A tale of two cultures

I don't mean to boast but for the last couple of months my mental health has been the best it's ever been, or at least for as long as I've been an adult. But there's a problem – I don't know why.

I'm grateful that I have so much going my way – lots of the ingredients for good mental health – so in a sense I do know why. But most of these things haven't just come to fruition.

So it's scaring me. Why am I, all of a sudden, OK? It's not like I've had an epiphany that I can make accountable for this weird cocktail of calmness, stability and contentment that I've been experiencing lately. Unless those are just the side effects of the new vitamins that I'm taking?

Usually it's the prospect of something never happening that frightens me, but here it's the knowledge that a crash is inevitable. I know I should just enjoy it and get on with my life – which I mostly am because I'm currently involuntarily in too good of a state of mind to dwell on negatives – but the fear of a decline lingers. What's going to happen when the clock strikes midnight? When my brain exposes itself as a fraud.

No state is permanent. And I'm fearful that I won't know what to do the next time I'm in a rut. It's not like in this last month I've discovered an antidote to unhappiness. Nor is it like I've been previously averse to getting better. I've tried a lot of things. And I know what hasn't worked, but it's a total mystery when it comes to pinpointing what has worked.

My sense of bewilderment is compounded by what I can best describe as mixed feelings towards how I should approach mental health. I have this internal conflict that will be especially familiar to many migrants, those living in diasporas or multiethnic people.

As someone who's from Egypt, and is still attached to the country, but who's been in the UK for almost 20 years, the two cultures are no strangers to clashing with one another in my mind. That's mostly changing as parts of the global South become more Westernised and the world grows more connected. But it's not rare to find there's a struggle between two cultures contradicting one another. Take the example of romantic relationships and how in the UK it's more acceptable to have multiple or casual relationships, whereas in other societies, relationships are more precious and marriage is practically a duty. To put it crudely, the conflict between cultures can be understood as tradition versus progress, or conservatism versus liberalism.

I think attitudes towards mental health aren't immune to this fighting of cultures. There are essentially two contrasting viewpoints – imprinted in our sense of identity – that manifest themselves in the way people come to understand and deal with mental health issues. These are what I'm going to explain as Cultures A and B.

Culture A

For many men (regardless of nationality) and even more Arabs, mental health is an alien or novel concept. We're still trying to get to grips with it, or we might even have a tendency to outright reject it.

And as an embodiment of those two labels, I'm inadvertently drawn to the philosophy of 'Just get on with it'. Whether I like it or not, I mostly subscribe to the belief that the more attention you give an idea, the more you facilitate its cancerous growth. Beware opening Pandora's box because you don't know what you'll unleash, so it's best to ignore the problems and lead the path of least resistance. It's essentially burying our heads in the sand, but where the alternative is being caught in the quicksand of overthinking.

For those caught in Culture A, toxic masculinity is sold as a dream. Let's just pretend that there's nothing wrong here and get on with our lives. Vulnerability and transparency are weaknesses – we have no time for those. Deep down we know of the dangers of this attitude. It's a short term and unsustainable solution. But it's appealing and tempting too.

When I spend time in Egypt, I'm usually struck by a number of cultural gaps between my country of birth and the UK. And as I become more cognisant of the differences, mental health is the topic that interests me the most in terms of how the North African country approaches it.

On my latest visit, walking the streets of Cairo and reintegrating into the culture, I'm left with the impression that everyone is too busy to worry about worrying. Thoughts about affording food, paying rent and providing for children supersede concerns about mental health. Anxiety doesn't manifest itself socially like we often hear about in the UK – instead it reveals itself in stress over basic needs.

It's rare that in Egypt or most other countries in the global South you'll encounter people talking about mental health, at least with the same level of nonchalance as you'll find many in the West doing. No one talks of low mood or struggles with their wellbeing. Hearing about mental health conditions is reserved for a very limited number of settings. Ask an acquaintance how they're doing and they might mention their physical health or cite a tough situation, but you won't be any closer to finding out their levels of anxiety or depression. To be honest, I don't even know if there's an Arabic word for 'mental health'.

Like most things, you only ever hear about or see the extreme cases. About the great grandfather who was admitted to a psychiatric ward or the uncle who killed himself because of depression. There's neither the nuance nor the invitation to talk about how we're feeling.

In the Arab world you'd struggle to point to examples of media and popular culture intersecting with mental health – at least ones that don't present a very rudimentary understanding of the issue:

Looking at mental health through the prism of social class and socioeconomic status will bring up similarities to the Middle Eastern approach.

In the West, poorer people underuse or are under-prescribed mental health services and treatments. More and more research is showing that to be the case. People in low-income groups also tend to have a weaker understanding and acceptance of mental disorders when compared to richer people – this is what academics refer to as mental health literacy.

All this is in spite of a growing link between poverty and mental health conditions. Research is also showing that poorer people are more likely to experience issues with their mental health when compared to those with better finances. In some cases, mental disorders are twice as common among the poor as among the rich. It's no surprise, really.

And yet just like the men and Arabs I've clumped into this Culture, there's difficulty in – or a rejection of – accessing services and seeking help. Problems are generally left ignored.

Culture B

While one Culture finds its inhabitants bottling up their emotions, we have another on the opposite end of the scale. Here, people excitedly shake the bottle and spray its contents everywhere they can.

In Culture B, the stereotypical middle class White liberal Westerner values their own mental health above anything else. But not only that. They go about it in ways that are almost the polar opposite of what's seen in Culture A.

I couldn't tell you what the Arabic for 'mental health' was, but I could name about five synonyms for the phrase in English. In the West, mental health feels like an all-consuming topic. It's become a vehicle for most of our struggles, even an extension of who we are. Experiencing depression or anxiety has almost come to be a part of our identity.

Conditions like OCD, and terminology like 'trauma', are undermined and appropriated too. Terms that were once reserved for clinical environments and accredited professionals are now watered down, used colloquially.

I'm in no way trying to dismiss the fact that many people do suffer from these issues and live with mental health difficulties, but I'm pointing out how mental health has essentially become fashionable for many more people. If there's something wrong in your life, you feel compelled to anchor it in a self-diagnosed illness.

I'm guilty of this myself. As a teenager, I'd experience lots of mood swings, and after attending a talk about bi-polar disorder, I was convinced I had the condition. It felt comforting to believe that I had something to blame for my low moods, something to make me feel unique. But there was no basis for my belief.

Where issues are wrongly diagnosed, I think there are a number of reasons why we're eager to label and attach ourselves to a condition. Like I'd desired, it can give you closure or at least an understanding of what's wrong. Or maybe it's about attaching value to our lives. With the erosion of many communities and the dominance of materialism and consumerism, these new philosophies aren't exactly healthy or sustainable, so we seek a group to belong to and a renewed sense of identity.

Profit-seeking services and apps capitalise on this vulnerability and turn wellbeing into a commodity. Billboards and the App store are plastered with supposed quick-fixes for our negative feelings and shortcomings. But not only are these services, like online counselling, usually poorly regulated and moderated, they falsely sell the dream of a silver bullet.

These apps in turn add to the mountain of shallowness I find almost inseparable from mental health in this Culture. Looking after yourself is a pursuit that's catered towards the rich and the hedonists. Good mental health is reduced to walks, duvet days, self-help books. These 'solutions' create the illusion that they have all the answers and that they possess the ability to magically heal us of our issues with little effort.

For the most privileged in this Culture, I cynically think that perhaps substantial struggles are hard to come by, so mental health problems are created or accentuated as substitutes.

With how these approaches are portrayed, I can't help but wonder what a luxury it is to invest in a therapist who entertains your menial thoughts for weeks on end, or to let people know whether you're feeling 'red, amber or green' today. Who else other than self-indulgent, bored people have headspace and time for those things? They've mastered the art of creating trouble out of nothing.

Only the rich can – literally and metaphorically – afford to worry about their mental health to the extent that they seem to. Issues are magnified and fixated on. These groups not only have the privilege to be lost and then go on a quest to find themselves but they also find this pursuit appealing. Material objects that they don't own are sparse. So what else is there to live for? The pursuit of happiness. The rollercoaster of emotions. The traffic light system.

Ultimately, I feel like mental health in the West has become overly commercialised and trivialised, made into a commodity or luxury. Therapists are idolised and mental health conditions are eagerly self-diagnosed.

Counselling can be great, writing journals is useful for many people and being open about our mental health is important. I'm not knocking these things. But the fact that many of those in this Culture approach mental health with so much individualism and sense of entitlement is personally off-putting.

As the author of 'Humankind' Rutger Bregman says, "I'm not a fan of the self-help genre. If you ask me, we're living in an age of too much introspection and too little outrospection."

I'm usually all for the 'live and let live' attitude – Culture B seems harmless enough if people are ultimately seeking help and not negatively impacting others. But I don't think that's the case.

It feels to me a little counterintuitive – in this Culture we've become more concerned with our problems, but to the detriment of others and ultimately ourselves. We're so self-absorbed with our personal journeys that it's led us to be ignorant of other people's struggles. Our approach has become so simplified and trivial that we seem to be doing more harm than good.

Double trouble

The problem then is two-pronged. Poorer people are not only less likely to talk about mental health or receive help in comparison to affluent groups, but their problems are often worse, veiled away behind the voices and actions of those with collective power.

While people in lower income countries like Egypt appear to get on with their lives, they seemingly suffer in silence, heads buried in the sand. Meanwhile, the privileged are the poster-children for mental wellbeing; they've created a world where if you don't have problems it feels like you're the problem.

In this battle between the two Cultures it almost feels like rich people have dreamt up of mental health and its significance. But that's obviously not true. I think they've just 'hijacked' the conversation.

To me, there's a similar problem with the framing around the climate emergency. At face value, the debate on global warming feels like a playground for the privileged to just complain about yet another thing. It's the rich who are loudest and most concerned about the issues. And yet those who are most affected by its devastations are the poor and the marginalised.

Maybe I'm being harsh. Maybe it's magnanimous that the more well-off are fighting for the rights of the less fortunate. But the latter group are often not in the mix. On the whole, it's the minuscule and comparatively trivial things that are fixated on by the middle class. How often has the narrative been about plastic straws or hybrid cars as opposed to droughts or climate displacements? Reducing our individual carbon footprint becomes a competition and part of our privileged lifestyle or identity, while the marginalised are left to face the consequences.

Striking a balance

Ultimately, in this fight between Cultures A and B, neither of them in their fundamental form is appealing.

I want to reject the individualism and narcissism that I think has become synonymous with mental health in the West. But I inevitably end up associating instead with attitudes that almost entirely dismiss the value of good mental health.

I have to consciously remind myself that just because the White Western middle classes are driving the narrative in what I believe is a superficial way, it doesn't mean their concerns are fabricated.

Unfortunately I don't think this dilemma is unique to me. Mental health inequalities are growing, partly driven by disparity in mental health literacy.

If the more marginalised groups aren't given power or represented in mainstream conversations, the narrative will remain the same. Issues will still be framed in a damaging way, and progress in reducing inequality will be slow.

It's not self-centred nor is it a commodity to speak to a counsellor. There's nothing new-age or lavish about having a healthy emotional relationship with your loved ones. These statements are sensible enough. But they might seem odd if you've been christened in a culture that ultimately looks down on these things, where not dealing with your issues is instead encouraged.

If these two ways of thinking – or Cultures – remain at opposite ends of the spectrum, in conflict, then they will be viewed as mutually exclusive. Large swathes of the population will feel like they have to make a choice between one or another.

But this doesn't have to be the case.

By bringing together the two Cultures, I think the respective bubbles can be burst. Mainstream campaigns and narratives driven by the more powerful groups in society need to invite and better integrate the cultures that often aren't given a platform. Inclusivity and representation are becoming increasingly important principles across society – the mental health conversation should be no exception.

TV programs, national campaigns and other efforts to remove mental health stigmas and improve literacy in the UK feel to me like they're very much crafted by and catered towards the more privileged groups. Celebrities are very often the subjects of documentaries, and while I'm not ignorant of their influence, I worry that the conversation will remain enshrined in privilege. By lacking voices from harder-to-reach communities, the perception of mental health as a rich person's worry is unlikely to fade. When mental health is talked about in terms of 'wellbeing breaks' or similar concepts, it's not surprising if that puts people off.

I don't think representation is the sole answer – affordability of services and taking a more holistic approach, like creating better living environments, are also crucial – but it's a relatively small step in the right direction. Breaking down the barriers that are intertwined with Culture A can help change the way people perceive mental health, it can remove stigmas and it can make it easier to deal with our issues in a healthy way.

Like most things, the solutions will likely take lots of time, effort and luck. And like most people, I'm no expert on any of this. But I'm hoping that we're not far off finding some middle ground for how to approach mental health.

Notes

As I've been editing this blog I've come across two pieces that I think complement and add to what I've written – some of what I feel and have tried to explain are covered in more depth and coherence, so I highly recommend reading them:

• Are you mentally ill, or very unhappy? Psychiatrists can’t agree

• How trauma became the word of the decade — and the Covid-19 pandemic