Finding Mental Health

Finding mental health in a culture that misunderstands, stigmatizes, and sometimes views necessary life adaptations as a disease, is not an easy task. But it’s a good topic to explore this week of World Mental Health Day.

Before reading, please be advised it is not a how-to. It’s an exploration of the way we discuss and view mental health and the forces that make it hard to find.

Protecting and improving mental health will sometimes mean a fight against culturally accepted norms and established clinical protocol. And practicing good mental health daily will automatically put you at odds with the over-worked, over-obligated, under-still lifestyle we encourage in the US.

That’s a lot of momentum to overcome, even for those who are generally stable and balanced. For those of us who have no specific mental disease but have experienced neglect, abuse, violence, accidents, disasters, family loss, or other trauma that significantly affects how we move through life, it is often difficult to find trauma-informed care.

Someone can look perfectly normal on the outside and function well while struggling internally. They can do it for years. What you may not see is the toll it is taking.

Sometimes that will show up as physical symptoms. Other times, it may result in subtle depression that quietly diminishes a person’s ability to experience joy. Or it may sometimes lead to what appears to be a sudden breakdown.

Burnout, lashing out, perpetual anger, perpetual sadness, mood swings, multitudinous failed relationships, substance use, drinking, and overworking can all be indicators of a difficult inner life. But where we draw the line between adaptations that preserve sanity in unthinkable circumstances and mental disorders or illnesses is somewhat subjective. It’s also vulnerable to the unreliability of self-assessment.

Better definitions, more specific language, and more accurate expectations would be helpful in guiding all of us in finding mental health. Current discussions paint with such a large brush that what may be a normal response to the ups and downs of life seem to indicate poor mental health.

Have people struggled with the changes brought by a pandemic? Of course! But that doesn’t, by definition, mean a person is experiencing decreased mental health. It may mean I feel discomfort for a period of time while I adjust. During that time, I may feel a sense of loss. I may feel anxious or worried. I may feel frustrated or angry. I may need more rest. And, for a time, I may feel depressed. If I did not experience these “negative” emotions, I would not fully adjust and again find equilibrium.

Describing a healthy progression through negative emotions as decreased mental health feels dicey to me. It creates the idea of a problem where there would otherwise not be one. And the belief something is “wrong” can exacerbate the difficulty of moving through the process.

It can make one step along the way appear insurmountable. That may lead us to seek help. That help may diagnose an adjustment disorder. But is it really a disorder or did I fail to learn skills that would make adjustment tolerable? Should a lack of skill be characterized as a disorder?

This is the slippery slope we’ve been sliding down for years. Has that resulted in positive benefits overall?

Labeling with an inappropriate diagnosis can place the blame on victims and create social isolation or rejection. And it can cause practitioners to dismiss a patient’s experience.

Medicating for a short period may be helpful or it may prolong the healing process. It rarely solves an underlying problem without being combined with other therapies.

I saw a statement flash across my screen today that said reducing intimate partner violence will improve mental health. The way I read that, the victim of violence is the one with diminished mental health.

Obviously, a victim may have a negative response to abuse. (I hope so!) But that seems NORMAL and not in any way maladaptive in and of itself.

In that scenario, maladaptive behavior could include failing to report the violence and remaining in the situation. But staying for awhile until supports are in place may be the only way to safely exit.

How is it that we turn a victim’s experience of helplessness, hurt, betrayal, loss, anger, frustration, and resulting low self-esteem into an indicator that the victim has a mental health problem? Uh, no. The victim is a victim. And that doesn’t mean they’re weak.

The way we view this is bassakwards and stigmatizes the wrong party.

Do we need so badly to believe that could never happen to us that we need to put all victims in a “them,” not me category? Lobbing the mental health problem identifier at victims certainly accomplishes that.

Keeping the identity of victims secret also serves to create the illusion that they did something wrong. If we don’t believe a victim will be stigmatized, why do we need to keep their identity secret? Or asked another way: If we don’t believe our society will use the victim’s vulnerability against them, why keep their identity secret?

But the truth is, we do stigmatize and use vulnerability against victims all the time.

Is it possible to find mental health in the midst of the morass I’m exploring? Yes. But it may not look like what you expect. And that is a great place to begin. If you’re able to let go of expectation and willing to experience life as it comes, you’ll be much more likely to find mental health.

And it may look different for you than it does for your father, mother, spouse, or children. That is okay. It may look different today than it does tomorrow. That is normal.

The wonderful thing about humans is that we are each unique and capable of adapting and learning. These are things to be embraced, built on, and celebrated. Unfortunately, we create environments that often make us feel we must hide our best qualities in order to be considered “normal,” well-adjusted, and mentally healthy.

We can change that by keeping in mind, we are not the same. We don’t need to be. We can grant each other grace to find our own paths. We can be different and still deeply connect and understand each other.

Mental health has many faces waiting to be found. If we create safe environments in which to explore, we’ll be closer to finding mental health.

ad

Adherence vs Compliance

Is adherence better than compliance? I recently saw a doctor tweet a list of words he hates to read in patient charts. One of those words was compliant. He indicated adherent was superior, always. I’ve been thinking about that in light of the difficulty many of us have in complying with medical advice – including specialized diets.

I know, it may seem like semantics. But maybe in this case semantics matter. And I think this doctor makes an important point.

To get the greatest benefit from medical advice, patients need to adhere to plans developed by their medical team and agreed to by them. But I’ve most often heard this described as compliance, not adherence.

Why does this distinction matter?

In the strictest definitional sense, compliance means acquiescing or yielding, especially in a weak or subservient way. I don’t want to feel weak or subservient when it comes to decisions about my health. I’m pretty sure no one does.

I strongly believe in patient-centered care. In such a system, the patient is a valued part of their medical team. I’m not sure you can feel valued as part of the team when are related to by medical professionals as though you are, or should be, weak and subservient.

And let’s be honest, many times there’s pressure from medical professionals for patients and families to behave in a subservient way. If they do not, they may receive dismissive or condescending treatment. When this happens, it seems predictable that patients will tire of such treatment and rebel.

If a doctor talks down to, bristles at questions, fails to explain, or refuses to listen to patients, that physician is not going to be as likely to get a buy-in on a prescribed health plan. If that professional perceives there is pushback and relies on a position of superiority to attempt to enforce compliance, the patient will rebel even more.

And why not?

Our lower brains may perceive this kind of pressure as danger. When that happens, the patient must try to somehow twist their being into compliance while feeling they could be in danger. And the feeling of danger is exacerbated by a constant barrage of advertising pushing medications and health screenings.

Essentially, we’re asking people to do something very difficult to do. Intellect may not intercept the lower brains signals on a conscious level leaving behavior to be guided by survival instinct or reflex. Of course this won’t be true in every case. But it may be true often enough that we could improve adherence just by changing our rhetoric.

Adhering connotes steady devotion, allegiance, and attachment. In other words, if I choose to adhere to something, I embrace it. That sounds like the relationship I want when it comes to my health. I hope to embrace a plan that I perceive as the healthiest for me in any given moment.

Adherence places the patient back in a position of power in charge of their health. It is willingly given and does not require pushing at all.

Why not change our approach to seek adherence? When we treat patients in a manner that encourages them to embrace a plan, there will be no need for pushing, cajoling, shaming, or arm twisting them into compliance.

Could such a subtle shift make a difference?

There’s no way to really know until we try it. But if one physician has recognized the benefit, I’m guessing there are others. And if we as patients push for this change, we may get more palatable healthcare.

I feel like eating plans tailored to the needs of an individual and presented respectfully will make many dietary recommendations less objectionable and easier to embrace. That will take us a long way toward adherence.

Some may determine that adherence vs compliance is a bit potayto, potahto. I disagree. I feel like a shift toward adherence is just the shift we need.

Seeking Safety

How much of our relationship to food is about seeking safety? I’d like to know the answer to this question. I also understand that the answer is variable and individual and therefore impossible to answer in an objective way. 

Since Abraham Maslow proposed the idea of a hierarchy of needs in the 1940s, we have generally had a picture of physiological needs as the basis of a pyramid. That means physiological needs are the priority. After that, comes the need for safety, then the need for love and belonging, etc.

But it’s really not that simple. We aren’t a perfect pyramid built one layer at a time. We need to feel safe or we may throw up any nourishment that’s available. We need love and belonging to feel safe so it’s impossible to meet our physiological or safety needs without incorporating that next layer of love and belonging. If this were not true, it would be the norm for babies to thrive whether or not they recieve love and attention.

Perhaps it would be more helpful to view ourselves as layer cakes. The layers support each other. Each is the same size. Each is equally important. When tasted together, the flavors enhance each other. 

A layer cake is a stable tower when the layers are securely held together. In a cake, we use frosting as the glue that both sweetens the tower and keeps the layers connected. In people, the frosting is attachment. 

Secure attachment looks like frosting applied with a steady hand. It has uniform thickness across the layer. The amount is perfectly matched to the thickness of the layers. Secure attachment feels safe. 

When our attachment style develops as avoidant, dismissive, ambivalent, anxious, or disorganized, we may not always feel safe in our relationships. This can affect any or everything in our lives and may manifest in our relationship to food.

Sometimes, we will need a full pantry to feel safe. Sometimes, the urge to eat or not eat will be about the feeling in our stomach. Sometimes, we need to feel soothed by the act of swallowing.  

Most often, overeating or binging and purging are characterized as attempts to fill a void. Again, that seems like an oversimplification. If a person to whom I felt anxiously attached withheld food from me during my developing years, I may feel a need to protect myself from starvation any time a similar feeling appears. That feeling may be triggered by an event that looks situationally different, but feels the same. 

If I eat during an emotional flashback (heightened sensation moment), I’m not really trying to regain attachment. My lower brain is signaling me to survive. I have to calm the lower brain before I can begin to consider repairing attachment. That means getting past the feeling and/or subconscious belief that I won’t survive. 

Once I am able to recognize what’s happening in the moment, I can explore the food and eating choices I make any time I experience this trigger. Without this recognition, the subconscious will continue to sabotage well-intended eating plans. 

We often feel guilt or shame when we fail to follow an eating plan. Understanding that your body may be seeking safety without your conscious knowledge can help alleviate guilt and give you a beginning point for exploring how this affects your relationship with food.

With insight and exploration, it’s possible to move the subconscious to the conscious. From there, all change is possible.

Trouble With Gratitude

How can anyone possibly have trouble with gratitude? I appreciate knowing when someone is thankful for something I’ve provided. And I want others to have that feeling as well. But last week when I was working on a project centering around gratitude, I found myself writing things like: Gratitude is a hard pill to swallow; and gratitude may be an attitude, but it’s not mine. 

Typing out whatever pops into my head can help me get past a writing obstacle. Once the word flow begins, I quickly delete whatever nonsense I’ve been typing and forget about it. In this context, my seemingly bad attitude toward gratitude is a normal part of the process. What I wrote made me laugh and laughter is a catalyst for moving me forward.

But like all things funny, this makes me laugh because some kernel of truth resonates. I am truly grateful for many things. I’m grateful that I am resilient. I know how to gather myself up after a setback and try again. I know how to work past fear to meet a goal. I know how to temper my desire for immediate gratification. I understand the value of these skills and appreciate how they have helped me succeed.

While all of this is true, gratitude can also feel like a catch-22. Usually, I feel this way on days when something has triggered the sting of early memories. Some of my best skills were honed in (because of) less than ideal circumstances. And some days, for a few moments, the feelings pull me away from gratitude. That’s how I sometimes have a problem with gratitude.

I’m not proud of those moments, but I’m sure I’m not the only one who has them. And that is why practicing gratitude in a deliberate way is important for me. If I’m not intentional, it’s easier to lapse into old feelings rather than look at the good that surrounds me in any given moment.

It would be easy to say that if I did a proper job healing myself, that would not be the case. Anyone who believes that fails to understand the grasp long-term trauma can have on the subconscious. When damage has been done over a long period of years with no relief, the undoing can be nuanced, lengthy, and less than linear. 

There is no such thing as a proper path of healing for any of us. Life will throw unexpected obstacles in our way. Serendipitous meetings will bring unexpected support. The path will shift and we must shift with it. 

The best I can do is live with open eyes, open heart, and intentional action. The rest is beyond my control. Sometimes, I will feel truly grateful. Sometimes, I will know I’m grateful even when what I feel is sad. And that will have to be enough. 

Hopefully, it’s enough for all of us who, at times, have trouble with gratitude.