When I say that mental illness is like drowning and building better mental health is like learning how to swim, I’m not suggesting that mental illnesses aren’t real biological experiences. Drowning is a very biological experience.
If we took some guy that doesn’t know how to swim and pushed him off the side of a boat into deep water, he’s going to have a very stressful experience. It’s going to be distressing and traumatic — for him and for those watching.
He’s going to thrash around and try to stay afloat. His muscles — unfamiliar with moving in the water — are going to tire quickly. They’re going to flood with lactic acid and start to burn. He’ll move his limbs too slowly and awkwardly to battle the constant, random movement of the waves.
He’s going to feel helpless. Saving himself will feel impossible even though it’s the single thing that all of his energy and thoughts are focused on at that moment. He can drop all other responsibilities in life and focus entirely on trying not to drown. But he won’t even be able imagine how to save himself if there’s no knowledge or experience of swimming in his brain.
Based on his past experiences, he’ll try all sorts of different ways to stay afloat, but those attempts will only make him drown more quickly. There’s no way he can think himself into the ability to swim. It’s not a choice. He can’t simply choose swimming over drowning.
He can yell at himself and criticize himself, and still, he’ll drown. He can think positively about not drowning or distract himself by admiring the sea gulls soaring overhead, and still, he’ll drown. The people watching can shout abuse at him, or they can cheer him on with positive affirmations and motivational slogans, and still, he’ll drown.
His heart will pound frantically in his chest. He’ll be desperate for breath. His head will hurt. His body will give up. His lungs will ache as they fill up with sea water. And he’ll sink.
Drowning is a very physical, very biological experience. We could measure the cortisol, adrenaline, and blood oxygen levels in a drowner and say that they have a “chemical imbalance”. We could look at brain scans of drowners and compare those to non-drowners and it’s highly likely we would see obvious differences in activity and structures. We could compare the genetics of drowners and we would see tantalizing hints of combinations of genes that might be implicated in the onset of drowning (or might just show up because entire ethnic, socioeconomic groups, and geographic areas have historically been excluded from or not had access to the opportunity to swim).
None of those biological indicators would mean that somebody struggling to stay afloat has a chronic disease or that they’re incapable of learning how to swim. Right now, we need to help them get to safety, and get treatment for any injuries they sustained in the water. Tomorrow, they need to get themselves into swimming classes.
I’m bringing all of this up to suggest something radical: Our mental healthcare system and our society’s approach to mental illness is almost exclusively focused on treating injuries sustained from drowning and trying to prevent people from going near water instead of helping people learn how to swim and handle the water in a safe, effective way.
Drowning has physical symptoms. There are medical implications to drowning and it’s going to be very useful to have a paramedic or a hot lifeguard on shore to help resuscitate you and tend to your injuries, but the medical impacts of drowning are not the cause of the problem. They’re symptoms.
Not knowing how to swim has medical implications but it is not a medical problem. Not knowing how to swim is an accessibility, education, and poverty issue. It’s time to ask ourselves if we’ve been focusing on mental illness as a medical problem when it’s actually an accessibility, education, and poverty problem. If we want to get at the cause of the problem instead of throwing money and lives after symptoms, we need to shift our focus to prevention, knowledge accessibility, and helping people learn the skills to swim through the deep waters inside of them.
Shifting our focus to building mental health skills rather than waiting to treat the consequences of not having those skills can also fundamentally change how we talk about mental health. As a society we have a very illness-first approach to mental health. When a person encounters mental health challenges, the majority of interactions they have with the healthcare system are focused on labels connected to symptoms. But we don’t do that in other areas like with physical health and fitness. Again, swimming is a great example: If you’ve ever met somebody that’s learning how to swim, have they told you that they’re a “drowner” and they’re learning how to get over drowning? But that’s what we do with mental health — we label people with the symptoms of not having skills they haven’t had the opportunity to develop.
Swimming is not about learning how to not drown. It’s about learning how to swim. Can you imagine how popular swimming would be if everybody that wanted to learn how to swim was labeled as a drowner and that label was permanent?
With our current illness-first approach to mental health, no matter how many skills a person develops to take care of their mental health, no matter how much they improve their mental health, society, the medical system, charities, and often the individuals themselves, maintain that drowner label for the rest of their lives.
The moment you’re taking healthy steps to learn how to swim and you’re making changes in your life to support that, you’re a swimmer. You might be new at it and still have an enormous amount yet to learn, but as a society we acknowledge your practice with a label that recognizes the possibilities, not the past. It’s time we started to do that with mental health. We know that recovery is possible.
I don’t struggle anymore with OCD or GAD or depression or addiction. None of the labels stuck on me over the years have any relevance to where I am now. I’m not investing my time and energy each day in not being those things, just as an Olympic swimmer doesn’t wake up each day to practice not drowning. I put my time and energy into building great mental health and constantly improving mental fitness. That’s about much more than treading water so I don’t sink. It’s about about building skills and going where I want to go in life and constantly improving my ability to do that.
Having the experience of almost drowning — many times for many, many years — has not led to me being ill. I am significantly healthier than somebody who is not taking care of their mental health on a daily basis. Just as a person who almost drowned but then learned to swim is going to be much healthier than somebody who almost drowned and now avoids the water, or somebody who just never gets in the water. But it would have been beneficial to myself and so many people around me if proactive, preventative mental health skills were accessible before I encountered challenges.
Swimming lessons aren’t only for drowners but that’s because the focus is on learning skills. As long as we have an illness-first mental healthcare system, the prerequisite for access to health will always be failure and sickness. Let’s change that by shifting the focus to prevention and possibilities.
Many people don’t have the privileges or opportunities to access the knowledge and supports to take care of their mental health. Let’s change that by investing in removing barriers instead of paying exorbitant amounts to treat the injuries that result when people smash into those barriers.
You’re going to play a very important role in these changes. If you only want to treat the symptoms of drowning and be told to stay out of the water, you can connect with people who do that. You can build your identity around the excruciating details of that time you almost drowned. You can hold on to heavy labels that will pull you down to the bottom of the ocean. You can encourage people to avoid the water and you can build community and practice around your fear of the water. But if you want to learn how to swim, you can do that. You can share that experience of what you’re capable of accomplishing. You can connect with swimmers that practice swimming every day of their lives. They know how to make changes throughout their lives to support that practice. They know what challenges will come up and how to overcome them. Dealing with the complex internal and external factors that affect mental health is a skill. You can learn that skill. What was once challenging can become an exciting, pleasurable experience that’s incorporated into every moment of your day. What was once a nightmare can become the path to actualizing your dreams and potential.
So let’s throw on skimpy bathing suits, get in the water, and get practicing.