What exactly is good mental health? Joe the Plumber (or Sarah the Nurse or Ben the Mailman) might say “when I feel good most of the time I have mental health. If I feel bad most of the time, maybe I should seek help.”
One way to think about it is to consider what is good physical health. I’m not an expert in medicine but I picked up somewhere that health is what you have when you are not sick.
Western medicine treats what goes wrong when the body is not well. Once the illness is gone we are healthy again. Sure, there may be room for improvement, exercise regularly, eat a balanced diet and so forth. But as long as we’re not sick, we’re ok.
Using this model we can then ask, what goes wrong when the mind is not well? Depression and anxiety are common signs of mental distress. We all experience these things from time to time in various life events: loss of a loved one or having to speak to a crowd. But mental illness sets in when these become become chronic and are experienced everyday.
So are panic attacks, schizophrenia, post traumatic stress symptoms, drug/alcohol addictions, sexual problems, behavioral difficulties and so on.
The DSM-IV is the Big Book of mental health symptoms mental health professionals use to diagnose their clients/patients. Yet there is some controversy regarding this book.
A well known argument is advanced by the psychiatrist Thomas Szasz in his book “The Myth of Mental Illness: Foundations of a Theory of Personal Conduct.” He argues that you cannot x-ray any mental illness. Therefore, we have no objective evidence to prove any negative mental health symptom. What we deem as mental illness, he writes, is a social construct that is influenced by very subjective issues such as morality, values and ethics and what we as a culture simply deem as “normal.” Deviation from that construct is, well, abnormal.
But since we live in a world of many cultures, there would naturally be a difference of opinion about what is normal or abnormal, depending on where we are on the planet. For example, in asian cultures women are raised to be compliant, obedient and to defer to a male’s dominance. There are cultural shifts happening around this issue this role model continues to exert a strong influence in shaping asian women’s lives. Common symptoms for women in those countries who are uncomfortable in that role are depression, anxiety, frustration or anger. Yet these symptoms are somehow tolerated because “that is just how life is.”
Yet in the US these symptoms are not necessarily tolerated and are experienced as being in the way of “good mental health.”
In other words, it is all very subjective. To be sure, though, the DSM-IV is a useful tool and not one to be dismissed because it does describe clusters of symptoms that cause a great deal of distress to many people. Some kind of roadmap is better than none at all.
But all this leaves in the lurch. What does a mentally healthy person have that others who are not mentally healthy do not have?
It depends on who you ask but since this is my blog I can tell you what I think and have experienced over the years. People who can do the following things tend to have more successful relationships and careers and would probably say of themselves that, for the most part, they are content and happy and are able to derive a good amount of satisfaction from life. Keep in mind that what follows are “broad strokes” of the brush.
I divide mental health into three categories: emotions, thought process, interpersonal relations.
Emotions
They are relatively emotionally stable from day to day.They are able to regulate their emotions. Self soothe themselves under stress, express feelings when they are stimulated, tolerate frustration, separate their feelings from those of others.
Thinking
Have a good self observing thinker inside that can second guess one’s thoughts, emotions, behaviors. Have a good moral sense of right and wrong, able to perceive reality accurately (as opposed to how you want it to be), good ability to judge, discern, understand situations. Able to plan and execute actions, adjust to obstacles.
Interpersonal
Ability to see things from another’s point of view, able to tolerate being alone, good balance between emotional closeness (emotional openness, vulnerability, dependence) and distance (independent life separate from the other).
Do you know anyone who can do these things all the time? I don’t. The point is, can we do these things more or less most of the time. People who are “unhealthy” hardly do any of the above most of the time.
They have a hard time being alone and are often clingy. Or they are completely uninvolved and play the "I'm one up on you" game. They blame others when things don’t work out and only see things from their own point of view. Their emotions can fluctuate dramatically from day to day. It is hard for them to regulate their own emotions. They can fly off the handle at the drop of a hat. Internal or external pressures of life make them escape into various addictions. They redefine right/wrong to suit themselves and there is not much personal integrity. It is difficult for them to self reflect about themselves and see how they affect others.
I’m thinking most people will probably fit in the healthy category. But there is a segment of the population you’d think falls into the unhealthy box. You've probably met at least one of them in your life.
What separates physical pain from emotional pain is how much the later can be tolerated with endless rationales and escapism. Physical symptoms left untreated will often get worse until something in the body really goes wrong. Yet emotional pain be endured an entire life from birth to death. They may never see a therapist and never think there is anything wrong with them. Some of these people have been world leaders.
