Boxed In: The economy of space in a health crisis

By Ruth Stewart

Why is it only when our physical health is at risk that we recognise our need for personal space?

You only need to walk past a pub at the moment to see that the easing of lockdown – and, incidentally, the reopening of our nation’s boozers – has been joyously (and drunkenly) received by most. 

Overnight, the sounds of rowdy revelers – singing, shouting, fighting; the smashing of glass followed by the obligatory ‘Wheeeeeeeey!” – flooded the cities as if no time had passed, serving as a stark reminder that things are indisputably Returning To Normal. 

But for some people, myself included, the return of ‘normality’ is not a welcome relief but the source of anxiety; leaving us even less inclined to leave the house and rub shoulders with the masses than we were before.

The ‘luxury’ of space

For a little background colour: my name’s Ruth and I suffer with anxiety. My anxiety breeds in lots of fertile conditions – such joy! – but is often and most commonly triggered by social situations involving any more than my preferred optimum human interaction amount of Other People (five. It’s five. Five people. More than that and I go full Eminem: palms sweaty, knees weak, arms heavy). 

Living in a bustling city, I know I’m not the only one who, when quarantine began, breathed a sigh of relief that it was now a government-mandated obligation to avoid Other People as much as possible, a feat normally next-to impossible in a densely-populated area. No crowds = no worries. No parties? No problem. 

So, my question, as the streets, and restaurants, and shops and bars begin to steadily refill with people, is this: what about us? Where do we fit into this ‘return to normal’? Because ‘normality’ for people like me is panic and agitation when we have to venture into the city centre. 

And before you dismiss me as horrendously self-pitying: I am not alone. Studies have shown that depression and a plethora of other mental health issues are way more prevalent in bustling, over-populated areas. The Centre for Urban Design and Mental Health (UD/MH), a think tank dedicated to making urban areas more mental-health friendly, notes that:

“People who live in the city experience an increased stimulus level: density, crowding, noise, smells, sights, disarray, pollution and intensity of other inputs…This can have the effect of overload: increasing the body’s baseline levels of arousal, stress, and preparedness, but also driving people to seek relief: quiet, private spaces…People who live in the city may find that they have less access to the factors that are protective for good mental health than those in rural areas.”

While I’m not disputing that a global pandemic is a reason to enforce more distance between citizens, I’m left wondering why the vast number of people whose daily life is affected by mental health issues like depression and anxiety – eight in every hundred people, according to mental health charity Mind – aren’t provided with this luxury as par for the course; or in fact, why it is considered a luxury at all. 

Mental health is a serious public safety issue. Mental illness equates the second largest burden of disease in this country, according to research by Mental Health First Aid England (MHFA). However, further valuable research the MHFA also, depressingly, shows us that despite its ubiquity, mental illness is still horrifyingly misconceived or simply not acted on. A third of the population think that people with mental illness are likely to be violent; between 70 and 75% of people with diagnosed mental health problems will never receive any treatment; and those suffering with mental illness are twice as likely to lose their jobs as those who aren’t. 

All these factors contribute to the damaging ‘taboo’ surrounding mental illness, creating a chasm of misunderstanding between those who suffer and those who don’t. This certainly rings true with me: while I would have no qualms calling in sick to work because of a broken arm or tonsillitis, I have never once called my boss to confess that I’m unable to work because I can barely find the will to get up and shower, that everything feels hopeless and I can’t stop crying. 

I’ve killed conversations in groups of friends by daring to talk about my mental health; been accused of ‘stealing thunder’ when I suffered a complete mental breakdown on a friend’s birthday. Trepidation at being judged, feared or trivialised with the infuriating concept of ‘just pulling yourself together’ forces me, and the millions of others like me, to keep schtum about our suffering. 

Profit before people

It’s no surprise either to learn that those affected most by the stresses of the urban sprawl are typically less well-off than their more stable counterparts. Money, it seems, can buy you the ‘luxury’ of space – just a cursory glance at any house-hunting app and you’ll see rents rising along with the square footage. 

A friend of mine who recently clawed her way onto the property ladder had to forego the option of the garden to the rear to avoid being out an additional, and unaffordable, £30k. 

Before you decry this as basic common sense – and yes, even I can see that a bigger flat or house is undeniably going to cost more money – aren’t we all entitled to a little extra space for our mental wellbeing? Given the fact that mental illness costs the NHS an estimated £41.8 BILLION a year, does it not stand to reason that making better accommodation more affordable could lessen this expense, thus proving financially viable?

Because that, ultimately, is what it boils down to: money. 

If lockdown has taught us anything, it’s that our most densely populated areas are built for profit, not personal wellbeing – and when a worldwide health crisis dictates that we need a wide berth from one another, it’s extremely difficult to manage in inner-city areas. 

Modest two-storey houses converted into multiple tiny apartments, squishing as many people into a single space as possible. Cramped public transport with no leg room just to fit in another ten seats per carriage. But while coronavirus is a novel concern, mental illness isn’t. Why do the powers that be only seek to protect us from overpopulation when it’s our physical health at stake?

Re-imagining normal

recent article from Vice put forth a compelling argument for reopening the world in a more socially conscious way; reporting the myriad benefits for the environment of “not fight[ing] to raise the GDP at any cost”; that “the pandemic, from a sustainability standpoint, offers a rare window of opportunity both for quality of life and the habitability of the planet”. 

So, it’s not just the millions of struggling inner-city residents suffering from mental illness who stand to benefit from a more conscientious way of life, but our very planet itself. They’re right: this isn’t about recovery, but an opportunity for real change. Change that improves the quality of life in the most deprived areas, instead of just lining the pockets of a select few. 

Coronavirus may be a new threat, but as the world’s medical experts scrabble to find a cure, it’s worth remembering that the pandemic of mental illness in cities has existed long before and will continue to rumble on post-COVID; and vaccinating against that starts with reimagining ‘normal’.

For more of Ruth’s captivating writing, please see here. For more on her illustrations, see here.

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