Ask Rockridge: The Importance of Mental Health

Over a long career in hospitals, medical schools, and government agencies, I have tried to get the mental health needs of patients treated as well as many of the other kinds of health needs. But mental health services are often last funded and first reduced compared to many other kinds of care.  How do we establish mental health as necessary for health?

Rockridge Nation member jlipkin

Thank you for bringing up the important issue of mental health.  It is often overlooked in discussions of health care despite its immense importance.  There are several reasons why it remains peripheral in political discourse, starting with the stigma surrounding mental illness and the historical subordination of emotions, especially strong emotions, to reason in the Western tradition. 

But in this response, we would like to focus on an aspect of the issue that is usually overlooked and can only be seen from a cognitive science perspective.

The cognitive reason why mental health is a peripheral issue has to do with how our brains organize information: via category structure organized around “prototypes.” A prototype stands for an entire category in certain types of reasoning and other mental processing.  An example is to draw inferences from the stereotype of a "dumb jock" when thinking about athletes, as if this stereotype represents everyone in the category "athlete," even though it is not accurate to do so.  The existence of prototypes in human reasoning was first studied extensively by UC Berkeley psychologist Eleanor Rosch, starting with her seminal paper Natural categories published in the journal Cognitive Psychology in 1972. 

Technical Comment about Prototypes:
There are several kinds of prototype structuring categories. The kind of category structure that is of interest here is called a “radial category,” with a center and certain related categories that are linked to the center by certain kinds of mental operations, metaphor among them.

The central prototype of health is physical health, which contrasts with physical illness or injury. “Mental illness” used to be called “madness” and “insanity.” In the 20th century, it gradually came to be seen in the medical profession as a form of illness. The name was chosen on the basis of an incorrect theory of categorization with the thought that “mental illness” would be seen as a special case of illness in general. But the human brain doesn’t quite work that way.

Given that the prototype of health is physical health, and that the mind is understood conceptually as a different domain than the body, “mental health” was understood in nonprofessional discourse as a metaphorical extension of physical health, and thus a non-central member of the radial category of health. In expressions like “health care” or “health insurance,” what is accessed by the word “health” is the prototype of physical health. To access mental health, you need to add “mental.”

The existence of radial categories was discovered in the early 1980’s by George Lakoff, who is a professor in the Cognitive and Brain Sciences research group  at UC Berkeley.  You can learn more about them by reading the first six chapters of his book, Women, Fire, and Dangerous Things: What Categories Reveal about the Mind.

In Moral Politics, George Lakoff explains how the concept of harm can be thought of as a category with physical harm as the central prototype:

"The central case is physical harm.  But the category also includes kinds of harm that are metaphorically understood in terms of physical harm, e.g., financial harm, political harm, social harm, and psychological harm.  Our courts recognize that these are all forms of harm, yet they also recognize the centrality of physical harm, for which the most severe penalties are usually reserved."
                                                                                                                                - Moral Politics, pg. 8

This cognitive bias cannot be eliminated. It is conceptual in nature and so no new slogan or catch phrase is going to save the day. The only way around it is to consciously recognize the problem and try to consciously develop a new concept — wellness, or perhaps thriving or flourishing—which does not separate mind and body. This will be difficult, because of certain aspects of brain structure.

The problem is not one of fact. The facts contradict the false dichotomy of mind versus body.  We now know that emotional anxiety and stress are physical phenomena that drain energy from the immune system and increase susceptibility to illness and disease.  We also know that perceptions of risk shape behavior that can have serious health consequences.  Feelings of life commitment (e.g., inspiration, love of life, anticipation of future positive events) or the lack thereof can be decisive when treating terminal illness.

But these are facts, and unconsciously acquired frames and metaphors trump facts.

Ideas like thriving or flourishing have a possibility of being neutral between mind and body. But we are just starting on studying the framing, and possible reframing ,of “mental health” in such terms.

One thing that makes this more difficult is the fact that our culture does not have a clear notion of optimal mental wellness.  As a society, we aren't even achieving the better known standards for physical health.  Changing this will require more than a shift in the concepts for mental health.  A deep shift is needed to move society toward a culture of flourishing that recognizes the situational factors necessary for people to thrive.

It may also be helpful to keep in mind that conceptual systems are not part of the world, but rather are constructed, often unconsciously, and act as filters of perception for bringing meaning to our thoughts.  There will not be a single 'best way' to reframe mental health.  But we do know that we will have to work to overcome the cognitive centrality of health as physical health.

In the meantime, you can draw from your experiences advocating for mental health to find intuitive ways to think about (and communicate) the necessary role of mental wellness in overall human health.

And let us know what works for you.