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Interview with Mat Savelli

📷 McMaster University

Journalist: Emily O'Halloran

Emily: Hello and welcome to SciSection. I am Emily O'Halloran and I am your journalist for today. Today we are joined by Dr. Mat Savelli, who is a professor at McMaster University and a scholar with a research interest in the history of psychiatry. Thank you so much for joining us.

Dr. Savelli: Thank you very much for having me.

Emily: So do you think we could start by just giving us a quick overview of your research in general and what you've been working on?

Dr. Savelli: Yeah, so, at the broadest level, what I'm interested in is the way that societies come to define mental health illness. You know, these are not naturally existing categories, the categories we have to create, we're continually in the process of redefining them. So I have done a lot of work in the past on Eastern Europe and what sort of what mental health looks like under communism. But lately, I've actually been working a lot on advertisements for psychiatric drugs, and I'm interested in what those advertisements say about mental illness and mental health.

Emily: Oh, that's so interesting. So do you think there's kind of an aspect of profit involved in, in those advertisements that kind of change people's concepts of mental health?

Dr. Savelli: Well, I mean, they’re advertisements, so they are absolutely profit, profit driven terms of what they're trying to achieve. For me. What's interesting is the way that despite being advertisements, people often don't think of them that way. So instead, we think about them as informative or educational. And they are in the sense that they do change how people think about mental health and illness, whether that's practitioners reading it. And that's kind of interesting because we typically imagined practitioners are immune to things like advertisements that they just, quote unquote, listen to the science. But but there's lots of research that shows that advertisements make a difference. And then some country's advertisements are geared directly at consumers themselves. Which is, which is fascinating because it changes how the sort of lay public thinks about mental health and illness.

Emily: Wow, that's super interesting. Um, so during a global crisis like COVID-19, do you feel that the primary onus for kind of helping to provide resources for student mental health? Do you think that lies within universities? Or do you think that is more so something that should fall within provincial jurisdiction?

Dr. Savelli: Yeah, I'll be honest with you, I might see it a little bit differently than then some other people in the University. My own belief is that actually even independent of COVID the university cannot actually respond or resolve the the mental health needs that people have that students have. And it's, I think it's a mistake for universities to try to become kind of many communities that do all things for all people. Because frankly, we're just not set up for it. You know, we're not a psychiatric hospital, we're not a mental health clinic. Although we've sort of set up a counseling center, even then I think a lot of students would say, it doesn't function very well or it's too crowded. For me, I don't think the solution is to hire more counselors or to hire more therapists. I, I don't think that there's a number that we could hire that would actually meet the needs. instead. It's about one trying to get the the rest of the community as you said, the province to pick up to sort of contribute to the cost and, and help resolve that burden. But I think even more importantly, we have to reframe the way we think about mental health and illness, and really the way that we think about distress. So a lot of students I think right now the only language they have to express distress is that of mental health and illness, but I'm not sure that that's actually very useful.

Emily: That's interesting. So do you think that kind of the conventional ways that we go about helping people with their mental health would also have to change in that reframing?

Dr. Savelli: Yeah, I think so. Um, so like an interesting thing for me to think about is the, the move to de-stigmatize mental illness with the sort of anti stigma campaigns that exists and there are loads them around campus, loads of them around around the province, and they come from a really good place. You know, that the move to D stigmatize mental illness really started because people who were diagnosed with conditions like schizophrenia, were truly ostracized from society. They may have lived in hospitals on the outskirts of the city. People avoided them on the street because they seem to be behaving a bit unusual or a bit strangely. They were denied the right to vote if they lived in psychiatric hospitals. So we're talking about quite profound stigmatization. But I think, in the effort to address that, what's happened is inadvertently, we've also kind of promoted a language around mental health and illness that encourages all people to understand themselves as potentially mentally ill at any point, and kind of on a precipice of, you know, you're always facing some sort of mental health danger. And again, I know that comes from a good place where we want to encourage people to seek help and so on. But I think a byproduct of it is actually we've, we've kind of taken something away from people, which is their ability to think about things like stress and tension, anxiety and sadness, to think about them independent of this kind of healthcare system framing.

Emily: So would you say that's dangerous? Because it kind of creates more. I guess, as you were saying less of a language of discussing your stress and your issues in your life without taking into account kind of the medical aspects of it. Like what sort of dangers Do you think that poses to us as a society?

Dr. Savelli: There are a couple. So one is it creates tremendous burden on the mental health care system. So we see this at McMaster with with counselors who are overloaded with cases, we see this in the community with psychotherapists or with psychiatrists who are kind of stretched to the limit. I think another part of it, that's, that's kind of concerning is the way that we think about mental health problems. We kind of tie them into our identity, right? If you think about the language, a person says, I have an anxiety disorder. I have bipolar disorder, I have ADHD and that kind of implies a part minutes. But actually, it might be more helpful to think about it like this. At this moment in time and this snapshot of my life, I'm experiencing these things, I'm having these sensations I'm experiencing these thoughts, I'm participating in these behaviors. And I think the problem with the kind of medicalized view is that it really encourages us to take it on as part of who we are as a person. And I think that that can sometimes be beneficial for people but it can also be quite limited.

Emily: Yeah, that totally makes sense. So I guess, are you sort of advocating for separating the symptoms, maybe from the symptoms, quote, unquote, I realized that in itself is sort of a medicalized term, but kind of separating that from the category of a mental illness of some.

Dr. Savelli: I mean, I think what I'm in favor of is trying to To get all of us to think about mental health and illness in really complicated, nuanced, complex ways to kind of acknowledge that. Actually, it's not quite as simple as saying, you know, ADHD is a disease, just like tuberculosis is a disease. Because that's not really fair. Or with tuberculosis, we can identify a particular bacteria, we know that big bacteria causes this disease, it's quite specific. Whereas when it comes to to mental health problems, they're more like kind of, you know, sometimes helpful, sometimes problematic metaphors that explain part of the human experience. But I think what we need to do is interrogate those metaphors, and think a little bit about what the consequences are. So there was a book put out a couple years ago by a quite a famous psychiatrist, this guy by the name of valid Francis It was called saving normal. And this was Big deal because he was as insider as one could get in the field of psychiatry, he is one of those prominent psychiatry in the world. And when even he was beginning to say, we're kind of losing something here, in this sort of over medicalizing of suffering distress and pain. For me, that was that was quite telling. And it sort of reflected what a lot of people have been saying for a long time.

Emily: That must have been like, very brave of him to do that, since he's so deeply embedded in that system.

Dr. Savelli: Probably probably quite challenging, you know.

Emily: So, if you're looking at sort of different stressors in people's lives that some people might categorize as mental illness, but you're essentially saying that it's, you know, just a part of the human experience. Do you think that consistent stress stressors should be addressed, but just not from the perspective of mental health?

Dr. Savelli: Yes, so So one thing I do want to be really clear about is you No, I absolutely believe that people's suffering is real. Their pain is real. their frustration is real. Their sadness is real. The question is not whether those feelings or experiences are real or worthy of attention. For me, the question is, what's the best way to respond to them? And I think if we if we frame them as always being kind of signs of a mental health problem for most people, they assume then that it requires some kind of medical solution. And I'm just, I'm not convinced that constraining ourselves is the best way to do that. So you talked about these stressors that might be consistent in a person's life. I'm certainly open to the idea that for some people, it is this kind of almost congenital illness or this illness that they're going to that's going to be with them throughout their whole lives. But I think for a lot of people actually, if we demedicalize our understanding of those things, we're open to other ways of addressing those problems. In a way, and we're open to things that maybe fall outside the medical system, which then decreases the burden on the medical system, but also gives us a much broader toolbox to use,

Emily: For sure. And so do you think that those other ways of dealing with stressors? would those be things that you think universities would provide? Or would that also be more of a presidential responsibility?

Dr. Savelli: Yeah, I, I think universities could try to provide some of them. But again, I, I think that there's a danger that universities lose their core mission. You know, what, as I understand it, at least, as someone who sought, you know, sought out the chance to become a professor. I wasn't really ever thinking about the university as this sort of wraparound institution that handled every aspect of a person's life. You know, I don't think we we should be involved in managing lifestyles too much we, we need to pursue our academic mission. And that doesn't mean of course, we Do away with with any and all support services. I think some some support is absolutely fundamentally necessary and appropriate. But like, I'm not sure that bringing ponies on campus to make people happy once a week is the best way to spend our time or money. I think that actually we need to say to people, you're here to study first and foremost, and we want to support you in that. But, you know, some, you may need to sometimes search elsewhere for four responses of solutions. So the university can do some things, but I think everyone is is lying to themselves. We're lying to students, we're lying to ourselves as faculty, administrators, if we kind of pretend that the university could ever respond to all of these problems, right?

Emily: Let's shift focus sort of away from the university context and talk about mental health more in general. You are known for discussing how definitions of mental health are inherently linked to societal context and social interaction. You've touched on it a bit so far in this interview, but do you think you could kind of elaborate more on that idea?

Dr. Savelli: Sure. I mean, at its most basic level...

Dr. Savelli: ..when we identify something as mental illness, we are saying that it is an aberration or a deviation from what is normal.

Dr. Savelli: Now, that seems straightforward enough, but of course, I think anyone with even a little bit of thought, you know, put into it would say,

Dr. Savelli: Well, what is normal is contextual. What is normal is constantly changing, and it's constantly evolving.

Dr. Savelli: And we can think of lots of different examples of this. You know, the probably the most famous one would be something like homosexuality was a was a psychiatric diagnosis for a period of time. And eventually that was deemed medicalized and deepest apologized. And of course now we would never think about homosexuality as a mental disorder. And what I would say to people is that we have to be cautious about thinking that this is a complete process. You know, I think it's easy to get into the temptation that of thinking, you know, in the past, we were in darkness, but now we've got it all figured out. And, you know, science has written to the rescue and provided us with a perfect account of exactly what a mental illness is, and what is not a mental illness. But I would say, you know, was was still always defining things in relation to normality. So a really good example of that would be something like ADHD. So ADHD does not have a long history as a psychiatric diagnosis. Really, that the notion that a child with a lot of energy or a child who didn't focus super well, that was a kind of a medical problem that had to be dealt with. That's something that comes about only When you have people sitting in school for a long period of time, forced to stay at their desk, forced to compete for grades and so on. In another context, there's no problem with the idea that someone might be really energetic, or they might have trouble focusing. I mean, in some contexts that might be even adaptive, right. But it took that creation of a context of sort of being sat at a desk all day, in order for us to identify that as a problem. So if we did away with, you know, fordable schools, for instance, or if we did away with school, the way that we do it now, if we had more outdoor education, if schools were more mobile, less desk focused, you wouldn't need something like ADHD,

Emily: Right, and maybe, like, qualities that generally lead to academic success, like, you know, the ability to focus for really long periods of time. And really, maybe that would have been pathologized too. If it was, you kind of were more likely to lean toward being super focused rather than super energetic, for example?

Dr. Savelli: Absolutely. I mean, like, I will use myself as an example, I ruminate on things. ruminating happens to work really well, if you're a scholar, because it means you can think deeply on something. But, you know, if I had a different kind of job, it wouldn't be very helpful for me to spend so much time ruminating and thinking over things and tossing around in my head, and so on.

Emily: Yeah, that's so interesting. Um, so when you talk about how what's seen as normal, ends up defining what's seen as mentally abnormal. And do you think that discourse on mental health and its social context kind of is changing or will change as a result of the shifting normal caused by this pandemic?

Dr. Savelli: That is a really good question. I mean, I think the answer is Yes, for sure. Depending on how long you know how long it takes, for things to resolve themselves, I, I don't know exactly what direction it's going to go in. And I wish I had that ability to say, Well, I think this will end up being pathologized. Or this won't. You know, I could imagine if this took, because thing as things change in the world of mental health, but they, they tend to do so slowly. If this lasted for 10 years, I think we would end up with, you know, I mean, you kind of see already mentioned some things like zoom fatigue, which is not, it's not medicalized. But you know, if it lasted 10 years, I'm sure would be actually. So I do I think the pandemic has that potential. It depends on how long it lasts.

Emily: Yeah, even things like people who still go to parties are still, you know, are socializing and not social distancing. Like I definitely see that becoming pathologized as well.

Dr. Savelli: Well, I mean, so for example, there you know, there are several diagnose that already exists that include things like, you know, the inability to empathize with other people or disregard for the concerns or care of other people that's built into things like sociopathy, I'm sure people heard that term before. I mean, you could certainly frame what you're talking about in that context. Right now, I think we're thinking about it. Like these are people who are having a hard time deviating from what used to be normal. But at the new normal is everyone in these bubbles where we don't see each other, and you're that person going out to a party? It could be pathologized as a symptom. And again, I want to be clear, I'm not saying that those people are mentally ill, but rather, mental illness is always a kind of constant, changing dialogue. So it's a matter of how we frame things.

Emily: Super, super interesting. I think that that is about All of the time that we have today, and thank you so much for speaking with us. This is super interesting. And I love that you sort of brought a totally different perspective to the concept of mental health. I think one that a lot of people otherwise wouldn't have been exposed to. So that's really exciting.

Dr. Savelli: Yeah. Cheers, Emily, thank you very much for asking me on.


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