Recently I was with a group of people getting involved with Mental Health Awareness Month by discussing the question, What is mental health?” As the only full time professional there, I thought it would be good to remain silent and learn. The other people raised a lot of good points about happiness, feeling good, but missed something that clients present me with on a daily basis– how do you have mental health when life has handed you a bag of snakes? If my external circumstances are terrible, what is mental health then? It’s a commonplace that when life gives you lemons, make lemonade, but what if you have no sugar and no water and no pitcher? What I learned from listening, on reflection, is that we tend to mix up happiness and mental health.
Finally I threw out the idea that no one had yet contributed– mental health is about coping. It’s not always about happiness, self-actualization, optimism, or other aspects of life that I would put more as criteria for thriving. Granted, the folks I was with did hit on resilience as an aspect of mental health, and resilience, almost by definition, happens when confronting adversity.
But I want to give a nod here to plain old dogged determination. I keep going because I keep going. Because that’s what I do. I may not be bouncing back, but I’m not giving up. I may be doing what the English are known for– “muddling through.” Note that I am not specifying “coping well.” I’m also not saying we don’t stop to rest. Rest is a necessary part of life. Above all, stopping to rest is not quitting. It may be gathering strength for the next phase of the struggle, or taking a minute to give yourself a pat on the back for an accomplishment.
Everyone I have worked with always wants to cope better– that’s a given. That’s why they’re in therapy. But I’ve met people whose idea of coping with anxiety involves large quantities of distilled spirits, or in other cases unlimited access to benzodiazepines. A friend of mine who has described himself to me as having both a bipolar diagnosis and alcoholism (and has never been symptomatic as far as I could see, so qualifies as in remission, or recovery if you choose) once opined that medication doesn’t solve your problems, it just helps to create a space for you to work on them. I like this perspective. It’s just to note that when you go to therapy, your therapist may have a different point of view about what is going to get you where you want to go. Some may be quicker to suggest medications than others. Is one more correct than the other? That’s a judgment call. But a good therapist presumably can help us figure out the most effective coping strategies, whether through self-discovery, skills training, or other means.
But my original point is that when we are in pain or adversity, wanting to feel better– and not being able to feel better right away– can be taken by some as a sign of a mental disorder. There are a host of problems in life that can be difficult to deal with that are not mental illness. Grief is an obvious one. Survival problems like poverty or being a refugee are others. Can mental illnesses arise from these? Sometimes, but not inevitably. Sometimes, my life can suck, but I’m not suffering from mental illness. I still have my mental health.
On a parallel track, a person can be diagnosed with a major mental disorder, and still have many good things in life– many of those things that would be considered thriving. I have known people bedeviled by auditory hallucinations who had meaningful relationships, contributed to their community, and had zero of the external signs we normally associate with people who are hearing voices.
Just like physical health is not a unitary entity, neither is mental health. The poem Richard Cory is probably the most well-known depiction of someone with no visible problems, yet who is killed by his mental illness. Which brings us to one of the recurring themes of mental health awareness– stigma. The illness we conceal cannot be treated. And we hide symptoms– until they are too severe to hide– because of the fear of being thought fundamentally flawed, rather than in need of assistance. This is still the greatest barrier to treatment, in my opinion. And it is perpetuated at the highest institutional levels. Health insurance providers continue to, in effect, ration care and/or deny access to care, treating both those with illness and those who treat the illness as second class citizens. However, there is an ongoing movement at the grass roots, driven by need, to fight stigma and advocate for care. We can all take part. That’s the good news. And whether we’re feeling good or not, plain old dogged determination can help.