Depression, difficulties with anxiety, difficulties with adjustment to new circumstances, problems in relationships, and other psychological and related problems are more spoken about and acceptable today than they have ever been. This is not to say that ongoing stigma is no longer a problem. It is. But social media and other platforms have been very useful in highlighting that personal struggle is normal.
In this post I’m going to explore the common issues that contribute to out-of-the-ordinary psychological difficulties and their roots. I would like to say that anyone reading this post, or struggling, should not be afraid of asking for help. Despite ongoing stigma linked with a belief that it’s shameful to be battling. It isn’t. We all go through hard times, and we can get through them more smoothly and quickly if we aren’t facing whatever it is alone.
Common psychological problems
The South African Stress and Health study (SASH) estimated that 1-in-3 people will suffer from psychological difficulties over the course of their lifetimes. Each year, 1 to 2-in-5 people will suffer psychological distress (Herman, et al., 2009). Although these statistics are relatively old, more recent studies by the World Health Organization (2022) indicate that general rates of struggle have not changed much.
Of the huge variety of possible mental health challenges, the most common in South Africa and abroad are anxiety disorders. These are followed closely by substance use (mainly alcohol abuse and dependence), and then depression-related problems. These issues collectively make up around 60% of the types of distress that people experience (The World Health Organization, 2022).
Another interesting thought is the differences that different genders experience in terms of distress in the studies above. Women experience slightly more in the way of distress than men. While men’s issues are dominated by substance use, women are more likely to experience issues related to depression and anxiety. I think it’s important to highlight here that these statistics don’t mean that women don’t experience issues with substance use, or that men don’t experience depression or anxiety. What they refer to is more the main issues that top the list for each gender.
These figures show that personal struggles are relatively common. It's also important to consider that they only look at those who have diagnosable issues. For those who face personal struggles that are not severe enough to diagnose, the related areas of their lives are still going to be hard. If they were considered, the number of people who were found to be suffering, would likely be much higher.
Avoidable versus unavoidable suffering
Suffering in some form is an unavoidable aspect of life. Sometimes it comes from unavoidable difficult experiences. Examples of these include the death of a loved one, the end of an important relationship, getting ill, or facing natural or manufactured disasters. At other times these experiences come from issues which could potentially have been avoided. This is especially true in situations which would be improved if people in our lives were more willing to get help themselves. Examples of this include the long-lasting consequences of overly harsh, or inappropriate discipline in childhood, or experiences of abuse or neglect. Another example is experiences in adulhood with unreasonable people in one form or another, who aren’t willing or psychologically able to take part-in fair, or mutual relationships that benefit both you, them, and others.
A third area is suffering that is self-inflicted. Here I’m referring to difficulties making good choices about when to commit to, invest in, or end a relationship, or a job for example. I’m also considering choices about taking steps to look after yourself as another example. This includes basic forms of self-care like getting enough sleep and proper food. It also includes self-care dedicated to engaging in fun or rewarding activities.
Making good decisions through managing feelings well
This third area is related to our abilities to make satisfying decisions about our lives and the things we pursue. To do this we need to be able to notice and successfully manage or act on the many feelings we experience. Because of what feelings are, they naturally affect or colour our experiences of the world. This means that we never truly see the world as it is. Take for example the experience of potentially good job offers, or relationships.
Fear is a feeling which exists to warn us about danger (Gomes & Semin, 2021). When we’re confronted by a dangerous threat in our environment, or from a plan we’re yet to act on. The areas of our brains responsible for fear jump into action to get us to do something to avoid or neutralize what feels dangerous. The model to describe our intuitive responses to danger used to be called fight-or-flight, but it’s now been expanded to fight-flight-freeze-fawn (Merlo & Sugden, 2023).
These are quick, or hardwired responses in our brains. They’re aimed at keeping us safe. They have a valuable place in doing so, in situations where we are in immediate danger. But intuitively acting on fear where there is no immediate danger, and without any thought can lead us into trouble. It can also deprive us of good experiences. In the case of the example of rejection. There is rarely any immediate danger, and yet the urge to avoid the situation (flight), or to feel paralyzed in relation to it (freeze) can be very strong.
Acting on these urges in a thoughtless way, has the potential for unwanted consequences. The person (potentially you) removes themselves from the possibility of getting the job. In the case of a relationship, they (you) remove themselves from what might turn out to be something mutually satisfying. This happens because you’ve prevented another person from considering whether you would be a good fit for them, or for the job. You’ve done this so that you can feel emotionally or physically safe. But the safe feelings you've pursued have had a cost.
From a purely rational perspective, the benefit of not being rejected, is far smaller than the possible benefits of giving the opportunity a go. In the case of the job, you stand to gain all the money you might have enjoyed while you work there. You also stand to gain possibly finding yourself at a workplace that will provide years of enjoyment and personal growth. In the case of a new relationship, you stand to gain possibly being part of a loving and satisfying relationship with somebody who you’re also physically attracted to. Take yourself out of the running, and suddenly none of those things are possibilities anymore.
The example that I’ve used in fear, is important. But it could also be explored with almost any feeling that you can imagine. If you’re interested in some reading related to this, I highly recommend “The Hidden Spring: A Journey to the Source of Consciousness” by Professor Mark Solms (2021) or, “The Archaeology of Mind: Neuroevolutionary Origins of Human Emotions” from Professor Jaak Panksepp and Lucy Biven (2012). All three authors have been hugely influential in the way I understand feelings and people.
Where emotional and psychological struggle comes from
To come back to a broader discussion of the topic of psychological difficulties and their roots. Family, and community experiences such as attuned, active, and involved parents or caregivers during childhood and adolescence, physical security, and safety across the course of one’s life, positive social networks, a sense of social worth and value, and available sources of social support are massively important.
Structural factors like suitable access to work and income, good quality infrastructure, equal access to basic services, access to quality “green” or natural spaces, social justice and an absence of random forms of discrimination, an integrated and unified society or community, income and social protection, and social and gender equality are also important (The World Health Organization, 2022). Where people face familial, community, or structural hardship during their childhood or teens, their risks of experiencing anxiety, substance-related, depressive, and other forms of psychological difficulty go up.
For somebody experiencing such difficulties already, it can be immensely difficult to work through and sort out the issues on their own. This is because human beings are hyper-, or ultra-sociable (Steklis, Steklis, Penaherrera-Aquirre, & Figueredo, 2023). What this means is that like bees, or ants, human beings are very reliant on one another (and on broader human society) to achieve both practical and physical, as well as psychological goals. In terms of difficulty, we rely on each other for all sorts of things. This includes gaining perspective or having somebody help us look at an issue with more distance or objectivity. It also includes emotional regulation, or plainly, having somebody help us to feel better. Some of the things which others provide us with that can be immensely helpful include reassurance, encouragement, challenging us where our views are incomplete, helping us see issues or ourselves more broadly, or considering possibilities we might have missed.
Another very important skill we learn from others is our ability to successfully engage with our feelings. Learning in this area starts during childhood, but continues throughout our lives. Parents or caregivers who struggle to help the children and teens they care for, to learn to successfully engage with and manage their feelings, lead their children into adulthood with struggles in this area of life.
As I highlighted earlier in this post, difficulties with engaging with and managing feelings, can have far-ranging consequences for the decisions that people make, and the satisfaction they find in their lives. Where these people choose to become parents, without intervention, they will struggle much like their own parents to pass on such skills. Without diving too deeply into it, this is where psychotherapy or sessions with a psychologist become very helpful in breaking a very unhelpful cycle.
Summary and conclusion
Personal struggle and emotional difficulties are common. Diagnosable challenges will affect about 1 in 3 people in a lifetime. Difficulties that are not severe enough to diagnose but still cause suffering, are likely to affect many more people.
Anxiety, substance use, and depression are the most common (though not the only) challenges that people face. Different genders face different types of challenges (and likely require support that is sensitive and takes these differences into account).
While certain forms of suffering are unavoidable, others are. Our ability to navigate around avoidable suffering depends on our ability to successfully manage our feelings. The ability to successfully manage feelings and make reasonably good decisions, is a skill acquired from good parenting or caregiving, and from other good relationships over the course of our lives. The relationships we experience during childhood and adolescence have the greatest impact in this area.
Other forms of adversity also increase the risk of experiencing suffering that might be otherwise avoidable.
It’s important for me to note as I wrap up this post, that I’ve intentionally not covered biological factors such as genetics, or the brain and physical issues related to it. These issues were beyond the scope of what I wanted to explore in this post. I will cover the brain, and other related areas in more detail in a later post on emotion and feelings.
References
Gomes, N., & Semin, G. R. (2021). The function of fear chemo-signals: Preparing for danger. Chem Senses, 46. doi:10.1093/chemse/bjab005
Herman, A. A., Stein, D. J., Seedat, S., Heeringa, S. G., Moomal, H., & Williams, D. R. (2009). The South African Stress and Health (SASH) study: 12-month and lifetime prevalence of common mental disorders. SAMJ, 99(5), 339-344.
Merlo, G., & Sugden, S. G. (2023). Trauma Considerations. In G. Merlo, & C. P. Fagundes (Eds.), Lifestyle Psychiatry: Through the Lens of Behavioural Medicine (pp. 63-70). Boca Raton: CRC Press.
Panksepp, J., & Biven, L. (2012). The Archaeology of MInd: Neuroevolutionary Origins of Human Emotions. New York: W. W. Norton & Company.
Solms, M. (2021). The hidden spring: a journey to the source of consciousness. New York: W. W. Norton & Company.
Steklis, H. D., Steklis, N. G., Penaherrera-Aquirre, M., & Figueredo, A. J. (2023). Human-animal interactions from an evolutionary perspective: Symbioses as extended ultrasociality. Human-Animal Interactions, 2(1). doi:10.1079/hai.2023.0028
The World Health Organization. (2022). World mental health report: Transforming mental health for all. Geneva: World Health Organization.
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