Regular reports of a mental health crisis in the UK suggest a public health emergency. I saw the impact of mental illness myself during my time as Chair of a local mental health charity. Jobs, partners and families sometimes lost. For some, never even being able to get a job or begin a long-term relationship in the first place, or being sectioned under the Mental Health Act. Mental illness can be a serious issue, requiring a serious response.

However, everyday worries and normal human feelings and emotions are increasingly being described as ‘mental health problems.’ For instance, one mental health charity has said, ‘Mental health problems range from the worries we all experience as part of everyday life to serious long-term conditions’. This seems to me to devalue mental illness, a bit like lumping the common cold and cancer together as if they are somehow equivalent. Having a cold isn't pleasant and may last for a week or two but we don't describe the country as experiencing a physical health crisis when people catch colds. Presumably the same should apply when people experience everyday worries. 

Normal and abnormal feelings

The symptoms often now being described as mental health problems include feeling anxious, stressed, unhappy, having trouble sleeping, panic and mood swings. However, these are typically described by the NHS as ‘normal’ feelings and emotions. As the NHS explains, ‘Everyone has feelings of anxiety at some point in their life. For example, you may feel worried and anxious about sitting an exam or having a medical test or job interview. During times like these, feeling anxious can be perfectly normal’.

Unfortunately, short term negative feelings and clinically diagnosed mental health conditions are increasingly being conflated and wrapped up together under all-purpose labels such as ‘mental health problems,’ ‘mental health issues’ or ‘mental health difficulties.’

Negative feelings and emotions may sometimes be symptoms of a mental health condition but only when they become abnormal – for example if they have been going on for weeks, with a detrimental impact on daily life, and possibly no obvious cause. 

The nocebo effect

This isn’t just a question of semantics. The way feelings and emotions are described and interpreted has health implications. Take the nocebo effect (placebo’s evil twin) - where people subconsciously expect a negative health outcome and then experience a negative health outcome, unconnected with any pre-existing medical state. For instance, a large-scale study found the perception that stress adversely affects health is independently associated with an increased likelihood of worse mental health outcomes. This is despite research indicating that time-limited stress is actually beneficial for our mental health - providing ‘psychological immunisation.’

The more we describe negative feelings and emotions as mental health problems and the more we talk about a mental health crisis the more we are potentially cueing people’s brains to create the very crisis we are presumably trying to avoid.

Reframing how negative feelings are seen

Conversely, if we see these negative feelings in a more positive light, our minds and bodies tend to react accordingly. For instance, people who see anxiety as a source of energy are much less likely to suffer from emotional exhaustion than those who see it as a threat or a sign of weakness. Interestingly, the expectation that our lives should always be happy may lead us to exaggerate the small worries and upsets we regularly encounter in life. A 2018 study concluded, ‘individuals who accept rather than judge their mental experiences may attain better psychological health, in part because acceptance helps them experience less negative emotion in response to stressors.’

The key point is to recognise that (unless these are having a significant effect on our life for a prolonged period) these will usually be normal feelings and emotions. If we burden people with the idea that each time they are unhappy they have a mental health problem this may, as we’ve seen, become a self-fulfilling prophecy and end up actually harming their mental health.

Conclusions

From a public health perspective we should be wary of describing everyday worries, stresses and anxieties as mental health problems, because:

• These are normal human feelings and emotions – which only become mental health conditions when they become abnormal in their severity, impact and duration.
• Describing them as mental health problems may have a nocebo effect, subconsciously driving up levels of mental distress in a way that is harmful to people’s mental health and wellbeing.
• Conversely, positively reframing how negative feelings and emotions are perceived has been shown to often have benefits for mental health and wellbeing.
• We risk devaluing the seriousness and significance of mental illness if we conflate it with normal everyday worries and concerns under a catch-all ‘mental health problem’ label.

Michael Baber   February 2022