly been discussed as it relates to physical health – specifically, how it’s been used to stigmatize anyone living in an Othered body. Saying, “I’m so bad for skipping a day at the gym,” is healthism. So is believing there’s a “right” way to eat, exercise, give birth or experience gender. Writer Aubrey Gordon puts it like this: healthism is “a tool used to further anti-fat bias…ableism, transphobia, misogyny, racism, and more.”
As we come to understand how mental health and physical health are inextricably linked, I think it’s also worthwhile to inspect how healthism is perpetrated against people struggling with mental illness – like, for example, by focusing heavily and only on mental health.
By neglecting to name mental illness, we reinforce the idea that it’s shameful, taboo and – as healthism deems it – immoral. As a result, people struggling with mental illness must also grapple with the implication that they’re unethical for not being healthy. Now, not only are they distressed, they’re also bad people. And that only worsens their emotional load.
Moreover, healthism not only moralizes health – it individualizes it. In Crawford’s words, healthism turns the act of becoming and staying healthy into a matter of personal responsibility, “primarily through the modification of lifestyles.” A “good vibes only” approach to confronting mental illness places the responsibility of mitigating it entirely on the individual. It says, “If you’re struggling, that just means you’re not self-caring hard enough.”
Let me be clear: it’s not bad to share small things we can do to help ourselves feel better – especially since professional mental health care is often inaccessible, insufficient and even counterproductive for so many. But I think our discussions about mental health need to be supplemented with extensive and critical explorations of mental illness – and, even more importantly, the conditions that lead us to develop them.
The theme of this year’s Mental Health Week is #GetReal. The slogan is “Name it, don’t numb it.” And I agree. We should get real about mental illness – and why bath bombs, on their own, aren’t a sustainable treatment plan. We should name, not numb the fact that focusing exclusively on mental health makes living with mental illness harder. And we should focus on self-care as a tool, not an antidote.
So, to truly get real this Mental Health Week, I encourage you to face the discomfort that may come up when discussions turn from pedicures to panic attacks. If you live with a mental illness, have open, constructive conversations about how you feel and what you need – and if you don’t, listen. We can’t accommodate what we don’t address.
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“I do have mental illnesses,” I replied to my conversation partner. “And I always will. These days, I manage them OK, but that doesn’t mean they’re gone. I don’t think it’s bad to call it for what it is.”
They changed the subject.