I’m moving countries and my stomach has been in knots. My wife’s asthma is flaring up. We went to the doctor who listened to her lungs, kindly smiled, and told us she was suffering from anxiety. I didn’t even ask him. I just went back to our cousin’s house and threw up. Mental and physical health are obviously one interconnected system, one experience in one body, and we isolate them at our peril.

On the way out of Sri Lanka, I stopped at the Police Park bus stand where an old lady named Mrs. De Sozya, well, lives. It’s near my kid’s preschool. After I dropped my son off I’d get her some short eats and we’d have iced coffee together, letting the buses pass.

I guess you’d call her paranoid or schizophrenic or something. She always thought people nearby were listening, or that political figures were controlled by distant forces. Sounds crazy I guess, but the world really has gone mad. God knows what life is like on the streets, and I found her political opinions more astute than most people’s. I gave her some money on the way out, but I feel terrible. Jesus would have done so much more and as much as he loves me, God knows I fail him every day.

I think of her because my head is all fucked up by one uncomfortable flight. What would she feel like sleeping at the bus stand every day? Is Mrs. De Soyza having a mental health problem or a bad physical situation? Where does one start and the other begin? So many homeless people self-medicate with drugs, and I get it. I would too. If my life was uncomfortable and hard and I could get any sort of relief from a needle or pipe, I’d take it gladly.

We look down on homeless people as drug users, but most of them come from terrible situations or childhood abuse and then get abused and ignored by society as adults. When reality is so awful, when it’s made so willfully awful by other people, why wouldn’t you escape? And who are we to judge? We do alcohol (one of the most powerful drugs in the world) at fancy fundraisers, so we can tolerate talking to each other’s fake faces about these issues we pretend to care about. We are the issue.

Homeless people self-medicating with heroin is honestly not so different from society’s attitude to mental health at large. We give people drugs without changing their material conditions, and sometimes not even that. We try to get them back to work but not actually working. We try to get them to stop bothering us without really bothering about them. I’m not saying that drugs are not part of alleviating suffering, obviously for many cases they’re essential and I enjoy them myself. I’m just saying they’re not the whole thing. Not even close.

I’ve been in a mental institution (just visiting) after my wife had a psychotic episode herself. Sometimes she’d recognize me and sometimes she wouldn’t. She rarely made sense, but that was almost a blessing. When she realized what was actually going on, she was scared and hurting. The drugs worked in that they got her down to a manageable state, but the question then was how was that managed?

She had her husband wandering the grounds outside, her father nearby, and extended family that supported us all without question. She got sick in another country and me and her Appa just got on the next flight. We both took off work and just stayed with her for over a month. Then we brought her home and the entire family knitted around her — for years — until she got back to herself again. God knows the drugs helped (and hurt), but was it just the drugs? Obviously not. You can look around the same institution.

So many other people in that institution (which was a nice one) had terrible situations to go back to. Abusive homes, poverty, not to mention these new medical bills. I was the only person sleeping in the gazebo outside, worrying about my wife full time. It’s not that other people didn’t care, they simply couldn’t afford to. Everybody else’s family was working, they had no capacity to take such breaks and care for someone full-time.

Capitalism takes priority over caring, and even catastrophe gets fed into the capitalist system to make some rentier money. Which they don’t even enjoy. They’re taking drugs themselves to feel anything. It’s a system which produces and reproduces suffering endlessly, measures it, and calls it GDP.

My point is that a mental health system without changes to material conditions is just giving someone a shot to keep them working. To keep the system grinding. When the system itself is what grinds us into dust. So much of mental health is actually what an Asian grandmother would ask you. Have you eaten? Where are you staying? Do you want some tea? So much of mental health is the material conditions you’re actually feeling, not just how you feel about them. That is to say, when we ensure that every person has the right to food, safe shelter, and clothing we can talk about a mental health crisis. Until then we are the crisis. We’re not even doing the bare minimum to help as a society.

People say don’t give beggars money cause they’d spend it on drugs, but it’s the same logic. We give money to governments that maybe spend on drugs but mostly spend it on PR while cutting actual programs. We talk about mental health ‘awareness’ with no awareness that the brain does not live in a test tube and sometimes things are just materially shit. That maybe we need to change the material conditions that make people miserable and not try to drug or talk them out of their misery.

Again, my point is not that mental health does not exist. My point is that nothing exists. As the Buddha said, it is all illusion, just a stream of experience that we put labels on so that we can tread water for a few years. Sometimes our attachment to these labels also becomes a source of suffering. The Buddha said that even the Dhamma (his teachings) was a raft that you had to abandon at some point, when you actually reached land through meditation. The use of the label mental health is helpful sometimes, but within a deeply sick society, it also pathologizes the individual.

As the late Mark Fisher said in Capitalist Realism:

“I want to argue that it is necessary to reframe the growing problem of stress (and distress) in capitalist societies. Instead of treating it as incumbent on individuals to resolve their own psychological distress, instead, that is, of accepting the vast privatization of stress that has taken place over the last thirty years, we need to ask: how has it become acceptable that so many people, and especially so many young people, are ill? The ‘mental health plague’ in capitalist societies would suggest that, instead of being the only social system that works, capitalism is inherently dysfunctional, and that the cost of it appearing to work is very high.”

And Mark Fisher is dead. He didn’t make it himself. He took his own life. Which took something from all of us. Is it not like this with every connection that flickers out, on this network we call humanity? Is the locus of control really each blinking light, or is it the system? Or isn’t it all and nothing at once?

We talk about the ‘right’ mental health but what hubris do think we even know what that is. Everything is relative and my 97-year-old grandmother who cannot even understand what country I’m in has a better conception of the basics. Have you eaten? Where are you staying? Only then can we even talk about the state of the individual, these are the most basic requirements of a state, and only a few even pretend to address them. As long as people have these questions unanswered, they are not failing as individuals. We are failing them.

I think about this as my stomach does flips again. I think about this as I leave our family, our self, so far behind. I throw up and I feel momentarily better, but until we do better, that feeling that something is terribly wrong persists. Because it is. God knows it is. All gods of the island know it, even as I leave it.

We in our hubris think that mental health is one thing, but it’s all one system. One interconnected web of mind and body, self and other, we are all just islands in a stream. As the sages Dolly Parton and Kenny Rogers said,

Islands in the stream
That is what we are
No one in between
How can we be wrong?
Sail away with me
To another world
And we rely on each other, ah ha

They were talking about the mating instinct, which is one part of it, but this caring instinct is deep within us. Even within what Fisher called Capitalist Realism, it is what we work for. It is why we go across the oceans, to send money home. To provide a better life for our children. What the fuck are we even doing, competing against each other for survival, when we could care for all children as our own and suffer so much less?

We live in this tormented system and call ourselves crazy when we don’t feel good about it. Why should we? We take the very real problem of sickness in the brain (many people are completely disabled by mental health conditions, largely irrespective of material conditions) and somehow don’t wonder that it seems to be spreading.

The truth is that the conditions of growth and progress lead to physical sickness, mental sickness, and planetary death. We treat these as distinct situations that we just need to raise ‘awareness’ of, as distinct business opportunities for private equity, but we are blind to the interconnection of it all. The point is that whatever we’re doing, we’re doing it wrong. I can feel it in my stomach, people can hear it in voices, and gods know they told us enough. Nothing is isolated. No man is an island. I can feel it as I leave my own island. Honestly, I feel like throwing up. Whatever this idea of reality we’ve ingested, it’s all gotta go.