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Culture War Roundup for the week of August 25, 2025

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Given that presurgery mental health is surely part of the institution’s concern

Tangent here.

Not only no, but fuck no. To this.

The quick little slip of "mental health" here is an exemplar of how insidious current perspectives are on the topic.

When (normie) people hear the term "mental health" they automatically connect it to images of depression, bipolar, maybe even schizorphrenia, along with PTSD etc. A "mental health crisis" might even conjure desperate scenes of attempted suicide or some full blown panic attack that necessitates the men in white coats arriving.

Whatever the specific circumstance, we're dealing with a disorder of some kind. Perhaps mood related, perhaps cognitively related, perhaps something more broadly endocrine (note: there are some cases of neurological issues, but I always roll my eyes when people use the term "brain chemistry" as it is both horribly imprecise and, more to the point, they're usually talking about the endocrine system as opposed to a brain (as in the grey matter, not the concept of mind) specific neurological problem")

These things are called disorders because they represent an unexpected and maladaptive response to normal life circumstances. Depression; "I have a good job, an active social life, stay in shape, and don't abuse any substances. I'm horribly sad all of the time. What do?", Bipolar disorder: "I have a good job, an active social life, stay in shape, and don't abuse any substances. But these mood swings are causing me to drink, miss work, not go to the gym, and alienate myself from people. What do?", Schizophrenia: "The Jew Aliens keep reading my brainwaves without my permission. What do?" (Okay, I had fun with that last one).

What the NYT author describes is categorically not a "mental health" issue. Getting an unexpected and alarming piece of mail should cause some level of distress. If you're totally incapable of dealing with that distress, my first response would be to question general maturity and life capability. A second would be to look at your specific life circumstances at the time to see if there's a charitable reason why you might be in a bad position to deal with such an occurrence. Only much, much later would I start to think, "Well, maybe this guy has an awful mental health disorder which makes it hard for him to deal with ... things happening and mail."

"Mental health" is not a species wide mission to prevent bad feelings from happening. Especially when the given circumstances would naturally provoke negative feelings. But this is yet another wonderful biproduct of the culture war; bad feelings have become pathologized as a) horribly disturbing and never to be expected b) worthy of full and unquestioning accommodation by ALL others and c) probably both someone else's fault and responsibility to deal with.

The author slips all of this in, easy as you please, by asserting that of course his health care provider obviously considers "mental health" to be as high a priority as sterile operating room conditions and well trained staff.

How many run-ins with HR must a man have
before he recognizes the pattern?

The answer my friend
Is blowing in the wind

I think the author is making a somewhat more reasonable point than "we shouldn't have to worry about the bill" - it's that they shouldn't be having such a worry added on last-minute to the existing worries of a surgery! Maybe it shouldn't be called "mental health", but what would you prefer for such a reasonable ask?

Maybe it shouldn't be called "mental health", but what would you prefer for such a reasonable ask?

Not who you're talking to, but I believe a good word for this is "stress", which most people recognise as something that can play a part in adverse health outcomes. The possibility that the medical system might just saddle you with a gigantic, life-ruining debt by surprise and with no recourse would make absolutely be a significant source of stress.

Maybe it shouldn't be called "mental health"

That's my point, and that's why I caveated my post with "Tangent"

but what would you prefer for such a reasonable ask?

Nothing. It is, in fact, a reasonable ask. It's not a mental health question. "Patient comfort" sure, "procedural professionalism" whatever.

I don't think it was your intention, but please try to avoid conflating the points I'm making.

Your comment suggested to me that the provider shouldn't be concerned about what you're calling "patient comfort" here - that "bad feelings happen" and who cares if it's before your surgery. The author of the NYT piece is communicating that the provider SHOULD be (and probably is) concerned about that emotional state, and that having scary financial concerns get dropped on you the day before a surgery is something that ought to be avoided.

And not to get too linguistic-descriptivist, but I'm afraid it's too late to be too prescriptive about the expansion of the meaning of "mental health" for the wider world.