Millions of us were shocked and hurt by the sudden death of Chester Bennington, who died by suicide two days ago. He was 41. If you don’t know who he is and have never heard anything by Linkin Park, l suggest you familiarise yourself with Hybrid Theory immediately.
As well as sadness and disbelief, public reactions to suicide invariably include the judgemental. It’s the coward’s way out. It’s selfish to those left behind. They should have just pulled themselves together. I’ve seen plenty of those over the last day or so, but they have been far fewer than those expressing sorrow and sympathy, and many people have directly challenged the more hateful comments.
Encouraging as it is, what bothers me is how those defences are being constructed. They all seem to vary on a theme: that depression is a disease caused by a chemical imbalance in the brain, which people have no control over and are stuck with forever, and can happen to anyone without warning or reason. Hardly anyone talks about mental distress, or what might have happened to drive such a talented and much loved musician to take his own life.
Look up Chester Bennington’s history and it’s all there – childhood trauma, loneliness, sexual abuse, bullying, addiction, relationship breakdown. The music that so many related to was his own respite, an outlet for a lifetime of accumulated and unresolved distress.
Part of the problem is in the very notion of parity of esteem itself, or rather how this has been interpreted. There’s increasing consensus that mental health problems should be given equal priority to physical health problems – which, setting aside the problematic concept of mental and physical health as separate entities, is what parity of esteem is supposed to mean. What it doesn’t mean is that we should make direct comparisons with physical health conditions to explain problems like anxiety and depression, or other emotional states indicating mental distress.
On some levels this is appropriate. Most people wouldn’t feel ashamed or embarrassed about spraining their ankle or getting a chest infection, and none of us should be made to feel that way about a mental health problem. We should also receive a proportionate level of support, including adequate time to recover. But the idea that mental health issues should therefore be viewed and treated in exactly the same way as physical illnesses is inaccurate and damaging.
Depression, anxiety, post-traumatic stress and other manifestations of mental distress are usually rooted in experience, and are natural human reactions to adverse events or circumstances. The national Adverse Childhood Experiences study, aside from having the most inappropriate acronym ever, is just one example of how trauma can impact on health and wellbeing much further down the line.
Where these problems do correspond to physiological changes, e.g. changes in brain chemistry, the latter is often a reaction rather than a cause. It’s part of the ‘fight, flight or freeze’ response which is intrinsic to all species.
When we describe mental distress in terms of medical pathology (e.g. saying that someone ‘has depression’ rather than that they are depressed, or implying that they’ve ‘broken their mental health’ like we’d say they’ve broken their leg), we are ignoring the social causes and influences, and trying to ‘fix’ individuals with medical solutions to much broader problems. We view the distress as the problem in itself rather than a symptom, which in most cases oversimplifies the tip of a very complex iceberg. We are also suggesting that the distress is only valid if it has a diagnosis or label attached to it, and can be ‘treated’ with medication.
The result is that diagnostic criteria are continuously being expanded to label more people as ‘ill’, when they may simply not be well or not coping.
The cut-off point for diagnosis is typically described as that which prevents an individual from functioning; but that is largely dependent on our expectation of what functioning means. Someone who still feels unable to go to work a month after a close bereavement isn’t necessarily ill or ‘not functioning’, but expanded diagnostic criteria might label them as such. In our emphasis on economic productivity as a measure of all human worth, we don’t allow perfectly normal emotions like grief to take their natural course. Perhaps it’s the definition of functioning we need to expand to include adjustment, rest and recovery.
That’s not to say medication doesn’t have a place. Many find it helpful as part of the journey to addressing the causes of their distress, or managing the way it manifests itself – but it should never be a sticking plaster, or a (poor) substitute for considering the whole person and their context. Ditto cognitive behavioural therapy, which can be a useful tool in helping people to manage how they respond to their distress, but can also impede long-term recovery through focusing on changing behaviour without fully addressing the causes. All it does is provide a temporary fix until the underlying issues cause the problems to surface again.
That’s the key thing here: underlying issues. There’s a popular view that mental health problems never go away and should be accepted as who people are, but again that implies individual pathology rather than social causes. Not everyone recovers, and some have more recurring episodes of difficulty than others, but that’s often because what makes people vulnerable persists (unaddressed past trauma, or continuing adversity) rather than some underlying pathology. As well as hindering recovery, this mindset diminishes our collective responsibility to prevent and adequately deal with abuse, violence and neglect.
Over-medicalisation of mental distress is partly the reason why anything aimed at promoting mental health invariably ends up focusing on the negative: distress, disorder, illness, or whatever you want to call it. The widely cited ‘1 in 4’ statistic overshadows the fact that 4 in 4 of us have mental health, and we will all suffer some kind of mental distress at some point. It neglects the importance of promoting mental health and wellbeing in individuals, families, communities and populations.
It’s also partly a response to the stigma that still surrounds mental health issues. Many people seek a diagnosis because being able to say there’s something ‘wrong’ with them protects against accusations that their problems aren’t real, or that they can simply choose to stop being distressed. It also allows them to access support that would otherwise be unavailable in the face of increasing cuts to health and social care budgets.
Unless we stop equating medical with valid, and suggesting that only diagnosable ‘mental illnesses’ are worthy of help, then we cannot truly challenge the stigma of poor mental health, or support people to overcome the causes.
Rest in peace, Chester Bennington.