People ask me how I come up with topics for my blog each week. My biggest challenge isn’t searching for something to write about; it’s narrowing down all the possibilities!  This week I had several I was going to explore, but answering the question posed in the title stayed with me.

First, Some Context

Those of you who know me understand that I need to ‘set the stage’ in order to make my point. Sometimes this requires a long-winded explanation. So here goes . . .

I was in a meeting this week with folks who are committed to improving the quality of life for aging adults here in my neck of the woods. Presentations were made in this meeting by groups and agencies who work with aging adults. The aging adults they serve have varying degrees of autonomy, physical and cognitive challenges, as well as access to and understanding of technology.

The groups and agencies all have volunteers and employees who care about the older adults in our community and bring to the table unique sets of skills, education, programs, and funding. Every presenter dropped the term “mental health” somewhere in their respective presentations.

Second, More Context

I just happen to be a “mental health professional”. I went to school, got a couple of degrees, studied for and passed a national licensing exam, and then continued to keep myself educated about my field through both taking and teaching courses on mental health. You would think I would know what mental health is.

So, as I sat in this meeting, and listened to these wonderful folks discuss my field of expertise, it occurred to me that what was assumed to be an understood term, — mental health — actually meant very different things to each of those in attendance. And that is a problem.

Hang In Here with Me . . .

The reason it is a problem is that the term is being used by different people in different ways.

For example, you may have noticed that there have been a lot of people killing each other. Often, after these events, there are conversations that suggest that there is a connection between mental illness and slaughtering people using automatic weapons.

Then there is the conversation about children spending too much time on social media leading to increased levels of depression, anxiety, and self-harm. Also referred to as mental illness.

Then there is the conversation about growing old in this country, experiencing memory problems or isolation, frequently described as poor mental health.

And then there is the whole wellness industry that offers exercise, guided meditation, herbs and supplements, and helpful experts who can reduce your anxiety, bring calm to your life, and open your mind and heal your trauma.

Each of these examples use the words ‘mental health’. But they cannot, by any stretch of the imagination, be considered to be describing the same thing.

Mental Illness vs. Mental Health

These two terms might seem interchangeable, but they are not. Most licensed professionals in my line of work are trained in diagnosing and treating “mental illness”. We learn about “mental illness” by studying symptoms of suffering.

We learn about people who hear voices and see things we don’t hear or see. We learn about children, young adults, and aging adults who can’t sit still, can’t concentrate, and who have a hard time staying on a topic for more than a few minutes. We learn about people who have really dark thoughts and think about killing themselves, who cry or sleep a lot, or who can’t even get it together to shower. We learn about people who worry about EVERYTHING, to the point that they can’t function.

In my training, within each of these discrete groupings of symptoms, there are measures of severity. One group is called “severely and persistently mentally ill”. These are folks who can’t function at all and are possibly dangerous to themselves or others.

Another group is called “chronically mentally ill”. These folks may be out and about, but they still really can’t care for themselves. Often, they will be using substances as a way of trying to manage their suffering, which also complicates matters.

And then there are the ‘worried well’. This last group probably describes most folks I know. These are folks who typically are doing just fine, but for one reason or another (stress, change in circumstances, unexpected events) lose their footing and, for a short period of time (less than six months) are struggling to come to terms with their changed lives.

Mental Health vs. Mental Illness

So, can we just assume that the opposite of “mental illness” is “mental health”?  Of course not. Mental illness got rebranded into “mental health” because there is SO MUCH STIGMA attached to the kinds of suffering described above.

Unlike physical health, the absence of sadness, worry, or ants-in-your-pants, does not mean you are mentally healthy.  It just means your feelings, thoughts, and beliefs aren’t interfering with your ability to function.

All of us come with pre-loaded aps that run in the background: emotions, nervous system, and memory. Each of us has the capacity to experience happiness, sadness, anger, envy, disgust, joy, and love. Some of us experience these emotions intensely. Some of us experience life events that stay rooted in our memory and can be triggered, causing flare-ups and break-downs.

For a few of us, these experiences interrupt our daily life and can be debilitating. For most others, there is only a bump in the road, and life goes on.

Physical Health vs. Behavioral Health

Physical health is different from behavioral health in that it can be measured: temperature, height and weight, blood pressure, blood work. Physical health care looks at your symptoms using X-rays, C-T scans, and MRIs. You see your provider and s/he explains what is wrong and gives you a pill or sends you to a specialist.

Behavioral health is different because we don’t measure the same things. We look at the symptoms you tell us you have. We listen and look for duration, intensity, and frequency of these symptoms and figure out how they are interfering with you doing what you do. Then, depending on what our license allows, we either prescribe you a pill, set you up with talk therapy sessions, or refer you to a treatment program.

Health Care Caste System

Providers in this arena practice within a caste system. At the top are the physicians (known as psychiatrists). FYI, within the medical caste system, psychiatry is considered one of the lower-level fields.

Those without medical degrees make up the bulk of mental health providers. They also have their own hierarchy, with psychologists at the top (PhD/PsyD), followed by licensed clinical social workers (LCSWs), followed by licensed professional counselors (LPCs, MFTs.) They are collectively known as “therapists”, even though there are important differences in training, skills, and philosophic approaches to care.

Find A Therapist!

All of that matters little, however, if you are the person who is supposed to find help with your suffering!  Nowadays, the typical route to “mental health” is a stop at your primary care physician (who only has on-the-job training with mental illness) for a pill. This may result in a referral to a “therapist” who could be anybody ranging from an intern to a seasoned practitioner. Or you may just go home and get on with your life.

If you are able to get an appointment with a “therapist”, you will typically spend three to ten sessions talking about your “problem” and then return to your life. You will have acquired “tools” and hopefully, the intensity of your discomfort will have decreased.

You’ve Read This Far – Thank You!

Which brings me back to the beginning:  just what is mental health?  I would love for people to stop self-diagnosing (“I’m depressed!”). If I could wave a magic wand, I would focus on how we look at suffering, and instead, use different words:

I’m depressed/anxious/not sleepingI am experiencing distress and don’t know how to feel better
I need something for my . . .Please make sense of what is going on for me and stay with me until I feel better
I already tried . . .There is something wrong and nobody can explain it to me; I’m running out of hope

And I would love for agencies and programs to look at restoration of full-functioning instead of prescribing program outcomes.

Instead of . . .We should ask . . .
Why are you acting this way?What is healthy functioning for you? 
You need to get some help!What would be most helpful when you are not functioning well? 
You need to call/see/apply for . . .What services or supports do you need if you can no longer function as you once did?
We don’t provide that service; you need to check with . . .Can you return to previous levels of functioning?  If yes, how long will it take and what resources will you need?  If no, where will you be able to live safely and with adequate care to meet your needs.

This is a radically different approach to this issue and would upset all aspects of healthcare in this country. Systems at the federal, state, and local levels are organized around mental illness and would have to be deconstructed. I recognize that. And maybe that is what needs to be done.

4 responses to “Just What Is “Mental Health”?”

  1. Berkeley F Fuller-Lewis Avatar
    Berkeley F Fuller-Lewis

    Mary, as always your roving and lively mind here grapples with much that “people” “think” they understand (such as a clear definition of the very term, “Mental Health,”) — as always, you strive to get us all thinking afresh.

    So, two people in my life have offered me their “working definitions” of “mental health.”

    First, a famous relative, Buckminster Fuller, once told me HIS definition of “mental health.” “If we let ourselves get stuck in the past . . . we become chronically depressed. Or, if we let ourselves get fixated on the future . . . we become chronically anxious. Being always in the Present IS ‘mental health.’ ” (Easy to say of course, because all too many people ARE “time-unhealthy,” yet Bucky didn’t offer me any clues for how to GET and STAY in “The Present!” And yet: (cliché alert): “Why do we call it ‘The Present?’ Because it is life’s main gift”. 😛

    Secondly (and more helpfully!!!), from my mother (Grace). . . who was essentially orphaned at age 2 and had much of her life shaped by her deep inner terror of abandonment. But then finally, in her 80’s, she “figured out” mental health. Sagely she shared this with me.

    “It’s OUR job to find and to KEEP re-creating THREE THINGS in life: (1) Someone to love, (2) Something meaningful to be doing, and (always) (3) Something wonderful to look forward to.” Importantly she added the key: “We humans need to be self-responsible for ACTIVELY DOING all three. And, when we DO actively build those three things, we will find ourselves ‘happy’ — and more importantly, ‘mentally healthy’.” She told me this, after she herself had become VERY depressed—in her posh yet socially superficial and (to her) quite lonesome, senior living facility. But then, Grace figured it out. “Oh, I had FORGOTTEN that creating those three things is MY job, never someone else’s.” So, she resumed doing “her jobs” and became happier than I’d ever known her.

    Thanks for reading.

  2. Tim Gieseke MD, CMD Avatar
    Tim Gieseke MD, CMD

    The target of prescribing program outcomes is a common problem in population health where targets that are easy to measure become the primary goal for caring services rather then the harder to define goals of what good health would look like for an individual person. However, in geriatrics, we the evidence shows that organizing care interventions about what matters most to a patient, is the most likely to be beneficial and a more precise way of delivering health services. Unfortunately, the investors in health care are not convinced that this is a cost effective way to do business. This is a black hole that begs for more research.

  3. nan sullivan Avatar
    nan sullivan

    excellent! LEARNED A LOT many thanks as usual ms mary

  4. Patti Bowdler Avatar
    Patti Bowdler

    Very good reading- thank you!
    Great up-beat ending- exactly what I would expect from you, Mary : )

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