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We are experiencing one of the biggest public health crises in our lifetime. The impact has been devastating for the physical, financial, and social health of millions. Add mental health to that list. Aside from the threat of catching a widely spreading virus, the high rates of unemployment, the loss of income, the diminished social contact, the conversion of our homes from sanctuaries to desks and cubicles, and the sudden need for parents to become teachers and for spouses to be working side-by-side as if they were coworkers, can have a serious impact on our mental health.
A number of research studies have already been published showing that the rates of depression and anxiety in the general population are already much higher than typical baseline rates for these mental illnesses. For example, a collaborative study by public health researchers at Boston University, Brown, and Columbia published in September 2020 in one of the JAMA Network journals has shown that the number of people with moderate and severe depression has more than doubled in the early months of the pandemic. Presumably, since studies take a few months to be completed, to have the data analyzed, and to have the results published, after many more months of the economic impact, the social isolation, and the restrictions of personal decision making, subsequent studies may reveal even higher rates of mental health problems.
How did we get here?
I am certain that this is not the first time you've read about the toll of the pandemic on our mental health. I am also certain that many of you may have felt stretched to your limits and very close to a breaking point. And I am sure that many of you have followed advice about what to do to protect your mental health. The reason for writing this blog post is not to re-list the familiar "how to" tips and hacks to stay mentally healthy. Instead, I wanted to share some thoughts about the big picture problem that I see in the field of mental health.
The alarming rates of declining mental health are bad news but also good news. The bad news is obvious. The good news is that we have finally put a spotlight on the importance of mental health and how fragile it can be under intense and extended duress. But it also highlights an important misconception that many of us have regarding mental health.
We often misunderstand the concept of mental health by conflating it with mental illness. We think of mental health as the presence or absence of mental illness. We pay attention to mental health only when it turns to mental illness. We seek help for mental health only when we reach that breaking point. And that is a big risk.
Is mental health merely the absence of mental illness? Are they on opposite ends of the same spectrum or should we start thinking of them as two completely different dimensions?
Years of inquiry, research, and clinical experience lead to the conclusion that we need to draw a line between mental health and mental illness, and define each of them very clearly but separately if we want to prevent mental illness and promote mental health: two separate and equally important goals.
Let’s start by drawing the line between mental health and mental illness.
1. Mental health is not the absence of mental illness
First, mental health is not simply the absence of mental illness.
Mental illness is a broad term that refers to a large and diverse number of mental disorders. These mental disorders can range from depression and anxiety to dementia and psychosis. Each of these disorders has a specific set of symptoms. If you have the symptoms, you have a mental illness. If you don’t have the symptoms, you don’t have a mental illness. The job of the mental health expert is to check to see if your symptoms are consistent with the diagnosis and if they are, to provide you with treatment specific to that diagnosis.
But does not having the symptoms make you mentally healthy? Not quite. To use physical health and illness as an analogy, it would be like claiming that because you haven’t suffered a stroke, you are in good health. That you can run a mile without losing your breath, that you can eat as many cookies as you like, or that you don’t need to take showers anymore.
In contrast, there are no signs and symptoms of mental health that the scientific community has identified and catalogued. There are no theories of mental wellness. There are no established interventions on how to improve your mental health, only interventions on how to prevent and treat mental illness.
2. Improving mental health vs. treating mental illness
Second, improving your mental health is not the same as treating a mental illness.
Treating mental illness, which is what the mental health experts do, means helping someone deal with their symptoms or take care of problems they are experiencing related to their diagnosis.
Improving mental health is different. It goes beyond protecting us from developing problems like depression and anxiety, trauma and pain, fear, and isolation.
Taking care of our mental health means learning how to be focused and productive, loving and creative, energetic and spiritual, generous and grateful, curious and caring, thoughtful and deliberate, playful, and carefree.
We know what to do to prevent heart attacks and strokes, the leading causes of death. But we don’t really know what to do to deal with self-doubt, procrastination, impatience, negativity (our own and others’), lack of focus, reduced motivation, fear of failure, stressful jobs, burnout, failing relationships, or the lack of purpose in life, which are the causes of spiritual death, until they reach the threshold of clinical diagnosis.
3. Mental health and mental illness require different actions
Third, if you continue to draw a parallel between physical and mental health, the distinction between health and illness becomes clearer.
In terms of your physical health, there is one set of actions that you take when you are ill and a different set of actions to be healthy. When you are ill, you go to the doctor and seek treatment for the illness. When the illness is cured, you stop the treatment. When the fever drops, you stop taking the antibiotics. When the wound heals, you stop applying the ointment. When the bone mends, you take off the cast. But after the illness is cured, you don’t stop and wait idly till the next time you are sick. You continue to do a lot of other things to stay physically healthy. You eat well, drink a lot (of water!), get plenty of sleep, exercise, use sunscreen, take vitamin A through Z, and avoid processed food, radiation, and riding bicycles without a helmet. To be physically fit and healthy it’s not just enough to say: I didn’t catch pneumonia, I didn’t break a leg, and I didn’t grow a tumor. Staying in good health is not the same as hoping not to get sick.
The same is true for mental health. There is one set of actions that are designed to treat mental illness. There should be a different set of actions to foster mental health. To be in tip-top shape mentally, it’s not enough to say I am grateful that I don’t have bipolar disorder or schizophrenia. It is also not enough to say I am taking my antidepressants or I am seeing a therapist. It is even more important for people who suffer from mental illness to engage in actions that could help them stay mentally fit so that they can deal with the illness even more effectively.
4. Availability and access to resources
And finally, if you want to improve your physical health, you know where to go.
You join a fitness center, you do yoga, you sign up for tennis lessons, you consult a nutritionist, you go to a spa, you read Men’s Health or Women’s Health, and so on. You know the resources and where to get help to stay physically healthy and youthful.
But where would you go to stay mentally fit? Where would you go to make sure that you are a good parent, a supportive spouse, an outstanding employee, or an inspiring leader? Whom should you ask about how to balance work and family life? Where would you sign up your kids to protect them from becoming bullies or bullied? Who will help you decide if it's time for a career change?
We know how to take care of our bodies so we can live well and live longer, but now that we live longer, what will we do for our mental, our emotional, and our spiritual well-being? How will we make sure that our long and healthy life will also be a life filled with purpose, meaning, and joy?
Should we go to therapy? See a psychiatrist? Take antidepressants? Probably not. And you know that your health insurance company will not cover coaching for how to make better career choices, how to be a better parent, how to build the life you want.
One thing is clear: For various reasons, we have fused mental health and mental illness. We don’t know where one starts and the other ends. We talk about mental health, but we mean mental illness. Our mental health system is better equipped to deal with mental disorders after people have developed them rather than focus on promoting the life skills that would keep people mentally and emotionally healthy and, therefore, protect them from ever needing services. It should more accurately be referred to as the mental illness system, rather than the mental health system.
The adjustments to the way we have been living, working, and interacting the last few months require qualities like optimism, resilience, patience, creative problem-solving, and good emotion regulation. These qualities are not personality traits that we either have or we don’t. They are skills that we can develop and practice and that will enable us to bolster our mental health and plow through these and any other tough times ahead of us.
