explanations of mental illness that have gained currency in the West actually strengthen stigma rather than reducing it – the popular perception is of the person with the problem belonging to ‘a breed apart’.3

Another big society It has long been recognized that the roots of mental illness lie in three areas: biological factors (including genetic predispositions), life events of the individual concerned, and the social sphere. The first two have hogged the attention, whereas the third is possibly the most important. Even mental health problems at the more extreme end of the scale, such as schizophrenia, can be triggered by experiences of social deprivation and exclusion. The social matrix becomes crucial when one considers that anxiety is the underlying thread of most mental illness. A British lecturer in mental health nursing went as far as to say, ‘Good mental health is rooted in social cohesion, not the individual.’4

Both the promotion of mental health and the recovery from mental illness need to happen at a social level. Many mental health workers will tell you that being able to work and reconnect with society can be of greater benefit for an individual than other, more specialized, interventions.

In the West we are caught in the bind of fragmented, unequal societies that often lack any resemblance to community, and where individualism and the desire for privacy has led to alienation and loneliness. The material security we count on is getting increasingly wobbly for many as the financial crisis keeps racheting up. When in trouble, there is often no social safety net. In addition, there is the onslaught of consumer culture, the constant corrosive influence of advertising, and a hitherto unforeseen state of perpetual distractedness brought about by the multiplicity of digital media channels. Having forgotten how to live in the moment, it would appear we are being forced to live in the instant.

A survey of depression published last year showed that rates are higher in wealthy countries (with France and US heading the list) than in poorer ones, with the poorest respondents in the wealthy countries being doubly at risk.5 This led to much speculation about income inequality within rich countries actually being a cause of depression. (The gender imbalance where depression is concerned was global – women are twice as likely to be affected as men.)

Social erosion is also increasing in the Majority World, where modern psychiatric provision is usually sorely lacking. I was surprised to read that, in India, the break-up of extended families as a result of urbanization and industrialization is being blamed for higher rates of psychiatric problems in nuclear families.6 Having grown up in an Indian nuclear family, I had always taken a dimmer view of extended families as repositories of coiling intrigues.

There is no doubt that people with mental health problems benefit from being in the community. The question is: does the community exist? Here is one view from the US: ‘[In the 1970s] large numbers of patients were discharged from psychiatric hospitals only to find themselves adrift in uncaring communities: isolated, lonely, and lacking meaningful relationships. Limited financial resources restricted their social activity. The media’s frequent portrayals of persons with mental illnesses as dangerous validated community rejection... Community and mental health professional stereotyping altered the quality and spontaneity of interpersonal relationships as negative attitudes were internalized.’

How, then, to create a real community? Obviously we need to go deeper than the greetyour-neighbour ‘wellbeing initiatives’ beloved of government departments. Radical equalitybased restructuring of our societies would fit the bill, and now seems as good a time as any, but the world still holds its breath on that one.

In 2010, the WHO published a checklist of specific ways to promote mental health – and they are all social approaches. They include: supporting children through skills-building programmes and child-friendly schools, improving women’s access to education and credit, befriending initiatives for the elderly, stress prevention at work, improving housing, and community responses to prevent violence.7

The goal of developing a healthy society has been termed ‘recovery on a collective scale’. This view recognizes that such a collective journey requires not just building social supports but fighting discrimination and being politically active.8 This, in short, is about being human – and humane – again. It’s a dimension that needs to become much more visible in the way we work for better mental health. ■

Having forgotten how to live in the moment, it would appear we are being forced to live in the instant

1 Duff Wilson, ‘Side Effects May Include Lawsuits’, The New York Times, 2 October 2010. 2 Robert Whitaker, ‘Andreasen drops a bombshell: Antipsychotics shrink the brain’, Psychology Today, 8 February 2011. 3 Ethan Watters, ‘The Americanization of Mental Illness’, The New York Times, 10 January 2010. 4 Andy Young on NursingTimes.net, 18 January 2010: nin.tl/Hk8IPD 5 Stephanie Pappas, ‘US and France more depressed than poor countries’, LiveScience, 25 July 2011: nin.tl/GXTnrF 6 WHO Regional Office for South-East Asia, ‘Conquering Depression’, 2011: nin.tl/GVTxdM 7 WHO, ‘Mental health: strengthening our response’, September 2010: nin.tl/H1b9r1 8 J Weisser et al, A Critical Exploration of Social Inequities in the Mental Health Recovery Literature, CGSM, Vancouver, 2011.

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