Why I Hate Talking About Mental Health, from a PsychologistMay 09, 2023
It's that time of year again...Mental Health Awareness month.
As a practicing psychologist, I am quite literally in the business of mental health.
And yet, I hate it.
Not my job. I am fascinated by the brain, and I love helping others learn how their minds work and using that information to shift their life experiences.
And don't get me started on "mental illness."
Just kidding. We're hitting that one today, too.
Inwardly, I cringe every time I have to say either one of those. It's not because they aren't real or aren't important.
It's actually the opposite.
The Case Against "Mental" Health
It drives me bonkers that we talk about health and then mental health, like mental health is some sort of "oh yeah, I guess we should think about that, too" red-headed stepchild.
Right out of the gate, we're setting up this subtle hierarchy that holds that caring for our bodies, our health, is the primary goal, and mental health is an afterthought, only to be considered if we really have to, if things get bad enough that we can't just set it aside.
When we separate out mental health, we fail to normalize it. We all know that our health is important, and we do a lot to care for it. But separating out mental health low key communicates that it is different, other, something that only some people have to worry about or that we only have to consider it under certain circumstances rather than all of the time. Not only is that just not true, it's actually harmful because it keeps people from taking measures to protect their mental health in the ways needed.
You might say, "Fine, Dr. Ashley. I'll take your point. Mental health IS important. I have an easy solution. Let's just use the terms "physical health" and "mental health". Are you happy now?"
While I would thank you for your open-mindedness and creative problem-solving, I would politely decline.
That solution isn't any better. Separate but equal has never worked.
The Line Between Physical and Mental Health
When we separate physical health and mental health, we are setting up a false dichotomy. We are trying to pull apart two things that are intricately interwoven, two sides of the same coin.
Mental health and physical health are not two distinct entities.
We are a closed system. Our brains are part of that system, and things that impact our brain (and other components of our bodies) can impact our thinking, feeling, and doing habits. In turn, our thoughts, feelings, and behaviors directly and indirectly affect our tissues and biological processes.
Let's look at some illustrative examples.
Behaviors and habits typically fall in the realm of mental health, yet they affect every aspect of our health and wellbeing. On a cellular level, the field of epigenetics is showing just how true that statement is. Our environments and our behaviors literally turn certain genes on and off.
For example, engaging in a mindfulness practice has been shown to affect our DNA and the genes involved in our stress response, not to mention bigger scale body systems like immune and cardiovascular functioning.
Something aimed at impacting the quality of our minds impacts every part of our being. It doesn't stop there, though. Loneliness literally shortens our life spans as do certain beliefs (yes, you read that right. Beliefs) about stress.
It goes the other way, too. Rapidly evolving research is linking inflammation and the gut microbiome to things like depression and anxiety, things typically lumped under mental health.
Blood sugar affects mood and anxiety. Lack of sleep and exercise have drastic effects on those same variables as well as things like learning, memory, information processing, optimism, attention - all "mental" health concerns.
Setting aside the awe I feel when I consider all of these research findings, science and even our direct personal experiences highlight just how indistinct these facets of our health are and underscore why I am so passionate about defining health and wellbeing based on all the metrics that matter.
I specialize in the treatment of anxiety disorders, the most common of the psychiatric conditions or mental health concerns. These are very real and can be quite debilitating if left untreated. They have zero to do with intelligence, strength of will or character, personality, or lack of effort. They are not always the result of our upbringings or events that occurred in our lives (though both can influence their development as do our genes and other biomarkers).
I think of anxiety disorders as the manifestation of an overactive nervous system and treatment as the equivalent of physical therapy for your brain. So does that make anxiety a mental or physical health issue?
I have long sought to help people conceptualize anxiety disorders as legitimate medical conditions, like allergies or diabetes. This conceptualization makes sense to me because 1. It's true and 2. It works around the deeply ingrained stigma surrounding "mental illness."
Which brings us to soapbox number 2: my beef with the term "mental illness."
Should We Designate Mental Illnesses?
My discomfort with this term boils down to 3 main points.
1. The first is that stigma is real...and a huge barrier. To acceptance, to seeking care, to lots of things. While the younger generations seem to be shattering that stigma - thank goodness - by talking openly about mental health, old attitudes remain.
Truth told, I catch them cropping up within myself sometimes.
My explicit beliefs - the ones I have reasoned through and intentionally, logically believe - are laid out here. Mental health IS health. I view historically categorized mental illnesses as the same as any other illness, syndrome, disease, or disorder - just something in our complex systems going awry or not working optimally.
Still, I'm a 42 year old American woman, and my implicit beliefs - subconscious programming that took root whether I wanted it to or not - was influenced by the times I grew up in, which were times when people did not talk openly about seeing a therapist or struggling with anxiety or depression. Times when "emo" was used as an insult, "weird" kids were shunned, and "crazy" and "mental illness" were used interchangeably.
So, to me, the term "mental illness" can still carry an old, buried connotation that is undeserved. I'd rather just avoid the issue altogether by doing away with the term.
2. Clusters of symptoms and dysfunction that typically fall under the mental illness umbrella - like OCD, bipolar disorder, depression, or schizophrenia, even addiction or substance use disorders - are the result of complex internal and external influences spanning the micro DNA level to the macro societal level. And, to complicate it further, the interactions among those levels.
Where is the line that demarcates an illness from a mental illness?
Is that differentiation even important or meaningful to make?
I'd argue not. We don't struggle to take time off work or prioritize our health needs when we have a "real" (that pains me to type but reflects common attitudes) illness. We call in sick when we have the flu (yes, I know viruses can be transmitted, which opens the door for another discussion. I'm going to gently close that door, though, in the interest of time) or a flare up of rheumatoid arthritis. We more willingly and readily consult providers, take medicines, engage in other therapies or programs to manage those kinds of things, but then get squeamish when it comes to doing the same things with "mental" illness.
If we truly just viewed it all as illness, disorder, or syndrome, we could approach it in the way it needs to be handled, which is do what you can to optimize functioning and wellbeing.
3. Finally, over the years as a clinician, I have found myself shifting from "You have a legit medical condition. It's called OCD/Generalized Anxiety Disorder/Panic Disorder/whatever diagnostic label fits" to a more "You're a human with a human mind, and this is what they do" stance.
Not always. Sometimes it is still quite helpful to label it or give a formal diagnosis.
But, increasingly, what gets categorized as mental illness is really just the result of ancient DNA in our modern society.
It's analogous to obesity, which is also a complex phenomenon with a multifaceted cause and, admittedly, beyond my expertise. That said, it makes the point here. One factor that contributes to obesity is that our genetic code dictates that our bodies hold on to energy, which is stored as fat. This internal process developed eons ago when food was not readily available. Now, with an abundance of food always around (at least for a portion of the population), we're seeing a mismatch between evolution and modernity. The result is a health issue.
Same thing with some of the "mental" illnesses.
Stay inside, on a screen, disconnected from community, getting inadequate sleep, being overly stressed and overly stimulated, while hearing polarizing bad news, feeling pressured to be productive all the time but zoning out with mindless consumption. How can you NOT end up depressed or anxious?
Pathologizing natural responses as disorders or illnesses, which carry with them stigma and its added psychological burden, may do some undue harm. It puts the onus on the individual, almost saying something is wrong with you, rather than reflecting the inevitability of the situation. Of course you're struggling with XYZ. That's what happens when we put normal human minds in these circumstances. That normalizing view is a pathway to compassion, which, turns out, has a positive effect on both our physical and mental health.
Because they are one and the same.
Where Do We Go from Here?
Circling back to Mental Health Awareness month, it's a start. The tides are shifting, and I am so grateful that we are increasingly considering mental health.
The impact of poor mental health is real. It affects not only the individual who experiences it, but their families, friends, communities, all the way up to their employers, the economy, and our society as a whole.
We can no longer afford to ignore mental health, and we need to start considering it well before any sort of crisis or notable deterioration occurs.
The ideal time to intervene with cardiovascular health is BEFORE the heart attack happens. The time to intervene with mental health is BEFORE the crisis happens.
Mental health IS health and it affects every single one of us.
Every single one of us must prioritize and put forth effort toward protecting and optimizing our mental health.
"Whether an illness affects your heart, your arm, or your brain, it's still an illness, and there shouldn't be any distinction. We would never tell someone with a broken arm to stop wallowing and get it together. We don't consider taking medication for an ear infection something to be ashamed of. We shouldn't treat mental health conditions any differently. Instead, we should make it clear that getting help isn't a sign of weakness - it's a sign of strength."
- Michelle Obama
Written by Dr. Ashley Smith
Peak Mind Co-founder
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