Recently it was ‘Mental Health Awareness Week’ here in the UK. It has been around in the UK since 2001 having originated in the US in 1990, but the likelihood is that many of us will have only heard about it in recent years since high-profile celebrities made it ‘OK’ to talk about mental health. Hosted by the Mental Health Foundation the aim is to “.. raise awareness of mental health and mental health problems and inspire action to promote the message of good mental health for all.” As a psychologist I am completely behind this sentiment and I am delighted that the public is beginning to engage with the subject; (when I researched response styles to stress and depressive symptoms as a PhD student over 20 years ago, the mere mention of my research topic would provoke a tumbleweed situation, as NO ONE admitted to having personal experience of stress or depression. Any comments were always hypothetical, about someone else or whispered in the strictest of confidence.) Whilst I am 100 percent behind de-stigmatizing mental health for myriad reasons; as someone who has had the opportunity to work therapeutically in mental health and neurological services, I feel strongly about pulling apart the concept of mental health to make it more accessible for those of you who don’t comfortably engage with this topic by bringing attention to the role of our brain and our mind, and conceptualizing mental health as a continuum upon which we are all located – and upon which our position is not fixed.
So, let’s take a moment to think about why owning our mental health is such a challenge – here I think we need to look into history. If I asked the question, ‘what does the term ‘mental’ conjure up in your mind’s eye?’ you might start to picture the haunting Victorian asylums, or maybe images of people with psychiatric diagnoses who present with ‘unusual’ behaviour. Perhaps sensational headlines about crimes committed by people with a mental health diagnosis pop up for you – regardless of the specific image, chances are, you are likely to think about ‘difference’ from the so called ‘norm’, indeed the word ‘mental’ is even used as a derogatory term in social slang. So, with all of this negative imagery socially constructed over the years mental health awareness week and the wonderful charities and individuals supporting it have a real challenge to re-brand how people perceive ‘mental health’ in one generation. I wonder whether part of the challenge is rooted in our language, and whether by pulling apart the term mental health, what it actually means and thinking about alternative language could be helpful?
From the outset we need to be clear that mental health is not the same thing as mental illness, and herein lies some of the problem. Let me explain a little more; the medical model is currently used to diagnose mental illness or disorders, by listing the name of the condition, the associated symptoms and duration that those symptoms must be experienced to reach the diagnostic criteria – so right from the outset we need to be thinking about continuums where there is a threshold from which diagnosis is given or not. There are two main sources for this information that psychiatrists and psychologists turn to, The Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (a hefty reference book of 947 pages), and the ICD-10 Classification for Mental and Behavioural Disorders published by the World Health Organization. Whilst there is considerable debate within the professions about diagnosis which I’m not going to go into here, I am wanting you to notice, the language – both resources link the word ‘mental’ with ‘disorder’ – i.e. lack of order. Perhaps this linking of language in the professional discourse perpetuates and reinforces the ‘difference’ that the word mental triggers when we use it.
Part of raising awareness is about de-stigmitizing which is what Mental Health Awareness week is about and indeed what the Government is trying to do. I’ve read a lot of articles over recent years citing how common mental health ‘problems’ are an attempt to normalize the experience. For example some statistics suggest a 1 in 6 ratio of people experiencing a common mental health problem in the past week, this figure is provided by the UK government (once again note the word problem associated with mental health). Another common figure is the 1 in 4 provided by the World Health Organization. However, what this figure actually reports is that 1 in 4 of us will be affected by mental or neurological related issues at some stage in our lifetime. At some time in their lifetime implies transience not permanence, and it really is important to be clear on what we are talking about here… notice this frequently cited figure combines mental or neurological issues, not mental illness as is sometimes supposed or reported.
This reality is summarized elegantly in an article published by Harvard Medical School it reads, “Everyone feels worried, or anxious, or down from time to time. But relatively few people develop a mental illness.” This once again is placing ‘symptoms’ on a continuum. It is entirely normal for us to go through ups and downs, that is life, to experience times when we feel stressed, anxious or even a little depressed is an entirely natural response to life events, but that does not mean that we have a mental health problem, illness or disorder. Our emotions are usually transient, they come and go and are often related to situational triggers, if we experience them it does not necessarily mean it is a problem or that it will escalate to meet the diagnostic criteria, or that if it does, it doesn’t mean that it will be with you for life. At this stage I need to be clear I am not intending to minimize the daily challenges that many people with long-standing, diagnosed conditions experience, what is important is for people to realize that we all share inbuilt emotions and experience them on a continuum and that this is always changing.
I have discussed the idea of a continuum of experience and that there exists a diagnostic framework, but what exactly does mental health actually mean? Well according to the Cambridge Dictionary, mental relates to the mind and involves the process of thinking – now this is interesting because it opens up the potential for conscious thought. This slight change of language opens new opportunities for discussion, understanding and change – and is indeed one element of what talking therapies do. So, let us take this further, what about the mind then? The mind is defined by the Cambridge Dictionary as the part of a person that makes it possible for him to think, feel emotions and understand things – now this is more like it, and actually more helpful when thinking about people. So once again we go back to the idea of shared emotion, thinking and understanding – in other words cognitive processes.
Having unpicked the word mental, now let’s move on to the word health. The Cambridge Dictionary describes health as the condition of the body and degree to which it is free from illness, or the state of being well. So, when we are talking about mental health – inadvertently what we are actually talking about is a mind that is absent of illness – which isn’t the inclusive, destigmatizing agenda that I’m sure is intended to be promoted when we talk about mental health, and possibly explains why some people have difficulty relating to the term.
Here I think it is time to re-visit that 1 in 4 statistic offered by the World Health Organization that I referred to earlier. You might recall that the figure combined ‘mental’ or ‘neurological’ issues – so issues of the mind or the brain. This is where we could really start to promote the concept of health, by drawing our attention to the importance of our brains.
Our brain is an incredible organ. It is the most complex organ of the body, it weighs about 1.4 kilograms, and is the center for one hundred billion nerve cells, or neurons. Neurons form millions of highly complex connections throughout the brain which make us all unique as no two of us form identical connections. It is through these amazing connections which run through different parts of the brain that do different things, that we develop memories, interpret situation and form habits or patterns of behaviour that shape our minds and personality.
Our brains are divided into different structures which have different functions, the part that looks like a walnut also known as the cerebral cortex, is what differentiates humans from other animals. Our developed cerebral cortex and specifically the neo cortex enables us to have what we know as a mind- our conscious thought. It allows us to weigh up information, to plan, to make decisions, to inhibit our behaviour so we don’t act on impulse and also plays a role in the recognition of social relationships and emotions, language etc… the list goes on.
Over recent years with the advance of neuroscience, we are starting to learn more about this amazing organ. We are also starting to realise that we can take responsibility for looking after the health of our brains. Taking responsibility for our brain health is really important and should not be overlooked just because we can’t see our brain and know relatively little about it. If our brains are not in good health, this could impact the functioning of our minds, and we could end up with diseases of the brain as we all are living longer.
Let me put it this way, we are our brains. Yes, we are made up of our genes, and are influenced by our environmental experiences, but essentially all that we are and all that we do is controlled by our wonderful brain. So, when we talk about mental health, behind this we really need to be considering our brain health in order to promote a positive relationship with our brain and our mind.
Through considering our brain health we are distinguishing organic or acquired conditions of the brain from those experienced at the level of thoughts that are common to us all from time to time. By seeing the mind as something that we can get involved with, we can start to understand, relate and show more compassion and solidarity to people who are experiencing a tough time, because we all go through it – or at least have the potential to. It is here where we need to engage more. Indeed, often people become more open to talking about mental health when they have personal experience of how those suppressed and ignored little niggles rise up over time and cause a bigger issue at which point it can no longer be ignored… rather like the stone in your welly that is a bit uncomfortable at first and then rubs away until it causes you to stop and deal with it. If we learn to recognize and then deal with that metaphorical stone when we first become aware of it, rather than plod on until it really starts to hurt, then we could avoid a worsening situation. Prevention really is better than cure and I’m pleased to see that this message is advocated at the highest level of Government.
So how do people look after the brain and the mind? Let’s borrow from the world of physical fitness here – strength, flexibility, endurance all contribute towards physical fitness, I would suggest that this can also be applied to keeping the mind ‘fit’. Through the work of the positive psychology movement, Carol Deweck’s growth mindset paradigm explicitly addresses the need for flexibility of thought in order to be open to learning new information. The resilience literature emphasizes the role of cognitive strength and endurance in the face of challenges. So, by intention or otherwise, I consider many psychological theories having similar themes to those applied to the body, and as fitness is a concept widely accepted with the word physical in front of it, why not apply it to the mind? Can we look to psychological theory to help us keep mind fit? Indeed if you have read this far, I would argue that you are exercising your mind perhaps even making it more flexible and therefore contributing to your mind fitness.
So, to recap, the aim of Mental Health Awareness Week is threefold  raise awareness of mental health  raise awareness of mental health problems and  promote the message of good mental health for all. Let me be clear, I think this work is amazing and incredibly important – extending the concept a little further to make us think about our wonderful brains and our beautiful minds can in my view only contribute positively to this agenda. Perhaps helping people engage with the concept of brain health, mind fitness, and the continuum that we are all on could help us take more ownership and focus on what we can do to help our brain and mind and further work to destigmatize this topic. I wonder if it is possible for us to apply similar aims and personal goals to our mind and brain health and fitness as we do with our physical health and fitness? I sincerely hope so.