Locating wellbeing, understanding distress: reflections from the Layton Dialogue 2023

By Laura McGuire ~

“We feel conflicted about thought”, begins Professor Tanya Luhrmann. The experience of thought as interior and individual, or more diffuse – contained only partially, by a penetrable self-boundary – is non-universal. Different people may experience thought as less or more bounded, Luhrmann continues, and intuitions of the former are not unusual. We are hailed and entrained by “cultural invitations” to map the locatedness of thought in certain ways, and may, through practice, come to experience thoughts as not wholly of the individual mind. Traces of these kinds of intuitions, that the mind is powerful, and that a thought over here might affect something over there, are found in common expressions, ideas, and in idioms and metaphors. The way a poem might be said to have “come to me”, or how close relatives may be thought to have near-telepathic bonds, are given as examples. Other such traces might be found, perhaps, in the increasingly commonplace language of “manifesting” one’s desires through thought. Practices and places which enculture more porous experiences of mind continue to emerge, it seems. Bracketing questions of whether one’s thoughts have some external origin, or whether private thoughts might impact the outside world, these experiences of mind can be personally impactful. The development of a conversational relationship with a God through religious metacognitive training can be a comfort, and Luhrmann’s work finds that porosity beliefs shape the severity of distress in psychosis.

Both Luhrmann and Professor Daniel Nettle draw attention to the many practices and sites at which the (un)boundedness of the mind may be espoused and enacted. Focusing less on the experience of porosity, Nettle explores how varied conceptions of depression locate the mind and mental illness as of-individual or of-world. When the diagnosis of depression relates so closely to adverse life events, and correlates (and fluctuates) alongside income, might synapse- and neurotransmitter-oriented models of depression rightly be considered incomplete? A memorable diagram, charting a complex web of causes and contributors, is presented, demonstrating how different boundaries may be encircled as causes of depression. These boundaries have implications for how depression is approached, for which areas of policy and academic practice become relevant for its treatment and prevention, and how resources are mobilised for these purposes. Nettle argues that, while the drawing of boundaries may be useful – necessary, even, in certain circumstances – it is important to work against short-sightedness. Researchers might analyse their own boundary-making practices, and present their findings as only part of broader systems shaping mental illness and wellness.

Pharmaceutical solutions, suggested by serotonin-deficit models of depression, are alluring. Highlighted by medical anthropologist and Dialogue organiser Dr Liana Chase, while clinical trial evidence finds bounds to the effectiveness of antidepressant drugs, there exist many personal testimonies to their transformative capacity for some individuals. Luhrmann adds that suffering and anguish can too encourage optimism around pharmaceutical treatment. Well-intentioned researchers, and a desire to alleviate suffering, may combine with commercial incentives to produce a pharma-optimism concerning mental distress. This pharma-optimism may sometimes draw boundaries exclusive of the social, political, and economic factors shaping how we work, live, and play, which ultimately shape wellbeing and illness. Awareness of these broader social and political ecologies may aid in the avoidance of narrow attributions of illness causation: others, for example, highlight how mothers have been attributed undue causal weight when exploring outward-looking explanations for mental ill health.

A part of the Dialogue’s premise, and explored by the presenters and discussants, is the growing consensus that mental health and illness are not only the domain of the brain. Efforts to incorporate the “social” and “wider” determinants of health are increasingly prevalent in public health research, practice, and theory. Discussant Dr Anjana Bala highlights the emergence of condition-like neologisms (including “solastalgia”), linking from the outset forms of distress to their environmental context. Such consensuses, suggests discussant Professor Rob Barton, are continually reinvented, gaining traction at certain times while overshadowed at others. He cites Brown and colleagues’ 1970s Camberwell study, which relates “chronic psychiatric disturbance” to class-linked environmental differences, and more recent “4E” theories of cognition, as examples of cyclicity in the (re-)emergence of ecological understandings of mind.

Together, the presenters and discussants suggest the continuing relevance of an ecology of mind, both for understanding the lived experience of mind, and the complex systems shaping mental distress. The contexts in which boundaries of these systems are drawn are important too, becoming the assumptions which inform research, practice, and policy. What, asks an audience member, is shaping the presently forming consensus of more distributed understandings of mental health? This extended dialogue welcomes ongoing consideration of circulating cultural invitations to remember and forget, to entrench or crowd-out, more ecological understandings of the mind, mental illness, and wellness.

Laura McGuire is a medical anthropology doctoral student and research fellow. Her work explores practices of community gardening, and active and sustainable movement, and their promotion.

Further reading

Albrecht, G. 2005. ‘Solastalgia’ : a new concept in health and identity. PAN: Philosophy, Activism, Nature, 3. pp.44-59

Brown, G.W., Bhrolchain, M.N. and Harris, T. 1975. Social class and psychiatric disturbance among women in an urban population. Sociology, 9(2). pp.225-254