Although we still have a long way to go on mental health we should acknowledge progress made. Now we can speak of depression and other troubles and not be thought less of. We can discuss stress and pressure; the terrors of working our way towards gender identity and sexual orientation; dealing with loss and defeat and financial catastrophe; drug, alcohol and other addictions. And now, in the main, we do so in terms of mental health rather than mental illness.

Granted, there are appalling gaps in services in Ireland, especially for young people between 16 and 18; and such services as exist are overburdened and poorly distributed. Far too many of the general population are dependent on anti-depressants, prescribed or otherwise. In one of Irish society’s greatest unfairnesses, many families carry the great burden of a mentally ill or unstable member with little or no support. And to be clear about this: community care simply doesn’t work for people with more extreme disturbances. Nonetheless, we’ve come a long way. In particular, there is now a broad social acceptance that people’s mental wellbeing will oscillate across the life course. It wasn’t always so and in many places it still isn’t. Notwithstanding the probability that many prophets and sages and inventors, and great artists, were unstable, driven by visions and voices and familiar with the black dog, as it were, historically a stigma attached to anyone who wasn’t mentally well.

This is despite that fact that much of the world around us is terrifying, appalling and infuriating, as though designed to unbalance even the soundest mind. There are those, for example the late RD Laing, who saw madness as a justifiable response to the world around us. Or, as the great Japanese film maker Kurosawa put it, “In a mad world, only the mad are sane.”

One must add that people who are on the edges often make significant contributions to music, theatre, literature and the visual arts. Vincent van Gogh finally teetered over the brink. The poet Robert Lowell was bipolar. There was schizophrenia in Joyce’s family. There’s debate as to whether Syd Barrett was schizophrenic or bipolar – and there are so many more.

And that’s before we include those who have at one time or another had to face depression. Most recently, Bruce Springsteen has written of his own struggles – and, also of great significance, the role played in addressing his troubles by his wife Patti Scialfa.

GOING COMPLETELY SANE
The boundaries between mental health and ill-health are permeable and it is palpable nonsense to imagine that they are fenced off from each other. Through the course of life, we encounter events that throw everything off kilter – and periods of depression or even, in terms coined by psychoanalyst and Freud editor Adam Phillips, “lying fallow”, are among the ways we deal with them.

So it’s not the case that we are simply either well or sick. There are myriad variations and fluctuations across society, and most people succeed in managing their mental health. The problems arise when that control slips.

In his book Going Sane, Adam Phillips makes the point that “sanity” was first used by physicians in the 17th century to refer to “health in body and mind” and that its modern meaning as the opposite of madness only really developed in the 19th century. He comments that even though “sanity” has no poetic associations or scientific credibility, it has become a necessary term. In mental health, much like the rest of the human condition, it seems we find disorder much more interesting than order.

Just imagine a scene in a pub where tempers flare. As protagonists reach for bottles and barstools one of them restores order by becoming calm and reasonable. “What happened?” everyone asks. “Oh, he went completely sane!”

Also, Phillips notes that whereas there is tremendous fear of madness in our society “there is no particular enthusiasm for the idea of sanity.”

That’s true. There are vast outpourings in the media and social media on how to live, how to be happy, how to succeed, how to deal with problems with partners and children, how to have a perfect body, bedroom, kitchen, office, how to deal with this, that and every other thing.

In comparison, there is little about how to be – and remain – sane. It might not be the same as being “happy”. It’s likely to involve accepting degrees of unhappiness or imperfection.

It might, in other words, be about managing things so that they are as good as we can get them, given whatever resources we have and the pressures and constraints we have to deal with, rather than becoming ill because things aren’t perfect.

BRUCE’S DECADES OF THERAPY
Life isn’t easy. The black dog is out there. Drink and drug dependency can be a symptom as well as a cause. And so on.

In all of this, some people are innately more resilient than others. They have the temperament and the capacity to act and to exert control over their lives. Others, those who might be described as “people to whom things happen”, are more vulnerable and less able to exert that control and therefore are more in need of support from an alert networks of friends, co-workers, teachers, coaches and the like.

For our mental well-being, it’s good to talk and to be listened to, even just to know that you’re heard and that you matter. But there are also times when it’s good to seek professional help. Springsteen writes about decades of therapy, and how it has helped him be who and what he is. Let us not be afraid. Lots of us have done it.

But in so doing, exercise caution. There are, apparently, 5,000 psychotherapists and counsellors in Ireland and there has long been concern about the lack of qualifications, motivation, standards and regulation. If it ducks like a quack then it probably is a quack.

With that in mind, the Minister for Health Simon Harris has invited submissions on plans to regulate their practice and set out rules of professional conduct. If you have views on this, make them known.

If you’re trying to escape the black dog you don’t want to find yourself alone with the wolf in sheep’s clothing...