Neurosis to Anxiety: The development of contemporary mental health

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In the mid-90s, my mom used to subscribe to a magazine that was titled – I kid you not – Going Bonkers? It was literally a magazine for neurotic people, striking a self-deprecating tone that was just humorous enough to poke fun at the constant anxious thoughts of a nervous person while still legitimizing them. In a cruel twist of fate, this extremely niche magazine, realizing it didn’t have enough subscribers to keep it afloat, abruptly shifted gears to a dog humor magazine without telling its readers, leaving neurotic individuals floundering in gaslight, wondering if they were just imagining the change.

I grew up casually identifying my mom as neurotic or a worry wart, not really thinking about what that meant. And it was part of the culture of the latter half of the 20th century. Think of the charm of Woody Allen (enough to keep people making excuses for his likely history of sexual abuse), the poster boy of the neurotic Jew. Or even Meg Ryan, who managed to make being high-maintenance sexy. And then of course there’s Seinfeld, which was an entire show about people making mountains out of molehills. This wasn’t just a problem, it was an identity. The anxious New Yorker, immortalized in the lyric from Rent, “I’m a New Yorker, fear’s my life.” That era was full of neurosis, and then suddenly it wasn’t.

Around the turn of the millennium, we as a culture stopped thinking that neurosis was cute or funny. As with every change around that time, 9/11 probably had something to do with it. We went from mocking people who were afraid the world was going to end because of Y2K to collectively recovering from trauma as a society. Trauma simply became a topic within the public consciousness starting in late 2001. And it wasn’t just 9/11 itself. Of course it was also a new awareness of PTSD as a result of the Iraq and Afghanistan wars. And maybe because we were suddenly talking openly about one kind of trauma, we started talking about a lot of other kinds of trauma. A range of feminisms rightly capitalized on this dialectical shift, and the early 2000s saw a frank public conversation around topics such as female teenage bullying, eating disorders, and sexual assault. All of these were brought into pop culture thanks to Law & Order: SVU, a show that probably wouldn’t have found any success if it had been made 10 years earlier.

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Once trauma worked its way into conversations about daily life, people started to talk about anxiety and depression as more normal features of life for many kinds of people. A rash of gay teen suicides in the late 2000s sparked the It Gets Better Project and a new awareness of the anxieties the plague LGBTQ+ individuals. That further added to a conversation around bullying. And once mental health conversations were focused on teenagers, the public was open to talking about the pressures on the Millennial generation, who, at the time, were mostly known for being overworked, overscheduled, and overburdened with expectations of achievement in a future made uncertain by the Great Recession.

The question in all of this is whether the public became more accustomed to talking about mental health because there were more anxieties and stressors in the mainstream, or because public health had finally made enough inroads to expose the anxieties and stressors that had always been there. The shift in vocabulary around mental health in the last few years certainly supports the latter. Efforts to humanize mental health issues have meant campaigns to stop referring to people by their illnesses, preferring instead clunky phrases such as “a person with schizophrenia” or “a person who uses drugs”. While these may not roll off the tongue grammatically, they work to change the mindset around these disorders, disconnecting the person from the disease.

This gentler approach has also reflected on the availability of mental health services. Like many areas of health care, Obamacare mandated coverage in a way that has made seeing a therapist or psychiatrist who is covered by insurance as affordable as a $40 copay per visit. A recent trend in healthcare startups has also meant that people can now access talk therapy through a subscription service app. The viability of such apps is a testament to the fact that the changes in attitude toward mental health are not just among academics, doctors, and policy-makers, but within individuals, who now feel comfortable and motivated to seek out their own treatment. And that is really the most significant change. Like the modern wellness movement as a whole, which has made personal health and well-being a form of aesthetic self-care, mental health treatment is something that the public at large is seeking out for itself, rather than being convinced to take on by a primary care physician issuing a prescription. But since these apps aren’t authorized to treat illnesses, merely to provide support, their help is the kind of gentle talk therapy that is used to help with some of the more common and benign mental health issues – anxiety, mild acute depression, and relationship issues, among others. In the culture of the 90s, people with these problems either had to pay out of pocket to see a psychologist, or manage their issues with a humor magazine. Today, they can video chat a therapist as easily as visiting a nail salon.

The last 20+ years of mental health discourse have not only taken the shame out of many mental health issues, they have made treatment a matter of personal comfort. Easing the stigma around mental health has meant that many issues can be treated in less clinical scenarios. This has put mainstream mental health on a similar trajectory to other aspects of wellness that have both medical and aesthetic components, such as weight loss and fitness, the care of skin, hair, and nails, dentistry/orthodontia, and optics. In all of these areas of health, their commodification has given people easier access and a wider range of options, but it has also left them vulnerable to over-prescription, unnecessary expenses, and snake-oil salesmanship. This is the open market of healthcare – with greater agency comes less protection. And so as we continue to make mental health more of a publicly-discussed issue, we also need to be careful about how information about it becomes commodified.