Jess Mookherjee Consultant in Public Health at Kent County Council @
I’m curious why there are people who still struggle to get a clear picture of the potential for public mental health. For me, public mental health has a fundamental part to play in behaviour change and tackling health inequalities. In fact public mental health can help to answer how the ‘environment’ gets inside the body.
I studied human evolution and biological anthropology at UCL. This fascinating series of courses helped me to learn how important social interaction is to our biology, and also how evolving, as we did in the dangerous savannahs of Africa, – it paid off for us to have a pretty well functioning nervous system that could quickly alert us of danger.
It wasn’t just the sight of tigers that caused fear in our evolutionary history, but it was also other people. We are such an intensely social species that feeling left out, isolated from others, shamed and humiliated – often has fatal consequences.
My second epiphany – was reading Richard Wilkinson’s “Mind the Gap: Hierarchies and Human Evolution”. Later I read everything else by him and Michael Marmot and I would urge others to do the same. What Richard articulated so well for me was the link between the psychological and the social worlds and how both could rapidly become biological i.e how feeling bad – can get inside your body. Feeling upset, hopeless, full of shame, being humiliated and anxious – for long periods of time – actually ‘corrode’ your internal organs and leads to illness and disability! His book with Kate Pickett, “Spirit Level” is full of excellent research that backs this up.
Another of my public health heroes, Sir Harry Burns (CMO for Scotland) is often heard saying that – what seems to happen is that people, when faced with the shame, humiliation, loss of livelihood combined with living in poor, cramped conditions will often “fight, drink and kill each other”. What Richard and Michael say is that chronic and long term stress – wherever you live – can also end up killing you.
The agent of these behaviours is the hormone – cortisol. This has become known as the ‘stress hormone’. It has an important role in helping our immune and digestive systems functioning properly. Linked to our production of adrenaline, it sits with our ‘fight or flight’ system. If we have short bursts of cortisol – then that’s fine, it’s a good signal to start running away, or it can even feel quite good – like watching scary movies, or getting ready for a performance. But if you are getting slow, continuous and long term bursts of cortisol – say for many years, and more dangerously – during childhood, then this can lead to real physical changes in your biology.
It can lead to your bodies self regulation system mal-functioning, the hunger triggers can malfunction, the glucose production system can go awry. Wound healing can take longer because the body becomes less efficient at coping with inflammation. People end up doing things that that take away these bad feelings- often these things are ‘addictive’ and lead to further damage – chemicals like alcohol, tobacco and poor quality sugary food provide temporary relief. But these can also lead to people feeling even more powerless.
No wonder- as Sir Michael Marmot’s long term “Whitehall Studies” showed, the more powerful you are – the healthier ( and longer) you live. For me – this clearly shows – how emotions and the environment (and this absolutely includes the social environment) gets inside us. This is how important it is to get our ‘public mental well being’ programmes right.
I think there is an antidote. For me the evidence points to two main things, firstly – having some sense of control. This can range from mindfulness practice, CBT, building confidence, knowing who your MP is, to having some say in being able to make life better for yourself. Acting in ways that either calm the cortisol response or use up the cortisol and signal that ‘help’ is at hand will be helpful.
Secondly – living near and being close to people who can help you, who will be kind to you and perhaps – even love you. There are many communities like this, who group together and take care of each other – even in adversity. These add up to individual and social Resilience and public mental health programmes must help build both.