‘Spreading the word about mental health, accurately, compassionately… that's a priority of mine’

Neuroscientist and best-selling author Dr Dean Burnett has a new audiobook out today, World Mental Health Day.

Psycho-Logical is a new Audible Original asking the question that's often overlooked when it comes to mental health: 'why?'. We took some of those 'Why?' questions from the press release, added a few of our own, and fired them over to him.

Why an audiobook?

There are several reasons for this. 

There is still a great deal of mental health stigma in modern society, as those who deal with their own issues with it will no doubt be very aware of. While this is gradually improving, it's still often a taboo subject. That's part of the reason that there are so many books and articles about it. However, a lot of people read in public – on commutes, in coffee shops… Reading a book with a cover that prominently announces it's all about mental health, in public, is sometimes a brave move, as it could invite judgement and suspicion. You don't get that with audiobooks.

Similarly, it's a book intended, at least in part, to explain and demystify mental health issues in a way that's hopefully very useful to those dealing with such things. But dealing with such things is often a huge drain on energy and motivation, to the point where reading a book about the technicalities of it is perhaps a bit more than can be managed. Having someone read it to you, that requires less effort, so an audiobook has the scope to be useful to perhaps a greater range of people who would most benefit from it.

On the practical side, traditional print publishers are seemingly more interested in mental health books which are personal journeys and retrospectives, not the science or technicalities, probably for the reasons given above. Basically, it's an audibook because Audible were the first and so far only publishers interested in making the book.

Why are conditions like depression and anxiety so common?

There are so many technical answers to this, which explore in great depth in the book, but leaving aside the genetic and developmental aspects that contribute to it, the short answer is, because there's so much in the modern world to be depressed and anxious about. This may sound glib, but it's not meant to be. And I'm not saying the world is an inherently awful place, but the human brain seems predisposed to look for threats and concerns, even making them up when none are immediately available (we all worry about things that could happen, even if there's no clear indication that they will). Too much stress, too much focus on the negatives and so on, that can max out a brain's ability to cope, and we get depression and anxiety.

Because we're so 'aware' of what's happening in the world around us, thanks to our highly-evolved brains and technological interconnected society, there are a great deal of things that can, and do, overwhelm our systems. The parts of the brain that deal with and handle the stress response are very old, fundamental ones. This means they respond to more abstract, modern day threats and stresses ("Am I going to get that promotion?", "The economy is looking dodgy", "I must have the latest model smartphone or my friends won't respect me" etc.) in the same way as they would to immediate physical threats, like we encountered in our evolutionary past (predators, violent rivals, environmental dangers etc.) 

So while we consciously know that the stresses of modern life are more abstract and don't pose any tangible threat to us, we still worry about them, and the deeper parts of our brain recognise this (wrongly) as a sign to trigger the stress response. Over time, the constant, repeated triggering of the stress system leads to mental health problems.  

Why do so many mental health problems have pronounced physical symptoms?

It's traditional to talk about mental and physical health as if they're two distinct, separate things, and in some ways they are, but there is a great deal more overlap between them than many appreciate. Mental health is a product of the brain after all, and the brain, for all it's brilliance, is still an organ, still part of the body… so brain and body impact on each other in many prominent ways. A severe/terminal physical diagnosis can have a serious impact on ones mental health, because what could be more stressful? 

On the other side, conditions like depression and anxiety have physical components, like elevated levels of cortisol, the 'stress chemical' in the blood. Cortisol has many physical effects, like weight gain, increased blood pressure and muscle tension, reduced immune system activity, and so on. The downstream effects of all this are many and varied. And that's just the direct consequences. People drinking more to keep anxious thoughts at bay, people not going out and exercising due to serious depression, these are all things that impact on physical health too.

Basically, a human being is not a static object. They don't remain completely still once a diagnosis is given, until it's dealt with or managed. No, they need to keep living, and this means the diagnosis will affect both their physical and mental health, often in unpredictable ways. 

Why, if mental health problems are so commonplace, does anyone need to be made 'aware' of them in the first place?

Why indeed. This is a big part of why I wrote the book. The traditional stat is that 1 in 4 people will experience a mental health problem at some point in their lives. 25% of the population. Far fewer people are fans of football, yet football is a billion pound industry with rolling media coverage and multiple channels dedicated to it. 

So why does ignorance of mental health endure? Part of it's because mental health issues are a lot harder to pin down and recognise, particularly when compared to physical ailments. Someone's arm falls off or turns blue, you can look at it and say 'That's not meant to happen' with certainty. But you can't observe someone's mind and what's going on it it. And human minds, their thinking and personality and behaviour, varies from person to person a great deal more than their physiology does. Even the leading mental health experts struggle here, with the criteria for diagnoses and classifications of disorders being constantly updated and revaluated.

So, despite them being as old as our species, mental health problems have gone unnoticed and unrecognised, by and large.

It's also worth mentioning that, while they may do a great deal of good, a lot of campaigns for mental health awareness convey a relatively simple message, like 'Depression is real, pass it on'. To really convince people that something is worth considering, it helps to ground it, to give it tangible aspect, like explaining how and why depression is a real problem. That's what I've tried to do in my book. 

Why is there still so much confusion and stigma about mental health matters? 

It ties in with the last answer. Mental health has far fewer baselines and norms that we can point to and say 'that's what should be happening', because the mind has no physical presence and it varies enormously from person to person. And this has frustrated the medical, psychiatric and psychological communities for some time, and still does. Efforts to introduce a more physical, tangible aspect of mental health inevitably comes down to the workings of the brain, and given how that's the most complex thing in existence at present, confusion (regarding what's happening and what to do about it) persists. 

The stubborn and widespread stigma also has many causes. The uncertainty and 'invisible' nature of mental health problems undoubtedly leads to a lot of suspicion and paranoia, but perhaps the ironic aspect is that a lot of stigma, like mental health problems themselves, come from our brains being unhelpful. There are numerous defensive traits and impulses inherent in the brain, one of which is the attribution bias. Put simply, when we observe something bad happening to someone like us, we reflexively try to attribute the responsibility to the individual, to convince ourselves it's their fault, not just bad luck, or circumstance. It's a defence mechanism; accepting that it's just poor fortune means acknowledging that such a thing could happen to us too, and that's really scary. Concluding that it's the person's fault removes this possibility, because we're not them. 

You can easily see how this would happen with mental health problems, given how they afflict so many people around us who are like us, in the same situation as us. So much more reassuring for our piece of mind to conclude that they're 'lazy' or 'attention seeking' or 'should snap out of it' and so on. This would also explain why awareness can be such an uphill struggle despite the prevalence of mental health problems; acknowledging that they're real and common robs people of the unconscious security blanket of denying they're a real thing. 

And let's not forget that mental health problems and those who deal with them are a convenient scapegoat for unscrupulous types with agendas and ideologies. How many mass shooters are said to have 'mental health issues' as soon as they're apprehended? 

Why do you care?

First and foremost, I'm a human being who cares about other human beings and doesn't want innocent people to suffer needlessly. That such a thing even needs to be stated suggests we've still a long way to go as a society. 

But on a personal level, it's true that I do not and have never had (as far as I'm aware) mental health problems of my own. This has been reason enough for some people to disregard anything I say about the subject. However, I grew up in a pub in a South Wales mining valley in the '80s. The coal mine that was the reason for my village's existence was shut down by the Thatcher government not long after I was born, so my community was economically deprived, isolated and largely purposeless. You live in a pub, a drinking establishment, frequented by a bunch of ex-miners in such a context, you see a lot of mental health problems manifest, even if you don't know what they are. But yeah, a lot of people close to me and my family suffered greatly with mental health, and if there was just more info and understanding out there, this could have been avoided. 

And I'm from Bridgend. Many I knew and cared about were rocked by the Bridgend Suicide spate of the late 2000s, which were compounded by shamelessly sensationalist and uncaring media coverage. So yeah, spreading the word about mental health, accurately and compassionately – that's a priority of mine.   

Why is there so much disagreement in mental health discussions?

I've said that mental health disorders can be subjective and largely intangible, but another consequence of this, is that it leaves a copious amount of space for variation in interpretation, theorising, ideology, approaches and everything else. We all know that people tend to prioritise their own beliefs or experiences over the raw data and evidence no matter what the subject, but when it comes to mental health, someone's experience and personal take often is the most valid information, so subjectivity is a lot more potent.

On top of this this the fact that humans are tribal and argumentative anyway. Hence you get patients disagreeing with practitioners, psychologists disagreeing with psychiatrists, nurses disagreeing with doctors, psychologists disagreeing with other psychologists. When you have so much uncertainty with an issue, it ironically provides a lot more scope for people to be very certain about it in many different ways.

And as ever, there are the unpleasant types who refuse to accept it's a thing and will attack anyone who suggests otherwise. The internet is rife with such people, as everyone is no doubt aware.   

Why do you make jokes about mental health?

I feel it's important to clarify that I make jokes while talking about mental health problems in the abstract, conceptual sense. Explaining complex properties via amusing analogies, stuff like that. That's very different to mocking or belittling someone's problems for the sake of a cheap laugh, which a disconcerting number of people are willing to do.

However, there are those who feel that any form of humour used in the context of mental health is inherently harmful and disrespectful. I have to disagree here. As someone who's been a neuroscientist (specialising in memory formation) for nearly two decades, and who's been doing stand up comedy for almost as long, I can confirm that if you attach a positive emotional experience to important information (like, say, about the workings of mental health) then people are far more likely to engage with and retain it. That's just how we work. It's sort of a 'neuroscience lifehack', if you want to think of it in those terms.

On a more general scale, the fact that mental health issues are so common means they shouldn't be exempt from being the subjects of humour. It's entirely possible to make jokes about mental health without condemning or mocking someone who struggles with it. And I've always found that laughing at something means it's a lot harder to be scared or wary of that something. It 'defangs' it, essentially. I guess the shorter answer would be 'Why wouldn't you make jokes about mental health?' Certainly the vast majority of people with mental health ailments I've spoken with enjoy it being talked and joked about so casually, like it's a normal everyday thing. Because it is exactly that. 

Why aren't psychologists winning the fight against mental illness?

Aren't they? I'd argue that this is an unfair question. Firstly, mental health problems are probably as old as the human race, but only in recent decades have we been able to appreciate them in a scientific/clinical sense. And while we've made great advances in technology that allows to study and investigate the working human brain, we're still a long way off being able to objectively look at and identify and deal with mental health problems, to an extent where everyone can agree what's what. 

This isn't helped by the fact that there are many schools of thought in psychology regarding mental health, many of which aren't compatible. Indeed, some psychologists argue that 'mental disorders' aren't a thing. They're not denying that people struggle with it, but many argue that the mental health issues are meant to happen, they have an evolved purpose, so the whole notion of mental 'illness' is conceptually wrong.

Basically, it's not that psychologists and similar are in the ring with mental health and constantly being beaten. It's more like they're still in the car on the way to the arena, and everyone's arguing about the directions.    

-       Psycho-Logical is available now from Audible, priced at £14.99. It is narrated by Matt Addis; with contributors: Bethany Black, Dan Mitchell, Guy Kelly, Girl on the Net, Amelia Stubberfield, Rachel England, Lowri Williams & Martha Mills.

Also find more from Dean Burnett in our archive.