I try and intentionally use the term “mental healthiness” as much as I can when I talk about my overall philosophy on wellness. It’s not because I personally have any issue with the term “mental health” but unfortunately there’s layers of meaning connected to the term that can be confusing. One main confusion is that the term “mental health” is often equated to “mental illness” – but it shouldn’t be. For instance, let’s examine the idea of mental health treatment. If mental health was in fact about health, why would you need treatment for it? Because of the unfortunate stigma attached to mental illness and its treatment, “mental health” is a euphemism for a topic we’d rather not address directly. There are other examples of this clever use of language too, such as how life insurance is really about death, and how health insurance is really for sickness. In some ways, at least for marketing purposes, it works. We are more likely to buy life insurance than disability insurance. We value keeping our health insurance but paying for a gym membership or counseling seems like a luxury. In other ways, it’s just confusing. For example, costs for things like gym memberships, prosocial activities, and health education courses are not covered by “health” insurance, even though exercise, being in relationships, and having meaningful insights about our own health and wellbeing all actually promote healthiness with measurable positive outcomes. The problem is that even though this euphemistic labeling works to make unpleasant things more appealing, it is at the expense of being accurate about what things really are. Maybe it makes it so that treatment for mental illness is something we can talk about if we say it’s for our “mental health” but in reality mental illness and its treatment generally remains a mystery to most.
But here’s the thing. If we actually focused on mental healthiness, we could treat mental illness more effectively. And being more effective is necessary because even if we took all of the current best evidence-based practices for the treatment of mental illnesses, there’s about 25% of people that are getting less than optimal results. A mental healthiness perspective includes the whole range of human experience, from at our very best to at our very worst, so this includes all of Psychiatry and clinical Psychology – it just has room for much more. But this isn’t my idea or even a new one. Starting in the 1940’s, Psychologist Abraham Maslow, in response to the Psychoanalytic preoccupation with what was “wrong” with people, suggested an alternative view on the study of the human experience:
“It is as if Freud supplied us the sick half of psychology and we must now fill it with the healthy self.”
Also in response to the other major school of Psychology at the time, Behaviorism, which attempted to equate our behavior with that of animals, Maslow founded the Humanistic Psychology movement, focusing on optimizing the uniquely human experience. Interestingly, in our current era of rapidly expanding knowledge of the brain and its functions through functional brain imaging, Positive Psychology, Emotions research, Social Cognitive Neuroscience, Interpersonal Neurobiology – what we’ve come to recognize is that many of the intuitive theories and assumptions of Maslow and his Humanistic contemporaries, like Carl Rogers and Marshall Rosenberg, have proven to be more accurate and more comprehensive than the pathology focused lenses of Psychoanalysis and Behaviorism.
Well, that may apply to when we are doing our best, but what about when we are at our worst? In my blog series, Psychiatry and Mental Healthiness, I talk about the evidence behind how chronic unhealthiness can lead to illness, and how research supported strategies that focus on personal growth and wellbeing, in conjunction with best evidence-based practices, actually can help treat some of the more challenging aspects of mental illness, including in the most serious conditions – Schizophrenia, Depression, and Bipolar Disorder. For example:
Medication is the least helpful for the negative symptoms of Schizophrenia and in most cases those suffering from Schizophrenia live isolated and dysfunctional lives. However, psychotherapy that focuses on changing self-defeating beliefs and prosocial interventions that support and reteach social skills have been shown to be effective in improving both positive and negative symptoms, and more importantly the quality of life in persons with chronic Schizophrenia.
Both antidepressants and Cognitive Behavioral Therapy have been shown to be equally helpful for the symptoms of depression, however, the normal lifetime course of Depression is to have recurrent episodes. However, Depression can also be treated by focusing on different aspects of improving relationships and beliefs in self-efficacy, without medication and without focusing on Depressive symptoms or Depressive behaviors. These interventions also may have more long lasting benefits in preventing future relapses as well.
Almost half of people diagnosed with Bipolar continue to be disabled even when symptoms have completely resolved. By changing the way in which family members interact and communicate, a person with Bipolar Disorder can drastically reduce the number of mood episodes and hospitalizations in the long term, which makes a huge difference in whether or not a person is chronically disabled due to Bipolar Disorder, or lives a full and unimpaired life.
This ties into the second part of the confusion regarding the meaning of mental health – the word “health” is sometimes defined as the absence of illness, especially in the medical context – but it isn’t. Being healthy is so much more than not being sick. Healthiness is a whole state of being where personal growth, wellbeing, relationships, connectedness, and authenticity are experienced and sustained. The absence of illness can be the same as health. But it can also be the state of no longer being ill while still being chronically unhealthy. Imagine that there’s two high risk patients who recently had a heart attack and they both successfully had a stent placed by their Cardiologist. They are both now improved in terms of their health. But there’s a different outcome for the person who otherwise makes no change in his lifestyle after the procedure, versus the other patient who then goes on to quit smoking, starts exercising, changes his diet, loses weight while also focusing on his mental wellbeing. The former is no longer “sick” thanks to the marvels of modern medicine, but still has all the unhealthy risk factors that got him to the point where he had his first heart attack, and statistically is more likely to have another. The latter is moving towards health through a process of growth and wellbeing, and is not only decreasing his future risks, but is simultaneously living a more gratifying life.
So I’d like for the terms “mental health” and “mental healthiness” to mean the same thing, it’s just that the term “mental health” is interpreted in ways that distort its direct meaning. Those distortions may confuse us to think that we don’t need to work on our mental health because we don’t have mental illness. Or, when we are suffering from mental illness it may make us settle for a goal of not being sick, though we may still be unhealthy. However, when we work towards the higher goal of achieving mental healthiness, rather than just focusing on fixing problems or maintaining stability, not only do we actually achieve better results, we are also able to have greater happiness, experience better physical and mental wellbeing in the process, and maybe even live longer. In addition, when we see illness as part of the spectrum of our shared human experience, then we are more likely to be inclusive and compassionate to those that are presently suffering, knowing that there is more that we have in common than there are differences between us. Lastly, by shifting the focus away from individuals, and instead to our dynamic state of health, we also separate illness from identity – creating distance from depersonalizing labels like Schizophrenics, Alcoholics, or Psychos. Perhaps this kind of change in language and perspective would do more to help end the stigma against mental illness than trying to educate “them” about “us.” Sound appealing? I believe it’s something we can all learn and achieve if we are willing to change our minds about “mental health” so that it does mean the same thing as “mental healthiness.”
I’ll provide an overview on how to get to mental healthiness in my next post.