The term ‘mental health’ seems to spring up everywhere nowadays – without a clear definition, it’s mentioned from the boardroom to the classroom, in articles, hashtags, awareness campaigns and professional and personal development literature. And there seems to be a lot of enthusiasm about this newfound dialogue - the words psychotherapist, counsellor, depression, anxiety and OCD have entered mainstream discourse. But if we are serious about tackling mental health issues, we also need to educate the public about personality disorders, which are surreptitiously wreaking havoc in the home and the office.
The Objectification Of Mental Health
Many media personalities are opening up about their own mental health. It is something which requires an enormous amount of courage and vulnerability. And it is an amazing first step. Lives can be saved by talking. However, the kind of narratives shared in the media can do a disservice to the very cause they are championing – labels like depression or anxiety fail to capture the complexity of subjective emotional experiences which can sometimes have very deep roots. In addition, the overuse of these labels risks narrowing distressing affective states to mere biological phenomena to be diagnosed, measured and managed. There is a dangerous domino effect that occurs as a consequence of this ‘medicalization’ of mental health – individuals relinquish responsibility for their own behaviour, attributing the cause to some external source, like a disease-carrying insect. With such a mindset, these same individuals may then expect that a label, followed by medication and/or short-term therapies, will resolve their issues. The institutional mental health service providers, on their side, increase the number of psychiatrists and clinical psychologists whose job is to analyse, diagnose, prescribe, and does little to empower the individual to enact long-lasting change. At work this also facilitates an environment where managers are faced by a younger workforce who easily disclose their mental health issues and using it as a free mental health 'get-out-of-jail' card to justify what could be their incompetency.
Mental health is much more complex than a biological disease – one way of conceptualizing mental health would be to view it on a continuum, along which stretch our ways of coping with the world. At one end we have character traits and on the other extreme we have psychosis – a detachment from the world. In between these two extremes lie the ways of coping most readily associated with the general term ‘mental health’ - starting with neurosis and progressing to personality disorders (PD). Ways of coping with life, which some psychotherapists may refer to as ‘defenses’, are pretty much the same across the continuum, except that they drastically increase in firing capacity the closer we get to Personality Disorders. In some cases these defenses are clearly visible to people, while in other cases they are hidden in plain sight.
Human beings are relational - we live in and among others from even before the day we are born. Our sense of self develops in relation to our caregivers from the earliest days through what is often termed as mirroring or attunement. As a matter of fact, some say our sense of self is the experience of the other. Our subjectivity imbues our experiences of others, and vice versa. We are both observer and observed. So what does that mean about our mental health? Well, let’s try to make sense of this by looking at a fictional office scenario:
M. finds out they were not included in an email chain. M. could deem something is awry (‘Am I being sidelined?) or that it was just an oversight. How M. goes about dealing with this uncertainty will greatly reflect M.’s capacity to read or misread the intentions of others. This capacity may often (but not exclusively) be rooted in early attachment patterns (parent-child relationships) and can later in life take the form of personality disorders (PD).
Personality disorder in the office
Personality disorders (PD) are notoriously difficult to discern and to treat. These maladaptive modes of coping with the world reflect a pattern of early relationships which morph into rigid belief structures and defences that are well entrenched. The literature often refers to these early experiences as traumatic and abusive – but one need not have endured physical or sexual abuse to develop PD. Most often, invalidating or emotionally manipulative environments in respectful middle class families can yield the same disorders one may expect from the more ‘mediatized’ households ridden with poverty, drugs, alcohol, and violence. After all it’s not about how much, or how little, love parents show their children – it’s more about whether the child felt loved. So not only can these disorders be hidden behind a veneer of socio-economic propriety, but their manifestations can be subtle, seemingly conforming to a prevailing cultural ideal of drive and competitiveness.
To continue with the earlier office example, M. may very well construe their exclusion from the email chain as intentional, consequently blaming colleague O. for cloak-and-dagger tactics. However, M's misattribution of manipulative intentions to O. could be more reflective of M.’s early childhood experiences of rejection than any tangible fact related to current office dynamics. Regardless, M. will feel persecuted and therefore legitimized in defending their job at all costs, maybe going as far as thwarting O.'s professional development. Individuals with PD often engage in manipulative and passive aggressive behaviours, putting things in motion to discredit whomever they see as the source of threat, strengthening alliances or wooing managers and colleagues to fullfill their goals.
The relationships these individuals have with others are never experienced on an equal footing - rather, others are either tools to feed their (empty) sense of self, or are threats to their integrity. Their world is very black and white. But all this behaviour can remain quite under the radar and out of conscious awareness - M’s tactics can be subtle and can fester for long until O. feels the anxiety of an altered situational dynamic.
So how does this relate to mental health awareness? Well, if the target of M.’s resentment were to approach a manager to address the issue, what could they say? O. could fear coming across as accusatory, overly sensitive, incapable of working in a team with strong personalities. So would the only recourse for O. be to disclose a bout of anxiety and stress? But what will that solve? M. will go on operating as they do, possibly making it hard for many others – individuals with narcissistic personality disorders are known to function very well in corporate environments.
So despite all this mental health awareness, the crux of the issue, which began by a misreading of intentions, will remain unchanged and fester until the pattern repeats with others, in the hope that one day someone will have the courage to file a formal complaint with HR. An investigation could ensue, stressing out all the colleagues and managers involved in the process, and end up in a payout for M. who will then continue with the same behaviour in another office. So what can we do about these kinds of situations which are fundamentally related to mental health?
The first step would be to recognize that mental health is relational, and that it isn’t some objective disease out there that can be isolated and fixed. Our mental health is embedded in a context of relationships with others. A big part of training to become a psychotherapist is personal and group therapy. The aim is to get to that place of vulnerability which then fosters that embodied self-reflexivity so crucial in helping us discern what is occurring in the split second interactions that occur implicitly between people (i.e through tone, prosody, body language, facial expressions) and which influence our thoughts and actions. Now we cannot expect employees to spend five years training in psychotherapy while carrying out their day jobs. But we can help foster a culture of self-reflexivity, one that may help avoid what could be construed as accusations from an overly sensitive employee or the manipulating behaviours of a narcissist, both of which can equally dampen a team’s full potential.
The Real Chatham House Rules
Humans are relational beings, whether we like it or not. So what if these relational dynamics could be discussed openly, before they create excessive stress and anxiety resulting in time off work on one end, or investigations on the other end?
In one of my previous corporate jobs, we had a weekly team meeting held under the Chatham House Rules. I believe the aim of this group was well intentioned – fostering personal development and improving relational dynamics in the office through open communication which would remain 'confidential' (a la 'what happens in Vegas stays in Vegas'). But unfortunately no one had the courage to really say what was happening underneath the surface – and so the hour was wasted with inauthentic discussions that did not reflect reality – a real missed opportunity.
But what if there was a space aimed at fostering self-reflexivity? One where the aim is to let ourselves be slightly vulnerable, safely, and to reflect on our own behaviour and how it impacts others? These discussions could be led by a psychotherapist, bound by rules of confidentiality and privacy, as in group therapy. From the point of view of the manager, such a group could help process underlying tensions that are difficult to address but which are still impacting everyone in the team. The money invested in the psychotherapist could offset the additional stress and legal costs of investigations and future payouts.
In Mental Health Training there are modules that address these issues of communication.