The coronavirus crisis has collided with mental health crisis, creating a truly “wicked problem”. In this article, learn from Dr. Robert Voloshin about the structural changes we need to address our chronic mental health issues.
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 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.
Mental Health refers to a human being’s subjective experience, that which is most personal, including perceptions, thoughts, sensations and emotions. Our thoughts, emotions and perceptions are interwoven with our social and physical environments into an intersubjective lattice that makes up the consciousness of humanity. As the Mental Health treatment system has been constructed, we too easily see mental illness as problems of the individual, instead of the systemic, political, cultural, and familial problems which they truly are.
We tend to hyper-focus on the individual and 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, including the shortcomings of the Mental Health system at large. It’s critical to have a binocular vision which 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, with Mental Health being defined by numerous factors including rates of suicide, rates of antidepressant and antipsychotic prescriptions, wealth inequality, atmospheric carbon levels, etc.
People with pre-existing medical conditions are the ones that are most vulnerable to the effects of COVID-19, and cultures and nation states with the least amount of resiliency and health are the most vulnerable to the macrosystemic effects of this pandemic. And in this way, our culture’s way of of life has contributed to our vulnerability to COVID-19 as a society, while our response to COVID-19 is exacerbating our pre-existing Mental Health issues.
The Mental Health issues of individuals in these times can not be separated from the suffering people are experiencing due to lack of purpose, social and economic hierarchies, 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. To isolate 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. Adolescents are some of the most vulnerable people to the cultural shifts imparted by COVID-19. 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 these days continue to be treated independent of their family system, although it is abundantly clear that the problems that teens are facing are cultural, familial and systemic in nature, and do not live solely within the teenage brain.
As 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. Ketamine-Assisted Psychotherapy, one of treatments I specialize in, does allow deep and fundamental changes to occur for individuals, but it’s unfortunately limited to the individual. And though helpful, does not contribute much to the larger systemic shifts that we need for societal and individual health.
The real treatment we need to address our chronic mental health issues include structural change at the level of politics, culture, education, families and systems of care. We need our social structures to evolve into systems that are truly based in care and empathy as well as the meeting of actual human needs. 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, which for the majority of us include family, friends and colleagues.
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, though not with one individual, but with numerous individuals within a system. And, iff 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.
My prescription for improving Mental Health is not as simple as taking a daily antidepressant, or doing a 30-day treatment program. The mental health crisis caused by, uncovered by, and contributing to the COVID-19 pandemic and socioeconomic collapse can best be treated by addressing our basic needs while helping others to meet their basic needs, as well as through processing the trauma that has contributed to the ongoing isolation and lack of safety that is at the root of our Mental Health issues.
Skilled Mental Health practitioners are needed not only to help people process their trauma and facilitate therapeutic relational experiences, but to also create systems of care that can steward that process on a larger scale. We need to begin to create real Community Mental Health centers, one’s that are focused on community mental health more on substance than name. Wicked Problems such as COVID-19 and Mental Health tend to get oversimplified, but if we can calmly engage the complexity of the topic, we often see that the solutions are hidden in plain sight within the problems themselves.