The Problem With Saying ‘We All Have Mental Health’

It’s often said that attitudes towards mental health are changing for the better and yet what we mean by the term 'mental health' remains vague. While 'health' normally implies an absence of illness, 'mental health' is an umbrella term encompassing both wellness and distress. The campaign slogan 'we all have mental health' has only added to this confusion. Though a well-intentioned attempt to combat stigma, it conflates a whole spectrum of human experiences and fails to raise awareness of any specific condition.

Life coaches, Instagram therapy accounts, mindfulness apps and media platforms offering generalised advice have helped to fuel the idea that 'we all have mental health'. They often trade in the language of self-care, encouraging us to practise self-love, to stop gaslighting ourselves, to maintain boundaries. Consequently, therapy speak has infiltrated our everyday lives as 'coping mechanisms', 'codependency' and 'attachment styles' become the lenses through which we understand ourselves and our relationships. It’s hugely positive that people are speaking about mental health more than ever before. But the mainstream mental health movement focuses overwhelmingly on the more common issues impacting people – namely, anxiety and depression. We’re told to look out for exhaustion, low self-esteem or lack of motivation, while more unusual symptoms – such as hearing voices, mania or psychosis – are routinely neglected.

Micha Frazer-Carroll is a journalist with a focus on mental health and author of the upcoming book, Mad World: The Politics of Mental Health. She thinks the idea that 'we all have mental health' is a double-edged sword. "It has had utility for some people, because we live in a society which tells us to override our feelings, limits, struggles, so that we end up in crisis or real mental distress," she says. "We may all have mental health [in that] we all have feelings and struggles but not everyone is stigmatised as mad. Not everyone becomes so mentally unwell that it’s disabling or that they can no longer work or have to go on benefits; not everyone is vulnerable to being sectioned under the Mental Health Act." Efforts to destigmatise certain conditions by, for example, saying that autism does not make people violent or that bipolar does not cause hateful actions, though often well-meaning, overlook the fact that it is impossible to distinguish between behaviours that are attributable to 'mental illness' and whether a condition has amplified an existing trait. This positing of what mental health is or is not has left us with a sanitised understanding that ignores groups and conditions that do not fit within socially acceptable parameters.

For people who don’t fit into the narrative of what mental health 'should' look like, it can be profoundly isolating. Candice Alaska, a 32-year-old from Trinidad and Tobago, knows this feeling all too well. She explains that while receiving a diagnosis of borderline personality disorder (BPD) "helped a lot of things fall into place", she was also faced with a lack of understanding. "I still continued to experience a lot of judgement for my experiences and traits by my loved ones," she says. "I was shamed for my chronic suicidality, and for my substance use and self-harm that helped me to cope." Eventually she set up her Instagram account, @understandingBPD, to shed light on overlooked symptoms such as dissociation, splitting (the tendency to take an extreme emotional viewpoint) and paranoia. "I think that the experiences of people with [BPD] are extremely misunderstood, which causes us a lot of harm and isolation to those who bear this label," she says. "Finding somewhere where we can finally be seen and understood can be so rare for many of us but is often what so many of us are looking for."

Candice agrees that there is a lot more awareness and understanding of anxiety and depression compared to what she describes as "scarier-sounding or lesser-known psychiatric diagnoses and mental health differences". But as she puts it: "That acceptance only goes so far – and that is often up until it challenges capitalism or it manifests in ways that are socially unacceptable." She points to the way that someone’s inability to work because of depression or anxiety is still often met with a dearth of understanding and compassion. "In this way, we can see that our fights, across diagnoses, are often the same."

Despite these shared struggles, there has been a concerted effort to draw a distinction between 'mental health' and 'mental illness'. On the face of it, this seems to get around the blurriness of the term 'mental health' but it can also perpetuate stigma. 'Mental illness' can imply that something has gone wrong in the brain, individualising the problem and failing to consider that it could be a product of a person’s environment or lived experience. It might ignore, for example, the toll that rampant inequality or epidemic levels of loneliness is taking on a person's mental wellbeing. Labels like 'mental illness' can get in the way of empathy and can lead to a situation where people are prescribed antidepressants over an effort to understand or try to improve the material conditions of their lives. (NHS statistics have shown that one in eight people in the UK are on antidepressants, with the pandemic fuelling demand.) Medication can be beneficial for some people but it shouldn’t necessarily be the default response to someone in distress.

"While some people find antidepressants helpful," says clinical psychologist Anne Cooke, "being told you have an illness and need drugs can also be quite disempowering. It risks giving the message that there’s nothing much else that you or others around you could do to make a difference." It can leave people in stasis and without the sense that they might have some ability to improve the conditions of their own lives, whether through collective action or finding community.

Candice makes a similar point, arguing that not all of her struggles and experiences can be attributed simply to BPD. "Medicalising our suffering is a convenient weapon in the hands of those invested in maintaining the status quo," she says. "Righteous anger at oppression and injustice is at easy risk of being invalidated by attributing it to a symptom of mental illness." Being diagnosed with a mental disorder can have devastating consequences, stripping away a person's rights under the Mental Health Act. 

The term 'mental illness' can be extremely othering, particularly for those who don’t perceive their differences as an illness. "I completely respect people's use of the term, particularly to define their own experiences," says Candice, "but the reason it doesn't resonate with me is that it individualises experiences that often have larger origins and it pathologises as 'illness' all mental differences and neurodivergences." When we consider the fact that up until 2019, the World Health Organization classified being transgender as a mental disorder, we can see just how harmful it can be to perceive difference as 'illness'. Thankfully, there are groups and organisations advocating for a different approach. Hearing Voices Network, for example, promotes a view whereby hearing voices – a heavily stigmatised symptom – is not necessarily seen as a sign of 'mental illness' but as meaningful and understandable. The voices are not the problem; rather it is the relationship the person has with their voices that must be worked on.

A recent study supports this approach. It found that when therapists engaged with hearers and their voices, the voices could provide valuable insights. "Often you find out voices are related to something that has happened to the person in the past and may be playing some function in helping them process trauma," says Anne, who co-authored the study. "The point is that if you're just seeing it as illness and pills as the answer, it closes down all that exploration that might actually be quite helpful – at least for some people." 

So what would a more compassionate language look like? "I usually advocate being more descriptive, rather than just using these rather meaningless umbrella terms like 'mental health' or 'mental illness'," says Anne. "Actually talk about what somebody feels or experiences, whether that's hearing a voice or feeling very down and despondent." She questions the helpfulness of psychiatric terms such as 'depressive disorder' or 'schizophrenia', saying: "They can be quite kind of distancing and also a bit opaque."

Micha makes a similar point. "'Mental health' is a phrase that creates this binary of either you’re healthy or ill, when actually I think things can sometimes be more of a spectrum and less straightforward than that," she says. "I think the diversification of terms would be a good thing. For example, instead of 'psychosis' or 'schizophrenia', some people use the phrase 'extreme states', which articulates more precisely what they've experienced, rather than just using the phrase 'mental health', and also doesn't necessarily assign a value judgement to that experience." Efforts to 'normalise' mental health – while hugely positive in many respects – have often resulted in a limited understanding. The mainstream mental health movement must acknowledge a full spectrum of conditions and groups, not just those whose symptoms are the most relatable or the least threatening. Ultimately, it’s about building a disability justice future where, as Candice puts it, "we recognise that all people, regardless of their capabilities and how they experience reality, are equally worthy and all belong here".