I’ve been trying to figure out why my discomfort sometimes evolves into anger whenever I see a “check on your (insert word related to one’s health or state of mind here) friend” post, particularly when it’s in relation to mental illness. It’s not that I’m bothered by the sentiment. Because, all things considered, it’s a good thing to check on your friends and make sure they’re feeling supported. But when the sentiment is expressed to convince people to act in such a way that they can help prevent a friend from committing suicide or struggling or harming someone, including themselves, that is when the discomfort sets in.
Living with mental illness, and/or being impacted by structural violence and systemic inequity, makes navigating our world more difficult. And since people in those circumstances are also statistically more likely to be involved with the justice system, subjected to housing and food insecurity, and at risk of medical issues that are life-threatening, the idea of “checking in” with them for the sake of their mental health misses the mark with regards to helping in a way that does more than just address symptoms. In other words, “checking in” on your struggling friends is only step one. The next steps are to work towards structural, systemic, and institutional changes that would ensure that marginalized people have fair, equal, and affordable access to the resources they need to thrive.
In a society where people die because they can’t afford their medication — and they develop illnesses as a result of living in harmful or stressful conditions that are a direct result of structural, systemic, and institutional inequity — or they lack access to culturally-competent health care, and/or they live in a culture that shames and stigmatizes them for mental illness making it more difficult for them to seek help, which only further impacts the state of their mental health, things like “checking in” on your friends or even self-care seem like, what Serene Khader refers to as, “making the best of a situation under which basic flourishing is not available.”
Put simply, we’ve adapted to living in bad, unjust, and harmful conditions. And we’ve come up with coping mechanisms, like self-care, and we’ve popularized interpersonal solutions to structural problems, like “checking in” on our struggling friends. In Adaptive Preferences and Women’s Empowerment, Khader explains that when we “incorrectly assume that a person is failing to flourish primarily because of problems with her psychology (her values, desires, etc.) rather than because of her structural environment, we’re “psychologizing the structural.” She goes on to explain that “interventions aimed exclusively at changing people’s values and attitudes — like helping people build self esteem, for instance — will likely do little on their own to improve the lives of people whose flourishing requires expanded options or structural change.”
If we lived in a society, or a global community, that was just and provided all people with the conditions of possibility for flourishing and thriving, would we even have a concept of self-care? Or would living in a just society, rooted in an ethics of care, make it possible for us to focus on other things because we would live lives free of the stressors that impact our ability to make sure we are cared for? I’m not suggesting that, in this hypothetical world, we wouldn’t take time for ourselves or “treat” ourselves. But I am suggesting that the idea of self-care as we understand it, especially as it relates to capitalism, might not exist in a society committed to universal ethics of care.
In a 2013 interview, Eva Fedar Kittay asked the following questions about ethics of care: “How should we think about institutional structures when we consider the first virtue of social organization to be care rather than justice? What sorts of institutions can foster caring relationships? What sorts of institutions are indifferent or even hostile to promoting them?” For the intents and purposes of this piece I want to focus on the conceptual thread that ties those questions together. Namely, the relationship between institutional structures, care, and justice.
Consider the different institutions people navigate on a regular basis: schools, hospitals, museums, and, even though we rarely think of it as such, families. Now consider the ways that these institutions perpetuate harmful and discriminatory ideas about the people that navigate them, and the people who lack access to them. Think about how wealth inequality impacts school districts, racism and classism impact medical services, museums embody colonial sentiments, and families are political entities that often function via domination-based power dynamics. And these considerations don’t even take into account the physical aspects of institutions as built environments.
The Centers for Disease Control and Prevention define the built environment as all of the physical parts of where we live and work. Be it the place you call home, your neighborhood’s streets and sidewalks, local public spaces, or any number of other types of infrastructure, the built environment in which you spend the majority of your time has an impact on your quality of life. Particularly, the built environment has direct and indirect effects on mental health, as reported by Gary W. Evans for the Journal of Urban Health.
In The Built Environment and Mental Health, Evans explains how poor-quality housing and residential crowding appear to increase psychological distress, design elements of buildings affect people’s ability to regulate social interaction, and toxic air pollutants cause behavioral disturbances. He then goes on to argue that poor environmental conditions tend to concentrate among marginalized folks, highlighting the importance of public health initiatives aimed at harm reduction and risk management in underserved communities of color.
So, when we talk about the importance of self-care and “checking in” on our struggling friends, we’re focusing on reform not revolution. We’re prescribing surface-level quasi-solutions to systemic, deep-rooted, institutional problems. We’re continuing to put the onus on the individual, and psychologizing the structural, while the overarching systems of oppression make it difficult for us to thrive and flourish.
And while you should continue to check in on your friends, and continue to find forms of self-care that help you function and survive, you ought to also use whatever capacities you have to work with other members of the global community to promote necessary changes at the structural level. Self-care and “checking in” on our friends will never be enough.