The mental health crisis and Covid-19 collided, creating a truly “wicked problem”. Learn from Dr. Robert Voloshin about the structural changes we need to address our chronic mental health issues.
Wicked Problems of Mental Health and Covid-19
One way of understanding complex problems is through the lens of Wicked Problems. Wicked Problems are multidimensional and have numerous causes, symptoms, and potential solutions. They cannot be definitively delineated or demarcated. This is because many stakeholders frame the problems within different world-views.
Wicked Problems can be considered a symptom, as well as a cause, of other problems, and even of themselves. Wicked Problems are complex and consequential. Yet solutions are hard or impossible to test accurately. Wicked Problems have a tendency to fester or get more severe over time, with nothing automatically stopping their vicious cycles or intensifying feedback loops. With Covid-19 and mental health, we have two intersecting Wicked Problems.
Hyper Focus on Individual
Mental health refers to a human being’s subjective experience. A person’s experience that is most personal, including perceptions, thoughts, sensations and emotions. Our thoughts, emotions and perceptions are interwoven with our social and physical environments. They form an intersubjective lattice that makes up the consciousness of humanity. Due to the construction of the mental health treatment system, we too easily see mental illness as problems of the individual. Instead of seeing the systemic, political, cultural, and familial problems which they truly are.
We tend to hyper-focus on the individual. Thus we become blind to the larger context; the proverbial missing the forest for the trees. This hyper-individual focus is both a symptom and a cause of most mental health issues. It includes the shortcomings of the mental health system at large. It’s critical to have binocular vision. This vision includes both system and individual, both forest and tree when trying to make sustainable change.
The wicked nature of Covid-19 is evident in its multidimensionality. The disease exists on the level of virus, cell, immune system, individual and economy and culture at large. The Wicked Problems of Covid-19 and our mental health issues are mutually constituting. The way of life for much of western society was not mentally healthy to begin with prior to Covid-19. In this regard, we define mental health by numerous factors. This includes: rates of suicide, rates of antidepressant and antipsychotic prescriptions, wealth inequality, atmospheric carbon levels, etc.
Shifting Focus to Systems
People with pre-existing medical conditions are most vulnerable to the effects of Covid-19. Meanwhile, cultures and nation states with the least amount of resiliency and health are the most vulnerable to the pandemic’s macrosystemic effects. Through this lens, our culture’s way of of life contributes to society’s vulnerability to Covid-19. At the same time, our response to COVID-19 exacerbates our pre-existing mental health issues.
In this era, individuals’ mental health can not be separated from the suffering people are experiencing. This suffering is due to lack of purpose, social and economic hierarchies. It also stems from lack of connection, lack of economic security, and increasing proximity to mortality. All of these things cause anxiety in individuals and cultures as a whole. Isolating the individual from the socioeconomic and cultural components of mental health is both a symptom and a cause of the deeper mental health crisis itself.
For example, this occurs through the forced treatment of adolescents. Covid-19’s cultural shifts causes adolescents to be the most vulnerable people. The dominant model of mental health localizes the problem to the individual adolescent, and more specifically into their brain. Many teenagers experiencing depression and anxiety in this era continue to be treated independent of their family system. Although it is abundantly clear that the problems teens face are cultural, familial and systemic in nature. They do not live solely within the teenage brain.
Changes to Structures and Systems Needed
I am a psychiatrist working with individuals, families, and couples. I am involved in a system that perpetuates a mythology of individual mental health issues separate from cultural and systemic health. Seeing people in a one-on-one setting perpetuates the myth that individuals are the ones with the problems. One of treatments I specialize in is ketamine-assisted psychotherapy. Ketamine-assisted psychotherapy allows deep and fundamental changes to occur for individuals. But it’s unfortunately limited to the individual. Although helpful, it does not contribute much to the larger systemic shifts that we need for societal and individual health.
The real treatment we need addresses our chronic mental health issues at the structural level. These changes include: politics, culture, education, families and systems of care. We need our social structures to evolve into true, care and empathy based systems that meet actual human needs as well. A movement towards a caring socioeconomic structure is one that can cross the political divide. The places that this can most readily happen is in our proximal social circles. For the majority of us this includes family, friends and colleagues.
Change Done One by One Changes the System
If we can bring virtuous cycles of care into our personal interactions and extricate ourselves from vicious cycles of blame, then we can begin to contribute to a shift towards systemic health. So yes, change starts with the individual. Although not with one individual. But with numerous individuals within a system. And, if we attempt to force change in others, we inevitably will be faced with the unintended consequences of our force. Even if it was well-meaning.
Improving Mental Health
My prescription for improving mental health is not as simple as taking a daily antidepressant, or doing a 30-day treatment program. Covid-19 has amplified the pre-existing mental health crisis. Covid-19 greatly contributes to it and simultaneously uncovers it. The pandemic inflames the subsequent socioeconomic collapse. Our best treatment addresses our basic needs while helping others to meet their basic needs. This includes processing the trauma that contributes to the ongoing isolation and lack of safety. Isolation and lack of safety form the root of our mental health issues.
We have a need for skilled mental health practitioners. People need the help of skilled mental health practitioners to process their trauma and facilitate therapeutic relational experiences. We also need them to help create systems of care that can steward that process on a larger scale. We have to begin to create real community mental health centers. Facilities that focus on community mental health more on substance than name. Wicked problems such as Covid-19 and mental health tend to get oversimplified. However, if we can calmly engage the complexity of the topic, we often see that the solutions hide in plain sight within the problems themselves.