[00:00:00] Hello, hello hello, and welcome to English Learning for Curious Minds, by Leonardo English. 

[00:00:11] The show where you can listen to fascinating stories, and learn weird and wonderful things about the world at the same time as improving your English.

[00:00:20] I'm Alastair Budge, and today we are going to be talking about a sensitive topic: mental health.

[00:00:28] It’s a topic that affects every single one of us, with some of us struggling with it more than others. 

[00:00:35] This episode, however, is not going to be preachy or to try to give you any advice about your mental health, of course it isn’t.

[00:00:44] Instead, we are going to explore how mental health has been perceived throughout history, we’ll talk about mental health today, and look at some of the reasons that led a top UN official to declare that we are living in a mental health crisis. 

[00:01:00] This is also a member request from Hana, so Hana, if you’re listening, thank you, and I hope you enjoy it.

[00:01:07] OK then, A Short History of Mental Health.

[00:01:13] If I had to ask you what you thought the oldest surgical procedure in the world was, what would you say?

[00:01:20] Perhaps it might be removing a tooth. 

[00:01:24] Perhaps the amputation of an infected toe.

[00:01:28] Perhaps it might be stitching up a wound. 

[00:01:31] These are all contenders, but let me add one that you might not have thought of.

[00:01:38] It was a procedure that was thought to be too dangerous and too risky to have been performed by anyone apart from the most skilled of doctors, something that barely anyone would have survived.

[00:01:52] But when a team of French archaeologists excavated a burial site from 6500 BC, eight and a half thousand years ago, they were struck by something strange about the skeletons they found there.

[00:02:10] Of the 120 skulls that they found there, 40 had holes in, holes that had been carefully drilled into the skulls.

[00:02:22] This was the first evidence of trepanning, or trephination, a medical procedure that involved cutting a hole into the skull.

[00:02:33] Why might someone do this, you might ask?

[00:02:35] Well, it’s thought that one of the main reasons was that it was to cure a patient suffering from a mental health issue. 

[00:02:45] You can, perhaps, understand why a society with a very primitive knowledge of the human body thought this.

[00:02:53] If you cut your leg, the problem is clear, there is blood, you stop the bleeding and fix the cut.

[00:03:00] If you have a rotten tooth, you pull the tooth out.

[00:03:03] If there is a visible physical problem, you might not know how to fix it, but at least you can see what’s wrong.

[00:03:12] But if someone is behaving in an erratic manner, how can this be solved? 

[00:03:19] Well, perhaps the clue lay somewhere in their head, and by opening it up, perhaps whatever was causing the problem would go out and the problem would be solved.

[00:03:32] And as you may know, trepanning, the act of drilling a hole into someone’s head, was widespread; there is evidence for it all across the world, from South America to China, France to Russia.

[00:03:47] Something you might not know, however, is that this practice had advocates as recently as the 1960s, when a Dutch librarian drilled a hole in his own head as a publicity stunt.

[00:04:00] This is just one example of how confusing mental health was to medical professionals, and debatably, still is.

[00:04:10] For thousands of years, drilling a hole in someone’s skull was one way that people tried to “cure” mental health issues.

[00:04:20] And, while the advances we have made in most areas of medicine have been vast, with most people now able to live longer and healthier lives if they so choose, the same progress has not been made in the field of mental health.

[00:04:38] And, looking at the number of people who report having experienced mental health problems, this is now higher than ever before. A recent report from the Harvard Medical School estimated that 50% of the world’s population will experience a mental health issue during their lifetime.

[00:04:59] So, before we dive into the current mental health crisis, let’s talk about some history of mental health. 

[00:05:09] Fortunately, it isn’t all holes in the head, but there are plenty of equally grisly treatments.

[00:05:17] Given the fact that mental health problems are less visible than physical health problems, across cultures and societies, mental health problems were frequently associated with some kind of religious defect, someone was possessed by the devil, it was a problem between the individual and God, or some kind of moral failing caused by sin.

[00:05:42] Mental health problems were also understood by some physicians to be linked to physical health. 

[00:05:49] There was the Hippocratic idea of the four humours, that there are four elements of the body that need to be balanced, to maintain physical and mental health. Depending on how you felt, both physically and psychologically, different actions would be taken to rebalance these four humours.

[00:06:10] Now, this was completely flawed logic, we now know it to be untrue, but the shift from considering mental health issues to be some kind of religious defect to being a medical condition to be treated was an important one.

[00:06:27] Unfortunately, the “treatments” were pretty horrific. 

[00:06:33] If you were declared “insane” or “mad” in England, you might have been sent to a so-called “mad house” to live with other people suffering from similar conditions.

[00:06:45] If you were a woman suffering mental health issues, these might be interpreted as witchcraft and you might have been burned at the stake.

[00:06:55] You might even have been chained up, with hundreds of other people suffering similar issues, and members of the public would be able to pay to come and observe you, like animals in a zoo.

[00:07:08] Life was pretty grim. 

[00:07:11] In 1845, the British Parliament passed something called The Lunacy Act, which officially classified people who were mentally ill as “patients”, recognising mental illness as something to be treated as a health condition.

[00:07:26] They would be sent to “mental asylums” where they would be treated by medical staff.

[00:07:33] Unfortunately, conditions for people in these asylums were not much of an improvement. 

[00:07:38] It was, however, the start of an increased interest and more concentrated research into mental illness and how to treat it.

[00:07:49] Although the intentions might have been good, the results of viewing mental illness as a disease to be treated were, in many cases, horrific.

[00:07:59] In the 1950s both lobotomy and electroconvulsive therapy were popular “treatments” for a variety of mental illnesses. 

[00:08:09] A lobotomy is an invasive treatment where the lobes of part of the brain were severed, cut off.

[00:08:17] And electroconvulsive therapy, or electroshock therapy, involves sending electrical waves through the brain.

[00:08:25] Nowadays, lobotomies have been completely discredited, seen as being part of a dark period in psychiatric care, and electroshock therapy is only used in the most severe cases, such as imminent suicide, when all other options have been exhausted.

[00:08:44] Now, this brings us more or less to the present day.

[00:08:50] You heard at the start of the episode that the Harvard Medical School estimated that half of the world’s population will experience some form of mental health issue during their lifetime.

[00:09:03] And mental health issues are particularly prevalent among certain demographic groups.

[00:09:10] In the case of the United States, a recent survey shone some interesting light on this, on the reported one in five Americans who is currently living with a mental health issue.

[00:09:22] Women report suffering from mental health issues more than men, with 27% of American women saying that they have a mental health issue vs. 18% of men.

[00:09:34] And mental health issues are disproportionately skewed towards the young, with 34% of Americans aged 18-25 suffering from a mental health issue vs. 28% of adults aged 26 to 49 and only 15% of those aged fifty and over. 

[00:09:55] And there is also an interesting split by race. 35% of mixed race Americans reported a mental health issue, 24% of white Americans, and only 16% of Asian Americans.

[00:10:14] So, the million dollar question is…why?

[00:10:19] Or actually there are many more than one question.

[00:10:22] Why are so many people living with mental health issues in the modern era when people weren’t reporting the same mental health issues 100 years ago?

[00:10:31] Why are so many young people reporting mental health issues compared to older people?

[00:10:37] Why are women 50% more likely than men to report having a mental health issue?

[00:10:43] In the US at least, why are there more than twice as many mixed race people reporting mental health issues as Asian Americans?

[00:10:53] One theory that proposes an answer to all of these questions, in fact, is to do with the social stigma around talking about mental health.

[00:11:03] 100 years ago, if you thought you might be put in a lunatic asylum for telling someone you were struggling with your mental health, you would probably just keep quiet about it and suffer in silence. 

[00:11:17] Similarly, as discussion of mental health is something relatively recent, it’s natural that younger people are more willing to talk about it and admit that they have a problem than older people. 

[00:11:31] And to answer the question of why mental health problems are so low with Asian Americans, there is a particular stigma around talking about mental health in Asian communities, so, again, people suffer in silence.

[00:11:46] And of course, the same thing goes with men compared to women; there is more stigma for a man talking about his mental health than a woman talking about her’s.

[00:11:57] Or that’s one theory at least.

[00:12:00] Now, it’s clear that more people report suffering from mental health problems than ever before, but as to the question of whether this is actually because more people are suffering from mental health issues than ever before, or it’s only because more people are admitting that they are suffering from mental health issues, this is another very interesting and divisive question.

[00:12:24] In other words, did just as many people suffer from mental health problems 500 or 1,000 years ago, but because people didn’t talk about it, most people suffered in silence, and only the most extreme cases were reported?

[00:12:40] Life in the 21st century is easier in many ways than it has ever been before. We have machines that do most things for us, we don’t have to worry about being attacked by Vikings or dying from the plague or our children having to work in coal mines.

[00:12:58] But more people are living alone, there is the constant pressure to compare yourself to others, people are more individualistic than ever before.

[00:13:10] Life is, in many ways, more complicated than at any other time in history.

[00:13:16] So, perhaps, yes, these are all factors that have meant that people are more likely to develop mental health issues. 

[00:13:24] And these simply weren’t factors that existed 100 years ago; people had different, some might say more important, things to worry about.

[00:13:34] But, on the other side of the argument, there are those who say that there really aren’t any more people suffering from mental health issues than ever before, but we have enlarged the category of mental health and have created a crisis where there is none.

[00:13:51] Pharmaceutical companies, so the argument goes, have seen a golden opportunity to treat “mental health” issues with expensive drugs, and this has led to a boom in people who are looking for quick, pharmaceutical, treatments to problems that they would have historically solved on their own.

[00:14:10] And, to continue the sceptic's view, it is completely natural and human for people’s moods to change, to feel better some days and worse the others, and so to encourage everyone to start viewing this as a health issue is to trivialise people who are suffering from real, more serious, mental health issues.

[00:14:31] To reiterate, this is not to belittle or cast judgement on anyone’s experience with their own mental health, but rather to explore both sides of what’s clearly a complicated and nuanced argument.

[00:14:46] Now, to finish off this exploration of mental health I want to leave you with a quote from the great French philosopher and historian, Michel Foucault.

[00:14:57] I like this quote for two reasons. Firstly because it comes from Foucault’s seminal work, Madness and Civilization: A History of Insanity in the Age of Reason, which is an amazing history of mental health over time, and one I would highly recommend for you to read if you can get your hands on a copy.

[00:15:16] And secondly, from an English language perspective, it is a complicated grammatical sentence that consists of very simple words.

[00:15:26] So, here you go, I'll say it slowly: "People know what they do; frequently they know why they do what they do; but what they don't know is what what they do does"

[00:15:46] OK then, that is it for today's episode on mental health.

[00:15:50] I hope it's been an interesting one, and that you've learnt something new.

[00:15:54] As always, I would love to know what you thought about this episode. 

[00:15:58] Do you think there is a global mental health crisis? What are some of the reasons behind it, and what are some of the solutions?

[00:16:05] How have attitudes towards mental health changed over the years in your country?

[00:16:10] I would love to know, so let’s get this discussion started.

[00:16:14] You can head right into our community forum, which is at community.leonardoenglish.com and get chatting away to other curious minds.

[00:16:21] You've been listening to English Learning for Curious Minds, by Leonardo English.

[00:16:26] I'm Alastair Budge, you stay safe, and I'll catch you in the next episode.

[END OF EPISODE] 

[00:00:00] Hello, hello hello, and welcome to English Learning for Curious Minds, by Leonardo English. 

[00:00:11] The show where you can listen to fascinating stories, and learn weird and wonderful things about the world at the same time as improving your English.

[00:00:20] I'm Alastair Budge, and today we are going to be talking about a sensitive topic: mental health.

[00:00:28] It’s a topic that affects every single one of us, with some of us struggling with it more than others. 

[00:00:35] This episode, however, is not going to be preachy or to try to give you any advice about your mental health, of course it isn’t.

[00:00:44] Instead, we are going to explore how mental health has been perceived throughout history, we’ll talk about mental health today, and look at some of the reasons that led a top UN official to declare that we are living in a mental health crisis. 

[00:01:00] This is also a member request from Hana, so Hana, if you’re listening, thank you, and I hope you enjoy it.

[00:01:07] OK then, A Short History of Mental Health.

[00:01:13] If I had to ask you what you thought the oldest surgical procedure in the world was, what would you say?

[00:01:20] Perhaps it might be removing a tooth. 

[00:01:24] Perhaps the amputation of an infected toe.

[00:01:28] Perhaps it might be stitching up a wound. 

[00:01:31] These are all contenders, but let me add one that you might not have thought of.

[00:01:38] It was a procedure that was thought to be too dangerous and too risky to have been performed by anyone apart from the most skilled of doctors, something that barely anyone would have survived.

[00:01:52] But when a team of French archaeologists excavated a burial site from 6500 BC, eight and a half thousand years ago, they were struck by something strange about the skeletons they found there.

[00:02:10] Of the 120 skulls that they found there, 40 had holes in, holes that had been carefully drilled into the skulls.

[00:02:22] This was the first evidence of trepanning, or trephination, a medical procedure that involved cutting a hole into the skull.

[00:02:33] Why might someone do this, you might ask?

[00:02:35] Well, it’s thought that one of the main reasons was that it was to cure a patient suffering from a mental health issue. 

[00:02:45] You can, perhaps, understand why a society with a very primitive knowledge of the human body thought this.

[00:02:53] If you cut your leg, the problem is clear, there is blood, you stop the bleeding and fix the cut.

[00:03:00] If you have a rotten tooth, you pull the tooth out.

[00:03:03] If there is a visible physical problem, you might not know how to fix it, but at least you can see what’s wrong.

[00:03:12] But if someone is behaving in an erratic manner, how can this be solved? 

[00:03:19] Well, perhaps the clue lay somewhere in their head, and by opening it up, perhaps whatever was causing the problem would go out and the problem would be solved.

[00:03:32] And as you may know, trepanning, the act of drilling a hole into someone’s head, was widespread; there is evidence for it all across the world, from South America to China, France to Russia.

[00:03:47] Something you might not know, however, is that this practice had advocates as recently as the 1960s, when a Dutch librarian drilled a hole in his own head as a publicity stunt.

[00:04:00] This is just one example of how confusing mental health was to medical professionals, and debatably, still is.

[00:04:10] For thousands of years, drilling a hole in someone’s skull was one way that people tried to “cure” mental health issues.

[00:04:20] And, while the advances we have made in most areas of medicine have been vast, with most people now able to live longer and healthier lives if they so choose, the same progress has not been made in the field of mental health.

[00:04:38] And, looking at the number of people who report having experienced mental health problems, this is now higher than ever before. A recent report from the Harvard Medical School estimated that 50% of the world’s population will experience a mental health issue during their lifetime.

[00:04:59] So, before we dive into the current mental health crisis, let’s talk about some history of mental health. 

[00:05:09] Fortunately, it isn’t all holes in the head, but there are plenty of equally grisly treatments.

[00:05:17] Given the fact that mental health problems are less visible than physical health problems, across cultures and societies, mental health problems were frequently associated with some kind of religious defect, someone was possessed by the devil, it was a problem between the individual and God, or some kind of moral failing caused by sin.

[00:05:42] Mental health problems were also understood by some physicians to be linked to physical health. 

[00:05:49] There was the Hippocratic idea of the four humours, that there are four elements of the body that need to be balanced, to maintain physical and mental health. Depending on how you felt, both physically and psychologically, different actions would be taken to rebalance these four humours.

[00:06:10] Now, this was completely flawed logic, we now know it to be untrue, but the shift from considering mental health issues to be some kind of religious defect to being a medical condition to be treated was an important one.

[00:06:27] Unfortunately, the “treatments” were pretty horrific. 

[00:06:33] If you were declared “insane” or “mad” in England, you might have been sent to a so-called “mad house” to live with other people suffering from similar conditions.

[00:06:45] If you were a woman suffering mental health issues, these might be interpreted as witchcraft and you might have been burned at the stake.

[00:06:55] You might even have been chained up, with hundreds of other people suffering similar issues, and members of the public would be able to pay to come and observe you, like animals in a zoo.

[00:07:08] Life was pretty grim. 

[00:07:11] In 1845, the British Parliament passed something called The Lunacy Act, which officially classified people who were mentally ill as “patients”, recognising mental illness as something to be treated as a health condition.

[00:07:26] They would be sent to “mental asylums” where they would be treated by medical staff.

[00:07:33] Unfortunately, conditions for people in these asylums were not much of an improvement. 

[00:07:38] It was, however, the start of an increased interest and more concentrated research into mental illness and how to treat it.

[00:07:49] Although the intentions might have been good, the results of viewing mental illness as a disease to be treated were, in many cases, horrific.

[00:07:59] In the 1950s both lobotomy and electroconvulsive therapy were popular “treatments” for a variety of mental illnesses. 

[00:08:09] A lobotomy is an invasive treatment where the lobes of part of the brain were severed, cut off.

[00:08:17] And electroconvulsive therapy, or electroshock therapy, involves sending electrical waves through the brain.

[00:08:25] Nowadays, lobotomies have been completely discredited, seen as being part of a dark period in psychiatric care, and electroshock therapy is only used in the most severe cases, such as imminent suicide, when all other options have been exhausted.

[00:08:44] Now, this brings us more or less to the present day.

[00:08:50] You heard at the start of the episode that the Harvard Medical School estimated that half of the world’s population will experience some form of mental health issue during their lifetime.

[00:09:03] And mental health issues are particularly prevalent among certain demographic groups.

[00:09:10] In the case of the United States, a recent survey shone some interesting light on this, on the reported one in five Americans who is currently living with a mental health issue.

[00:09:22] Women report suffering from mental health issues more than men, with 27% of American women saying that they have a mental health issue vs. 18% of men.

[00:09:34] And mental health issues are disproportionately skewed towards the young, with 34% of Americans aged 18-25 suffering from a mental health issue vs. 28% of adults aged 26 to 49 and only 15% of those aged fifty and over. 

[00:09:55] And there is also an interesting split by race. 35% of mixed race Americans reported a mental health issue, 24% of white Americans, and only 16% of Asian Americans.

[00:10:14] So, the million dollar question is…why?

[00:10:19] Or actually there are many more than one question.

[00:10:22] Why are so many people living with mental health issues in the modern era when people weren’t reporting the same mental health issues 100 years ago?

[00:10:31] Why are so many young people reporting mental health issues compared to older people?

[00:10:37] Why are women 50% more likely than men to report having a mental health issue?

[00:10:43] In the US at least, why are there more than twice as many mixed race people reporting mental health issues as Asian Americans?

[00:10:53] One theory that proposes an answer to all of these questions, in fact, is to do with the social stigma around talking about mental health.

[00:11:03] 100 years ago, if you thought you might be put in a lunatic asylum for telling someone you were struggling with your mental health, you would probably just keep quiet about it and suffer in silence. 

[00:11:17] Similarly, as discussion of mental health is something relatively recent, it’s natural that younger people are more willing to talk about it and admit that they have a problem than older people. 

[00:11:31] And to answer the question of why mental health problems are so low with Asian Americans, there is a particular stigma around talking about mental health in Asian communities, so, again, people suffer in silence.

[00:11:46] And of course, the same thing goes with men compared to women; there is more stigma for a man talking about his mental health than a woman talking about her’s.

[00:11:57] Or that’s one theory at least.

[00:12:00] Now, it’s clear that more people report suffering from mental health problems than ever before, but as to the question of whether this is actually because more people are suffering from mental health issues than ever before, or it’s only because more people are admitting that they are suffering from mental health issues, this is another very interesting and divisive question.

[00:12:24] In other words, did just as many people suffer from mental health problems 500 or 1,000 years ago, but because people didn’t talk about it, most people suffered in silence, and only the most extreme cases were reported?

[00:12:40] Life in the 21st century is easier in many ways than it has ever been before. We have machines that do most things for us, we don’t have to worry about being attacked by Vikings or dying from the plague or our children having to work in coal mines.

[00:12:58] But more people are living alone, there is the constant pressure to compare yourself to others, people are more individualistic than ever before.

[00:13:10] Life is, in many ways, more complicated than at any other time in history.

[00:13:16] So, perhaps, yes, these are all factors that have meant that people are more likely to develop mental health issues. 

[00:13:24] And these simply weren’t factors that existed 100 years ago; people had different, some might say more important, things to worry about.

[00:13:34] But, on the other side of the argument, there are those who say that there really aren’t any more people suffering from mental health issues than ever before, but we have enlarged the category of mental health and have created a crisis where there is none.

[00:13:51] Pharmaceutical companies, so the argument goes, have seen a golden opportunity to treat “mental health” issues with expensive drugs, and this has led to a boom in people who are looking for quick, pharmaceutical, treatments to problems that they would have historically solved on their own.

[00:14:10] And, to continue the sceptic's view, it is completely natural and human for people’s moods to change, to feel better some days and worse the others, and so to encourage everyone to start viewing this as a health issue is to trivialise people who are suffering from real, more serious, mental health issues.

[00:14:31] To reiterate, this is not to belittle or cast judgement on anyone’s experience with their own mental health, but rather to explore both sides of what’s clearly a complicated and nuanced argument.

[00:14:46] Now, to finish off this exploration of mental health I want to leave you with a quote from the great French philosopher and historian, Michel Foucault.

[00:14:57] I like this quote for two reasons. Firstly because it comes from Foucault’s seminal work, Madness and Civilization: A History of Insanity in the Age of Reason, which is an amazing history of mental health over time, and one I would highly recommend for you to read if you can get your hands on a copy.

[00:15:16] And secondly, from an English language perspective, it is a complicated grammatical sentence that consists of very simple words.

[00:15:26] So, here you go, I'll say it slowly: "People know what they do; frequently they know why they do what they do; but what they don't know is what what they do does"

[00:15:46] OK then, that is it for today's episode on mental health.

[00:15:50] I hope it's been an interesting one, and that you've learnt something new.

[00:15:54] As always, I would love to know what you thought about this episode. 

[00:15:58] Do you think there is a global mental health crisis? What are some of the reasons behind it, and what are some of the solutions?

[00:16:05] How have attitudes towards mental health changed over the years in your country?

[00:16:10] I would love to know, so let’s get this discussion started.

[00:16:14] You can head right into our community forum, which is at community.leonardoenglish.com and get chatting away to other curious minds.

[00:16:21] You've been listening to English Learning for Curious Minds, by Leonardo English.

[00:16:26] I'm Alastair Budge, you stay safe, and I'll catch you in the next episode.

[END OF EPISODE]