Hello discoverers!

The rise of mental health awareness is a good thing. Fewer people suffering in silence, more shared language for experiences that used to be nameless. So I want to be careful here, because questioning mental health labels can be received as being dismissive towards people who are genuinely struggling.

Clinician and author Gavin Francis threads this needle well. Writing in The Guardian, he argues that we’ve grown too comfortable squeezing the messy, fluid reality of human suffering into rigid psychiatric categories – and that the labels we’re exporting around the world weren’t “gleaned from lab science but were decided in committee rooms by a group of western medics”.

I enjoyed reading about Francis’ first mentor as a physician, Dr M, whose approach was a kind of antidote to the tick-box GP model: “His consultations were impressive, filled with kindness, gentleness and a kind of tranquillity. He was unafraid to let silence fill the space of the consulting room.”

Dr M would ask his trainees not just to summarise a patient’s complaint, but how they felt after each consultation – a practice rooted in the idea that “your patient can’t help but transfer their emotions into you, and that you can discern a lot about someone by examining how they make you feel”. I love that.

Francis calls this ideal clinical state ”almost meditative, remaining engaged and emotionally aware without getting entangled by a paralysing excess of compassion”. Gosh, I want a GP like that. I think we all do.

His broader argument gets really interesting when it crosses cultural lines. Psychiatrists working across different contexts point out that many non-western societies treat low mood, anxiety and delusional states as spiritual, relational or religious problems rather than psychiatric ones.

“...by making sense of states of mind through terms that are embedded in community and tradition, they may even have more success at incorporating our crises of mind into the stories of our lives.”

He quotes a former WHO director of mental health who remarked he’d rather receive a schizophrenia diagnosis in Ethiopia or Sri Lanka than in the west, because there’s “a greater chance in those countries of making a life that continues to have meaning, of being able to make sense of your experience, of remaining connected to community”. Oof!

This says so much about what we mean by ‘normal functioning’. In most western contexts, it tends to mean: able to work, able to produce, able to participate in the economy without too much friction. The question of whether someone is mentally well is now almost inseparable from the question of whether they’re pulling their weight.

Francis doesn’t end with clean answers, and I appreciate that.

“If we were able to hold the mental health labels more lightly, aware of the human tendencies they oversimplify, would we be able to create a society more accepting of difference? Might it be less stigmatising, and also more hopeful, and more open to recovery?”

I take all of this with a grain of salt. I’ve seen what a clear diagnosis can do: it can give people a new frame for their experience – a way to say ‘this isn’t a personal failing, it’s a thing, and here’s how to work with it’. That can be life changing.

But I’m also inclined to listen to the observations of thoughtful GPs who spend their days in conversations with patients, watching what labels do to people. If you want to dive deeper, check out Francis’ new book further below.

And now to this week’s discoveries. – Kai