What should we be doing for young people’s mental health?
The following is a speech delivered by Mark Brown at the Beyond the Therapy Room one day event on young people and mental health at the Temple of Peace, Cardiff on 19th January 2018.
I’ve been given the job today of talking to you about young people and mental health. Over the last few years I’ve spent a surprising amount of time hanging out with young people and talking about mental health and digital. But today I want to talk to you a bit about how we understand young people and mental health and how we might think about what it is we are actually trying to do around young people’s mental health.
Until relatively recently I used to get booked for gigs not to talk discursively about young people and mental health but to somehow represent young people and mental health. This was getting a bit embarrassing.
I am no longer young. I turned forty this year. In theory this should mean that it is all sitcom from here. I should be driving my hatchback to the garden centre; worrying about whether it’s bin day or not and beginning to wear jeans that are a little bit too tight and wearing silly hats because I’m worried my hair is thinning. Or something.
Being forty is weird because I’m not quite generation X and not quite a Millennial. I grew up in the last dregs of the pre-internet age. I have to explain to people that when I went to school — in the last century — who you knew and what you knew was limited by actual physical presence. You couldn’t find out about a book until you somehow knew a book existed. You couldn’t hear a song unless you could find somewhere it was playing. You couldn’t know about groups of people that you might get along with unless you could actually find them. It can be tempting to see the progression of history as an orderly series of cause and effect changes where everyone behaves as if they know what is coming next. The actual experience of travelling through history is chaos. No one knows what’s coming next. The way things are now seems as if that’s the way they’ll be forever. As a not quite generation X-er I didn’t quite benefit from the remains of the seventies in affordable houses and well funded public services, but I also as a not quite millennial haven’t quite benefited from some of the things I’m going to talk about today. The reality for young people today of precarious employment; lack of paths into stability and an exposure to the prevailing winds of economic, political and social change is much closer to my experience than the experience of people a few years older than me who found a career path, got on the property ladder, got all of the things that we traditionally recognise as the symbols of being grown up and being a fully functioning adult.
As someone who experiences mental health difficulties and someone who isn’t straight and does not conform to the gender expectations of the culture I was raised in, what I am aware of is that it is continually people younger than me that inspire me, rather than people who are older, both in mental health and in wider culture.
What I have noticed, moving through the wider world of mental health politics is that often the pioneers of one generation, those who bring liberation and broaden the palette of colours in discursive and practical worlds, often become the gatekeepers for the generations that come after them. When I look at what is respectfully referred to as mental health service user politics I keep looking around the room and thinking ‘blimey. We’re still playing the greatest hits of the Miner’s Strike here.’ The radicals of one generation often fail to lay the path for those that come after them to take forward and develop their ideas. Ideas and concepts that made sense of one world become stuck and fixed and are assumed to be universal. The answer has been found by the pioneers and everything else is just paying homage.
I know some of you work with young people. I know some of you live with young people. I know some of you might even be young people. What I’m going to do today is try and have some ideas about what mental health means for young people now and to make some guesses about where they’re at with it.
What things mean depends on where you are
We make a mistake when we assume that what mental health and mental illness means remains a fixed quality over time. When we talk about young people we talk about them as if they are an exotic, fascinating alien species with rituals, qualities and attributes of which we have no understanding. We talk about them as ‘other’.
When it comes to something that they know about and we don’t we assume that this is beyond our ken and also something that we will never understand in a million years. And is thus something we must treat either with complete silence or alternatively kill with fire until it goes away.
But, when it suits us, we talk about the things in young people’s lives as if they have a universal, monolithic, unchanging quality that has never been different and will never be different.
When it comes to something that we think we know best about we assume that young people are exactly like us but noobs that haven’t got the hang of things yet. What we want to impart, and our sense of mission in doing so, overrides our sense that they are different to us and have had different experiences and have grown up in a different world to the world in which we grew up.
Both of these approaches ignore the specific context and reality of being a young person now, in the present. In our debates young people remain in a constant state of being exactly like us or so completely unlike us that we just can’t even deal with it.
So what’s different?
One of the things about the arrival of the web and internet as a ubiquitous fabric of interaction and information is that ideas now spread far more quickly. For both good and ill, our sense of what constitutes reality is far more porous. Ideas seep into our lives, stretching the boundaries of what we know and what we think we know almost against our will. Ideas that we had no awareness of previously quickly find a place in our worlds as if they had always been there. The accessibility of the internet has brought visibility of things previous generations would have only have know about or considered if they had personal access to the thing in question or if the issue was deemed noteworthy enough to raise in popular media.
Extending what it means to be human
In much of the western world, accelerated by the effect of the internet on people’s ability to seek out specific information, the last decade or two has seen a great broadening of the definition of what it means to be human.
Where once visibility of diversity and marginalised people’s experience was a targeted activity carried out by campaigners and charities and NGOs and crusading journalists; now visibility is about being. Being authentic. Getting your experience and your world out there. Vloggers, bloggers, instagrammers, tumblr folks, tweeters, and going back a bit livejournalers and myspacers and web forum denizens have all brought the stuff of themselves into public view in a collective act of self definition. If you define yourself you can find others who define similarly.
Previously, what had been defined was the centre of the bell curve. Now it’s the narrow ends of that curve who can find each other and and be found by others. Young people are now far more aware that being human is not about the average. In some ways the growth of pejorative online term ‘Social Justice Warrior’ reflects the reality of this. Young people are growing up in a world where they are aware that their experience may not be the same as someone else’s: a world where gay people exist, where trans and non-binary people exist, where people of other ethnicities and other countries exist, where people with a variety of disabilities exist, where bi people exist, where people on the autism spectrum exist, where people who are dyslexic or dyspraxic exist, where people of different cultures exist, where people with ADHD exist, where people with tourettes exist, where people with learning disabilities exist, where people with mental health difficulties exist. For all of their desire to belong; young people also know other people may be different from them.
When we’re talking about our young people, young people with mental health difficulties, few of them grow up feeling completely like they are the only one who experiences the things that they experience. People laugh at the lists of hashtags on young people’s social media profiles defining which ‘tribe’ they belong to, but this is as much a cry for fellowship as it is a strident cry of individualism. For young people who are not different, who do find what they need in their lives, online life is an extension of offline life. As young people told danah boyd in the interviews she carried out for her book ‘It’s Complicated’, most social media use is just extending what normally happens into a portable form: gossip, speaking with friends, updating and arranging and generally just goofing about. When I’ve had the chance to hang out with young people and talk about mental health and tech and social media, they’ve told me much the same story. They keep in touch with friends, maybe follow some special interests. Few have been using their online life to be something very different from the self they present in real life. Maybe online they were a bit less shy, or a bit more curious. They, however, all knew of other people who used the internet for more divergent past times and all were aware of the kinds of diversity I’ve been talking about. Kids might not be, for example, furries, but they know what furries are.
The web as zone of proximal development
Some of you will be familiar with the idea of the zone of proximal development in regards to learning. There is what a learner can already do on their own at the centre of a circle, like the molten core of the earth. Outside the edge of the circle, way out in the deep darkness of space and of possibility, is what the learner cannot yet do. Between these is the zone of proximal development: what the learner could do with help from, or in collaboration with, others. I think with ideas and concepts and meaning, the web has become a massive accelerator of collaboration. It’s the zone of proximal development for thoughts. When you think or feel something; the web helps you to finish that thought off. Young people now are in a real time, interactive, ever changing process of development. Once you commit to a path of thinking, the web can accelerate that thinking by providing you more and further steps to and jumps in those thoughts. As active, purposeful creatures looking to become themselves, the web is designed to supercharge that process. Where once our zone of proximal development was defined by school, by our neighbours, our family, our friends, now it’s the world. As with all of the features of the web as we know it this is filled both with angels and with demons. Young people might know what they are, but it’s the gap between knowing and being able to put it into operation that is the space of terror and sorrow and difficulty.
Young people’s online lives are often derided as self absorbed, selfie obsessed brag fests, or misery fests in the context of mental health, but where we as people who are no longer young have a role is in our understanding and the kindness and with which we can pass on what we know about how to get from what you feel you are inside to being what you could be in the world.
Epistemic homelessness and the need for a safe home
My own thinking about what we should be doing to help young people with mental health difficulties has been hugely shaped by the work of others who work with and have experienced marginalisation, prejudice and violence. It clicked for me about this time last year. The twitter account of Black Lives Matter, the social justice movement formed in the face of fatal shootings of African Americans by police, posted a series of tweets that began “In this moment PTSD (post traumatic stress disorder) is at an all time high. Please take care of yourself and each other. Here are some tips.” The tweets that followed the gave advice on how to spot PTSD in yourself — “memory of feeling unsafe is difficult to ignore, repetitive, and/or makes it hard to focus”; “You feel physically stuck or frozen. It may feel hard to move freely or think clearly”; “Trembling, shaking, and sweating uncontrollably.”; “Physical and or emotional numbness, or less feeling, in an unsafe situation.”; “Feeling intense emotion (such as anger, sadness, fear) that doesn’t change or feels like it has a life of its own.” — followed by tips to minimise the distress these feelings and sensations might cause.
The popular imagination attaches the idea of Post Traumatic Stress Disorder to soldiers and fighters and those that have witnessed disasters: but what if your entire life has been a war to be who you are? The experience of racism, misogyny, religious hatred, homophobia and transphobia and the violence that can go with it are a trauma, living knowing that regardless of what you do there will be people ready to harm, threaten or even kill you based on who you are not what you do. A fight for freedom is always a fight for safety from harm, for a safe space. As Black Lives Matter state: “We deserve not only to live, but to thrive.” Thriving takes safety, stability, a sense that the world when you go to bed will be as calm when you wake up in the morning. Trauma is about feeling unsafe and comes from previous experiences of being unsafe. Marginalised and discriminated against communities live on their wits all the time, constantly reminded that there are those from the majority who wish to do them harm. Trauma requires time to heal. Repeated and consistent exposure to inescapable stress creates trauma. Black Lives Matter are trying to create healing justice, justice that creates space where people can overcome trauma but also find new ways to relate to each other that don’t recreate it. They don’t think it’s an easy job.
I’m a huge fan of Guilaine Kinouani’s work on epistemic homelessness. A therapist who has worked with women and non-binary people of colour for years, she writes and speaks of the importance of importance of being able to find a home in the world. Epistemic homelessness is a literally the lonely, isolating destabilising experience of being unable to find a home for who you are. Injustice, racism or other forms of marginalisation create ontological insecurity. As Kinouani describes it: “ a person’s lack of security in relation their “being” in the world. It has been defined as a state of dread which stems from being unable to give meaning to events in our lives, or when we struggle with being sure about the reality or existence of things, others and ourselves.” Being without a home for yourself places you in the position of always being in someone else’s home, always being unprotected, always being the problem, the one that has the chip on your shoulder and which upsets everyone else’s happy applecart. From this a person learns to distrust themselves, distrust others. To be without a sense of having a safe space, a home, is to be in a position of unequal power.
For me, the experience of mental health difficulty is entwined with such epistemic homelessness. Young people with mental health difficulties are growing up with a far wider view of what the world can be and a far wider view of its dangers. Many of our young people are looking for a home, a place where they can become who they might become. Much of what I see in young people’s public attitudes to mental health chimes with this idea; even if the severity of their exclusion is more felt than it is actually experienced. Certainly it is true for our young people of colour and who belong to actively marginalised groups.
In a world of #metoo, young women have never been more aware of the threats arrayed against them. Despite the tragic and unsettling fact that men are more likely to die by suicide — the highest prevalence is for men aged 40 to 44 (23.7 deaths per 100,000 in 2016) and it is the biggest killer of young men — it is women who are more likely to live with common mental health problems. According to NHS data obtained by The Guardian in September 2017 hospital admissions for self harm in girls under 17 rose by 68% in the last decade. The rise for boys was lower at 26%. Self poisoning admissions of girls under 17 rose by 50% over the same period.
The way that this rise in mental health difficulties for young women, which is not a secret, has been covered by the media in the main has focused on young women and girls use of social media, especially upon ‘selfie culture’ and expectations about body image. Every time I appear on a panel discussing technology and mental health a usually well meaning middle aged man will suggest social media is especially damaging for young women and they’d be better off out of it all together.. From this I conclude two things. The first is that as a society we are keen to minimise any evidence that young women are struggling in ways that aren’t somehow related to concerns traditionally coded as frivolous; and the second is that middle aged men are way way way too interested in what teenage girls get up to online.
Both young women and young men are stepping out into a world where the future is uncertain, as the future always is. But unlike previous generations they are acutely aware of this fact. They are worried about what they will be, they are looking for security of meaning.
This web as zone of proximal development has its dark side as well as its life affirming side. Just as the web can help you feel you aren’t the only trans person in the world, or the only person who hears voices, it can can also help you complete other, much more damaging thoughts. Like when you type in something to a search engine; sometimes the autocomplete in the search for meaning delivers something awful.
The quest for respect and how it goes wrong
On June 17, 2015, the day after Donald Trump announced he was running for president, 21 year old Dylan Roof walked into the Emanuel African Methodist Episcopal Church in Charleston, South Carolina, the oldest African methodist Church in the south, sat down with the congregation to pray and to discuss scripture and then shot dead nine of the congregation because they were black. Roof was not raised in a racist household. He had black friends. One day after the death of Trayvon Martin at the hands of police he googled “Black on white crime.” And google showed him pages and pages and pages of racist websites and slanted, bigoted opinion. From then, Dylan had found his purpose and his meaning.
That’s how radicalisation works. A couple of years ago I wrote an article about the way that Men’s Rights Activists pray upon men who feel unsuccessful and weak and ill at ease in the world, the kinds of feelings that plague all of us from time to time. This led to an exciting few days of being trolled by irate men telling me I was a cuck and that feminism was cancer. But I had a thoughtful exchange with a young man who in between the insults answered a few of my points. Men’s Rights Activism — in capitals, not the same as work that looks to look after the mental health and wellbeing of men and boys that doesn’t also believe that feminism and women are to blame — had really helped him with his depression. The guys on the forums had accepted him and made him feel like he wasn’t powerless. There was a lot of comradeship, he said. I asked whether that had to involve hating women and that set him off again. He just wanted somewhere to be; even if that somewhere was based on hating women. He wanted some easy route to respect, and to self respect. He was wrong in his hatred, fundamentally. But he wasn’t wrong in his need to belong somewhere.
In mental health, we often wheel out super inspirational figures, so that they can be heroes for those experiencing distress. Being young and having stuff going badly in your head is not always a situation where it’s easy to find respect. Young people when they are thinking about what could be done around mental health often become advocates or campaigners or become involved in attempts to improve services. They want others not to go through what they have been through. They want to be useful. Or they start zines. Or websites. Or blogs. They want to prove that they are not impeded, not held back by their difficulties. They are on a self redemptive quest, trying to find a way of saving the world so that they can save themselves. What they choose to do in response to their own struggles and experiences is shaped by what they know is possible in the world; what they feel like someone like them can make happen.
In his 2003 book ‘Respect: The formation of character in an age of inequality’ sociologist Richard Sennett tells of how so-called inspirational figures can challenge people’s self-respect rather than encourage people.
Sennett grew up in the projects of Chicago where his mother was a social worker. He excelled at cello and gained a scholarship which led him to New York, shifting to sociology after a condition reduced his ability to play.
Years later, when invited back to his old neighbourhood to give a speech of hope to a mainly black group of excluded young people, Sennett spoke alongside an electrician, a secretary and a young doctor who had worked his way up from nothing. The doctor had had the roughest life. His parents had been involved with drugs. He’d been a bit naughty then found his way to education and then to qualifications and stability
The secretary told of learning shorthand and getting a job with a union official, the electrician of how he broke into his trade despite the racist attitudes of his colleagues. Sennett said his mother had been a social worker, he’d had cello lessons and was lucky enough to be really good at it and got to go to college. They all got polite applause. The young doctor told of his journey, of his strong faith, of his gumption and his strong will saying: “If I can do it, so can you if you believe in yourself.”
Despite his story appearing the most inspirational to outside eyes, the audience heckled the doctor — they didn’t appreciate his message. In fact they hated it. Why had this inspirational message got their backs up when the far more mundane stories of the others
Sennett wondered for years why this was and realised that the young doctor’s story had challenged the self-respect of those listening. “Whereas the secretary showed the young people what to do, the young doctor told them who they should become,” reasoned Sennett. In his keenness to inspire, the young Doctor had told the young people, who maybe didn’t believe that they were good at things, that all that was holding them back was their attitude. They could overcome if they just tried hard enough.
Young people with mental health difficulties don’t necessarily see them as challenges to be overcome. They are as likely to see them as parts of their identity and as things that are not necessarily shameful when around others of similar mind or experience. They’re more likely to situate their sense of injustice in people not getting the help they need; or in feeling let down by services than they are to have the older generation’s political understanding of mental health services as mechanisms of social control. They feel acutely stigma directed towards them, but do not necessarily carry the same sense of shame at being a ‘malfunctioning human’ that previous generations did. They want as much to just get on with life as they do to be cured. This changes what our wider social responsibility is to young people with mental health difficulties. They, whether they can express it, want help to be who they are. They know who they are, or who they think they are, they just don’t know how to be that person or what someone like them might actually do. If they begin to know the destination, we can help load the ship and plot the course.
Just
A few years ago a young person asked me to contribute a short piece to a zine they were making about mental health. Already feeling my ever encroaching middle age, I decided to address an open letter to anyone growing up mental, which I called ‘Just’. I’ll read you it now.
“I’m lucky. The time I spent very ill wasn’t amazingly long. The rooms full of rubbish and rotting food and unwashed clothes and ribs like a clenched fist under my pale skin did not last for years. The terror and the loss and ache in my chest and the days and days spent in bed, trapped in the smell of myself, were not infinite. The scars are not too numerous and, in the end, never getting a degree hasn’t mattered too much. I found people and I found help. And then I found different people and different help. I’m still finding people and still finding help.
I was 23 when I first received the diagnosis of bipolar II. Like me, you’ll spend most of your life looking for a name to explain what you’re feeling; what you’re experiencing and even longer trying to escape from it once it’s been named. You’ll look at other people as if you were on a ship pulling out into dark rumbling sea surrounded by mist. You’ll fall in love with the romantic image of yourself; lonely and slowly waving at everyone else happy on the shore. As a teen you’ll find it hard to know if you’re unwell or weird or angry or fed up. Other people will find it hard to tell, too.
And there’ll be shame and embarrassment. At things you didn’t do and things you did. At times you’ll feel so heavy with horror at your own actions you’ll want to fall into the heart of a star or burrow deep into the mouldy; wormy earth. There’ll be times when your thoughts aren’t your own; where what you see and feel isn’t what others see and feel. And you’ll be terrified.
There’ll always be people who are having far more upsetting experiences than you and people who are having problems that cause them less trouble than yours do. People will tell you that but it doesn’t matter: your life is your life.
You’ll be tricked into thinking other people have it sorted; that you are just like them but gone wrong, like a plant growing the wrong way or a cake come out the oven the wrong shape. In reality; it’ll probably take you longer than them to find out what the right path is for you because you’ll be forced down paths they’d never choose to travel. Some of you will find out you’re gay or bi or something else. Some of you will find out you’re straight. Along the way you’ll make friends and you’ll lose friends. Some of you will lose your religion and some of you will find it. There’ll be births and deaths and dramas. Some of you will end a different gender to where other people thought you started. There’ll be times where you desperately hide what’s going on in your head and other times where you’ll be desperate to let it out and it won’t come. There’ll be other times when you’ll think you have it all under control while to everyone around you it’ll be as obvious as clown make up or an extra limb.
You’ll spend years looking for ‘it’: that intangible sense that you are allowed to be who you are and that there is a space in the universe for you. Some of you will find it in the eyes of your first child or in a kiss behind your ear from your lover. You might find it in contemplation of God or in the dirtiest joke in the world. It’ll hit you one day slipping to the corner shop in your pyjamas for fags and a paper; on a monotonous grey motorway drive; answering a text from a friend; shrieking in ecstasy at a sex party in a European suburb. It might be in work, or it might be in everything but work. One day; maybe just for a minute you’ll feel ‘it’s OK to be me; it’s OK to be who I am’. The feeling will pass, other less existential concerns will crowd in, but you’ll remember it: the feeling of no longer beginning with an apology.
I’m 38 now (not anymore!). I still need a whole mess of help. I still fuck up. You’ll still fuck up, too. But you’ll get better. Stuff might never go away; but you’ll get better at living through it; living around it; finding people to help you get through.
Eventually you’ll find some way of living with being you in all of your terrible, horrible, gorgeous, glory and you’ll be able to whisper to your past self: ‘See, I told you you’d make it. Just.’”
Be good people who show the way
So, where does this leave us? What should we doing? Well, I think our mission is to help the young people we meet by showing that it’s possible to find ways of being in the world and of getting things to happen while also not being superhuman. We don’t need to teach, we need to share. We’re the people who can show that you can be as weird as fuck or as normal as fuck and not be a dick and harm others. We’re the people who can show that there is a path from the horrors of adolescence to finding a place in the world that works. We’re the people that can help doing that bridging between what someone feels they are and finally getting to be that thing in the world. We can help build those spaces and opportunities that are not safe from only risk, but are safe for experimentation and exploration. We can help create the stages upon which young people can find their role to play in life. We can help young people not by lecturing them or judging them or ‘when I was your aging’ them into boredom. Our young people, the young people with mental health difficulties need us to be there not as inspiration but as helpers, fellow travellers, by understanding their world and chipping in where we might help them to understand it better. We can help by being on the side of good things happening.
Ultimately we help young people with their mental health by being people who’ve made it to adulthood and by showing that its possible to be kind, to give others a leg up a to do so without becoming an utter, utter dick.
Mark Brown is @markoneinfour on twitter.
