On Mental Health

A critique of contemporary thought

I

It’s impossible to start an article of this kind without the token clichés. So I’ll keep them short. We all know, as we certainly can’t avoid being told, that today mental health problems abound. I’ve heard countless sermons that cite statistics indicating as much, and doubtless my readers have too. It’s been one of the big themes of the Covid-19 pandemic, of course. As a postgraduate student, my email inbox is full of constant reminders to ‘look after my mental wellbeing’, and that sort of thing. Seventy-five years ago this country won the war; now its elite institutions have ‘welfare puppies’ to help young people deal with the stress of exams. But it’s not all worthy of my cynicism. There was a danger in the late-Victorian invention of the stiff upper lip, some of whose force is mitigated by the greater openness in society today surrounding such matters. What that greater openness has revealed is that many people do indeed struggle with anxiety, depression, and the like, and that being able to talk about those things and find help is immeasurably better than suffering in silence and stigma. But is that all the picture?

I want to argue that much of the narrative we have woven around mental health – indeed, even the concept of ‘mental health’ itself – acerbates, rather than ameliorates, the problem. Sometimes I fear it has even created the problem, at least in certain instances. Because we live in an age of PhDs and experts, of irrefutable doctors (especially if from the sacrosanct NHS) and ‘trusting the science’, it is hard for us to engage critically with the discourse that surrounds mental health and its consequents – hard, even, to know that a narrative, per se, exists at all. That is where history comes in: for a timely study of past thought patterns, revealed both in the high castles of academy and politics, and more powerfully in the day-to-day parlance of the average Joe, is wont to expose the contingency of those frameworks that we have come so to rely upon as to be unable to distinguish them from reality itself. Of course, to cry ‘contingency’ is not to deny the eternal or the God-given. I do not doubt the existence of serious soul-troubles, the likes of anxiety and depression. Again, history holds the answer here: they are very obviously a perennial feature of human existence, albeit couched in different terms down the ages. But I do want to call into question the framework we use to understand such things, and I shall do so by way of four observations.

1. The danger of mental health hypochondria

Let me make a confession: I am prone to hypochondria. My mind has a remarkable influence over my body, and that can be hard to manage at times. Even now I am experiencing a degree of stress that is resulting in frustrating physical symptoms. It’s not to say that these are made up – they are psychosomatic, not merely psychological. But it’s easy to see how a mistaken belief in my own possessing a particular infirmity could easily hasten along some of these symptoms, cause new ones, and generally create a self-fulfilling prophecy of my own doom. Hence why I try to be an optimist.

It doesn’t seem to have crossed the minds of many of those promoting increasing discussion of mental health problems that mental health hypochondria is a very real possibility. I would argue that it is a more likely condition than hypochondria with regard to certain non-mental/non-brain-related symptoms,[1] for a positive feedback loop between mind and mind is much shorter, and therefore more easily activated, than one between mind and body.[2] Teaching people, especially young people, to interpret their struggles through the lens of mental health – with all its clinical weightiness, and implicit associations of serious mental decline – is only going to inflame those struggles. A sadly all-too-typical level of melancholy is transmuted in a jiffy into the mental equivalent of a serious illness. But I think it is worse in the case of anxiety: for what could be more anxiety-inducing than telling someone struggling with a normal level of anxiety (which I believe can be quite extensive) that they are in fact on a par with those sorry folk who inhabited bedlam of old? But that is the language here, even if the understanding is that the particular instances differ by degree.

I have known, and known of, children as young as eleven or twelve describing their wellbeing through the lens of ‘mental health’. But it surely is not fair to teach children to interpret the usual ups and downs of life, and especially those rather bewildering childhood vicissitudes, as on a clinician’s sliding scale from ‘able-minded’ to requiring sectioning. The thought makes me shudder. Mental illness is a terrible evil, a part of this fallen world which I both lament and profoundly fear. It is best, then, to raise the spectre of its possibility only when we are sure of appropriate evidence to believe in its presence.

2. The clinicalisation of the human spirit

I have alluded to this second point in my mention of clinicians above. One of the great detriments of contemporary dialogue surrounding mental health is that it casts the struggles and triumphs of the human spirit in the cold language of the clinical. Joy – which, in its truest sense, can only ever be of the transcendent – comes to be described and conceived of in terms of chemicals and ‘good health’; so too the evils of melancholy and other disturbances of the soul. There is no space for mystery in this world, no space for beauty or the poetic. It is a soulless outlook, a scientistic take on the human condition that views men and women as problems to be fixed or various jobs to be undertaken. At some level that makes sense, of course, given the origins and purported purpose of the clinical. If a physician is to bind up a wound or perform a surgery, many would regard consideration of spirit, soul or the divine to be superfluous. I do not share that view; I think it is hopelessly reductionistic, and at its heart godless. But at least it has a kind of logic to it: bodily considerations for bodily matters.

But the clinician’s touch, we are now told, reaches the metaphysical. (And make no mistake; ‘mental health’, in its modern formulations, most certainly inhabits the metaphysical, not the sphere of mere naturalism, as the entrenched dualism of describing ‘mental’ health in contrast to ‘physical’ health makes abundantly clear.) The result, as I say, is soulless, for it views those states which are the heart of each self in a mechanistic, flattened view. Melancholy, fear, sadness, destitution, even anxiety of an existential kind – all these move from states that I, as a conscious self, inhabit, to things that merely happen to me. Roger Scruton makes this point with regard to pornography. Pornography makes sexual arousal a mere state of the body, and thus something that the self experiences, rather than a state that it inhabits in intentionality towards the object of desire. Scruton argues that this is a de-centring of things that are crucial to our selves as human beings. But it is also a diminished view of the self itself. As states of desire, despair, longing, fear, and the like, move from integral features of my being that I inhabit – whether wanted or not – to things that merely happen to me, the ‘me’ that experiences them shrinks a little. Dualism has already distanced me from my surroundings, from my body; but now, under this conception, ‘I’ become distanced from my very spirit.

That may be intended to remove the sting from depression and anxiety. But in fact it does quite the reverse. For one thing, if depression merely happens to me, much as cancer does, then why not also the good things of the human spirit: joy, peace, hope, and of course love. But there is something deeper than that. For there is a joy – if I can be so bold as to call it that – in the meaning of depression. It is the attachment of these states of being to the transcendent that provides their meaning. That meaning may be harsh – depression becomes a sickness of the soul, not merely a condition inflicted upon me – but not so harsh as the ultimate depression of eternal meaninglessness and insignificance. The psalmist’s lament has a depth of pain to it that a godless world can never know: where is my God in this? But somehow it is a lasting joy too, for a God lost in the mire of human pain is of immeasurably more worth than a God never found. And as the psalmist attests, time and again, the God whom human pain seems to obscure is never truly lost to us.

3. Dualism

Again, I have pointed to this above. But it ought to be profoundly worrying to Christians that our culture is so conquered by dualism; it ought to be, except that many of us haven’t noticed, for it is simply the air we breathe. And that is seen very obviously in discussion of mental health. There is no longer ‘health’ considered in the holistic sense. These days there is the body (‘physical’ health), treated on its own non-spiritual terms, and there is the mind, treated on its own, categorically different, terms. At this point many of my readers might object: does not the notion of the psychosomatic dispel this? (After all, I myself have been content to use it above.) But dualism does not posit an ineffable gulf between mind and body, spirit and matter; that kind of philosophical doctrine would be both inconceivable and of little use to anyone. Dualism in all its guises believes there to be some site of interaction between the physical and the mental or metaphysical. The notion of the psychosomatic, far from being antidualistic, is predicated on metaphysical dualism. Let me give an example from my own life. My gut health is poor. Perhaps the biggest reason for this is the anxiety and stress that I often experience. We in the contemporary West understand that readily; my mind is bad, we might say, and so my gut is bad. The latter is caused by the former. In the pre-modern, non-dualistic worldview, however, this statement does not make sense. For the average medieval bloke, my gut being bad is my anxiety.[3] Anxiety, a mental state, is not here conceived of as categorically distinct from its physical sign or manifestation; rather, the mental (for it has always had an undeniable mental or metaphysical character to it) is woven into the physical. For us, by contrast, the mind and its realm are separate, distinct from that of the physical; distinct enough that when the two meet it is worth labelling that site of meeting the ‘psychosomatic’.

Why is dualism problematic? For one thing, it is not biblical. My medieval bloke, by and large, shares the metaphysics of Scripture, be it Hebrew or New Testament (which is largely Platonic). Spirit and matter are not categorically distinct in the same way that they are to so many of us; rather, they exist as different but interwoven planes of being. To us, this looks almost ‘incarnational’, and perhaps that is the right word to describe it. At one level body and soul are distinct (Matt. 10:28), but at another interwoven; the body matters because it is where the spirit does its work (and for a whole host of other reasons, of course).

The move from this biblical perspective – which, admittedly, I have not spelled out wholly clearly – is profoundly detrimental. For one thing, dualism has facilitated secularism, with its sharp divide between the internal/religious and the external/civil, a divide which, before the God who rules over all, is patently false, and which lies behind much of the cultural crisis we find ourselves in, accompanied by the lamentable confusion amongst Christians as to how to respond to it. And of course, dualism facilitates (intellectually, at least; I am not denying the simple role of sin here) the strange approaches to the human body that, again, are tearing our society apart. A man can only say that he is a woman trapped in a man’s body if dualism is true, for the ‘I’ in such a sentence can only be the dualist’s ‘buffered self’ (in Charles Taylor’s memorable phrase), uncannily separated from the body which it merely inhabits. Expressive individualism thrives on this dualistic notion of the body as categorically separate from the mind, a mere object or mechanism that must be suitably conformed to the mind for the latter to be at peace. That the soul, though ontologically superior to the body, might in some sense emerge from it (as Aquinas taught), and thus be limited and in a measure defined by it, is wholly contrary to this worldview. But this latter view has been that of Christians for centuries, and it is, in my opinion, in tune with the biblical worldview.

4. A fountain of solipsism

That brings me to my final observation. The profoundly dualistic position implicit in our discussion of ‘mental health’ tends, inexorably, towards solipsism. Solipsism is the belief that the mind is all that can be known to exist. It plagued me when I was a four year-old – more a mark, I realise now, of the embeddedness of this way of thinking in our language and culture than a gauge of my precocity or genius (alas). But it is, I believe, the great existential blight in the Western mind, and perhaps in the human condition at large. And it is not helped one bit by our understanding of mental health.

In the solipsistic worldview, value, meaning, good, happiness, etc. exist only in the mind, since the mind is all that truly exists, or can be known to exist. The problems with this are manifold, but nonetheless difficult to articulate. Of course it is profoundly lonely; but I have long wondered if we can actually operate within a thoroughly solipsistic outlook, provided it goes deep enough to become an axiom as entrenched as the air we breathe and the water in which fishes swim. Somehow, though, we can never quite achieve this, and a solipsistic suspicion has a stubborn habit of lingering on, much like Mal’s niggling doubts as to the reality of the real world in Inception. It would seem that we fail to achieve full immersion in the world of solipsism precisely because we don’t want it – at which point, we are back to square one, wondering why we cannot really stomach solipsism. The biological approach would doubtless point to the ‘ultra-social’ nature of homo sapiens, perhaps indicating the evolutionary advantage conferred by this. But that doesn’t hit the mark at all, since the question fundamentally hinges on the mystery of consciousness, and thus of the metaphysical, none of which is answered by appeal to mere biology. I know that I am a self-conscious subject; my fear is that I am the only self-conscious subject, and my longing is not to discover you as a useful member of my family/tribe/community, but as another truly self-conscious subject, thus capable of providing some answers to the mystery of self-conscious existence.

My hunch is that solipsism is problematic because of that central paradox of human nature, that we are spirit and flesh, rational soul and earthly body. Two expressions of this come to mind. The first is Hamlet’s great soliloquy, in which he declares somewhat melodramatically: ‘What a piece of work of man!’ For man is, as Hamlet eloquently observes, at once both ‘noble in reason’ and ‘this quintessence of dust’. That is thoroughly Judaeo-Christian, of course, thoroughly biblical; for mankind, Genesis tells us, is at once created in God’s image and of a piece with the dust of the earth. So we are both created, as any animal, and yet uniquely paradigmatic of the Creator himself. That leads us to ponder eternity and the things of God – to ask the biggest questions – while in our created infirmity failing to produce the answers that will do them justice. This is the gist of another great expression of human nature, the book of Ecclesiastes. Qoholeth couldn’t have put it better:

I have seen the business that God has given to the children of man to be busy with. He has made everything beautiful in its time. Also, he has put eternity into man’s heart, yet so that he cannot find out what God has done from the beginning to the end. (Ecclesiastes 3:10–11)

Eternity, without eternity’s answer – that is the human condition. And that, surely, is one component of our God-given urge to worship. The trouble with solipsism is that it only stokes the pain of this paradox. We ask the big questions; but if our mind is all that is, then it is obvious from the limitedness of the human spirit that there are no answers. In a sense, solipsism is the cosmic enthronement of mankind. Only, we have found that we don’t make good kings, and certainly not happy kings.

The problem is that solipsism thrives on the same experientialist, epistemologically-heavy view of the world that provides the philosophical underpinnings for the current narrative surrounding mental health. That has become particularly apparent in the course of the Covid-19 pandemic. Most concerning has been the frequent descriptions of the ire of lockdowns in terms of the effect on mental health. The site of the good, in the understanding of those who couch these problems in such terms, is not in the nature of the physical, the communal, in reality itself. Lockdowns are not bad in themselves, because not seeing family is bad, because being alone for extended periods of time is bad. No, they are bad insofar as they produce undesirable effects within the human mind. This is the great solipsistic vision of human good: a positive mental state is the highest virtue, the greatest attainment towards which we direct our labours. This is the chief end of man, because this, truly, is all that man is – autonomous mind.

And as with the clinicalisation of soul-troubles, so with solipsism; the mire of depression and anxiety might be mitigated, but true human goods are also attenuated. If lockdown is bad only insofar as it effects my mind, then its inverses – family and community life, journey and adventure, enjoying the countryside, gathering as God’s people – are likewise denuded of their innate good. Their ‘good’, if we can call it that, exists merely as a function of my determining its status as such, as based on my own experience. And so the loneliness that solipsism ushers into every plane of existence and experience comes to encapsulate my worldview.

II

Given these faults in the current narrative about mental health, what ought the conscientious Christian response be? The answer, as with any of my gripes with contemporary thought (and there are more to come) is surely a return to a truly biblical worldview. Many of the problems I have outlined above are symptomatic of the man-centredness of modern western thinking. It is, as Carl Trueman has so often pointed out, the triumph of the therapeutic, a putative victory that can only be vanquished by the truer and surer triumph of God himself. We must return to God, as individuals, as the Church, but as a society also. A truly biblical approach to mental health issues will not remove the problem, as anyone who has actually read the Bible will know. But it will help immeasurably.

Many Christians, however, are confused as to what it means to inhabit the biblical worldview. We have confused biblicism with being biblically-minded. I want to write more fully on this at a later point; it is an observation that underlies much of my engagement with contemporary issues. But two points are worth sketching out in brief.

(1) Language matters. Some of my readers might think I am reading to much into common turns of phrase and the like. But subtle linguistic moves are profoundly indicative of the underlying assumptions shaping our worldviews. As I say, for us to use terms like ‘mental health’ in the way we do is for us to buy into a kind of dualism that is foreign to the Scriptures (and isn’t true). That’s just how language works; new words reflect new ideas, and these ideas become entrenched in a cultural outlook once they become entrenched in common parlance. For this reason, so-called ‘progressives’ realised long ago that to control the language is to control the terms of the debate – hence the devious shifts of meaning for terms relating to sexuality, gender, race, etc. But many Christians haven’t cottoned onto this. I’m not entirely sure why, but I suspect the overly-biblicist approach has something to do with it. The Bible is all we need, right? So all we have to do is translate the Bible into our own language and – hey presto, you’re good to go. That our own language itself might by laden with dogmas that are unscriptural and possibly un-Christian is a foreign idea in this way of thinking. So the emphasis on reading and understanding the Bible falls upon accessibility. We take the Bible and we transmute it into where we’re at linguistically (and thus philosophically). That the Bible itself might reform our worldview to the extent of reforming our language is not considered; but that is the very reasoning behind the King James Version’s literalist approach, or behind the teaching of doctrine and dogma in catechesis of old.

Our failure to learn this has led to much confusion among Christians. We have imported language referring to sexuality, gender, the mind and mental health, society and politics – the list goes on – from a world that is profoundly far from God and from the authentic biblical worldview. In so doing we are – however unintentionally – importing the thinking that lay behind the creation of that language, and the dogmas reflected in the continued use of it today. Mental health is one particular site of this confusion.

(2) Philosophy matters. This is essentially the same point. Back in the day, theologians used to have to go through rigorous philosophical training as a preliminary to theological study. Philosophy was known as ancilla theologiae, the maidservant of theology. The thinking was that in order to study Scripture well you needed to know how to think well. And there was the understanding that no-one is metaphysically neutral; we all have implicit philosophical dogmas with which we approach Scripture, so it is best to bring those to light through careful study, before reforming them as far as possible in the light of Scripture’s teaching. It was for this reason that my ancestor, the Presbyterian minister Philip Henry, was grilled on Aristotelian metaphysics before his ordination. Today, Protestants have lost this understanding, though it lives on in the Roman Church (absent, in my admittedly partisan view, the same urge to reform in light of Scripture). But that is to our detriment, since, as I say, we are no less philosophically neutral. Craig Carter makes the point well:

All too often evangelicals try to pretend that they are uninterested in and unaffected by metaphysics, which simply means, more often than not, that they are unconscious disciples of some anti-Christian sophist. (Interpreting Scripture with the Great Tradition, p. 85.)

It is not enough to cite Colossians 2:8 as an excuse to avoid serious philosophical thinking, nor to cry sola scriptura to the same ends. This biblicist approach results not in handing down the deposit of true doctrine but in importing into our reading of Scripture the wayward philosophies of the world around us. Hence much Christian confusion today, and hence many Christians sharing with the world around us the same mental and existential anguish reflected in discussion of ‘mental health’.

But the Bible has a better framework of understanding. Not one that prohibits giving voice to the troubles of our souls – far from it. But one that does expunge many of the philosophical ideas that exacerbate the issue. Scripture rejects dualism, solipsism, and the clinicalisation of the human spirit. Instead, it presents an integrated, holistic vision of the world, one in which the natural and the supernatural touch one another, the transcendent is incarnate in the everyday, body and soul have purpose in God’s plans, and the good lies as a gift from God inherent in creation itself. Not only is that a worldview that I want to believe; it’s also true, and we should tell the world as much.

The Fourth Discourseman

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[1] I am trying to avoid using any language that suggests a mind-body dualism; it is, however, unfortunately prevalent in our general cultural outlook, and this is reflected in linguistic norms. Bear with me.

[2] I have failed already. Forgive me.

[3] For this idea I am drawing on Charles Taylor’s analysis of theories of melancholy in Sources of the Self.