Understanding student mental health difficulty deflection and darkness

Introduction

Mental health is something we all have to varying degrees. It is a phenomenon that transcends social, cultural, economic, and geographic divides – and most of us will encounter its edges if not its depths. Often defined as a state of wellbeing in which every individual realises their own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to their community (World Health Organisation 2001), mental health has become a particular concern for our young people. Research suggests that the majority of long-term mental health difficulties begin before the age of 25 (Kessler et al. 2007) and that as many as one in four young people struggle with their mental health (Dooley and Fitzgerald 2012; Dooley et al. 2019). Universities have noticed an increase in the number of students seeking help for mental health issues with the American Psychological Association (APA) (2011) describing as ‘alarming’ the increase in the number of students seeking help for serious mental health problems at campus counselling centres. While the APA go so far as to label this phenomenon ‘a crisis on campus’, they suggest that the percentages are ‘probably even higher’ (Eiser 2011, 18) based on the suspicion that many struggling students do not come in contact with student health centres.

The question asked by many is whether this increase in significant mental disorders reflects an actual increase in their prevalence or a narrowing in how we describe, diagnose, and respond to experiences of distress (Rose 2006; Brinkmann 2016; Johnstone et al. 2018). Using the example of depression, Rose (2006) deconstructs what he refers to as the ‘problem/solution complex’ which understands particular experiences only within particular frameworks. The ‘problem/solution complex’, in his words:

[. . .] simultaneously judges mood against certain desired standards, frames discontents in a certain way, renders them as a problem in need of attention, establishes a classification framework to name and delineate them, scripts a pattern of affects, cognitions, desires and judgements, writes a narrative for its origins and destiny, attributes it meaning, identifies some authorities who can speak and act wisely in relation to it and prescribes some responses to it. (Rose 2006, 480)

Thus, Rose (2006) presents constructions of ‘depression’ as discursive efforts to simplify the complex. In the most straightforward terms, these efforts embody ‘ways of making aspects of existence intelligible and practicable’ (480).

This paper sits carefully within these discursive efforts and wishes to explore them philosophically. Specifically, it turns to the work of Cora Diamond both to challenge dominant constructions – those initiated and entrenched, as Rose points out, by practices of framing, scripting, classifying, and diagnosing – and to open up new ways of conceptualising the nexus of mental health, well-being, and personhood. With reference to the title terms of our paper, we claim that Diamond offers a compelling insight into that experience of human difficulty so often subsumed by a medicalised vocabulary. We propose that she offers philosophically astute perceptions of the related human attempts at deflection (as when we fail to confront those very same difficulties because they are characteristically resistant to our thinking and immeasurably painful in their resistance). Bearing in mind the particular focus on Higher Education, this reading of Diamond is set against a broader understanding of the contemporary university as a place of institutional darkness. We argue that Diamond allows us to acknowledge this darkness as she returns us in a Wittgensteinian mode to an ordinary sense of the human.

In developing this general discussion, we place ourselves within a very particular context. We draw on the narrative landscapes of a number (n = 27) of third-level students in Ireland, who shared their experiences as part of a hermeneutic phenomenological study into the lived experience of mental health difficulties (Farrell 2017). Represented amongst these were undergraduate students (n = 21), postgraduate and doctoral students (n = 6), and a self selection of genders (9 males, 18 females), ethnicities, and types of higher education institutions (public universities, private colleges, and Institutes of Technology). For the purposes of this paper these data are used as stimulus rather than evidence. They are intended not to prove (a point or a theory) but to provoke. Diamond would say that they provoke us towards that which ‘is impossible to think, and yet is there’ (Diamond 2003, 15). Inspired by the work of Paul Standish (2001), as well as Fulford and Hodgson (2016), we acknowledge the empiricist bias of contemporary educational research and look again to Diamond to suggest that data (from the Latin datum – ‘that which is given’) might be invoked not so much to settle a difficulty but rather to stimulate or scaffold a new way of looking at it. It is in this vein of provocation rather than proof that we present these narrative landscapes.

Difficulty

People were completely misunderstanding the way I was communicating and I think it just, not that I got a little bit lost, but just things weren’t heard and especially when you go in to a therapy session and you have people who already have ideas about who you are because you have an eating disorder, it cuts you off, you stop. [. . .] I had one therapist who refused to believe that I wasn’t abused. She said, ‘until you can admit it, you are never going to get better’. She would give me books about not remembering being abused and I was like ‘But I wasn’t fucking abused (Kate).

I didn’t understand what it was, I didn’t understand what was going wrong and although you know, my parents, my mother was always very, ‘You can always ask us anything,’ and stuff, I would have still been an embarrassed child and you grow up in the west of Ireland, Catholic Ireland, you’re kind of just taught to be that way even if you don’t want to be and I didn’t really know how to understand what was going on myself (Ella).

Borderline personality disorder, that’s my favourite. I’m like, ‘You literally give that to everyone’ (Lauren).

Mental health difficulties are difficulties of reality. The students who participated in this study described the ways in which their experiences were difficult to identify, difficult to understand, difficult to describe, and difficult for others to understand. The first difficulty arose in recognising ‘it’. ‘It’ was the word students used to describe their own particular brand of mental health difficulty – be it depression, schizophrenia, anorexia nervosa, bipolar disorder, or anxiety. JD. described the onset of ‘it’ as being ‘like ageing. You don’t even notice yourself getting worse’, while Greg recounted that throughout his adolescence and years as an undergraduate he had ‘been suffering without really knowing’.

Not knowing made ‘it’ profoundly difficult to identify. For Marie, she ‘didn’t really understand’ what was going on for her: ‘I thought it was just me, this was how I am’. This lack of understanding permeated the students' accounts: ‘I didn’t understand what it was, I didn’t understand what was going wrong’ (Ella). If a student did manage to identify that something was wrong, they were then faced with the difficulty of describing it. Sarah described how she ‘couldn’t really articulate, I still can’t, what goes on for me, like, in my head’. She struggled to ‘put words on’ what was happening for her, something that is echoed in Mae’s experience: ‘I didn’t know what that name was’.

Interestingly, the work of Diamond points to an essential congruity between our particular inability to name things properly and a more general unintelligibility of experience. In Diamond’s work [particularly her articles ‘Losing Your Concepts’ (1988) and ‘The Difficulty of Reality and the Difficulty of Philosophy’ (2003)], there is a distinct deprivation in ‘not being able to name things properly’ (1988, 259). We search for the right words for the experiences that we encounter and sometimes, often in the experience of rupture or challenge, we fail to find them. We fail in our command not only of words but of concepts. Thus, tragically, we lose a sense of necessary connection with ourselves and our broader community.

For Diamond, the capacity to identify and to name has a profoundly important role in human life because a rich conceptual life enables a rich understanding of personal experience. To possess or to command a concept that is meaningful to your own biography and that locates that biography within a broader community of understanding inscribes your experience within a shared linguistic practice. Finding our concepts makes public the private and salvages community from isolation. Specifically, in ‘Losing Your Concepts’, Diamond outlines two ways in which conceptual articulacy may fail. Such failure may manifest either in the mis-expression of one’s thoughts or in a complete lack of expression: either in ‘misnamed’ or in ‘unnamed’ experience (Diamond 1988, 259). In the experiences of Ella and Lauren above, we find instances of the former (‘She would give me books about not remembering being abused and I was like ‘but I wasn’t fucking abused’; ‘Borderline personality disorder, that’s my favourite. I’m like ‘you literally give that to everyone’) and a consequent turning to anger, to cynicism or to a gallows humour.

Perhaps it is in the experience of Ella that the latter (the grappling with unnamed experience) comes most obviously to the fore: ‘I didn’t understand what it was, I didn’t understand what was going wrong’, she says. Kinsley, meanwhile, captures the struggle of misnamed experience on describing how he left hospital with this sense that his ‘leg was broken and now it was fixed [. . .] It was just making sure I didn’t break it again’. Finding and engaging with a usefully illuminating concept – in Kinsley’s case the concept of psychological trauma rather than the metaphor of a broken leg – offered ‘a bit of a turning point’ and the ability to articulate his experience in ways deeply empowering and validating. In Diamond’s terms, Kinsley’s coming into possession of the necessary concepts enabled him to ‘come into life’ in a very distinctive way. The recognition of himself as himself was made possible (Diamond 1988, 286).

In her emphasis on our involvement with language as a necessarily communal practice, Diamond is of course deeply indebted to the later Wittgenstein. Rejecting the prevailing picture of language as representation, or the idea that there is an objective connection between words and world, Wittgenstein argues that language does not link us to the external world per se but that language links us to each other. Words gather meaning not statically but in practice where such meaning is determined by context – by human ‘language games’, human ‘criteria’, human ‘forms of life’. Thus, Diamond follows Wittgenstein in his call that we return to our everyday and existing contexts and that we stop worrying about some kind of transcendent or metaphysical perspective. On this picture, meaning is a matter of use but this is not tantamount to saying that meaning is only a matter of use. Human imperfection is the best we have, in other words, and making peace with this imperfection involves acknowledging it as both limiting and constitutive.

One of the key aspects of Diamond’s interpretation of Wittgenstein is its profoundly moral inflection. If Wittgenstein denies the possibility of a private language, and urges instead that private utterances make sense only against a public framework of understanding, then Diamond interrogates what this denial might mean for the individual within the community. This moral inflection of Wittgenstein’s work is expressed most powerfully in Diamond’s 2003 essay, ‘The Difficulty of Reality and the Difficulty of Philosophy’. It is in this context that her acknowledgment of epistemological limitation combines with a profound emphasis on vulnerability and animality, and on the fleshiness and woundedness of our embodied selves.

What Diamond wishes to foreground in this paper is the human experience of conceptual failure. She wishes to draw attention to a cluster of experiences where everyday concepts falter or lose traction on encountering the inexplicably beautiful or the inexplicably horrifying. This is more than an absence (of language or understanding). It is an incidence of exile where we are driven out or literally ‘dis-ordered’ from our structures of signification. Such disorder is profoundly painful and profoundly isolating as it evicts us from everything and everyone that we thought we knew. In Diamond’s words: ‘What interests me there is the experience of the mind’s not being able to encompass something which it encounters. It is capable of making one go mad to try, to bring together in thought what cannot be thought. [This is] a difficulty that pushes us beyond what we can think. To attempt to think it is to feel one’s thinking become unhinged. [. . .] the difficulty, if we try to see it, shoulders us out of life, is deadly chilling’ (Diamond 2003, 12).

In the most straightforward sense (though there is nothing straightforward about Diamond’s paper), ‘difficulty’ involves a sundering between concept and reality. It involves a breakdown in its very literal sense. What interests Diamond philosophically in her range of examples (and these examples are literary rather than medical: a poem by Ted Hughes; a lecture series by JM. Coetzee; a memoir by Ruth Klüger; a story by Mary Mann) are those moments of uncoupling, or disconnection, or cleavage – those moments of conceptual collapse – when clarity gives way to bewilderment and comfort or habitat collapses to pain. ‘I mean that they can give us the sense that this should not be, that we cannot fit it into the understanding we have of what the world is like. It is wholly inexplicable that it should be; and yet it is’ (Diamond 2003, 13).

We suggest that Diamond’s concept of difficulty is particularly intriguing in its illumination of the gap between experience and concept. Highlighted continually in her writing is the profoundly disappointing aspect of language – the inadequacy of its communicative potential – and this disappointment is strikingly present in the accounts of these students struggling to attach words and meanings to their experience. Ashley, for example, describes unsuccessful efforts to communicate with a mental health practitioner armed with a professional framework of understanding: ‘you go in and you desperately want someone to help so bad that you can’t communicate what’s going on so they can’t understand and then they can’t get there’. For Millie: ‘It was all, kind of, just one big jumble in the head that I was just trying to figure out but I couldn’t. [. . .] When I was going through it I couldn’t actually grasp what was going on. I didn’t even really know how to explain it because it wasn’t like, oh I feel sick or something.’ And for Kinsley: ‘You can’t fully give voice to it, you know, because each individual experience is so unbelievably charged with incoherence that it’s hard to properly voice what, voice it, you know, and give logic to it. Because the thing with me was it was just unbelievably intense and acute’.

The experiences of Ashley, Millie, and Kinsley go to the very heart of human life. These are experiences that demand understanding (a particular phenomenon is so affecting that we are desperate to make sense of it) and yet jeopardise intelligibility (our failure to make sense of a particular phenomenon threatens our sense-making capacities in general). In Diamond’s work, we are alerted to these very disappointments and failures. She foregrounds the very real possibility that we might feel, at times, insurmountably unknown – even unknowable – and thus painfully distant from other people. Thus, Diamond urges us to be ‘realistic’ in her very particular understanding of that term. Given the disappointments of language – given the impossibility of transcending our human perspectives for a perspective transcendent or objective – she urges us to appreciate the limits of what we can think, the limits of what we can know, and the limits of what we can capture in language. And interestingly, she draws a profound connection between these epistemological limits and our limited condition as human – as finite, as vulnerable, and as mortal beings.

Deflection

When one specialist doesn’t know what to do and they send you to another and another diagnoses you with something else and another thinks you should be on different medication because you have something completely different you start to get a bit confused. You are like, OK, maybe just everything is wrong with me (Adrianna).

Once you have one diagnosis you end up with ten – every time you go in you get a different one (Sarah).

When he talked it wouldn’t be about the social side of things. It would be more like the chemical imbalance in my brain and he’d be more interested in the medication and stuff like that. He really noticed the medical side of things more than the other side (Thomas).

The sense that mental health professionals were exclusively interested in a process of diagnosis followed by medication reverberated in the experiences of a number of students. While for JD., it was hugely helpful to ‘name the monster’, for Sarah such naming could be both helpful (‘it would be good to know what is wrong with me’) and problematic (‘once you have one diagnosis you end up with ten’). Equally prevalent is the impression that psychiatrists were focused solely on righting hormonal discrepancy (fixing ‘the chemical imbalance in my brain’, in Thomas’s words). Millie understood her treatment for psychosis in the problem-solution complex identified by Rose (2006)(‘it was just psychiatrists, it was just medication, really quite medical’) but nonetheless resisted the value of this diagnosis as well as the value of the proposed treatment (‘that wasn’t at all what I needed’).

These young people all articulate a deep-seated resistance to being defined and treated only as medical problems. And perhaps one way to understand this resistance is to see it in Diamondian terms as an instance of deflection. For Diamond, it is a characteristically human tendency to distort or diminish the complexity of our experience. It is a characteristically human tendency to avoid difficulties of reality – those phenomena, again, that are ‘simply inexplicable’ by current conceptual frameworks or that cannot be reconciled with our present understanding of the world. A key facet of this avoidance is the turn to closely related but more explicable phenomena; the move here is from the opaque to the transparent or from the complex to the straightforward.

Moreover, according to Diamond, this tendency is a particular problem for the discipline of philosophy. At least partly because of its increasing specialisation and professionalisation, philosophy – for Diamond – circumvents unnameable difficulties for epistemological or moral problems ‘apparently in the vicinity’ (Diamond 2003, 12). Philosophy is only interested in those textbook problems that have been legitimised by thousands of years of discussion or that can be easily located in one specialised branch or another (How does the mind understand the world? How can I be sure that I exist? What do we owe to ourselves and to each other?). Thus, as philosophy falls victim to its own version of the problem/solution complex, it characteristically misaligns or misrepresents human phenomena. In the discipline as it currently stands, to cite Diamond once again, ‘an understanding of the kind of animal we are is present only in a distorted or diminished way’ (Diamond 2003, 11).

Diamond charges that it is characteristic of philosophy to deflect from experiences that it cannot understand. And in this sense, she picks up on a profoundly important motif in the work of her philosophical contemporary, Stanley Cavell. Cavell has in many of his writings drawn attention to our very human tendency not to grant other persons the complexity that we grant ourselves: it is a ‘human wish to deny the condition of human existence’ (Cavell 1988, 5), he writes. What Cavell means by this statement is not easy to parse but it involves at the very least his insight that an essential part of our human condition is the drive to see other persons in a two-dimensional or superficial way. We are never entirely comfortable with the reality that other persons might be just as complex and just as contradictory as we are. Rather, we characteristically deny and disavow their humanity and this disavowal too often has tragic consequences. This idiosyncratic interpretation of philosophical scepticism has taken Cavell from the silences of Lear and Cordelia to the hesitancies of Fred Astaire and – like Diamond – has extended traditional questions of epistemology (how can we know) into the complicated realm of human interaction and avoidance (how can we acknowledge).

According to Cavell, our relationships with other people are not a matter of accumulating more and more facts about them in order to prove that they are really there in front of us. Indeed, this drive towards accumulation is exactly why modern epistemology – from Descartes to Locke and on into the twentieth century – has faltered. When engaging with the problem of other minds, Cavell argues, modern philosophy has consistently been asking the wrong question. In place of ‘How can I know that you exist?’, he would wish us to ask ‘How can I acknowledge your full humanity?’ For Diamond, similarly, we have a human tendency to prioritise knowledge over acknowledgment. We have a human tendency to seek full control over another’s pain – to be more certain, more fixed, more in control – even if this problem-solving tendency causes us to bypass the depths and complexities of idiosyncratic experience.

‘The deflection into discussion of a moral issue is a deflection which makes our own bodies mere facts’ writes Diamond (2003, 13), and in this identification of avoidance we are returned again to the potentially deflecting practices experienced by our interviewed students. Here is Kate, who struggled with an eating disorder: ‘She said “we’ll being you in and you will eat and we’ll get you at a proper weight to be physically healthy and then after that we will assess you and see if you need to go on medication”. [. . .] I was like, if that is the way you are going to approach this, it’s ridiculous because it’s not about food . . . it’s not a solution’.

The last 100 years have seen a surge in medical and psychological conceptualisations of mental health which, combined with what Light (1991) terms ‘countervailing powers’, have made them the dominant and most culturally available narrativities of mental health in the west (Johnstone et al. 2018). These ‘countervailing powers’ include, amongst others, government regulation, corporate interests, and the actions of the public and the mass media (Light 1991; Busfield 2012, 2010), although Rose and others have taken care to highlight that ‘individuals play their own part in the medicalisation of problems of living’ (Rose 2006, 480).

For Kate, the professional response to her suffering indicates a too-easy reliance on such conceptualisations and narrativities and on a related diagnostic apparatus prioritising treatment over understanding. For Thomas, similarly, the idiosyncrasies of personal experience were evaded: ‘When [my psychiatrist] talked it wouldn’t be about the social side of things. It would be more like the chemical imbalance in my brain and he’d be more interested in the medication and stuff like that’. For Kate, Thomas, and for many other of the interviewed students, there is a distinct tendency to treat mental health difficulties as disorders. There is a distinct tendency to evade difficulties of reality, in Diamond’s terms, and to cleave to dominant practices of diagnosis and medication.

Darkness

People would say ‘why are you unhappy’? And I don’t have a reason. I don’t understand it myself. It is just the way it is (Fiona).

That’s one of the big problems with people understanding it. Because people don’t understand. [They say] ‘oh you must feel crap for a reason’, but the whole thing about depression is you don’t and that really sucks. That was probably one of the worst parts, trying to explain that. In the end you don’t explain it. Because it’s just too hard and people don’t understand (J.D.).

One thing which annoys me is that I can’t put my finger on why I feel this way. I don’t
come from a broken home, my family have been so supportive of me my entire life.
I sometimes wonder what I have done to deserve this? (Sarah)

In the Irish context, studying at university has become a social as well as an educational rite of passage. Nearly half of all Irish adults have a third-level qualification (OECD 2019) with almost a quarter of a million enrolling in a higher education course in 2018 alone (Higher Education Authority 2020). In the context of a highly competitive post-crash global economy, however, Irish university students are placed under increasing pressure to distinguish themselves from their peers via a portfolio of learning excellence and extracurricular achievement. Worsening economic variables necessitate growing numbers to undertake part- or full-time employment in order to cover registration fees as well as the basic costs of living. Almost one-quarter of university students now describe feelings of depression and/or anxiety with researchers noting a marked decrease in associated protective factors such as self-esteem, optimism and resilience (Dooley et al. 2019).

A recurring frustration for many of the students interviewed as part of this study was the inability to identify any factor in particular that led to the development of the problems they experienced. For many, not having a reason for ‘it’ made their experiences more difficult to make sense of or in some cases to justify. It was profoundly difficult for these young people to accept that someone might struggle for no reason at all. In Annie’s words: ‘I don’t think there was ever really a cause for it. That kinda makes you feel like you don’t have a right to be upset, you know? Because you don’t have a massive reason behind it’.

While the struggle to identify a particular cause or reason for life-long distress was a factor in many of these students’ experience, it is nonetheless the case that the university itself can be a contributor to mental health difficulties. Indeed, in Philosophy of Higher Education, and in Higher Education Studies more broadly, there is a nascent but nonetheless distinctive research literature that identifies darkness at the very heart of the university institution. Probably the most influential piece of work in this area is a 2017 article by Søren Bengsten and Ronald Barnett entitled ‘Confronting the Dark Side of Higher Education’. The authors use the term ‘dark’, in their own terms, ‘to comprehend challenges, situations, reactions, aims, and goals, which cannot easily be understood and solved by agendas of quality assurance and professionalisation of higher education’. They draw attention to the multiplicity of conflicts that are emergent at a student as well as an academic level. Here the quotidian activities of teaching and research are stymied by paralysis and fear. ‘There are no guarantees that higher education will lead us out of the cave’, write Bengsten and Barnett. Rather, ‘higher education could, uninten- tionally, get students sidetracked into an existential or epistemological darker place’ (Bengtsen and Barnett 2017, 124).

Higher Education as a distinctively dark place is explored also in work relating to doctoral education (Bengtsen and Barnett 2017; Elliot et al. 2016) and with reference to the university as a concrete space as well as an abstract ideal (Nørgård and Bengtsen 2016). Enslin and Hedge (2019) write of academic friendship ‘in dark times’ while Dall’Alba and Bengsten (2019) ‘delve into darkness’ in their re-consideration of contemporary modes of teaching and learning. Oravec (2019) questions the ‘dark side of academics’ as she explores the realities of research metrics and professional gamesmanship while Barbour (2016) references ‘dark clouds on the horizon’ in the interrogation of education and neoliberalism. Barbour’s discussion is anticipated at least by Elizabeth Gibney in her 2012 piece for Times Higher Education (‘Caste into darkness? Academy losing soul in Faustian bargain’).

Over the past 10 years, there has been a notable increase in scholarship which does not mention darkness explicitly but nonetheless furthers the related idea that Higher Education on a global scale is falling far short of its ideals – that its discourses of progress, efficiency, and functionality have entirely replaced those of education, transformation, and care (Macfarlane 2019; Roberts 2013; Lynch 2010). This is a literature that speaks of alien landscapes, of gathering clouds, and of hidden dystopias. It extends the notion of educational darkness beyond teaching and learning to encompass all imaginaries of the university; here, the experience of Higher Education is potentially damaging for students as well as for academics. As Ian Kidd has pointed out, there are aspects of contemporary educational practice that accidentally or sometimes intentionally corrupt. Universities are typically imagined as special spaces to cultivate young hearts and minds but in actual fact they are just as likely to injure or to harm (Kidd 2019).

Certainly, the number of students disclosing mental health problems to their university is on the increase. A report by the UK Institute for Public Policy Research (2017) found a five-fold increase in the number of first-year students disclosing a mental health condition to their institution from the 2006/7 to 2015/6 academic years. These trends are mirrored in Irish universities with Psychological Counsellors in Higher Education Ireland (O’Brien 2019) reporting record number of students accessing university counselling services particularly for concerns such as anxiety, self-harm, and identity issues.

To the ongoing issue of mental health difficulties, Irish universities have responded in a variety of ways. Most commonly, they draw on medical, psychological, and public health conceptualisations (of mental health and dis-ease) to offer a variety of supports to students – from positive mental health weeks to free student counselling to psychiatric referral. These same conceptualisations are directly linked to culturally dominant discourses of mental health, which in turn are formative for key policies in Higher Education as well as third-level students’ own understanding of their well-being.

However, as established very recently by the British Psychological Society (Johnstone et al. 2018), such dominant discourses and conceptualisations change over time depending on changes in society. Our ‘vocabularies of distress’ are invariably ‘vocabularies of deficit’ (Gergen 1990); they pathologise or medicalise the individual and radically simplify a broad array of emotional and behavioural challenges. To cite the landmark ‘Power, Threat, Meaning Framework’ directly: ‘some of the most dominant and culturally available narratives are those which transform problems of living, usually involving deviation from a valued social norm, into an individualised medical problem’ (Johnstone et al. 2018, 84). In this focus on ‘an individualised medical problem’, we are returned again to the work of Diamond, for the emphasis throughout her work is not on the first-person experience of that which they find inexplicable but on the more general accord (or lack of accord) between mind and the reality it wishes to comprehend. In other words, Diamond’s difficulties of reality are not presented as problems for one mind but problems for Mind in the global sense. Jonathan Lear captures this point well when he writes of Diamond’s essay that ‘this is not merely an account of a person being driven crazy; it is mind’s report of casualty from a battlefront of understanding’ (Lear 2018, 1200).

This paper has focused on casualties from the battlefront of our understanding of mental health. It has been concerned with the experiences of young people who found themselves at key moments of their university experience shouldered out (to use Diamond’s phrase taken from a poem by Ted Hughes) from a shared everyday. The concepts offered to these young people by a professional or medical apparatus were in important senses limited or deprived. And so these young people struggled profoundly both to recognise themselves as themselves and to feel acknowledged by others.

Conclusion

As highlighted at the beginning of this paper, mental health issues are routinely understood in terms of a ‘problem/solution complex’. Everything from vague discontentment to extreme emotional suffering is rendered intelligible and practicable through related processes of judging, framing, problematising, classifying, scripting, narrating, identifying, diagnosing, and prescribing (Rose 2006). In this ‘problem/solution’ format, we are frequently encouraged to think of mental health difficulties as being ‘just like’ physical health difficulties. Kinsley describes this well when, upon leaving hospital following a major psychotic episode, he thought ‘OK, I’m totally cured, that was a crap seven weeks!’. In his own understanding: ‘there was just this sense that like my leg was broken and now it was fixed again. It was just making sure I didn’t break it again’. But Kinsley highlights too how drawing this conceptual parallel can be limiting; only a couple of weeks later, he again struggled profoundly and had to take time out of university. It was only when he was encouraged by a psychologist who ‘made me look at it in a way I hadn’t looked at it at all before’ to see himself as on ‘a path of recovery’ and began to take steps that he described as ‘massaging the brain a little bit back to normality’.

Overall, the students interviewed as part of this study were united in their frustration with this problem/solution complex. Sophie described desperation and disappointment on encountering a perceived evasiveness in the behaviour of mental health professionals: ‘they [psychiatrists] basically just medicate, that’s what I found anyway’ . . . [I] found it to be very much on the medical side of things and my actual stuff wasn’t being dealt with’ (emphasis ours). Such focus on ‘the medical side of things’ and not on the more holistic aspect of individual wellbeing was echoed in the experience of Thomas, who felt that his psychiatrist’s interest came solely from ‘a medical point of view’. For Adrianna, similarly, her perception was of a complexity of individual experience flattened to a diagnostic template: ‘When one specialist doesn’t know what to do and they send you to another and another diagnoses you with something else and another thinks you should be on different medication because you have something completely different you start to get a bit confused. You are like, OK, maybe just everything is wrong with me.’

What would it mean for us, when faced with accounts of distress, not to reduce complexity to simplicity – but to sit with difficulties of reality? What would it mean for the students encountered through these interviews if individual experience had not been deflected (into dominant conceptualisations of health or well-being) or avoided (turned into ‘ways of making aspects of existence intelligible and practic- able’, to cite Rose once more)? This, perhaps, is what Diamond encourages us to consider when towards the end of ‘The Difficulty of Reality’ she invites us to think about ‘what it would be not to be deflected as an inhabiting of a body (one’s own, or an imagined other’s) in the appreciating of a difficulty of reality’ (Diamond 2003, 13).

Such an appreciation would recognise the difficulties we are experiencing not as individual deficiencies but as metaphysical finitudes. It would recognise our students’ experience of distress as indicators not of personal but of human limitation. In this way, to parse Diamond as well as Cavell, what we are invited to consider is not knowledge but acknowledgment. What we are invited to face up to are the impossibilities of fully understanding ourselves as well as each other, the terror this presents, and the need for constant deflection of the difficult and the unknowable. We are invited to be compassionate in the face of all that we cannot quite understand.

Such compassion comes through in the performative dimension of Diamond’s 2003 essay which is consciously presented as struggling with its own knowledge. The philosopher in this context is not constructing any kind of stable framework. Her essay characteristically undermines and questions and doubles back on itself. There are no bullet–pointed sections suggesting a linear or straightforward progression. There is no tidy conclusion. Rather, what Diamond appeals to are four literary ‘touchstones’ united only by their foregrounding of the inexplicable. At the very least, we do not get the impression that she is offering anything like a confident or final word. There is no pretension or ambition towards expertise. All this of course is an attempt to critique the usual procedures of philosophy but there is significance also for constructions of discourse in general. Maybe in the lack of such pretension or ambition, the usual power assertions (‘here is a professional document explaining what mental health is, using a stable and agreed-upon socially constructed language’) are interestingly challenged or subverted.

We have suggested throughout this paper that the work of Diamond offers a philosophical space to explore the tensions and contradictions provoked by those mental health issues often embodied in human lives as an unnamed or misnamed difficulty – as an ‘it’ that cannot be identified but must be lived with nonetheless. We have appealed to Diamond’s work as a philosophical resource to palliate these absences or ruptures in our knowledge and to encourage an acceptance of human vulnerability. In the final analysis, what the philosophy of Diamond might offer the discourse of Mental Health is a richer sense of what human life is and an encouragement to hold this sense in mind without resorting to solutions or deflections. This is ‘where and how philosophy has to start’, writes Diamond (2003, 18) for it is at such instances of beginning – difficult as they might be – that the human condition is not resisted but fully taken in.

Disclosure Statement

No potential conflict of interest was reported by the authors.

ORCID

Emma Farrell

References

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