Does mental health matter most?

Does mental health matter most?

Dr. Trevor Hancock

20 March 2018

701 words

There is an interesting common thread underlying many of my recent columns. It is the question in my title: Does mental health matter most? By which I mean, in high-income countries in the 21st century, does mental health matter more than physical health? Which in turn means, in terms of public health, does mental health promotion and the prevention of mental disorders matter more than preventing heart disease, cancer and other physical disorders?

There are many threads to my emerging argument. To begin with, the 70 year-old definition of health from the World Health Organisation is that health is a state of complete physical, mental and social wellbeing. Since social wellbeing is primarily about how we feel about and respond to our links to and relationships with others in our families and communities, it means a significant part of the definition is really about our mental wellbeing.

Add to this the relationship between the mind and the body – our state of mind affects our neuro-hormonal and immune systems, and the latter is involved in allergy, auto-immune disease, and the detection and elimination of both infection and abnormal cancer cells – and our state of mind assumes an even greater importance.

Another important issue is the changing pattern of disease and death. Globally, the World Health Organisation noted last year, “Depression is the leading cause of ill health and disability worldwide” – depression, we should note, is only one form of mental ill health. WHO also notes that there are “strong links between depression and other non-communicable disorders and diseases” and that “depression increases the risk of substance use disorders and diseases such as diabetes and heart disease”, while pointing out that “the opposite is also true . . . people with these other conditions have a higher risk of depression”.

We can also see the importance of mental health in the decline in life expectancy in the USA in each of the past 2 years, the first time this has happened in more than 60 years. But that decline is driven not by physical disorders such as heart disease and cancer but from the so-called ‘diseases of despair’; alcohol and drug use and suicide, which are largely mental and social disorders. And as I pondered in my last column, we may need to consider whether the growing concern about the state of our environment is adding to that despair.

Another factor to consider is the impact of poverty and inequality. Absolute poverty is unhealthy because people lack the basic necessities for life and health – clean water, food, shelter and so on – and we have some of that in Canada. But for the most part our problems are now those of relative poverty. Kate Pickett and Richard Wilkinson, in their book “The Spirit Level”, showed that in high-income countries, a range of health and social outcomes are not related to national income per person, but to the degree of inequality.

It seems that being lower in the ‘pecking order’ of society is harmful to health because we experience inequality as a lower sense of self-esteem and self-worth, relative powerlessness and even helplessness. All of which are mental and social experiences that, again, can translate into physical conditions.

The implication is that if we want to have a healthy population we need to pay much more attention to mental and social wellbeing than we have been doing. We need to provide more funding to research focused on understanding the root causes of mental and social health problems, and to policies and programming for preventing mental and social health problems, as we do to understanding and preventing heart disease and cancer – because we have under-invested on the mental health side.

Beyond that, we need to give at least as much attention to promoting mental and social wellbeing as we do to promoting physical wellbeing and fitness, recognizing that they are mutually beneficial. What would it take to create mentally healthy families, schools, workplaces, colleges and universities? How do we help people maintain mental wellbeing in the face of adversity, or as they age? How do we re-focus our society – including public health – to ensure mental health matters at least as much as physical health – maybe more.

© Trevor Hancock, 2018


Solastalgia: The painful result of reviling nature

Solastalgia: The painful result of reviling nature

Dr. Trevor Hancock

13 March 2018

699 words

In my last column I described gazing with horror upon a clearcut; what I was experiencing was – in a small way – what today would be called ‘solastalgia’ – “the pain or sickness caused by the loss of, or inability to derive solace from, the present state of one’s home environment”. In my case, it was not my home environment, but I can well imagine what the impact would be on people for whom that forest was part of their home environment.

The term solastalgia was coined 15 years ago by Glenn Albrecht, an Australian philosopher. He derived it in part from the idea of nostalgia, which means home-sickness. In the 19th and into the 20th century, he wrote, it was considered a medical condition caused by a desire to return to one’s home. But while nostalgia is related to removal – voluntarily or involuntarily – from one’s home environment, Albrecht was interested in something different; dramatic change in the home environment where you still live.

He believes that we derive comfort and solace from our home environment, but that when it is radically changed, we suffer distress. He suggested that this is particularly true for Indigenous people around the world, who may not only have been displaced from their home environment, or seen that home environment radically transformed, but at the same time suffered the radical disruption of their culture. (Note that the Truth and Reconciliation Commission referred to this as amounting to cultural genocide.)

Radical environmental change – and thus solastalgia – can arise from both natural and human-created sources. Natural sources include volcanoes, earthquakes and tsunamis, hurricanes, forest fires, droughts and floods, while human sources include war, resource development and extraction (e.g. deforestation, mining) and urban (re)development. These are not entirely separate, of course; human actions – particularly those that drive climate change – contribute to several of the examples of ‘natural’ changes that I mentioned.

Contributing to the problem is both the speed and the scale of change; mostly these events happen in a matter of minutes, hours or days, or at most over a few years. And increasingly, they happen at a large, even global scale. As a result, they can “undermine a personal and community sense of identity, belonging and control”, leading to a sense of hopelessness, or even despair.

Evidence for the existence of solastalgia has been found among Australian farmers facing drought; residents of the Hunter Valley, a major coal mining area in Australia; people in Appalachia affected by mountain-top removal for coal-mining and people in Arizona affected by a large wildfire, to name but a few.

Here in Canada, as reported by Livia Albeck-Ripka in a November 2017 article in the New York Times, climate change and warming in the Nunatsiavut region of Labrador is having an impact on mental health among the Indigenous communities. Research conducted by Dr. Ashlee Cunsolo, director of the Labrador Institute of Memorial University, “found that the melted ice, shorter winters and unpredictable weather made people feel trapped, depressed, stressed and anxious, and, in some cases, led to increased risk of substance abuse and suicidal thoughts”. Sadly, I suspect, that may be the case across the Arctic.

I think what makes it worse is when we understand that the damage we see, and that pains us, is caused, in part or in whole, by thoughtless human action. Thus solastalgia is likely to become more prevalent as we enter the Anthopocene – a new geologic epoch characterised by massive human impacts on the Earth that will leave their mark in the geologic and fossil record – and the full extent of human impact on the Earth becomes increasingly apparent.

In fact, I have been wondering recently if solastalgia is contributing to what in the USA are called the diseases of despair; death and disease due to alcohol and drug use and suicide. I don’t think it is something people are necessarily conscious of, but surely the almost daily drumbeat of stories about how we are harming the earth has an impact. As Glenn Albrecht wrote, “Many people sense that something is wrong with our relationship with the planet. This unease might just be an expression of deep-seated solastalgia”.

© Trevor Hancock, 2018


Our health depends on revering, not reviling nature

Our health depends on revering, not reviling nature

Dr. Trevor Hancock

6 March 2018

700 words

I first came to Vancouver Island about 30 years ago, on vacation, and have never forgotten the sight of my first clearcut. I found it appalling and gut-wrenching, and it prompted me to write a letter to the Times Colonist. In it, I described what I had seen as ecocide, and likened it to genocide. I also wondered how we had managed to raise a generation of people who so hated nature that they could do that to the forest in the name of profit.

It elicited an interesting and revealing response. A professional forester in BC wrote to the College of Physicians and Surgeons in Ontario asking that my medical licence be revoked, on the grounds that I was unsuited to be a physician because I let emotion distort my scientific reasoning and thus my judgement was clearly impaired. (The College forwarded me his letter but otherwise, correctly, ignored it.)

What his response revealed was two things: First, that he didn’t understand that emotion and compassion must be part of a physician’s make-up if they are to be a good practitioner, and second, that in his view, any emotional response to the forest – and thus to nature – was wrong. This indifference to and lack of an emotional connection with nature is the basis of our modern society; it enables many of the large corporations that dominate our society and economy to exploit nature for profit, with little regard for the consequences. And that, in a nutshell, is our modern problem.

So where did it come from, this insensitivity to the natural world, this desire to dominate rather than live with nature, to be apart from our natural ecosystems rather than seeing ourselves embedded in them? The American historian Lynn White, in a famous 1967 article titled ‘The historical roots of our ecological crisis’ (and note that it was recognised as such 50 years ago), suggested that Western society has adopted a set of values deeply rooted in Christianity, which has always taught that “it is God’s will that humans exploit nature for their own purposes”.

He wrote: “The whole concept of the sacred grove is alien to Christianity”, and that “for nearly 2 millennia, Christian missionaries have been chopping down sacred groves, which are idolatrous because they assume spirit in nature”. White believed that the effect of “destroying pagan animism”, which had formerly protected nature from man, was to make it “possible to exploit nature in a mood of indifference to the feelings of natural objects.”

But he recognised that there had been at least one attempt to change that Christian narrative by “the greatest spiritual revolutionary in Western history, Saint Francis”, who “tried to substitute the idea of the equality of all creatures, including man, for the idea of man’s limitless rule of creation”. It is interesting that we now have, for the first time ever, a Franciscan Pope; could that be a sign of a more significant change in our values?

But there is another force at work here; we are now an urban species, and that is moving us away from and even making us fearful of nature. This leads to what Richard Louv, in his book ‘Last Child in the Woods’, called nature deficit disorder – kids with no relationship to nature, and even fearful of it. This is dangerous; at a time of ecological crisis, we are raising a generation of kids that will not respect, cherish and protect nature, that may even fear and revile nature. It is not a cheery prospect.

The only way to develop a reverence for nature is to experience its beauty, its sometimes awesome power, which is why we need to get kids outdoors – and why we need to bring nature into our cities and our lives. And we need to re-create a spiritual connection, perhaps simply on a personal level, or through a modern-day form of animism, or through a Franciscan-inspired Christianity or other spiritual and religious beliefs that are more in harmony with and see the spirit in nature.

Ultimately, saving us from ourselves is not a technological but a spiritual quest to live in harmony with and as part of – not separate from – nature.

© Trevor Hancock, 2018