NASA defines a black hole as… “a place in space where gravity pulls so much that even light cannot get out. The gravity is so strong because matter has been squeezed into a tiny space. This can happen when a star is dying. Because no light can get out, people can’t see black holes.”
This seems an apt metaphor for many lay people’s understanding of mental health. The branch of medical science called psychiatry is largely misunderstood – and further complicated by the dicey and arcane pharmacopeia that today is largely replacing talk therapy.
But the black hole metaphor belies a complexity far beyond mere mental health. The social safety net – nearly 50% of our state budget – clearly shows we’re not making good social investment choices when we fail to invest in and regulate towards equal opportunity, self-sufficiency, social justice, and prevention. Bad choices cost us dearly and only energize a future collapse.
In order to have a useful discussion about the need for more mental health services, we first must differentiate among the various labels used to describe the “mental health” population. Educators and school boards, under attack for burgeoning school budgets, rightly argue that many of their cost drivers are socio-economic, not educational.
In similar fashion, we often misunderstand and conflate clinical or biological depression with situational depression – or what we used to call “discouragement.”
Mental illness, after all, may be endowed or it may develop circumstantially, so where does a diagnosis of “mental illness” lie on the spectrum from discouragement to depression to despair?
Policy makers have long known that lack of education and access to preventive health care can lead to poverty and that poverty itself can cause physical and mental illness. Psychologists have long acknowledged that many alcoholics and addicts self-medicate for depression with alcohol, processed food, opiates, and other addictive substances. So, is the human wreck shambling down Main Street a free-ranging mental patient, a self-medicating drunk, or simply someone who has given up on life? It matters when we talk about help because policies that put people in solitary for months or jail for decades, that allow people to live under a bridge and eat out of dumpsters with no hope of employment or the dignity that comes of self-sufficiency, that turn a blind eye to physical or sexual abuse, or reduce access to health care and education only generate further turbulence in the black hole we wrongly ascribe to mental illness.
If we think the social safety net is a black hole today, wait a decade or two. We must penetrate this black hole and understand what social and economic policies we create that further energize its collapse.