Psychoeducation Self-care

Rethinking Wellness: A Holistic Perspective on Health

Despite our medical advancements and a relentless pursuit of wellbeing, we are less happy and healthy than before. Why is that?

By Mental Health Academy 2024-02-24 05:39:44

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18.0 mins read

In the midst of our thriving global wellness and health market, there is a paradox: we are less happy and healthy than our medical advancements and relentless pursuit of wellbeing would imply. In this article, through the lenses of Thomas Szasz and Dr. Gabor Maté, we delve into the notion of illness as a manifestation of an increasingly harmful culture.

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Introduction

The global wellness and health market is healthy and booming, estimated to garner $12.9 trillion by 2031, increasing from $4.7 trillion in 2021 at a compound annual growth rate of 10.9% from 2022 to 2031 (Research and Markets, 2023). In an increasingly health-obsessed world, people invest not just precious dollars but also time and energy to live longer and livelier, eat better, be healthier (or at least, suffer fewer symptoms), and look younger. Our phone news feeds supply endless announcements of medical advances, hopeful health news, and warnings about what not to do if we would avoid the big, scary diseases such as cancer, dementia, heart disease, or stroke.

Advanced societies are at the pinnacle of scientific and medical research achievements, thanks to the dedication of healthcare workers and medical researchers; most people reading this article will be living in a country with a sophisticated health and medical system.

Yet for all that, we seem to be collectively less happy and healthy. As GlobalNewswire reported in 2023:

“One of the primary reasons driving [health and wellness] market expansion is the rising incidence of chronic lifestyle illnesses throughout the world. Cases of blood pressure, diabetes, asthma, arthritis, dementia, and other stress-related ailments are on the rise as a result of sedentary lifestyles and demanding schedules. This has inspired people to engage in different health-related activities such as yoga, meditation, and athletics” (Research and Markets, 2023).

Of particular concern to mental health professionals is the rise in mental health concerns, particularly anxiety and depression. We see this concern reflected in the ever-rising popularity of self-care, mental health science communication and the proliferation of “edutainment” options focused specifically on mental health awareness and strategies. As a society, we are concerned about mental health and how we, as individuals, can attain and maintain mental well-being.

But what if our focus here is too narrow, zeroed in on the manifestations of a far more insidious infection? What if we consider illness as a collective phenomenon, manifesting in individuals –the proverbial canaries in the coal mine – but having its roots in society as a whole? What, in this case, might be adduced as evidence to show where illness resides? And what, then, would be appropriate treatment: not just for the “canaries”, but for the whole coal mine?

Thomas Szasz and the social philosophy of mental illness

Over 80 years ago, Thomas Szasz published a seminal thought paper in the American Psychologist (Szasz, 1960), in which he refuted the idea that there is such a “thing” as mental illness (stay with us here!). Contending that the concept is merely a convenient myth, Szasz went on to note that the main support for the notion of mental illness up to that point had been various diseases such as syphilis of the brain or various delirious conditions, but that these were illnesses of the brain not the mind. Because patients’ mental symptoms typically consisted of communications about themselves, others, and their world, they were inextricably tied to social context. A better way to understand mental illness, said Szasz, was to see it as a problem in living.

Moreover, he observed, a person is deemed to be “ill” when their behaviour deviates from some norm in their society; thus the “illness” is necessarily a judgment made about the person with the “symptom”. Accordingly, diagnoses of “mental illness” must always have an aspect of ethics, and are tied to humankind’s responsibility to understand the self better and professionals’ duty to help people face up to their problems in living, whether these be “biologic, economic, political, or sociopsychological” (p. 118). “Mental illness”, Szasz concluded, is “a convenient myth whose function it is to disguise and thus render more palatable the bitter pill of moral conflicts in human relations” (p. 118).

Now the better part of a century on from that bold declaration, we have had decades of therapies studying symptoms at increasingly granular levels. These observations upon more or less neat systems of symptoms are then extrapolated upon to develop treatments to “cure” (or more generally, to cope with) the mental unwellness exhibited in the symptoms. We can see then that most mental health fields operate on the assumption of treating the sick individual rather than a “sick” relationship or culture. And while this is a noble goal and we’re certainly not arguing that we should throw out all of the wisdom we’ve attained through this approach, it’s clear that we’re missing something here.

A rising tide of unwellness

Anxiety/depression/suicidal ideation/NSSI

The “garden variety” mental illnesses of anxiety and depression – often a barometer for more serious unwellness – has increased by 25% globally since the COVID-19 Pandemic, according to the World Health Organization. That said, the populations of different countries have experienced different rates of increase according to how their respective governments managed aspects of the pandemic. We can observe a “spotlight” look at these conditions through a cross-sectional study conducted in Slovakia via an online survey aimed to measure the lasting effects on mental health of the pandemic. Recalling the various measures that governments imposed on their people to try to suppress it, the study authors cited the following external factors which survey respondents noted had affected their health:

  • Lockdowns
  • Closed schools
  • Loss of employment or business
  • Rising deaths (and not just in nursing homes)
  • Lack of scientific information about the virus and its effects on the human body (especially in the earlier stages, but also impacting those with long COVID)
  • The fast spread of the virus
  • Lack of effective preventive measures (especially early on, pre-vaccine, but even after the vaccine was developed, because people could still catch the virus when inoculated)
  • Restrictions that harmed social life and finances
  • A sense of having little agency or control over life (Kupcova, Danisovic, Klein, & Harsanyi, 2023)

Specifically citing unemployment as a trigger for suicide, the authors noted that the above external factors interacted with individual psychological factors leading to psychopathologies such as threat appraisal, attentional bias to threat stimuli over neutral stimuli, avoidance, fear learning, impaired safety learning, impaired fear extinction due to habituation, intolerance of uncertainty, and psychological inflexibility.  The result for the survey was that pre-pandemic, every ninth citizen in Slovakia suffered from a mental health disorder (according to the Slovak National Office of Statistics, 2017, in Kupcova et al, 2023), but after the first wave of the virus in 2021, it was approximately 7 times higher. 86% perceived an effect on their mental health, with suicidal ideations rising from 5% pre-pandemic to 10.81% during the pandemic. Women and adolescents were more affected, with an increase of 27.6% in self-injury for the latter group during the pandemic (Kupcova et al, 2023).

Hypertension

One measure of population unwellness is the incidence of hypertension, a risk factor for kidney disease, heart disease, and stroke. Increasing from 594 million in 1975, an estimated 1.28 billion adults aged 30–79 years worldwide now have hypertension, most (two-thirds) living in low- and middle-income countries, with many (about 46%) being unaware that they have the condition and only 21% having it under control (World Health Organization, 2023). In South Africa, hypertension prevalence increased from 29% to 49% in men and from 34% to 51% in women between 1998 and 2016 (Peer, Uthman, & Kengne, 2021).

Obesity

Recent awareness of the role of emotional eating in eating disorders has led to an understanding in the mental health professions of the close connection between stress/trauma and obesity. Hence, its prevalence provides a useful barometer of how a population is faring in terms of wellness or not. The prevalence of obesity climbed from 30.5% in 2000 to 41.9% in the 2017-2020 period. This means that, according to data from the National Health and Nutrition Examination Survey, more than 2 in 5 adults in the United States are obese (and nearly 1 in 5 children are obese). Further, 19 states in America have obesity rates over 35 percent, increased from 16 states just last year. A decade ago, no states had obesity rates above 35 percent. Linked to several significant ailments – including diabetes, heart disease, stroke, and a number of cancers such as breast and colorectal – obesity alone carried an annual medical cost of nearly $173 billion in the U.S. in 2019. Medical costs for obese adults were on average $1,861 higher than medical costs for people with healthy weight (Awan, 2023; CDC, 2022).

Autoimmune system issues and the relationship with stress exposure

The National Institute for Environmental Health Sciences, or NIEHS, has found that autoimmunity, a condition in which the body’s immune system reacts with components of its own cells, appears to be increasing in the U.S. In a study published in Arthritis and Rheumatology, the researchers found that the prevalence of antinuclear antibodies (ANAs), the most common biomarkers of autoimmunity, is significantly increasing in the U.S. overall and particularly in certain groups. These groups include males, non-Hispanic whites, adults 50 years and older, and adolescents.

Through immunofluorescence, a technique in which fluorescent dye is used to visualise antibodies, the scientists examined the frequencies of ANAs in subjects from three time periods.

  • 1988-1991: 11.0%, or 22 million affected individuals.
  • 1999-2004: 11.5%, or 27 million individuals.
  • 2011-2012: 15.9%, or 41 million individuals.

Of the four demographic groups that displayed considerable ANA increases, findings in the adolescent group were the most worrisome to the research team. The values for 12- to 19-year-olds increased nearly three-fold over the study period (Arnette, 2020).

The trend for an increase in autoimmune disorders had been detected several years earlier. In a 2010 study, researchers found that rheumatoid arthritis has increased for women between 1995 and 2007. The 1.3 million women with the disorder previously rose to 1.5 million by January 2005 (Myasoedova et al, 2010). Maté (2022) notes that the autoimmune disorder of MS (multiple sclerosis) is also greatly on the rise, and that it has a gender-skewed distribution in that 70-80% of sufferers are women.

Researchers have acknowledged that, while they are uncertain what has caused the autoimmune disorder increases, genes do not exhibit change this quickly; thus, environmental factors are almost surely at play (here we must include factors of socialisation that prescribe how people “should” behave and what they “should” believe to be accepted, as clear agents of social stress to an inherently social species). Yet environmental factors in a broad sense do not easily fit into the traditional medical model paradigm that regards disease as something that happens within the individual.

Clearly, to understand these rates of increasing pathology during a period of peak obsession with health and simultaneous peak achievements of medicine, we need a different way of thinking about how pathology arises, even if we will be forced to draw the data to support our views from other than traditional sources.

Illness as a manifestation of sick culture

In his recent book, The Myth of Normal: Trauma, illness, and healing in a toxic culture (2022), Dr. Gabor Maté eloquently argues for a hugely broadened paradigm for both physical illness and psychopathology. It challenges traditional views that solely attribute mental illness to individual factors, suggesting instead that the broader cultural context plays a significant role in shaping mental health. Maté explores how societal factors contribute to psycho- and other pathology, arguing that cultural norms, societal expectations, and environmental stressors can create a toxic culture that negatively impacts individuals’ wellbeing. He emphasises the interconnectedness of individuals and their environments.

For example, he points to societal pressures, economic inequalities, and systemic issues which can lead to chronic stress, trauma, and adverse experiences. These, in turn, contribute to mental health challenges. The emergent paradigm urges us all, but especially mental health professionals, to look beyond individual pathology and consider the influence of social, economic, and cultural factors on mental health. Understandably, in this framework, mental health reflects the overall health of a society, so addressing mental health issues requires a broader approach: one that includes social and cultural interventions, advocacy for systemic changes, and promoting a more compassionate and supportive social structure. The bottom line for Maté and other proponents of this illness-as-cultural-issue paradigm? Individual wellbeing is deeply intertwined with the wellbeing of the community and broader culture.

Key takeaways

  • Despite advancements in medical science and sophisticated healthcare systems in advanced societies, there is a concerning trend of declining happiness and health among the population, marked by a rise in chronic lifestyle illnesses and mental health concerns such as anxiety and depression.
  • Thomas Szasz’s critique challenges the traditional concept of mental illness, suggesting that it is a product of societal norms and judgments rather than purely biological factors. Mental health issues are seen as manifestations of broader social problems rather than individual pathology.
  • Current mental health approaches often focus on treating individuals rather than addressing underlying societal issues. While valuable, this approach may overlook the systemic roots of mental illness and societal unwellness.
  • External factors such as the COVID-19 pandemic have exacerbated mental health challenges, with lockdowns, economic instability, and loss of social connections contributing to increased rates of anxiety, depression, and suicidal ideation.
  • Rising rates of hypertension, obesity, and autoimmune disorders highlight the complex interplay between environmental stressors, societal norms, and individual health outcomes, challenging traditional medical models that focus solely on individual biology.
  • The perspectives of Dr. Gabor Maté & Thomas Szasz outline and emphasise the role of cultural norms, societal expectations, and environmental stressors in shaping mental health outcomes. Adopting a broader paradigm that considers social, economic, and cultural factors is essential for addressing mental health issues and promoting overall societal well-being.

References

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