Modern life can be tough and with many people facing an unclear future, are we unhappier than previous generations? Or is there simply better awareness of what 'mental health' means with advancing scientific knowledge and greater social understanding? Let's delve deeper...
Are we getting | unhappier?
Mental health means everything to do with our mental wellbeing - not just the absence of a mental illness. That wellbeing will look different for different people, depending on what gives each person’s life meaning and helps them to feel content and fulfilled.
That doesn’t mean that to be well, everything has to be perfect. Everyone’s life has some stress or worry from time to time. Even having obsessive thoughts, or occasionally hearing or seeing things that are not really there are relatively common and not necessarily a sign of a mental health condition.
Mental health conditions occur when these everyday negative emotions, anxious thoughts or unusual experiences happen more often - and start having a significant negative impact on your ability to get on with daily life.
Dr Catherine Crane is an expert on mental health at the Department of Psychiatry, University of Oxford. Before she started her research, she worked as a teaching assistant in schools, and now her interests in education and mental health have come together in her current work, a project, called MYRIAD, exploring how to prevent depression and improve wellbeing in teenagers. The project team are working to find out whether teaching mindfulness in schools gives young people skills that could improve their wellbeing and reduce their risk of mental health problems later in life. Over 80 schools are taking part in the project. Half will teach mindfulness and half will continue with the normal lessons that they give young people to support their emotional health and wellbeing.
‘Mindfulness’ is a word that’s used a lot – but what does it mean?
“People sometimes say there’s a ‘what’ and a ‘how’ of mindfulness,” she explains. “The ‘what’ is what you’re doing - paying attention to what’s going on in your body and mind and what’s going on around you in the present moment. The ‘how’ is how you’re paying attention - what’s the quality of that attention? Is it kind, curious and accepting, or harsh and judgemental? Mindfulness is about paying attention to your moment to moment experience in a friendly, inquisitive way. Some people are naturally quite mindful, some are less so, and how mindful you are may vary over time. But it’s also a skill that you can train yourself in - through meditation practices and other activities you can enhance your ability to pay attention to the world.”
Below is an introductory video about mindfulness that was developed by the independent charity, the Mindfulness in Schools Project, whose mindfulness programme is being included in the MYRIAD project.
Mental health myths
Dr Crane has done a lot of research in the field of suicidal behaviour. She says that people are often concerned that asking someone whether they are thinking of harming themselves might encourage them to act on any suicidal thoughts they are having - or ‘put ideas in people’s heads’. In fact, the limited research that exists suggests that asking someone sensitively about whether they have considered taking their own life does not seem to increase this risk - and may actually help.
Likewise, she says that self-harm is sometimes seen as done for attention, or as a ‘cry for help’. But again, Dr Crane says the evidence suggests otherwise.
“I think there can be misconceptions, particularly when people are going to hospital with self-harm, that it can be perceived as attention-seeking behaviour,” she says. “When you look at the motivations that people describe, it’s much more complex than that, and it’s often about trying to find a way to cope with really intolerable distress and not having any other effective ways of managing feelings - we know that it's something that is quite widespread among young people and lots of research is being carried out to find out more about how to help.”
Looking at statistics
Dr Crane says it’s important to be careful when looking at the research into mental health. She explains that you must always think about who’s involved in the study, and what questions they have been asked. She adds that it’s also key to consider where and when the work has been done.
“As social attitudes to mental health conditions change, awareness increases and stigma is reduced. As a result, people may be more willing to discuss their own experiences, more able to recognise their experiences as symptoms of a mental health condition and more likely to seek help,” she says.
Do you think people are more willing to talk about mental health now? What do you think about trying out mindfulness practices?
What challenges do young people face today?
Dr Nicola Byrom (King's College London and founder of the charity, Student Minds) discusses the modern challenges that young people face. She also touches upon the potential risk factors associated with developing a mental health disorder, and how charities like Student Minds help young people manage stress whilst studying at university.
Happiness around the world
What does it mean to be happy?
In psychology, happiness is a mental state of well-being, which relates to the presence of positive emotions, such as pleasure, comfort, gratitude, hope and inspiration, and the absence of negative ones. It is a general feeling of life satisfaction. However, it is a subjective experience and can be tricky to measure. Traditionally, studies in psychology have relied upon questionnaires and surveys to try to assess participants’ happiness levels. One famous measure known as Cantril’s Ladder poses questions such as: “Please imagine a ladder, with steps numbered from 0 at the bottom to 10 at the top. The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you. On which step of the ladder would you say you personally feel you stand at this time?” But measures like these may struggle to capture a participant’s entire experience and state of mind. Plus, happiness does not necessarily mean the same thing for all people around the world. For example, research has shown that for many Americans happiness is commonly associated with personal achievements and positive experiences such as elation, enthusiasm and excitement. However, for many Japanese people, happiness has a component of social harmony while many Hong Kong Chinese people define happiness through positive states such as a sense of calm and relaxation.
What's the meaning of a smile?
Smiling is usually a sign of happiness. Yet, many societies have their own unspoken rule about when it’s appropriate to smile linked to their unique culture(s). This might dictate how and when people should express whether they’re happy, sad or angry. For example, a well-known Russian proverb says “smiling with no reason is a sign of stupidity”. Likewise, smiling at strangers is not encouraged in Norway. Prof. Kristin Rygg (Norwegian School of Economics) explains that: "We don’t bother other people unnecessarily. We don’t ask for help unless we feel we really need to. To us, that’s being polite." Other signs of happiness might also be misunderstood depending on the varying beliefs held by a society. For example, in Chinese culture, preparing for your own funeral and buying the clothes you’ll be buried in is a sign of a happy life. This is because death is viewed as providing a sense of continuity with a person’s ancestors and family members. This is in contrast to many countries in the West, where death is rarely portrayed in such a positive light.
What's needed for a happy country?
To answer this question, we can turn to the World Happiness Report, which is published every year. It indicates which populations around the world claim to be the happiest, measuring happiness by asking people how far they have lived a life similar to the best possible life they could imagine. In 2018, Finland, Norway and Denmark had the highest World Happiness ratings, along with Switzerland and Iceland, which also rank among the happiest countries over the years. According to this annual study, the main reasons why people are happier in these countries are: income, healthy life expectancy, social support (having someone to count on in time of trouble), perceived freedom to make your own life choices, trust (absence of corruption) and generosity (donations to charity for instance). Interestingly, people’s happiness seems to depend largely on the country they live in. Indeed, immigrants report a degree of happiness closer to the one of people living in their new country, rather than the country they come from. This shows that happiness depends a lot on your life circumstances.
Would you trust a chatbot therapist?
Hussain Manawer explores the pros and cons of using online therapy chatbots - could they one day provide a replacement for face-to-face mental health therapy? Prof Ilina Singh (University of Oxford) also shares her insights on this interesting area.
When discussing his personal grief, Prince Harry said: “once you start talking about it, you realise that actually you’re part of quite a big club”.
When discussing his personal grief, Prince Harry said: “once you start talking about it, you realise that actually you’re part of quite a big club”.
What other factors shape what we know about mental health?
Dr Sam Parsons (University of Oxford) discusses some of the ways in which how we measure and think about mental illness has changed over time. It can be useful to consider the factors below when reviewing statistics published on this complex area.
- Progress in understanding and treating mental health
- People with mental health disorders used to be imprisoned - or worse - because of suspicions that they might be witches or were possessed by demons. Psychiatric institutions used in the early 1900s were not much better. Patients would be ignored in filthy conditions, and borderline tortured in an effort to keep them quiet. Thankfully, due to campaigns for better treatment, the emerging field of psychological science and improvements in psychiatry, community treatment is normal practice. We know more than ever before about mental health and how disorders develop, but there is still much to learn. A useful tool for understanding and investigating mental health is the biopsychosocial model of mental health. This gives a general overview of mental health disorders and recovery outcomes as a combination of biological (e.g. genetics, biochemistry, hormones), psychological (e.g. mood, personality, cognitive biases), and social factors (e.g. culture, family, support system). This allows mental health researchers to investigate combinations of factors and clinicians to incorporate each into treatment options. For example, pharmaceutical interventions such as anti-depressants (biological) for depression would be expected to be most effective when combined with a talking therapy to promote more positive thinking styles (psychological), and a more supportive family environment (social).
- Varied methodologies
- The methods used in any particular study determine what we are able to learn about mental health. In psychology, designs generally fall into one of two categories: cross-sectional studies and longitudinal studies. In cross-sectional studies, researchers look for trends between different measurements taken at a single time point. This is a useful way to collect data on lots of participants very quickly, and it can give you an overview idea of genetic or lifestyle differences between people and how they are linked to mental health. However, just because two measurements are correlated doesn’t mean that one necessarily caused the other. For example, we know that international obesity rates are rising and sea levels are too, but we wouldn’t necessarily say that one was happening because of the other! To dig deeper, researchers might instead want to control certain conditions and watch them over time as part of a longitudinal study. Each type of study has its advantages and flaws, which is why scientists may employ a range of methods. It’s also why topics like mental health can be so challenging to understand since there are so many variables to study. Each one can take many researchers several years to come to a confident conclusion.
- Different populations
- Most participants in psychology studies are WEIRD, which means that they come from Western, Educated, Industrialized, Rich and Democratic populations. We need to be careful about this when interpreting the results of a research study. This is because the media might report on a study as if a new intervention - or “cure” - for a mental health disorder has been found. But in actual fact, the study may have used WEIRD subjects with no diagnoses of disorder, and it may have been designed to investigate an underlying process thought to be involved in that disorder. Often it's difficult, or in some cases unethical, to run a particular study on people being treated for mental health disorders. In these cases, researchers might recruit people that are thought to be just below a ‘diagnosis threshold’. For example, people that report high anxiety levels. This allows researchers to begin to answer questions about the benefits of a new intervention, before trialling it among patients. Nevertheless, it's important to think carefully about the population investigated in a study, the methods used to interpret the results, and how these findings could add to our understanding of mental health.
- Psychologist Dr Kristalyn Salters-Pedneault (Eastern Connecticut State University) describes stigma as: “a perceived negative attribute that causes someone to devalue or think less of the whole person.” Stigmatisation can lead to an unwillingness to associate with an individual with mental illness. Facing this kind of discrimination on a daily basis can make people with mental health disorders feel devalued, ignored and fearful. Sometimes, mental illness is used as a scapegoat when somebody commits something terrible. What often goes unreported is that people with mental health disorders are much more likely to be harmed by another person than to be violent themselves. Increasing public understanding and developing mental health policies are helping to shift perceptions to a place where this stigma is considered unacceptable. This helps people with mental health disorders feel more empowered to report their condition and seek help.
- Mental health labelling
- Access to mental health support has improved over the last few decades. The increased number of diagnoses of mental health disorders is partly due to this improved access and to changes in the way mental health disorders are diagnosed. It also helps that it is more acceptable, and less stigmatised, to talk about mental health issues and seek support. Over-labelling and over-diagnoses can be a problem, however. People might receive unnecessary medication, or be labelled as having a severe condition incorrectly. Labelling mental health disorders creates a distinction between people who ‘have’ the disorder, and those that do not. Labelling these groups based on faulty criteria can negatively affect the understanding that we have about mental health. Using mental health labels in everyday situations can also be problematic because it can lead to wider misunderstanding about mental health disorders and make light of the real-life struggles some people experience.
- High-functioning mental health disorders
- We might imagine someone with depression or anxiety being stereotyped as unable to stop crying or having a crippling fear of social interactions. But, mental health disorders are hugely varied and these stereotypes are often false. Generally, we wouldn't imagine a highly-educated professional, with a large friendship group, that has received tons of awards suffering from a mental health disorder. Yet, privately this person might wake up each morning gripped with anxiety, or struggling with long-lasting feelings of worthlessness. These disorders have been described as high-functioning anxiety and high-functioning depression. These conditions do not fit neatly into the Diagnostic and Statistical Manual of Mental Disorders, even though it contains over two hundred possible diagnoses. For most of these diagnoses, an individual must show that their lives and daily functioning have been negatively affected. We don't currently have a full understanding of high-functioning disorders; more research is needed that moves beyond current preconceptions.
Mental health and social media: what's the link?
Sometimes it feels like there’s always a new headline about the negative effects of social media particularly on young people and their mental well-being. But is all the hype supported by the research? Amy Orben (Experimental Psychology, University of Oxford) explains that it’s important to see the bigger picture…
Although research has shown some small negative effects of excessive social media usage on mental well-being, more research is needed to clarify the true extent of the impact. Amy Orben - an expert on the psychology of social media - explains that it’s worth “zooming out and taking time to consider some of the things we know affect mental health. For example, getting enough sleep; eating a balanced diet; taking regular exercise; gaining support from friends and family, and so forth. Social media has a role to play in this complex web of factors but it’s not the sole one to override any of the others.”
She adds that: “It’s particularly concerning when considerable sums of money are being pledged by policymakers to address a problem [i.e. social media negatively affecting young people’s mental health] which we still know so little about.”
This is why Amy Orben and her colleagues at the Experimental Psychology Department and Oxford Internet Institute are conducting comprehensive research into this area of ever-increasing interest.
Social media myths
Like many things in the public eye, several misconceptions have developed surrounding social media. Firstly, there has been a lot of media attention focused on the idea of social media addiction which suggests that young people become ‘hooked’ to social media since they get a hit of dopamine (a chemical released in the brain as a response to a pleasurable activity) when using it. Although this might sound scientific and credible, it’s not as straightforward as this. This is because the brain releases dopamine whenever it does anything pleasurable - social media is not unique in this respect.
Plus - as Amy Orben points out - we should be careful when labelling something as an addiction. In medical terms, an addiction is generally defined as an uncontrollable dependence on a substance whereby stopping its use is difficult and causes physical and mental reactions.
Over the years, this definition has been opened out to include behavioural addictions such as gambling. However, there’s not currently enough evidence to place excessive social media usage in this same category.
A spoonful of…social media?
Amy Orben compares trying to pinpoint the direct effects of social media usage on someone’s overall well-being to predicting what a single gram of sugar can do to a person’s body. In both cases, there are many follow-up questions that need to be addressed to get anywhere close to understanding the relationship between these variables.
For example, with the case of eating sugar, the follow-up questions might be: how much sugar is consumed in one sitting, how often and at what times of day? What kinds of sugar are consumed? What are the motivations for eating the sugary foods and in what context is it usually consumed? What is the medical profile of the consumer (athlete/diabetic etc.)?
For this reason, Amy Orben recommends taking a holistic approach to understanding this issue. In other words, social media usage is an important factor to consider when evaluating an individual’s mental well-being but it can only be understood in relation to the other things going on in that person’s life. For example, at the same time as frequently using social media, a person may also be getting little sleep, eating an unhealthy diet and going through financial difficulties. If they then go on to develop mental health problems, it would be unhelpful to single any one of these factors out.
We would not readily trust anyone who claims to predict how someone is affected by consuming one gram of sugar. The same could be said for social media usage. The outcomes depend on so many factors that only very crude predictions are possible at this stage where concrete evidence is not available.
So what do we hope to learn in the future?
Amy Orben and her colleagues are currently examining data concerning thousands of young adults' well-being and their technology use around the world. Making their analyses as clear and open as possible, they aim to provide an unbiased source of information about whether, and how, technology affects teenagers’ lives. This means not only quantifying the effect of social media use, but putting it into perspective by comparing it to the effects of other things we know should or shouldn’t affect well-being. They found, for example, that the negative effect on well-being of using technology was as small as the effect that wearing glasses can have on one’s well-being. Eating a proper breakfast and getting enough sleep often has about a 3 times bigger effect on well-being than technology use has. Amy Orben and Oxford colleagues have recently presented this evidence to parliament, hoping to support the debate about how government should address the rise of technology use in children.
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Eight artworks inspired by mental health problems
Over 30 artists from the UK, USA and Canada have contributed work to the Perspective Project, with the aim of ending the stigma surrounding mental health. Click here to view some of their amazing work.