As we in the UK move to a progressively relaxed series of social constraints, many are focussing on their proposed re-engagement with previous patterns of work and social life, others are seeking to hybridise their futures, and some have taken the opportunity to re-invent.
Many however, have experienced a change in circumstance and health status so profound, that they can see no easy way to reconnect with a life filled with potential or at least a life that they previously coped with. This appears to be especially true in the arena of mental health, social engagement, and the attainment of internal contentment.
This loss of contentment is typically nuanced, depending on the social, political, familial, and educational foundations that underpin each of our lives, and in particular our choice of social groupings or tribes, some of which are by choice, others by construct.
Inevitably ‘belonging’, the sense of a shared identity, a mutually agreed objective or common beliefs, creates an adhesion of constructs and can easily generate into persistent group think.
The Power of Group Think.
When it comes to social interaction, the aphorism is wrong: opposites do not attract. We unconsciously surround ourselves with like-minded people. This can lead to high costs of poor decisions, with highly charged and emotive defence of group opinion regardless of outcome. A state of being regularly witnessed across many professions and political groups, even more so in faith-based organisations, or those claiming righteousness or more often in those who rely only on their intuition – their “gut feeling” – when making decisions. People you see, are vulnerable to believing what they think is right, especially when it involves ‘identity’ or a perceived sense of ‘righteous belonging’.
The right groups, with the right processes, can make excellent decisions. But most of us do not join groups to make better decisions. We join them because we want to belong. Group think persists because group think feels good. Yet some professions are sending out feelers, encouraging discussions and exploring changes in treatment plans, and all the more so as the burden of Covid has demonstrated considerable resource depletion and capability.
Psychiatry is Evolving to Include Lifestyle Interventions.
Psychiatry is one of the professions embedded in strategic application of care via talking therapies and linear or stratified biochemical interventions that is undergoing a challenge to historically evolved clinical strategies. In large part this is driven by a recognition that there are increasing demands being made of a limited resource, and that the established clinical tools have limitations. The pandemic has pushed the fragility of many of our biological systems to the point of symptomatic breakdown, and mental health and wellbeing is leading the way. The system was already unable to meet clinical need and as primary care clinicians are leaving their profession faster than they are being replaced, other strategies, exempt from pharmaceutical, or supportive of pharmaceutical care, are making waves.
The concept of lifestyle based mental health care in psychiatry is considered somewhat revolutionary in mental health professionals and expands traditional understanding of primary risk factors such as genetic, early life, socioeconomic and personality factors. Rather, dietary, exercise and sleep improvement, alongside smoking, alcohol and other substance use cessation, should form the foundation of mood disorder management, with the 2020 Royal Australian and New Zealand College of Psychiatrists describing it as ‘essentially non-negotiable’.
Nutrition and Mental Health
Accumulating data suggests that diet and nutrition are not only critical for human physiology and body composition, but also have significant effects on mood and mental wellbeing. A healthy dietary pattern can affect mental health and well-being through anti-inflammatory, antioxidant, neurogenesis, microbiome- and immune-modifying mechanisms, as well as through epigenetic modifications. Some isolated nutraceutical agents are efficacious as adjunctive and monotherapies in some mental and neurodevelopmental disorders. For example, N-acetyl cysteine (NAC) a bioavailable amino acid that upregulates glutathione and modulates glutamatergic, neurotropic, and inflammatory pathways – has shown preliminary efficacy as an adjunctive treatment in schizophrenia and bipolar depression. Oily fish and its essential fatty acid derivatives EPA and DHA have also shown success in mediating inflammation driven depression. The factors that contribute to the development of mental disorders are complex and multitudinous, and dietary change should be considered an essential part of a range of safe and cost effective lifestyle strategies.
Given the very large burden of illness imposed by mental disorders and the evidence supporting the importance of nutrition to mental and brain health, it will be critical to continue to prompt key allies in public health to advocate for policy change to improve the food environment at the population level. As recently seen in the Sars-Cov-2, induced changes to societal operation individualism can be costly. Focussing as the UK and USA have done on individual imperative (which includes mask resistance, vaccine avoidance, viral denialism etc.) represents one end of a cultural spectrum with collectivism at the other, independence versus interdependence, “me first” versus “we first.” Our normal clinical work focusses on the individual or small groups, but the strategies we employ also have a role to play in public health. It will just require a significant shift in the economics of food companies and their consumers to bring this message home.
Interestingly an interior executive report from Nestle (reported in the FT) announced recently (June 2021) that the majority (60%) of their food portfolio is unhealthy and their shift towards less processed foods will be slow due to commercial constraints. Yet the executives recognise that consumers are increasingly turning away from unhealthy foods and as such their business model needs to get ahead of the curve. In part Nestle have already demonstrated their interest in specialist health promotion via their extensive portfolio of food supplement companies.
Ironically, it is the group most in need of better food that by geography, income and education tend to be exposed to the worst of foods and consequently generates the biggest challenge for public and private health generation.
Group think has permeated the world of Covid-19 related discussion, some with good reason others with little more than ensuring the tribe members hear what they want to, and as such reinforce their existing beliefs.
Yet outside of these often small, centralised memes of emotive opinion, there are clearly changes occurring. Many of these are slowly driven by rationalised decision making in the great food producing companies, others by more local and personal options. Some of which will be short lived, others will lead to lifetime changes in approaches to decision making.
Globally this wave of change will inevitably leave many behind. Politically focussing on measurements of recovery via GDP alone, is inadequate and unsustainable. Rather the health of the nation, founded on the health of the soil and the availability of nutrient rich foods, as well as mental wellbeing represent alternative, but under appreciated measures of a successful economy.
It’s quite clear that decades of poor public health policy, in which economic interests have swamped cultural and lifestyle imperatives have created the emergent risk of a pandemic exhausting medical capabilities.
Creating engaged, active, inspired and focused people to drive a systemic appreciation of lifestyle and in particular nutrition, is a simple, cheap and safe way to help reduce the burden not just of mental health challenges, but also all other chronic and infectious disease risks. Changing public health messaging to promote societal and individual engagement is a least risk, most gain, strategic plan available.