HealthyGamerGG - Is Mental Health Subjective?

Episode Date: September 5, 2022

Dr. K dives into what it means to be mentally unhealthy and how mentally healthy is more than the absence of mental illness. He also dives into cultural views, stigmas, and more! Support this podcast at — https://redcircle.com/healthygamergg/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy Learn more about your ad choices. Visit megaphone.fm/adchoices

So this is where there's a lot of really interesting data. So if you look at epidemiologic data of the incidence or prevalence of mental illness across cultures, what you discover is that there's roughly the same amount of mental illness all over the world. Is psychological mental health subjective? Is everyone mentally ill but just doesn't know it? Is being mentally healthy and being a good person supposed to go hand in hand? All really great questions. Okay, there's going to be like kind of a wall of text here.

Okay, so bear with me. It's worth reading, though. Some people say that examples of true mental health are inner peace or healthy integration into some sort of community. Does it really not matter what kind of community or what inner peace is based on? Take, for example, conventionally extreme examples like condoning slavery or genocide. Does it really make sense to say that a bunch of people who are probably hardworking, God-fearing, family-loving, and generous to the people in their social circle, are suddenly mentally disturbed because they do not advocate for those around them who were oppressed. There are many countries today where slavery still exists,

and I know many people from those countries who don't see it as a big deal in their home country, even if they live in the U.S. and are supposed to be westernized and normal. A lot of these people grew up with slaves, sometimes with slaves who were their same age, so it wasn't like the reality of being a slave was too vague and distant for them to be able to understand. In fact, some of these people think their people are doing their slaves a kindness because being enslaved is better than the living conditions they had when they were free. If people adapt and normalize these beliefs around them, at what point is that considered psychologically bad?

And if certain people genuinely believe that the oppressed deserve to be oppressed, even if the job of the therapist is to make a person functional and better integrated into society, I'm just confused about whether belonging and being integrated to a group makes you any healthier. Every generation, people try to outlaw things that were completely acceptable for all history before that time. Spanking children has pretty much always been considered the norm, but research has now solidified negative effects that correlate with spanking, and there is a possibility that spanking will be outlawed in the future.

Does this mean that most people are raised in the past become mentally unhealthy because of this and didn't know it? If most children were hit, do you consider that a pathology? What if the commonality of spanking made children unfazed by it? I see people calling those who would be physically hurt a child, who would physically hurt a child sick or monstrous. And all I keep thinking is that there is no way all these parents in history could suddenly be perceived as monsters. At what point do people stop being monsters or mentally sick and start being healthy if they believe what they're doing is right. The fact that all these parents really did not love their kids seems ridiculous.

Okay, so this person kind of goes on for a while. All right. Do you guys want me to continue reading or should we pause? Okay. The duality of chat. All right, we're going to just finish reading, okay? Some people mention that children are actually people too, and you wouldn't hit the adults around if they did something you thought was wrong.

This point makes it seem like parents have historically dehumanized children by default. Does that make those parents mentally unhealthy or ill or toxic? People adapt to all kinds of situations and in some situations, people might function more optimally than in others. Parents often conclude that the fact

that their children were well-adjusted in life means that they really loved and took care of their children and did what was best for them. Okay, people are saying finish. If I think society is terrible, then from my view, I would see these parents is obviously mentally sick for raising their children to become well-adjusted. I know older women in my family who were married and became pregnant at the ages as young as 11 or 12 to men much older than them. I know even more women who are not that old that didn't even know they were going to get married at all until right before their wedding day. If you ask any of them about it now, they honestly don't care and just say that their life was great.

Although I can't deny that not every woman accepted their fate deep inside. It wasn't like there was an epidemic of disordered behavior from these brides stemming from trauma. If society never taught them that child marriage was shameful, then do they ever become mentally unhealthy by being married so young? Can they really be so scarred by it now, even though they all genuinely seem so quote unquote normal? How can it also be reasonable to suddenly vilify the men they married? If culture influences the minds of men to find younger girls attractive or suitable for marriage, why should the mental state of these men be regarded as unhealthy? How can it be said that the families of the bride and groomer are all simply sick?

The image of frightened little girls and their monstrous husbands just seems so exaggerated to me from my experiences. Like, am I supposed to just suddenly view my grandfathers or uncles as evil? Even arranged marriage could be considered gross and dysfunctional in the West, yet there is no mass mental health crisis caused by it in the rest of the world. It can be argued that if someone is confronted and told their actions have negative impacts on people, but then they knowingly continue to do whatever they do, they are not mentally healthy. However, I'm doing something bad without caring about it and you confront me.

My belief system might allow me to ignore some aspect of your argument by default, such as believing that you are already untrustworthy or believing that whoever told you what you're telling me doesn't know what they're talking about or many other reasons. And so I will continue to feel the same way about what I do and consider you unhealthy. Likewise, your belief system might label me as unhealthy by default for similar reasons. Here's the TLDR. What really defines being mentally well? If I have strong morals, does this make me healthy or does this make me a slave to my beliefs and therefore unhealthy? Is the goalpost for mental health in society always moving? So I'm going to try to do my own TLDR here. So this is a really interesting post. The poster, in a slightly long-winded

way, basically asks the question, what does it mean to be mentally unhealthy? And they kind of make the argument that today, for example, we've done research on spanking. And we've, based on scientific research, we've concluded that spanking negatively impacts a child's mental health. 500 years ago, all parents used to spank their kids. Does that mean that 500 years ago, all children were mentally unhealthy? So does that mean that, like, if we kind of like follow that through,

what that means is that for the majority of humanity, people have been mentally unhealthy because people used to be spanked, right? And we're just sort of becoming enlightened now. So what does it mean to be mentally unhealthy? The other thing that they kind of talk about is mentally unhealthy, mentally unhealthy and harming another human being.

So they talk about things like child marriage or arranged marriage. And in these situations, we would consider, by today's standard, marrying an 11-year-old to be morally reprehensible. Does that mean that person is mentally unhealthy? Because if someone wants to marry an 11-year-old today, we also call them sick. Right? This person is sick. It's a sicko, pedophile. So the other thing that this person sort of tangles together, which I think is really important, is they're sort of using mentally unhealthy and morality like kind of interchangeably.

Whereas I don't think that they're interchangeable. And we'll get to that in a second. And so then the last kind of question here is that what does this mean for society? So like if we sort of assume that all children were traumatized by spanking because we know spanking is traumatic, does that mean that? that 100 years from now, we're going to learn that something that we're doing today is also traumatic. And so everyone today is traumatized. And so does that mean that being traumatized and mentally unhealthy is sort of the norm of society? Does that make sense?

So there are a couple of really important points here, which people in psychiatry love to discuss, by the way, about morality's, you know, what is mental illness, what is an adjustment to society, like what is kind of normal. So we're going to try to unpack these things kind of one at a time. The first thing that we're going to talk about is cultural accommodation and mental illness. The thing that we need to actually start with is that mental health is more than mental illness. Mental health is more than the absence of mental illness. So let's start by sort of looking at what is normal within a society and whether what is normal within a society and whether what is normal within a society qualifies as mental illness or mental health or what's the relationship between those things.

So what's the relationship between normality and mental illness or mental health? So this is where there's a lot of really interesting data. So if you look at epidemiologic data of the incidence or prevalence of mental illness across cultures, what you discover is that there's roughly the same amount of mental illness all over the world. So in places where there's child marriage versus not child marriage, in South America, in Africa, in East Asia, generally speaking, we know that mental illness is kind of comparable across the world. So the rates of things like an anxiety disorder is roughly the same. We're not talking about rates that are 70% in one culture and 8% in another culture. But, but

ballpark across the board, if you look at all the numbers, they tend to look about the same. There are certain outliers, for sure. But generally speaking, what we see is that mental illness may manifest in a culturally sensitive way. So, for example, in parts of South America, there's this thing called attack de nervios or something like that. So panic attacks, or they've got their own kind of word for it. We know that in East Asia and South Asia and Southeast Asia, major depressive disorder manifests with more somatic symptoms. So people won't talk about feeling sad or guilty or ashamed. They'll talk about low energy levels, headaches, weird GI stuff.

So the manifestation has a cultural context. But we know that epidemiologically, roughly, mental illness is the same across the board. So that's number one. Okay? So what is mental illness? Mental illness tends to be, the line that we draw is not cultural. It's not about whether you do arranged marriage or don't do arranged marriage. That's not a criteria for mental illness. The criteria for mental illness tends to be impairment of function. Okay. So what that means is that you can take 100 people from Japan with depression, major depressive disorder, and it may not look the same as it does in, let's say, the Netherlands. They may not. They may not. describe the same experience, but if you really tunnel down into it, all hundred people from both of these countries have a lot of difficulty working for months at a time, and they really struggle. So there are some unifying factors. So there may be cultural manifestations of mental illness, and that's how culture sort of shapes mental illness, but that the mental illness

process seems to be somewhat culturally independent. Now, the next question to kind of think about is what is the relationship between morality and mental illness? Right? So there are some places where it's culturally appropriate and not considered immoral to marry a 12-year-old. And for the majority of the world, or maybe I think so anyway, maybe that statement is technically incorrect,

but I do believe that that's correct. We consider an adult marrying a child an immoral act. Okay? So what's the deal there? Does that mean that all children are traumatized? If we spank all of our kids 500 years ago, does that mean that they're traumatized? So the first thing that I'd like to say is that for too long, actually, I think one of the problems with understanding of mental health, mental illness, and psychiatry is that we've conflated morality with mental illness. Whereas if you really look at the data, the two are completely separate. So a good example of this is if you look at something like, you know, school shooters. People will say school shooters are mentally ill.

Now, that could be true, but that bothers me a little bit as a psychiatrist. To blame some kind of act of violence against another human being on mental illness, I think, is kind of like unfair and an incomplete oversimplification. Does that mean that they struggle with mental illness and they deserve some degree of compassion? Sure. But if you say that a school shooter is depressed, there are a lot of people out there who are depressed. We're not shooting anyone, right? So the other thing is that you can have someone who struggles with mental illness and behaves immorally. And this is where if you look at the epidemiologic data, the number of people who commit acts of violence as a direct consequence of pure mental illness is exceedingly small.

So a good example of this is if you look at people with schizophrenia. So people have this perception that people with schizophrenia who are actively psychotic are more dangerous than other people. And that probably statistically is true. But the vast majority of people with schizophrenia who are actively psychotic don't hurt anyone. So there's a lot of misperception and stigma against people who are mentally ill. Now, this is where you may have people with diagnoses of mental illness who engage in by, violent behavior, but I don't think that that's necessarily due to the mental illness. Just as an example, so for example, like if I'm addicted to a substance like cocaine and I run out

of money or heroin and then I commit armed robbery and hurt someone, am I, am I, do I have a substance use disorder? Sure. Is it the substance use disorder that's causing the violence? That's where I'd say, not really. Do I have cravings? Is it a factor at play? Yes. But there are a lot of people who have substance use disorders who are not hurting other people. So I think that you can have both mental illness and the mental illness does not excuse moral or immoral behavior. Those are kind of like independent things. And there's a bunch of people out there who do struggle with mental illness who behave very morally all the time. In fact, that's the vast majority of people who have psychiatric diagnoses. So morality and like mental illness are kind of independent there. Do they

intersect in some ways? Absolutely. This gets further complicated when we pathologize something like antisocial personality disorder or sociopathy. So this is where things get really interesting. Because when someone is a sociopath, they lack a fundamental compassion or empathy for other living organisms. They'll do things. So one of the diagnostic criteria, or one of the things that will assess is like, for example, cruelty to animals as a child. So you'll have a seven-year-old who will do things like, you know, hurt animals, torture them. So that's like one of the diagnostic criteria for antisocial personality disorder.

Now when there's like a seven-year-old who's doing this kind of thing, I think it's fair to say that there isn't like a well-developed moral compass at that age. Or that there's something that's going on independent of whatever moral compass the seven-year-old has. Because this is also something that's conserved across different. cultures and across different moralsies. We also know that you can do different kinds of interesting tests on sociopaths that signal that there's something different in their brain. My favorite example of this is that people who have sociopathy or antisocial personality disorder are less likely to empathically yawn. So I don't know if you all know this, but if I yawn, even if it's a fake yawn, you'll feel like yawning and you may even yawn.

but for people with antisocial personality disorder, they don't actually yawn empathically. So there's something different in the brain. And so if I'm kind of immoral because I lack empathy, right? So now everyone's like, some people like I yawn. If it was a more genuine yawn, you would have yawn more.

It was a fake yawn. And that's the interesting thing. So if we ask, like, what's the difference between a genuine yawn and a fake yawn? It's the empathic circuitry in your brain, which can tell that I was fake yawning. So it doesn't actually trigger the yawn response. Whereas if I was genuinely yawning, your empathic circuitry would pick that up and you'd be more likely to yawn.

And when that circuitry is hampered in antisocial personality disorder, those people don't empathically yawn. So there does seem to be a biological component for people who are prone to cruelty to animals. So in that sense, do we call it their fault? Is this person immoral? So that's where we start to see an intersection between the pathology. and what we would consider, generally speaking, immoral behavior. So there is some connection. So there's some connection there, but I generally speaking think of those two things as separate.

And in fact, I think that society too often conflates those two. Another good example of this is for a long time, we viewed addiction as a moral failing. Right? Like we used to think, like, oh, you just need to stop. You just can't stop, et cetera, et cetera, et cetera. We think about depression is like a moral failing or a weakness, like a lack of character. Whereas I think those conflations kind of need to be separated. We need to stop mingling morality with mental illness.

We need to stop using mental illness as an excuse for immoral behavior. And we need to stop labeling people with mental illness as being immoral. The last thing that this person kind of asks about is like, okay, so like what does it mean to be mentally healthy? Is that culturally dependent? Is that change? Could people be mentally healthy? How could...

If spanking a child traumatizes as a child, and 500 years ago, all children were spanked, how were any of those children considered mentally healthy? Or were they all mentally unhealthy, and we considered that normal? So this is where we're going to draw on a different kind of perspective. So we've talked mostly about science and epidemiology thus far. This is where we turn to spirituality. So in the realm of spirituality, we've had people who have consistently told us across cultures and across time how to be mentally healthy. And they never talked about mental illness.

They talked about things like contentment, peace, happiness. They didn't talk about an absence of emotional fluctuation. They didn't talk about never feeling afraid, never feeling angry, never feeling sad. What they talked about is contentment versus suffering. So I think that karmic religions, this is probably, I'm probably biased, but I think this is where we get most of this stuff societally nowadays. I'm not saying that other people didn't voice the same thing from Judeo-Christian traditions, but I think these beliefs have been sort of best developed or most popularized for whatever reason by sort of the karmic traditions. So this is where like the people who essentially meditated, right? These are the yogis of ancient India and then Buddhism in East Asia and stuff like that.

And then we've got like, you know, the Zen schools and stuff like that. And what they essentially discovered was how to be mentally healthy, which has sort of nothing to do with mental illness. How to find peace and contentment. And the formula that they posited is, you know, developing some degree of detachment, Vairagya, about separating yourself from the outcomes of your actions, separating yourself from your ego. They discovered a lot of principles, which they said, if you follow these principles, and if you meditate and if you do this stuff, you will be content in life. And the interesting thing is that this has been independently discovered as well.

So I think the best example of this that I can think of is Victor Frankel and Man's Search for Meaning. So this is a Jew who is in a concentration camp and essentially discovered some degree of detachment and found peace, despite being in very negative circumstances. You could also say that this was discovered in some element by ancient Stoic philosophers from Greece. So that suggests that this pathway is true because it's been investigated and discovered

by culturally isolated groups of human beings. And so when it comes to mental health and finding peace and contentment and happiness, I think this is the best answer. It's this path that these people were talking about. Whether you call it Stoic Philosophy, whether you call it Man Search for Meaning in Victor Frankel, or you call it yoga and meditation. And so the interesting thing there is that people, irrespective of what culture you grow up in, irrespective of whether you were spanked or not spanked, and this is the key thing, is that spirit, spiritual tradition towards enlightenment is not actually about external circumstances. The key thing there is the path to enlightenment is not about what happens in the world.

It's about how we react to it. And this is why it transcends culture and time. Because whether you were spanked or whether you were yelled at or whether, you know, you lost a parent from smallpox, whatever the circumstances are, what leads to peace, is how you react to those circumstances. And so that's why I think that the spiritual path offers so much in terms of mental health. It's so useful because it's not just about mental illness, that mental health and being mentally strong and content is more than the treatment of mental illness. And I think the best explanation of this has been the spiritual path.

And now we also have to a certain degree, in a certain degree, is going to be somewhat of a oversaworth. oversimplification. We have scientific evidence for this as well. So we do know that there is, like, it's kind of interesting because there's one intervention that has been shown to be, essentially improve symptoms of all mental illnesses, mindfulness. Mindfulness improves things in schizophrenia, it improves things in anxiety, and it improves things with depression, it improves things with ADHD. So that's kind of. kind of interesting, right? And I think it's because the people who sort of developed yoga and meditation understood the fundamentals of how the human mind works and how to transcend all of the

patterns of mind. So whatever illness you have within the mind, if we can transcend all of it, if we can move away from ego, move away from identity, control our thoughts, process our emotions, it doesn't matter whether the emotion is shame from depression or fear from anxiety. It doesn't matter whether it's attachment to a substance or attachment to a promotion or attachment to a particular car or ego or whatever. Transcending ego gets rid of all of that stuff. So part of what I've learned as a psychiatrist is that these two things are independent. In fact, all three of these things are independent. Mental illness is one thing. Cultural manifestations may vary, but that mental illness tends to be somewhat independent

of cultural manifestations. Right? It's like conserved across humanity. That's number one. That mental illness and morality need to be separated. And when I draw on my experience training to become a monk,

what I sort of learned, which is kind of interesting, right? Because I went to medical school is that the development of mental health requires more than the treatment of mental illness. And that these two things can be pursued in parallel or even sequentially. I see the best clinical outcomes when we walk both of those paths concurrently.

So it's not just about giving up the addiction and conquering the addiction. It's about having a conversation about what do you want from this life? What would bring you peace, contentment, and happiness? And how does alcohol affect that? Well, I want to, like, have a family and I want to be peaceful at home. I don't want to be, like, going through couples counseling all the time. I want my kids to be proud of me. I don't want to be ashamed about myself because I'm drunk at their birthday party and pass out.

Okay, so like if that's what you want to be content and happy in life, let's think about how alcohol impacts that. And then there's the treatment element, right? So we can prescribe things like, let's say, dysulforam or, you know, like whatever medications. You can go to Alcoholics Anonymous. You can do psychotherapy. you can do cognitive behavioral therapy. You can do all these like treatment interventions. But at the end of the day, there's a spiritual element to overcoming addictions, which is something

that we've understood for a long time, which is why alcoholics anonymous and things like refuge recovery are very spiritually oriented interventions. So I think this post is really interesting because it talks about the connection or intertwinedness between morality and mental illness and mental health and mental illness and constantly. and cultural fluctuations. But the interesting thing is that as we dig into this stuff, we can actually resolve all of that stuff. We have to understand that mental health and peace

comes not from necessarily what the world does to us, but how we react to it. And so whatever our particular culture says doesn't matter. Whatever happens to you in a particular culture, in a sense, quote unquote, doesn't matter because it's all about how you react to it. The Stoics believe this. Victor Frankel figured this out,

and the yogis have been saying it for 5,000 years. And we also have to be careful about morality and mental illness. Because increasingly, we're getting those two things conflated, that people who commit bad things were mentally ill. That may be true, but let's not forget that just because you're mentally ill, you can be a good person or a bad person. Or even then, I don't think that that's really fair. You can commit good actions or bad actions. You can commit moral actions or immoral actions. And the vast majority of people who suffer from mental illness do not do immoral things.

or at the scale that we're talking about. So I don't think it's fair to blame immoral actions on mental illness. I think, in fact, what happens is once we start blaming our immorality on our mental illness, our immoral behaviors skyrocket because we stop accepting responsibility. And once we forego personal responsibility for our behaviors and start blaming them on mental illness, then there's like no internal check.