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Psychology Today

Is Mental Health Strictly Mental?

A guest column by University of Georgia professor Peter Smagorinsky

“She’s sick in the head.”

“I think he’s gone mental.”

“What a head case.”

When people talk about others whose behavior does not conform to expected norms, they often use language that treats the differences as a sickness located within the individual’s skull. When someone’s thinking seems to more or less follow expectations for acting properly in the world, they are considered possessed of “mental health.” In contrast, behavior that seems odd, unwarranted, illogical, threatening, or peculiar is referred to as “mental illness.”

Whichever you are considered to be, mentally healthy or ill, it’s widely depicted as a function of how the brain works, and thus a mental condition. If your head isn’t screwed on right, to use yet another common metaphor, you need to get straightened out so that you are well, and so that the rest of us are not unnerved or frightened by your actions.

I’m actually one of “them,” so I’m being coy with this introduction. As one who is neurodivergent from the neurotypical, to use a few terms currently in vogue, I have devoted a lot of time to trying to understand what it means to be mentally healthy or ill. Being on the Asperger’s spectrum, having chronic high anxiety, being subject to obsessive-compulsive thinking, and having mild Tourette’s syndrome hasn’t always been easy. At the same time, I don’t consider myself disordered, disabled, abnormal, or sick. And I don’t think it’s all in my head.

There is no doubt that the brain is part of what makes neurodivergent people different from the general population. But only a part. Many researchers, for instance, have long asserted that cognition is not a discrete process, but is fundamentally related to other functions of the bodily system. Historically, for instance, cognition and emotion have been considered separate realms, a major premise of the European Enlightenment. Not only separate, but unequal, with emotions serving to cloud the clarity of cognition.

But the whole body contributes to how people both think and feel. Most people have experienced involuntary responses to external conditions, such as the heart beating quickly and breathing coming in short bursts, adrenaline coursing through the whole bodily system, and physical or emotional pain driving a thought process. The idea that people can experience “cold cognition” is more an abstraction than something that real people ever do.

Given the seemingly countless ways in which these experiences are so common among most people, it’s hard to view thinking as a strictly rational process, or one corrupted by, rather than infused with, emotion. It’s not possible, then, to view the brain as the sole agent of mental functioning, and thus is where “mental health” and “mental illness” reside. The body-wide neurological system—the source of terms like neurotypical and neurodivergent—is a whole-body regulator, including the grey matter between the ears.

But there’s more. Many psychologists and researchers in a variety of disciplines consider the environment to be central to how human development unfolds, and thus to how people learn to think. This assumption is axiomatic in the Vygotskian perspective that I have adopted to understand human development. Many types of psychology assume that people develop according to biological stages, and that human trajectories that do not follow typical trajectories are abnormal and correctable. Vygotskian tenets look to social environments, and how they have developed culturally and historically, to understand how contexts provide the contours for how people within them develop.

This perspective changes the assumptions that motivate approaches to considering neurodivergence, such as the conditions typically classified as mental illnesses. They are only “mental” and “illnesses” when other people treat them as such. Many people on an atypical trajectory follow norms and orders of their own that have a coherent set of properties. People conditioned to viewing typical pathways as proper developmentally often construct those who march to different drummers as deficient, often to be feared until they are fixed.

What is generally considered “mental” is therefore not only whole-body, it is also part of a relationship with the environment. “Mental health” and “mental illness” mischaracterize neurodivergence by locating it as a problem, and a problem in the head, and nowhere else. Yet there’s a lot more to how one is neurologically and mentally organized than what is encased in the skull.

If that is the case, when you hear people say something like, “He needs to have his head examined,” you might pause and consider whether the problem is in someone’s malfunctioning brain. Perhaps the problem is just as likely to reside in the social environment, in which being a little weird is assumed to be a sick and deficient way of navigating the world, and where accepting difference is just not a normal way of thinking.

In a world in which racism, xenophobia, and the fear of many “other” populations have begun to shape the politics of many nations, it’s hard to imagine societies in which universal acceptance of all kinds is realistic. I’d love a world in which the lions lie down with the lambs, but I don’t see it on the horizon. What I do hope to contribute to, however, is a better understanding of one particular type of “other”: those generally considered to be mentally ill.

This understanding would require a wider acceptance of how people act in the world, a problem compounded by the problem that a relatively small number of people considered mentally ill do act out violently, perhaps in response to how others treat them. I do, however, know parents who have raised their families with unconditional love yet who fear their own children because of their threatening actions. It’s not quite as simple as encouraging everyone to be more accepting.

These extreme cases obscure the more prevalent issue that many people would live happier lives if there were mutual adaptations, particularly in terms of expectations for societal norms. Expanding understanding of what is possible in a fellow human could lead to greater recognition of the assets and potential of those considered odd and deficient, a stance that would benefit both those being judged and those making the judgments. I’ve learned through my own conditions that adaptations on my own part help with creating better environments for others as well.

My hope is quite realistic, I think. Society needs a better understanding of human diversity and the role of contexts in cultivating the potential of its members. That requires a broad commitment to recognizing that difference is not deficit, and that difference is a human fabrication that tends to Balkanize rather than unite people for the greater good

Professor Smagorinsky is editor of Creativity and Community among Autism-Spectrum Youth: Creating Positive Social Updrafts through Play and Performance, a collection presenting outside the box, creative approaches to what is typically treated from a deficit perspective. The book is part of the Palgrave Macmillan series Studies in Play, Performance, Learning and Development, and is due out this August.