April 28, 2014 at 9:27 pm

In the human services fields, we naturally focus on the “problems” or the difficulties clients are having, as we are working in the hopes of alleviating human suffering.  We have training and language to help identify personal challenges so we can help others move toward a state of well-being.  I’m wondering where we are trying to go and how we will know when we get there. What does it mean to you to be mentally healthy?  How does it look and feel, and how can we move ourselves toward being mentally healthier?

May 5, 2014 at 11:20 am

Great question, Lara! This is a big one, so prepare for an earful 🙂 (note: I’m writing some of this for other readers, realizing that as an LCSW, you’ll be familiar with some or all of this perspective already).

As you know, the concept of “mental health” is a subjective one, both defined and interpreted through a cultural lens and context.

For example, a white, middle class person from the US; a farmer in Bali, and a Syrian refugee are all going to have a different idea of what it means to be mental healthy. Even within individual societies, you can find many differences. For example, (generally speaking) a person of white Anglo Saxon Protestant (WASP) heritage is more apt to value independence as a component of mental health more than a first or second generation American of Mexican or Asian descent (i.e., if you still live with your parents when you’re an adult, in the white world, that’s seen as problematic, but in so many other cultures, it’s completely normal).

Sometimes it’s easier to identify what is unhealthy (vs. healthy), but an absence of symptoms is too simplistic of a definition that leaves out many important details.

Being mentally healthy = “the capacity to love, work, and play”

I really like this encapsulation of what it means to be “mentally healthy” from Rutgers Professor and Therapist, Nancy McWilliams, where ‘love’ refers to being able to engage in authentic relationship(s); ‘work’ may be paid or unpaid but involves making a contribution that provides meaning and sense of purpose in life; and ‘play’ is the capacity to experience joy and pleasure in the myriad forms that may take. I recently learned about Nancy’s work from this excellent video that a friend posted; it’s long, but well worth watching.

Professor McWilliams identifies the following additional indicators of mental health, all of which are extensions of ‘love, work and play’ (note: this is from a psychodynamic perspective of human behavior):

–Movement toward a secure attachment pattern: feeling a basic level of safety in the world and with regards to relationships; “ontological security.”

–Sense of agency/self-efficacy: the recognition that you can go after what you want, be effective and attain goals.

–Identity integration and self/object constancy: seeing self and others in realistic, rather than black and white terms (e.g., b&w=all good or all bad) and awareness of and sense of continuity of self in different contexts and over time.

–Ego strength/resilience: capacity to tolerate suffering and still function.

–Realistic and reliable self-esteem: be able to see oneself in a realistic manner – not overly harsh, but also not in denial about one’s struggles.

–Sense of abiding values: having morals, integrity, not hurting others.

–Affect and thought tolerance/regulation: ability to feel a wide range of emotions and move through them fluidly. Not reacting to every thought that goes through one’s mind, inhibiting action when necessary.

–Insight: also known as ‘reality testing,’ this refers to the ability to have some awareness and understanding about one’s problems.

–Capacity to mentalize about others: the capacity to make sense of another’s behavior; not taking things so personally.

–Flexibility of defenses/coping style: be able to draw on a variety of coping mechanisms/defenses, rather than always defaulting to the same ones (common defenses being things like denial, rationalization, intellectualization, projection, dissociation).

–Balance between relatedness and separateness: being able to be deeply close to others and also feel comfortable when alone.

–Sense of vitality: feeling enthusiasm and passion for life; recognition its preciousness.

–Accepting what can’t be changed: the capacity to surrender to and mourn what can’t be changed (e.g., losing a loved one, another person’s behavior, one’s own limitations).

Based on my life experiences and what I have studied (Western psychology, Eastern psychology/philosophy, socio-cultural studies, and the rigorous model of peer counseling known as Re-Evaluation Counseling) I like to point the compass toward an ‘optimal psychological functioning’ that likely exists in theory only, but may be possible with the right conditions, tools and resources. At its most core level, this includes the following characteristics, which aren’t mutually exclusive:

1.) Being present: paying attention with compassion toward self and others.
Being present doesn’t mean simply “living for the now” without a sense of responsibility, care or planning related to one’s life and others. When people are in this place, they won’t do harm to self or others, which is a fundamental element of mental health.

2.) Seeing life clearly: seeing through the conditioning that leads to all kinds of biases and distortions of self and other. For example, seeing people as better than or less than on some intrinsic level (e.g., from conditioning related to ethnicity, race, gender, class, age, sexuality, physical ability, etc.) is delusional thinking and not clear.

Out of this comes the recognition and awareness of a highly interconnected world. When people recognize their interdependence/connection, they can see how their actions impact other people and the environment (e.g., making decisions that aren’t purely motivated by self-interest, that aren’t short-sighted, that don’t cause harm, etc.).

3.) Exhibiting flexible intelligence and behavior: just like with the body, rigidity is (usually) a sign of illness. Being able to think, feel, and act in a flexible manner is “mentally healthy.” RC theory speaks to this piece well, as does Nancy McWilliams in her list above (things like resilience, affect/thought tolerance and regulation, flexibility of defenses, vitality, identity integration).

Everybody has moments (some more than others) when they’re in the space of “being present,” “seeing life clearly” and exhibiting “flexible intelligence and behavior.” But, we all know that it’s difficult to stay in these places due to the stressors and forces that pull us in different directions. Nevertheless, as with physical health, I think it’s good to have an ideal that we’re always working toward as individuals and as a society of people.

As to your question of how can we move ourselves toward being mentally healthier, I think there are many paths. Of course, as a therapist I’m a big fan of that medium (counseling) on both an individual and group level, but there are many other forms that can be helpful as well (instead of, or in addition to that). A big part of becoming mentally healthier, from my perspective, is about unlearning what has pulled us/people away from our natural humanness (see About page for more details). I do think that having some type of regular contemplative/self-reflective practice is necessary for a healthy psyche, whether that takes place in the therapy room, within a spiritual community (e.g., meditation, church), or among a really connected groups of friends or family members.

Other healing modalities, like medicine, bodywork or nutrition interventions may also be needed, depending on the person and their circumstances. Due to the forces that pull us away from our natural humanness, most people probably need a systematic and holistic, rather than off-the-cuff, approach to get there, but like I said before, there are many routes. For instance, some people I know have found supportive dance communities to be more healing than talk therapy. Anything that reduces people’s sense of isolation and increases community in general is a huge part of the healing/health process. Lastly, I’ll say that going for balance is also important: working on and looking at the hard stuff, but also putting ample attention on play, cultivating joy and connecting with the present moment.

How about you?

May 5, 2014 at 8:38 pm

Thanks Lara, for inviting such an important discussion.  I think this is one of those areas where there is a broad range of opinion.  Kim, I appreciate you bringing up the fact that being mentally healthy is often defined as being free of symptoms that impair functioning, a definition I have found limiting.  Health, in my worldview, is an optimal experience of functioning in the world; not the absence of sickness. The capacity to love, work and play definitely encapsulates the wide range of meaningful activity we are able to engage in when mentally healthy.  And I would agree that being present, seeing life clearly and exhibiting flexible intelligence and behavior are also characteristics of mental health.  In my personal and professional experience, I would add to your most thorough response Kim, that at its core, mental health is about deep acceptance of oneself and one’s personal experience in the world we live in.

As you mentioned Kim, mental health is relative to one’s culture and one’s position in that culture.  We are all looking for acceptance of who we truly are at our core, an unconditional love that we might hope for from our families or in relationships.  But this is difficult to find, especially so if we have been marginalized or oppressed.  If our experience in the world has been one where some or all of the parts of ourselves were not loved and accepted (so, basically I’m talking about everyone here), there are consequences to that.  The shame, fear, anger and sadness that result produce negative internal experiences, all of which contribute to negative mental health.  This is especially so when these painful emotions are combined with internalized thoughts about not being good enough in some way. Much of the work in a formal therapy setting is working toward an acceptance of the things we cannot change in the context of a loving, validating relationship with a therapist.  This acceptance leads to a sense of internal peace with what IS and not with what we wish could be.  And through this process, energy is freed up for the love, work and play that enrich our lives.  Of course, intimate, nurturing and validating connection with friends, family, partners, and communities can also move us towards true acceptance of ourselves and the world around us.  These connections help to remove the barriers to optimal experience and enjoyment of our lives.

I believe it is difficult to objectively define mental health since everyone’s experience of pleasure, pain, love, discomfort, satisfaction and connection are so individual.  Having been through childbirth three times, I can tell you that experience of physical pain is quite relative to the individual! I supposedly have a low pain tolerance.  Whether my physical experience of the pain is any different to another laboring woman, I have a very unambiguous relationship with physical pain.  I would like it to go away.  But like every woman who experiences childbirth I had to accept it as both natural and necessary.  Both in labor and life, this resistance to natural and necessary pain only serves to intensify it.  I recently reconnected with a colleague who suffers from chronic physical illness.  He feels physical pain on a daily basis, and doctors invalidated this experience of physical pain for over a decade until he was finally diagnosed with fibromyalgia.  I was thinking of him as I read your question Lara of what it means to be mentally healthy.  It is extremely hard to feel positive emotions and when we are in constant physical pain.  But our willingness to face and accept the vast range of feeling in our bodies makes us more present, human, and healthy.  And again, it frees up energy for love, work and play.  Physical or mental symptoms may always be present based on genetics or biology, but working towards acceptance of those symptoms moves us towards wholeness and peace.  Not that this is an easy thing to do.  Reaching out for support is a necessity to being mentally healthy because not only is connection crucial to good health, it is the only way to tolerate the intensity of our emotions and life experiences at times.

Everything operates on a continuum, but when our relationship to ourselves and our environments is one of acceptance rather than discord, I believe we all move toward better mental health.

May 6, 2014 at 9:58 pm

Kim and Laney, thank you very much for the depth of thought you gave in your responses to this question. Describing mental health—something so broad and so variable—has been a challenge for me so I really appreciate both of your expertise in this arena. Kim, I really appreciate your macro perspective and reminders of the importance of taking culture into account when defining and discussing mental health. And, Laney, acknowledging that all things exist on continuum and acceptance is critical to well-being. I think I’ll share on a more personal level since so many of these ideas are so deep and complex, and personalizing might help with thinking about mental health as it relates to every one of us.

How do I define my own mental health?

I don’t think of mental health as a fixed state, but rather as something that is fluid and variable among every individual on the planet. I think of mental health as an ideal state of being – a place of harmony between the physical, emotional and spiritual selves. For example, if the mind is not vibing with the heart or soul, it can feel taxing physically, emotionally and/or spiritually. Feeling in sync or mentally healthier can feel pretty good, even great. In general, it’s feeling more good than bad about my relationship to myself and others in my immediate social world and the greater community and world. Much more good than bad.  It’s about contentment.

Here are some personal examples illustrating when I’m feeling in sync with my humanness and generally mentally healthier.

I feel strong. I feel empowered that I have the capacity and worth to handle what life throws at me and am confident that I’ll do a good enough job at managing/problem-solving and coping through it all. Along with this strength is a positive energy that serves to motivate me and helps me feel enlivened, breaking me out of the mindlessness that can take over everyday life. (e.g. spending a whole day in and out of body kind of way—like when you don’t remember how you got somewhere or a conversation you had or misplacing your keys, etc.). I feel attuned to my own power and sense of agency-that where there didn’t seem to be options, possibilities exist, and with that comes a greater sense of personal freedom (and more victim-y feelings are diminished.)

I can move toward my own vulnerability. Rather than running fast as hell away from getting hurt or revealing something unbecoming about myself, I feel mentally healthy, when I can tolerate and even invite vulnerability. I see being vulnerable as one of my (just about anyone’s) greatest strengths and the most effective way toward intimacy with friends or family or even myself. I’m not saying I’m good at it, but I think inviting it is so very important. And, can it ever be uncomfortable and scary, but when I engage with it, I know I am being truly authentic, expressed, feeling worthy and unashamed, and, sometimes, more alive and connected on a higher plane. I believe one of our downfalls as humans is defending against vulnerability at all costs. Culturally, in American and many other societies, vulnerability is seen as weakness, but it is truly one of our potential greatest strengths. I think we’d have less bloodshed and no wars if being vulnerable were valued and respected.

Tolerance-this is a big one.

When I can find compassion and empathy for myself and others, the sense of spaciousness within me is immense. It is hard to do in our busy, rushed, reactive world, especially when people do so many jerky things and it’s so easy to get irritated when dealing with the difficulties and suffering exigent in daily life. But, being able to slow down, breathe and be present—practicing deep listening with ears and heart—helps with feeling community with others rather than envy, anger, distrust, etc. Again, it reduces my sense of isolation and hopelessness I often feel with the world. Another way to look at this is really being able to love without judgement.

Being multi-cultural in my own background, it can be difficult to integrate the conflicting messages and values I was raised (and live) with. Being comfortable with the consequences resulting from my choices (which values I accept and which I reject) and then being able to navigate back and forth in my relationship to myself, my family and society—not perfectly nor without offending or hurting others—but knowing I’m doing my best and with good intentions. Essentially, this example is about healthy coping skills—creating adaptive ways to reliably lead myself through adverse circumstances. And enduring the process.

So, how do I attain mental health? It is a significant task! Like with my physical health—it is something that requires regular attention, being pushed beyond my comfort zone, practice and maintenance. I write from the perspective of someone who is not struggling with significant mental illness, but, nonetheless does experience anxiety, depression and all other difficult negative feelings like most of us. Anxiety or depression may be a part of who we are, but becoming mentally healthier may mean changing how we relate to the more difficult emotional states we spend time living in, rather than eliminating them all together. Overcoming significant mental illness or even the more nebulous milder “illness” can be incredibly daunting and difficult. But, when we prioritize our own growth– a desire to feel better, be better, do better and live better-we can reap the rewards from it. My personal growth work is around the effort to be real. It can be scary to become more fully who you are since we may fear its impact on our more important relationships, but physical, emotional and spiritual balance can’t happen without it.