Separating mistakes – An analytical overview of why separating ‘mind’ and ‘body’ is so damaging [TW: Discussion of mental health, Suicidal ideation, Self-harm]

Table of Contents

It’s no secret that society is pushing to improve the knowledge and understanding of mental health. Since the start of humanities history, psychology has been a topic of study – it’s not all that surprising as to why, we have an innate curiosity within us, to dissect and analyse things. Understand it so we might recreate it, grow it and fix it when needed. While science and areas of study are ever changing and updating things, the birth of the internet and the accessibility of information has never been easier, making knowledge easier to comprehend than ever before. But what is mental health: do we all have it, and if emotions are inherently subjective why does what we name our experiences and emotions matter so much to wider society?

This post series originally started with a post about ‘triggers’ and ‘glimmers’ and how I manage mine and use glimmers to help. In trying to better understand human emotions, and the complex mechanisms involved in their presentation, I ended up with two massive ‘side notes’ that quickly became more of the content than the original topic, so I decided to split it up a bit more appropriately. In this post I consider the problems with viewing ‘mental health’ as something we ‘lose’ rather than something we inherently possess by the nature of having a brain, and how the current view and Western models of health are flawed. The next post is a more detailed overview of human emotions and their function, subjective experiences, and why what we name them has a broader impact in society’s view of mental health. The third post (at least as I intend it at this point) is the original one, discussing ‘triggers’ and ‘glimmers’ in the context of mental health.

Most people understand the broad concept of their ‘health’, as well as the potential for certain ‘markers’ to be collected and viewed to analyse the overall broader health of the data group considered. These markers and the resulting analysis is invaluable for a wide variety of things, including sign-posting how policy should be focused. I’ll be speaking more about it a little further down, but these correlative and causative data points were key in the conclusion that smoking and smoking related disease were causing a decline in overall health and incredibly damaging. Policy was created and focussed to bring greater education, change societal conventions and expectations surrounding smoking and secondhand smoke, and as a direct result many of the originally measured metrics decreased, concluding in a higher quality of life and the overall population’s health. There are a wide array of factors and data points to utilise, however this post is already long and specifying each one is not particularly relevant.

Most Western medicine models use a ‘biopsychosocial’ approach, meaning components of biology, psychology, and social aspects help produce our ‘mental health’ or positive ‘outcomes’. However, even before this view can be taken, what a human needs to thrive must first be considered and defined.

In Abraham Maslow’s 1943 paper A Theory of Human Motivation, Maslow proposed and later extended the premise that a distinct number of needs had to be met for people to thrive. Split into ‘basic needs’, ‘psychological needs’, and ‘self-fulfilment needs’, it makes sense that one can’t focus on the ‘self-fulfilment’ needs if their basic and physiological needs such as housing, clean air, and safety are not being met, or met without security. It is my personal opinion that in understanding this hierarchy of needs, we can better understand, analyse and improve the model of healthcare we have at present.

Broadly speaking within society, it’s understood that if you have a body, it has the potential to ‘break’. This understanding is reflected in how we research psychology and society, how policies are made by our governments, and even in the media we consume. For example, socially, we talk about the best exercises to do for a flatter stomach, or ten tips to improve your diet; while a scientific lens introduces different terminology, much of the content is still the same – how to measure ‘health’ and ways to improve it. While the narrative is improving, mental health is still viewed as sort of separate from our ‘health’, in this context the implied yet silent word before ‘health’ is ‘physical’. While we seem to understand owning a body requires maintenance and health choices, far too many still consider ‘mental health’ as something you lose, rather than something you intrinsically have by the nature of having a brain. Something that, like our bodies, requires maintenance and healthy choices.

Positive and negative outcomes are a metric used by scientists to consider a group of people’s ‘outcome metric’. These individual outcomes can stack, too many negative outcomes are correlative to poorer health overall, while good outcomes typically result in a healthier person as a whole. There are a lot of different ‘outcomes’ scientists can measure, and overlay other statistics such as ‘life expectancy from birth’, ‘condition-specific changes in life expectancy’, ‘age specific mortality results’, and even ‘self-reported level of health, functional status and experiential status’. What this boils down to is that, for example, someone wanted to know how ‘life expectancy from birth’ would be affected by the improvement of a set of ‘positive outcomes’ (for example: greater community and social support, free school meals, and raising the living wage). Typically we would expect to see ‘life expectancy from birth’ rise as a result of a higher quality of life. All these factors are contributive to our overall health, not just physical health, and it’s my personal opinion that we don’t discuss and expand on this point enough.

Even in the narrow scope of my own personal experiences, the number of times I’ve heard stories like mine repeated from the neurodivergent community leaves no room for misinterpretation: those assigned female at birth, people of colour, and non-binary/genderfluid individuals are far more likely to have their neurodiversity missed or ignored in childhood. While studies on the topic make it clear that neurodivergent traits and the inherent difficulties they manifest are transcendent through racial, ethnic, and socioeconomic groups the world around, the Centers for Disease Control and Prevention (CDC) estimate approximately 1 in 36 children have been diagnosed with ASD in the USA alone. An article published in the library of National Institutes of Health in 2022 surmises that “Early ASD diagnosis and individualised intervention plans have been associated with better overall outcomes” than when compared with individuals diagnosed later in life. This same article discusses the comorbid nature and cross over of ASD symptoms and ADHD symptoms, noting that while the DSM 4 prohibited the dual diagnosis of both, the DSM 5 thankfully modified the exclusion criteria to allow it, further it notes that “overlapping symptomology and the high frequency of ADHD symptoms in autism can lead to misdiagnosis or delayed ASD diagnosis”. The article continues to explain that: “Screening for ASD in children diagnosed with ADHD should be considered when considering ASD screening and evaluation” and I simply can not agree more with this idea. I was only able to afford the private evaluation for one, and ADHD seemed to be impacting me more than anything else at the time, but receiving that diagnosis ‘switched something on’ in my head. As though prior to that, despite ADHD being a neurodevelopmental condition I’ve obviously had my entire life, it was as though I had felt like I was somehow ‘appropriating’ information and resources, despite them being freely available and not something finite, I felt as though I didn’t have the right to utilise them before being diagnosed. I laugh about it, not because it’s funny, but because it was some sort of cognitive distortion of mine (if you experienced this too, do let me know because it’s weird) that I had also applied to the ‘vision’ accessibility features of my Apple tech, despite having undiagnosed visual impairments (not for lack of trying either, no one knows or can pinpoint why it’s happening), I was so hesitant to utilise features on technology I had purchased and now own, again as though I was appropriating it from someone else.

For me, though I can not change the past nor guarantee the outcome of any one change, both my personal observations and the copious data and research shows that with few exceptions earlier diagnosis results in better outcomes. Experiences of sexual abuse, according to a NIH article on the ‘Experience of late-diagnosed women with Autism Spectrum Conditions: An investigation of the female autism phenotype’, were widespread within their study sample, and I can include myself as having that experience too, unfortunately. The article, as well as my personal and observed community experiences, lead me to the conclusion that many of us have ‘pretended to be normal’ within our traditional gender role, the symptoms of ASD in many ways directly conflict with society’s expectations of what ‘women’ should be and do, the gender roles in how professionals view and evaluate individuals with the same symptom set can not be overlooked, the article notes that gender led various professionals to miss ASD in their sample group. Even outside of neurodivergence, after being suicidal for months I had my first psych appointment and it was agreed we needed follow-up. My high school prom was coming up and I had dyed blocks of my hair pink. Upon attending my follow-up appointment the doctor exclaimed how I must be feeling better since I dyed my hair, and despite my protests that I still wanted to harm myself I was promptly discharged.

The impacts of late diagnosis has felt earth shattering to me, and the diagnosis as though puzzles pieces I hadn’t known I was missing now slot into place. I could count on one hand the friends I had throughout primary and secondary school, even college. While I had no problem making friends, being I was open, sincere, and kind, I struggled to maintain these friendships, difficulties knowing when it was ‘my turn to speak’ led me to speak over people, misunderstanding appropriate social conventions led me to encroaching on boundaries I didn’t realise were present, and for most of my life I have felt as though I was modelling or using a script from popular media on how to be a social person. Seeing photos and being bombarded with, not only the way women should look, but how my home should be kept, the level of energy I should put into things ‘after work’, etc, only alienated me further when I simply fell short of the supposed expectation. I felt lazy, worthless, and broken, as though I simply wasn’t trying hard enough and should I put more effort in I could meet a standard that was always unattainable with my current mechanisms, trying to fit a neurotypical way of achieving the goal with a neurodivergent brain the saying about judging fish on their ability to climb trees.

While this blog is not a political one, I also don’t wish to shy away from difficult topics because they may be polarising – in fact I assert that in part this got us into the position we are currently in with mental health and treatment. As a society, achieving the WHO definition of health is hard, and far from universal in approach. Establishing and sustaining factors including healthy environments, equitable social and economic policies, and more. While many of our governments compartmentalise ‘school’ and ‘healthcare’, etc. into separate sub-categories of policy, they’re inextricably interwoven together, forming a wider lens of a population’s wellbeing. On occasion, the policy makers take note of a particularly wide reaching factor and make a community effort to improve it from a more interconnected point of view. A great example in recent memory is smoking tobacco products.

Under the Health Act 2006 and The Children and Families Act 2014, the UK prohibited smoking in all enclosed and substantially enclosed workplaces and public areas throughout, with this ban taking effect in July 2007. According to The Health Foundation, the ban was a result of decades of research and campaigning: studies beginning in the 1950’s demonstrated a correlative link between smoking and lung cancer. The Department of Health spear-headed a review on the impact of the smoking ban, and while the ban itself was not universally popular, social changes in attitudes and behaviour as well as second-hand smoke exposure in children fell, as well as admissions to hospital for heart attacks. Professor Linda Bauld, presently a professor of Socio-management at the University of Stirling and the UK Center for Tobacco Control Studies though at the time of authoring the report was Professor of Social Policy and Head of Department for Social and Policy Sciences at the University of Bath, conducted and produced a report outlining the existing evidence concerning the impact of the smoking ban legislation. It notes that while an outright ban on smoking was not introduced, the policies that were put in place with aims of protecting workers and the general public from the harmful effects of secondhand smoke also affected smoking behaviour more broadly, and the normal social view and conventions associated with it.

The result of the smoking ban had far-reaching effects, where and when it was acceptable to smoke including around children and sectors most affected by second hand smoke inhalation such as bar workers, health related impacts were lessened, the number of people requiring treatment for them lessened, the economic health of the society grew due to less people being unable to work due to related disabilities and chronic health conditions. Socially, the way smoking was discussed and viewed dramatically shifted, modern research accepts that the influences are multifactorial. For example, those in the lowest socioeconomic groups had a higher rate of smoking, and while they tried to quit at the same rates as those in a higher socioeconomic group, they were much less likely to succeed.

There is a wider benefit in promoting health overall for everyone, so why isn’t mental health being taken more seriously?

A survey of mental health and wellbeing from 2014 conducted by NatCen Social research in collaboration with the University of Leicester looked to provide data on treated and untreated psychiatric disorders in the English population, aged 16 and over. The study shows that around one in six adults (or 17%) met the criteria for a common mental disorder in 2014 (defined as different types of depression and anxiety, marked emotional distress and interference with daily function but that do not usually affect insight or cognition), while the study notes typically less disabling than ‘major psychiatric disorders’ the higher rate they are experienced at means a higher societal cost cumulatively. Common mental disorders were also found to be higher in women of colour, adults under 60 living alone, women who lived in big households, unemployed adults, benefit recipients and those who smoked cigarettes.

The results are clear: those within socially disadvantaged groups have a much higher risk of a common mental disorder. The study further acknowledges that an estimated one fifth of days lost from work in Britain is due to mixed anxiety and depression. If the cumulative impact on society is noted as great back in 2014, why in 2023 are people still struggling to access treatment and find support?

The World Health Organisation offers a framework, dividing the holistic approach between ‘promote mental health, prevent mental illness’ and ‘treatment and rehabilitation’. While I have used the term ‘wellbeing’ throughout this post, the 2013 Annual Report of the Chief Medical Officer titled Public Mental Health Priorities: Investing in the Evidence notes that the term has not yet been sufficiently “defined and measured to be used to evaluate and allocate health resources”, urging in its summary that it is poorly-evidenced, but only one strand within the WHO model I mentioned above and it does conclude that there is ‘sufficient evidence’ base to make a “real and sustained public health impact using the WHO framework”, this suggests that there is enough data to warrant public policy changes and funding. The reports by the WHO in 2004 and 2005 recognised that mental health is more than an absence of illness, rather it is closely interconnected with one’s physical health and forms a key part of ‘health’ overall. It also recognised that traditionally ‘mental illness’ was viewed as outside of ‘public health’ and impresses the importance of achieving improved mental health while lowering the personal and social costs of mental illness, it can only be achieved with a public health approach.

Conclusion and Tl;dr

I personally feel as though it’s a simple conclusion: either money invested now, in the form of awareness, promotion of healthy lifestyle and habits, education, and treatment or intervention; or money later, in terms of both lower individual and society wellness, productivity, and quality of life. While the initial investment and general maintenance cost may seem large, the evidence available shows that a society who are more satisfied with their quality of life are healthier in both mind and body, and are a society who are inherently more productive and who contribute more to the economy of the society.

If we don’t invest in our health, I can personally attest to the result that we lose it, as while my genetic condition was always there, it was exacerbated by stressors outside of my control. Learning to balance the needs of my physical and mental illnesses’ needs and symptoms has been a challenge, but one so worth undertaking. I am happier, have been self-harm free since 2017, and have been free from persistent suicidal thoughts since 2019. My mood is more stable, I feel more resilient when adverse events crop up, and not only am I motivated to work on my goals but I feel as though I am worthy of achieving them too! I’ve struggled with my mental health since I was 13: in 2012 I was sectioned under the Mental Health Act for multiple self-harm and suicide attempts. It was only when I had the puzzle pieces in perspective and learned to balance them that I felt in control of my mind and body more, and while no one is ever fully in control of processes that often are not conscious at all, a society more educated in mental health is a society more capable of preventing it where possible and seeking effective treatment where prevention was not possible. It seems awe-inspiringly shortsighted to feel the investment up front is an unwise investment, when the same if not a larger financial cost is paid later.

So what can we do? While individual impacts do matter and should be considered, trying to make an impact in a system inherently set up to fix things after they’ve broken – if they fix them at all – will broadly speaking lead to the same outcomes. To my mind, and this is simply my own opinion, we need to recalibrate the way we consider ‘health’ and stop separating mental and physical health. We treat everything as separate, even within the NHS. We don’t have medical records that are accessible to other hospitals you are attending. What this results in is quite frustrating. Despite the physician ordering the testing, the results are not immediately automatically sent to them – in one instance I had to get X-rays, bring the physical image to the ordering physician, and give it to them. While not everyone wants or needs their medical records shared, for those of us with complex medical needs it’s a time consuming, exhausting nightmare in which we are expected to do a job that could easily be automated.

There are many more ways in which we are wasting money in healthcare, whether through things that could easily be automated, to things that could easily be prevented with additional resources screening and education – prevention over cure where possible. This post is already too long though, so I’m going to end things here for the moment.