On a cold Tuesday in October 2015 in the Palace of Westminster, I listened to a smartly dressed professor argue that everyone who worked there, ‘from the front-line porter to the secretary of state’ needs support for their mental health. His audience of politicians, peers, and political advisors nodded in recognition as he described his experience of anxiety in real time: ‘So many thoughts going round in our heads, “Is my tie straight?” “Do I seem nervous?” “Are they going to make a judgement about me?” These thoughts are the social conditioning that we respond to and that distract us from the immediate experience of the moment.’ The talk was part of an All-Party Parliamentary Group (APPG) inquiry into the policy potential of mindfulness as a support for mental health. None of the audience, to my knowledge, had received a mental health diagnosis, but most, if not all, recognised themselves in the characterisation of anxiety with which they were presented.
I conducted long-term anthropological research on mindfulness and mental health with patients, therapists, politicians, and advocates in Britain. What I found is that, in addition to the terrifying prevalence of depression and anxiety, the development of preventative healthcare has radically transformed the category of ‘mental health’ itself. In Britain and America, mental health is increasingly thought of as a transversal issue, as important for psychologists as for patients, probation workers as for prisoners, politicians as for constituents.
In the 1950s, depression was so rare that pharmaceutical companies saw no benefit in investing money in its treatment (Healy 1997)[1]. And yet, by 2020, the national census reported that one third of Americans were showing symptoms of depression, anxiety, or both (Fowers & Wan 2020)[2]. Recently, Taylor Swift became the first artist to ever occupy the entirety of the top 10 spots on the Billboard Hot 100 list with the release of her album ‘Midnights’, heavy with the introspection of a therapy assignment. The situation is similar across the pond; in Britain, everyone from Stormzy[3] to the Football Association (FA) is talking about mental health. In the go-to metaphor of the FA, ‘[l]ife often imitates football: we all experience setbacks from time to time, some big, some small, some you see coming, others come out of the blue, and each setback puts our mental health to the test.’[4]
Whereas earlier categorisations of mental health led to the identification of ‘risky populations’ (Rose 1985)[5], or the treatment of acute episodes of ill health, ‘mental health’ is no longer reserved for those who might qualify for a clinical diagnosis. In this new categorisation, all people are more or less well at different points in their lives. Or, as the Mental Health Foundation says on its website, now ‘[w]e all have mental health.’[6]
My research revealed that the expansion of the category of mental health has led to two distinct but related changes. First, for people from diverse backgrounds in Britain, preventative healthcare is informed by a positive framing of mental health. It’s no longer only about mental illness, though that is still important; it’s also about flourishing, happiness, purpose, and resilience. Second, people across society have increasingly come to think of mental health as something that can be actively cultivated. It is a culturally new phenomenon to think of learning to develop a relationship with one’s own mind as a central constituent of the good life. This matters because, in the transversal shift from the prevention of illness to the cultivation of health, what one does about mental health far exceeds the realms of professional psychological intervention. Mental health practices, like mindfulness, are incorporated into the ‘small moments’ of everyday life (washing up, waiting for a bus), and living well is associated with maintaining a healthy relationship with one’s own mind amidst the ups and downs of everyday life. In the autumn of 2023, the next major update to Apple’s iOS system will see features that encourage users to reflect on their ‘state of mind’ and track their levels of depression and anxiety. Wherever you are in the world, if you have an iPhone, iPad, or Apple Watch, you can ‘stay on top of your mental wellbeing’ on a daily and weekly basis.
The meetings in parliament interested me because they reflect new modes of governance that emphasise evidence-based decision-making and citizen involvement in co-producing policy, but what marked them out from similar participatory fora was the way in which all participants related mental health and mindfulness to their own experience. Listening to testimonials from ex-offenders, probation workers, school children, teachers, patients, and clinical psychologists, as well as members of the House of Commons and the House of Lords, I was struck by how much the assembled group engaged with questions of mental health as emotional creatures themselves. In large wood-panelled meeting rooms overlooking the river Thames, each meeting began with assembled parliamentarians and experts closing their eyes as a mindfulness teacher guided them to bring their awareness to their breath and to notice the quality of their thoughts, emotions, and feelings in the moment. As one member of the House of Lords commented, ‘we’re all really peers in this’.
In my book I interrogate the ways in which the logics of preventative mental healthcare are incorporated into people’s relationships with themselves, therapeutic interventions, structures of governance, and political campaigns. While it may seem like common sense that mental health can be supported by reflection and awareness, much like physical health is supported by exercise and diet, this idea has a strikingly short history. My account of mental health examines the historical development of categories that we take for granted, the wider intellectual trends by which they are informed, the ethics through which they are constituted, and their meaning for people as they navigate the vicissitudes of life. What this illustrates is that preventative healthcare has had a profound influence on people’s efforts to live well, underscoring the significance of our understanding of the mind.
Joanna Cook is a Reader in Medical Anthropology at University College London. She is the author of Meditation in Modern Buddhism: Renunciation and Change in Thai Monastic Life and the coauthor of The State We’re In: Reflecting on Democracy’s Troubles and other books.
Notes
[1] Healy, David. 1997. The Antidepressant Era. Cambridge, MA: Harvard University Press.
[2] Fowers, Alyssa & William Wan 2020 ‘A third of Americans now show signs of clinical anxiety or depression, Census Bureau finds amid coronavirus pandemic.’ The Washington Post 26th May, https://www.washingtonpost.com/health/2020/05/26/americans-with-depression-anxiety-pandemic/
[3] https://www.theguardian.com/commentisfree/2017/mar/03/stormzy-depression-grime-mental-illness-black-men
[4] https://www.headstogether.org.uk/heads-up/
[5] Rose, Nikolas. 1985. The Psychological Complex: Psychology, Politics and Society in England, 1869–1939. London: Routledge & Kegan Paul.
[6] MHF. 2022. ‘About Mental Health’, https://www.mentalhealth.org.uk/explore-mental-health /about-mental-health (accessed 30 November 2022).