Is it okay to be not okay all the time?

On the unintentional consequences of an unconsidered approach to raising awareness on mental-emotional health, and its loose parallels to screening and overdiagnosis, briefly

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In "Is it okay to be not okay?", I had briefly written positively about the increasing awareness of the maintenance of mental-emotional health.

However, today I posit that this might not be a wholly societally beneficial trend, for the nature of the current implementations of such awareness-raising might bring about some unintended consequences.

Mental-wellness seminars peddled to students and young adults through our institutions of education today seem to always be quick to denounce the effects of stress and emphasise their deleterious impacts on our quality of life. Often, such seminars use scaremongering to make it almost sound like it's your fault if you have some mental-emotional issues that you cannot overcome because you simply weren't paying enough attention to your health to proactively seek help. 

Moreover, the bulk of awareness material today persistently perpetuates the platitude "it is okay to be not okay", focusing only on providing avenues to seek help and sharing common methods of "self-care", without clearly defining what issues might warrant the seeking of help in the first place. In addition to the lack of conversation and public discourse on the matter, this catalyses our inability to identify whether we actually have issues worthy of seeking professional help for. 

This seems loosely analogous to the problem of overdiagnosis in screening.

Simplistically, screening in medical science is where medical professionals try to look for the signs of a problem before a patient displays any symptoms, such that early intervention can be considered. Overdiagnosis is then the act of unnecessarily making people patients by identifying problems that might effectively never cause problems for the affected individual (for example, at the end of life, a person might eventually die with cancer but not from cancer, where a slow-developing mutation only starts causing problems a decade after they had died from other natural causes - the treatment of this mutation would not have extended the patient's life, thus its identification constitutes overdiagnosis). Overdiagnosis can also refer to the over-broadening of definitions of a disease, such that more people now "qualify".

Similarly, in the interest of extending the appropriate assistance to those who need it by not unwittingly leaving out persons on the higher extreme of the spectrum of mental-emotional health issues, the criteria for what constitutes a situation that qualifies for seeking counseling and therapy today has been calibrated generically, vaguely and low.

However, unlike a disease which might have objective indicators of infection, the mental health conundrum is compounded by the fact that everyone's standard of "okayness" differs from the next person, which would thus make counterproductive attempts to define the standard "okay".

Hence, since it is practically impossible to define a comprehensive universal standard for what is "not okay", it may be possible that many people face mental-emotional issues that are actually common, but fail to recognise them as such. 

This engenders a situation where frequently emotionally troubled individuals might be convinced that chronic mental disorders have befallen them and that it is all their fault, when this might not necessarily be the case. Their extensive worrying about these newly identified issues also likely leads to the deterioration of their mental-emotional well-being, further exacerbating their situation.

Similar to the nocebo effect, where a patient's negative expectations and beliefs of a treatment induces physiological effects that might cause the development of adverse side effects or symptoms that would not otherwise have occurred, this is a problem because these mental-wellness awareness-raising might build idealistic expectations of the "normal" experience in the youth, conversely causing increasing numbers of them to become "not okay" where they would otherwise not have been.

This quandary does not have an easy solution. 

By nature of its design, the entire field of self-help and self-improvement is beset by the paradox that the pursuit of such material might conversely reinforce the belief that one has a problem, for one does not seek help for a problem that does not exist; since one is pursuing self-help, it implies that one has a persistent problem that cannot be easily resolved.

Similarly, even if a redesigned school curriculum emphasises actionable techniques to tackle commonly identified mental-emotional issues, this very act of "teaching them how to cope" might conversely be undermining their confidence in their own coping mechanisms, fostering the false beliefs that there is something wrong with them should their unique coping mechanisms ever fail in trying circumstances.

Whilst these issues cannot be completely circumvented, their consequences can only start to be mitigated by the active identification and tackling of these issues in any concerned campaign.

Organisers of mental-wellness seminars can reframe their message and refrain from emphasising the detrimental effects of stress and pressure, by removing sensationalistic "audience engagement" activities that do not improve the participants' situation, such as quizzes to "measure your level of stress".

Instead, perhaps it would be appropriate to teach and allow participants to practice self-reflection and identification of personal triggers, and thereafter suggest actually actionable steps or mental questions that one can ask to regulate one's emotions and mental state.

Additionally, schools could systemically introduce robust and diverse systems for students to reach out for help by providing multiple sources of professional counseling services, and fostering a culture where it is not shameful or a "waste of time" to open discussion on mental-emotional issues that are, by their nature, non-academic.

This should be complemented by a comprehensive curriculum of emotional resilience training that is conducted unironically. Teachers must understand that these, alongside the current Character and Citizenship Lessons (CCE), are not a waste of time and deserve to be administered properly. Should some teachers really not be bothered as will invariably be the case, the detailed lesson materials could be made available and easily accessible for students to peruse at their own time.

Fostering a culture of openness can also encourage the development of spontaneous conversation that clarifies the community standard of what is "okay", so that students can share in the knowledge that they are not alone in facing some of the more common problems and concerns, and appropriately seek help for those that are indeed unique or more challenging to resolve. Not only would this allow students to learn from one another in adopting suitable coping mechanisms and strategies, but also individually personally build their emotional resilience through the experiential learning of surmounting various personal problems.

Through the trials of life and the associated development of maturity, it is okay to occasionally feel "not okay" - but when most of us so often feel that we are "not okay" all or most of the time, perhaps it would be timely to truly rethink, reassess, and redefine what being "okay" actually means.

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Important Advisory: I am not qualified to counsel, offer professional advice, or give medical diagnoses, but remain available for most well-intentioned conversation. If you think you or someone you know is facing severe mental-emotional issues, especially involving physical harm to self or others, please reach out to your local mental health service. You are not alone, and everything's gonna be okay. 

(Samaritans of Singapore 24-hour hotline: 1800-221 4444 )