The Issue of The Need to Understand before Accepting in Modern Mental Health

Introduction

In many situations, humans have an innate need to understand a complex situation or behaviour before we can come to accept it. This may be despite reassurance of its validity from professionals or loved ones around them. In mental health, this is a prominent issue, with some conditions characterised by their ‘un-understandable’ behaviour. Even conditions with more relatable characteristics, such as anxiety and depression, have elements that may be un-understandable to others. Those who have not experienced these symptoms will struggle to be able to understand and often find difficulty in truly accepting these conditions. The word accept has many connotations here: it is acceptance of mental health as a true health issue, of mental health sufferers behaviours, and fundamentally that mental health exists in society today. 

Acceptance significantly affects perception which can, in turn, affect treatment, research, job opportunities, and mental health sufferers own experience. As such in this essay, I will argue how our need to understand before we accept can be fundamentally damaging, and how it could be more beneficial to continue to seek understanding but to put acceptance at the forefront of our efforts with mental health.  

Contextual History  

Whilst our understanding of mental health has increased exponentially in recent years, the history of mental health’s acceptance is far more varied. In the middle ages, mental health issues were often seen as a result of sin or demonic possession, with treatments that mirrored this level of understanding. Whilst much of mental health is still a mystery, we now see it as a medical condition, with research done into its causes and treatments, no longer being seen as the result of a curse or deity.  

A good indicator of the state of acceptance a condition had is the level of compassion the treatment warranted. Whilst the infamous Bethlam, established in the 13th century, could be viewed as innovative and its very existence indicative of mental health’s acceptance as a condition, its often barbaric treatment of patients would suggest otherwise. A lack of understanding, acceptance and compassion has led to a series of brutish invasive treatments, which worryingly has continued into modern times with the prevalence ‘ice pick lobotomies’. These were performed in just minutes and arguably unethical surroundings, featuring as a prominent treatment far into the 1950s. In contrast, there is also evidence of less intensive treatments and care regimes which resulted in better social cohesion and quality of life for patients. We could consider the case of Emma De Beston, who in the 14th century, was cared for, like many others, by her community. She was accepted even though her condition was not fully understood. It is clear from history’s lessons that acceptance of mental health has a strong correlation with the quality of life for patients and as such is incredibly important.  

The Distinction Between, and Link of, Understanding and Acceptance   There are multiple definitions of understanding, all with slight variants which can, in turn, lead to different interpretations of a statement. At its core to be able to understand is to be able to perceive something in a correct manner, allowing for correct actions and correct links to be made. Where correct implies it is both factually true and appropriate. Beireter claims “Understanding implies abilities and dispositions with respect to an object of knowledge sufficient to support intelligent behaviour”. In his work, he discusses how understanding a situation is essentially different from being able to relate to it in some way. Simple relations can lead to an interpretation of a situation but, because the knowledge is limited, a true understanding can not be reached.  

It is potentially more helpful to see understanding as a scale rather than a defined point in a learning experience. Each level should help to lead to the next, with each stage poten- tially allowing for different levels of acceptance. Considering understanding as a continuum leads to questions about its links with acceptance: is there a specific level at which accep- tance is now possible, is it an effort to reach greater understanding that allows for it, or is acceptance itself a continuum?  

To help visualise this continuum we can imagine the scenario of a child’s relationship with multiplication:  

1. Contextual - a child in reception may understand it is something that comes up in maths, this is a level of understanding where a situation is able to be put into context.  
2. Operational - the child can now memorise and recall simple multiplications, they under- stand enough of the concept to be able to operate at the task in hand.  
3. Defining - now older, the child can understand that the definition of multiplication is to add one number by itself a certain number of times, they may not be able to explain this to someone with no understanding of the situation but can use the concept to a further extent than operationally   Relational- they now have an understanding how multiplication relates to other opera- tions, they understand how it is the inversion of division and treat the two accordingly.  

When we look at applying these categories to mental health it becomes more complicated. Some may argue that even a contextual understanding is enough to accept, whereas others may pursue a much higher level of understanding before they are willing to accept. In comparison to understanding, acceptance is described as “a person’s assent to the re- ality of a situation, recognising a process or condition without attempting to change it or protest it”. This is may seem an odd definition when applied to the context of mental health. It could be argued that by not attempting to change or protest a mental health condition then it discourages recovery or downplays the seriousness of it. An alternative approach is given by Tolles, a spiritual teacher, who defines acceptance as a response to a situation as a “this is it” moment. This is perhaps a more apt description. It does not claim that we do not try to change a situation, but recognise it as it truly is whilst not arguing against the existence of a situation. This is a helpful approach as it allows us to accept a situation in the moment whilst attempting to help prevent it being a continued existence.  

Acceptance of mental health is itself threefold in its forms: self acceptance, acceptance of it by those around you, and acceptance by society in general. The three categories come in various forms and stages, with their own often distinct issues to be solved.  

The Issue with Understanding  

Increasing public awareness and understanding of mental health issues are key aims in the mental health community. Recently there has been a huge rise in the “conversation” thanks to campaigns such as ‘UOKM8?’, ‘Time to Change’ and the increased participation in World Mental Health days or weeks. However many feel the spotlight for this particular aspect of the cause has now had its time. The general population are much more aware of mental illness now than ever before. The concern comes into play with regards to what extent they understand it, which is often limited to a purely contextual level. Therein lies a danger with some people claiming to understand mental health conditions to a greater extent than they truly do. We can say that these people have an interpretation of the situation around them, but they do not possess a true understanding of it.  

More worryingly, if these people have some interpretation that is actually incorrect, then their words or actions could become more harmful to others than before their attempt at understanding in the first place. When we imagine our understanding continuum now, this area perhaps lies outside of our own scale entirely. This is often seen with the ‘Theroux phenomeneom’: where subjects who watch an hour long documentary feel they are able to accurately explain and often begin to talk like an expert on the area, despite not actually having any first hand experience or having done any of their own research. “... recognise that posting “stars can’t shine without darkness” on social media might piss someone off in the midst of desperation and that, actually, anxiety can be a normal reaction and is different from general anxiety disorder, a serious condition. That feeling down is not the same as depression.”    

Patients often describe how a common struggle in this area is the persistent attempts, by those close to them, to understand their conditions. Instead of attempting to help, frus- trated love ones can launch interrogation style sessions, applying their lack of acceptance, or knowledge, of a situation in a damaging manner. The frustrations of the situation can lead to anger, guilt, and denial. The push for a patient to give a singular event or reason for their condition simply displays the lack of real understanding of the situation at hand. Often the questions asked do not have answers and instead of searching for answers together, patients can become ostracised from those around them.  

“If you know someone who’s depressed, please resolve never to ask them why.” - Stephen Fry  

“The question “why are you depressed?” made me even more depressed each time I was asked” - Hazel Stones   

It is important to make clear at some point the distinction between the form of under- standing that a professional, and a general civilian, aim to have and form. Whilst a greater understanding of mental health is always desired, this essay is not focused on the need to un- derstand in research or other professional medical environments. In these cases, it is entirely necessary to search for an understanding, but the notable difference here is that they are searching for a much higher level than those around them. At the core of their work, they are trying to understand the biological, lifestyle or eventual causes, and how to counteract these. In terms of our earlier scale this is beyond relational, in a way they are taking their relational understanding and using it to further break down the scenario.  

The everyday population, however, will never seek to understand to this same scale; whilst many have a contextual understanding, the desired level would be more towards operational. The aim is that they are able to operate appropriately around cases of mental health, with their actions aiding and not further harming. The issue with the general populations under- standing lies in that they are often unsatisfied with this level of understanding, searching for deeper meanings, causes, or explanations to behaviours.  

We can consider two rough categories of mental illness, the “accepted” and the “not” - which incidentally co-inside with the “relatable” and “not”. Conditions that seem to be ex- tensions on typical behaviours, such as depression and anxiety, are as such considered more relatable . This results in people believing they have a better understanding and grasp of the situation if it appears to be similar to one they may understand. Even more so if there appears to be an apparent cause such as a bereavement, significant change in personal circumstance, or trauma. In these cases, mental health issues are seen as somewhat more acceptable, easier to discuss and are deemed as a more appropriate response. Indeed when negative stigma was evaluated at multiple time points, it was always found that both anxiety and depression scored significantly lower in suffering from negative stereotypes and patient blame.  

In comparison Schizophrenia is viewed more negatively than anxiety and depression. This is clearly seen in trends observed over long periods of time as reported by Angermeyer and in many pieces of Crisp’s work. Whilst Jaspers focuses much of his work on the need to understand, he does concede there are some situations which do not fit this need, separating them:  

“The most profound distinction in psychic life seems to be that between what is meaningful and allows empathy and what in its particular way is un-understandable, ‘mad’ in the literal sense, schizophrenic psychic life”.    

Schizophrenia and other less relatable diseases are undeniably less accepted in modern society. The erratic behaviours and actions are so far from the social ‘norm’ that people are unable to understand or give reason for them, and as such they struggle to accept them. This demonstrates a core issue with the principle of understanding in mental health. Many mental health conditions are simply too complex to be understood in the way of having causes and an explanation, as would be desired from the general public.    

One must also consider the stark truth to being able to understand ‘un-understandable’ conditions, that to be able to understand and empathise with it, one must have experi- enced it. Even in a psychiatric field if one believes they can deeply understand a patient’s un-understandable condition, one could argue that in doing so they have become too close, breaking the traditional barrier between a medical practitioner and patient. It can be postu- lated that to be able to understand such distressing conditions, in a way which would allow them to empathise, the person must have or currently be suffering from a similar mental condition. In some cases this allows for recovered patients to go on and help their community such as in the case of Frederick Frese. Dr Frese has suffered from schizophrenia since he was 25, and has been hospitalised over 10 times, but has since gone on to manage his condition, gaining a masters in psychology. Ultimately he returned to the facility he once was held and treated in but now on the other side of the table, running the site and treating other patients. Frese claims “ many of those who were lending their voices to those of the rising consumer advocacy movement were persons who, despite having been diagnosed with, and undergone treatment for, schizophrenia or schizoaffective disorder...”.   

It is a fine line to be able to walk, many who have suffered from past delusions can be accidentally provoked into another episode if they try to relate too deeply to other patient’s own delusions.  

The Benefits of Acceptance  

 It is a well-established fact that acceptance is a positive step for many processes. Indeed one popular form of therapy, Acceptance and Commitment Therapy, is centred around train- ing people to become more aware of and crucially accept their own feelings and thoughts. This allows the patient to then go on to base their own actions on true realities rather than a misconstrued versions of events. Historically acceptance of race, religion, sexuality, and other prominent variables within human culture, has been seen as a step forward to a more progressive society. In many of these cases, a true understanding was not originally had, however, acceptance was given. This represents the efforts of a cultural shift and the hard work of many protesters and leaders, sometimes over hundreds of years.  

It is a fair question to ask what the tangible value of acceptance in, and of, mental health is. Acceptance in general is widely known to have positive impacts. Along with multiple other papers, Bond and Bunce consistently show that higher acceptance in general, correlated with greater mental health and job prosperity in all the studies they carried out. It is consistently used as a tool within multiple practices, ranging from mindfulness to its own branch of therapy. These practices cite multiple benefits to acceptance, most centred around the ability it gives us to process and act appropriately, as Theo Bennet says “If I dismiss you as crazy, then how can we start a dialogue?”.    

Acceptance can allow individuals to fully embrace a discussion, to become more in touch with their own and others emotions. At its heart it allows for progress, in helping others and ourselves to overcome issues. This is evident from the role it plays in developing Psychological Flexibility.  We are already acutely aware of the benefit that understanding has, and being able to first accept can in turn help an individual to later understand. Often a lack of understanding of a situation comes from an inability or unwillingness to communicate issues and emotion. Acceptance allows us to push ourselves through potentially difficult situations, by trusting that the situation is as it appears. Often people will credit acceptance by others (and by themselves) of their own mental health as a key stage in their recovery processes. To what extent we accept a situation can determine how we guide our own goals and aims for the future, and as such what actions we may take. Now instead of expending energy on fighting a situation, we may aim to manage it, or to begin to process how the situation first arose, hence leading to a greater understanding.  

Challenging ourselves to Accept Without Understanding  

It may seem counter-intuitive to our own natural learning process to accept without un- derstanding, however there are multiple issues throughout history where we have been able to do just this. In fact, some disciplines base themselves around this approach: science in general has been ruled by a search for explanations of widely accepted phenomena. We have accepted the evidence and existence of phenomena such as quantum effects and star cycles going back to the start of human history.  

On a less academic scope, we consider the views of others that we accept, even though we do not share their views and may be unable to understand them. Some heterosexual people struggle to understand homosexual attractions, they can not personally see the ap- peal and as such find it difficult to understand. However they accept this behaviour in spite of this fact. Society has over time overcome previously difficult conversations such as race, religion and sexuality, by pushing for greater acceptance which has in time led to a greater understanding and a richer culture among us.  

What is required of us to become more accepting is a cultural and self-reflection. Often in this scenario we are tasked to ‘put yourself in someone else’s boots’ but this seems hard in a situation you can not relate or understand. The mental health community often claims that mental health is just like physical ill health, however as earlier discussed this approach has its own problems as a method of encouraging acceptance.  

Perhaps in order to accept we should try and relate to a stripped down and bare state- ment about mental health. Which is that the majority of people with these conditions are suffering. A negative emotion that we are all familiar with too some extent. It is a two-fold statement, first in that they are in a negatively affected state which warrants compassion and some level of care, but also that it exists in principle as a phenomenon. 

There have always been critics of mental health, fuelled by their own lack of belief and the publications of sceptics such as Szasz.  

Szasz takes things to the extreme in his literature, listing mental health as a cause of events that will go down in history as false, joining the ranks of “deities, witches, and microorganisms”. A large proportion of his argument is based around the notion that it does not respond or seem to have a notable physical cause, which in some cases can now be challenged with various forms of scans. However even Szasz, with his seemingly out- landish comments, accepted the behaviours present in mental health, advocating for therapy of consulting adults.  

Risks Involved   Whilst it is important that we aim to be able to accept, it is arguably part of human re- quirement to be able to first understand. If we challenge ourselves to accept first, we may find ourselves attempting to understand by forging incorrect or damaging opinions on men- tal health conditions. Arguably Szasz accepts the existence and troubles of mental health, however his views may be incredibly upsetting or damaging to others. He seems a para- doxical preacher, advocating therapy sessions to help but at the same time undermining the conditions of the individuals that may come to him.  

Another concern is that if acceptance is reached, then it is entirely possible dialogue could be cut short. Individuals may feel that their social responsibilities are now over and that they do not need to make any further attempts to educate themselves or empathise within the field. Instead of allowing for advancements, those with a ‘bare minimum effort’ approach may take it as an excuse to cease actions. However if this was the case, we would have to question whether this is true acceptance or just a claim of it. Looking back at our definitions saying you accept something then burying your head in the sand is not elicit of intelligent and appropriate behaviour. So maybe what we need to be cautious of is the risk of incomplete acceptance.  

Conclusion  

Now more than ever it is important that we treat mental health in the correct and a com- passionate manner. There has been a substantial rise in the number of cases of mental health issues over the past 50 years, in more recent times this has been even more rapid with visits to mental health professionals by young patients doubling in a 20 year period. What we are aiming for is an almost epistemological particularism approach, where we trust that the conditions and behaviours in mental health exist, are valid, and warrant treatment and compassion, before we truly understand how and why they do. In this way, we will be able to create a less hostile environment for the growing numbers suffering from mental health issues and will also be able to open ourselves to the opportunity of a greater understanding. Whilst there are several challenges in taking this approach to mental health, it is impor- tant we consider why they are needed. Reminding ourselves that the very nature of some conditions makes them definitively un-understandable, and the damage that can be done in pursuing an understanding of one person’s situation. Whilst we should always endeavour to understand to the greatest of our ability, accepting that this may not always be possible is the first step to improving our ability to treat mental health patients with the respect and dignity they deserve.  

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