What is mental health?

May 26, 2020 Mental Illness 0
Stressed african lady at work

What is mental health?

Mental health refers to cognitive, behavioral and emotional wellbeing.  In other words, it is all about how people think, feel and behave.  According to the World Health Organization mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community.  Mental health is therefore more than the absence of a mental disorder

 

Mental health affects our daily living, our relationships, our physical being.  In fact, it affects our whole being in the world.  That it why I believe mental illness to be the worst kind of illness to have, as it involves huge suffering.  Mental health depends on a delicate balance of factors

 

Various factors in our lives can contribute to a disruption in mental health, like ongoing financial concerns, problematic interpersonal relationships, social isolation, socio- economic conditions, such as availability of employment, work- related factors, physical illness such as cancer, diabetes and chronic pain, death of loved ones and genetic family history, as certain genes and gene variants put a person at higher risk.

Types of mental illnesses

Historically, the two broad categories of mental disorders are neurosis and psychosis. Neurosis is defined as a chronic or recurrent disorder characterized mainly by anxiety, which appears alone or as a symptom such as an obsession, compulsion, phobia or a sexual dysfunction.  Psychosis is defined as grossly impaired reality testing where people incorrectly evaluate the accuracy of their perceptions and thoughts and make incorrect inferences about external reality, even in the face of contrary evidence.  Psychosis is synonymous to severe impairment of social and personal functioning characterized by social withdrawal and inability to to perform the usual household and occupational roles.  Neurosis implies that reality testing and personality organization is intact, but that the person is distressed by a variety of disturbing symptoms.

The most common types of mental disorders are anxiety disorders and mood disorders.

Anxiety Disorders

Include:

Generalized Anxiety Disorder ( GAD)

It is characterized by excessive worry and anxiety occurring more days than not,  for at least 6 months, about a number of events or activities, and causes clinically significant distress or impairment in social, occupational or other important areas of functioning. Dominant symptoms include complaints of persistent nervousness, trembling, muscular tensions, sweating, lightheaded ness, palpitations, dizziness and gastric discomfort.

Panic Disorder

The essential feature here is recurrent attacks  of severe anxiety /panic which are not restricted to any particular situation or set of circumstances and are therefore completely unpredictable. The dominant symptoms include sudden onset of palpitations,chest pain,choking sensations, dizziness and feelings of unreality. There is often also the presence of a secondary fear of dying, losing control, or going mad.

Phobic anxiety disorders

This is a group of anxiety disorders in which anxiety is evoked  predominantly in certain situations that are not currently threatening.  As a result, these situations are  avoided or endured with dread.  Agoraphobia is a cluster of phobias referring to fears of leaving home, entering shops, crowds and public places, or traveling alone in trains, buses or  planes.

Social phobia refers to the fear of scrutiny by other people, leading to avoidance of social situations.  Low self-esteem and fear of criticism is associated with social phobias.  Specific phobias are restricted to highly specific situations such as proximity to certain animals, thunder, darkness, closed spaces etc.

Obsessive Compulsive Disorder

The essential feature here is recurrent obsessional thoughts or compulsive acts.  Obsessional thoughts are ideas, images, or impulses that enter the  person’s mind repeatedly in a stereotyped form. These obsessions are distressing, and the person often tries unsuccessfully to resist them.  Compulsive acts are  behaviors that are repeated over and over again, in an attempt to prevent some unlikely event, often involving harm to or caused by the person, which he or she fears might otherwise occur.  When compulsive acts are resisted, anxiety increases.

Post-Traumatic Stress Disorder

This disorder arises as a delayed response to a stressful event or situation of an exceptionally catastrophic nature, which is likely to cause pervasive distress in almost anyone.  Typical features include episodes of repeated reliving of the trauma through  flashbacks and dreams, a sense of numbness and emotional blunting, detachment from other people, unresponsiveness to surroundings, lack of pleasure/joy and an avoidance of activities and situations reminiscent of the trauma. There is usually a state of autonomic hyperarousal with hypervigilance, an enhanced startle reaction and insomnia. 

Mood disorders

Major Depressive Disorder

Characterized by depressed mood, lack of interest/ pleasure, feelings of sadness and emptiness, insomnia or hypersomnia,  loss of energy, feelings of worthlessness, excessive or inappropriate guilt, diminished ability to think or concentrate, indecisiveness, recurrent thoughts of death, suicidal ideation, or suicide attempts.

Bipolar 1 and Bipolar 2 Disorder

People with bipolar disorder experience abnormal highs or lows in mood.  During a high, also known as a manic episode, people feel intense enthusiasm, anger and irritability, increased energy – characterized by being over-talkative or overactive, a diminished need for sleep, racing thoughts, difficulty concentrating and making decisions, reckless behaviour, such as increased interest in sex, alcohol, and drugs and inflated self-esteem. 

People with Bipolar 2 experience less severe manic episodes than people with bipolar 1, known as hypomanic episodes, but  do experience intense depressive episodes.  A diagnosis of Bipolar 1 does not necessitate a diagnosis of a depressive episode.

Two other well-known mental illnesses, just because they are often portrayed in movies, are:

Schizophrenia

Schizophrenia is a serious mental disorder in which reality is interpreted abnormally.  Schizophrenia may result in some combination of hallucinations, delusions and extremely disordered thinking and behavior that impairs daily functioning and can be very disabling. People with schizophrenia require lifelong treatment.

Dissociative Identity Disorder

Previously known as Multiple Personality Disorder, it is associated with overwhelming traumatic events and/ or physical or sexual abuse that occurred in childhood. Symptoms include the existence of 2 or more distinct identities, which are associated with changes in behaviour, memory and thinking and gaps in memory.

 

Stigma

Social stigma and discrimination can make mental problems worse and prevent a person from acknowledging that they have a problem and seeking the help they desperately need.  Three stigmas re mental illness have been identified in studies:  people with mental illness should be feared and kept out of communities; people with severe mental illness are irresponsible, so they should not be allowed to make life decisions – other’s should make it for them; people with mental illness are childlike and need to be cared for. The public seems to disapprove of persons with psychiatric disabilities significantly more than people who has physical illnesses.  Unlike physical disabilities, people with mental illness are perceived by the public to be in control of their disabilities and responsible for causing them. Also, the public is less likely to have empathy with people with mental illness, and instead reacts to psychiatric disability with anger, believing that help is not deserved.

People with psychiatric disability internalizes these ideas and and believe that they are less valued because of their psychiatric disorder and feel shame and hopelessness.  It is said that stigma prevents 40% of people with anxiety and depression from seeking help.  Stigma creates lack of understanding by family, friends, co-workers or others.  It creates fewer opportunities for work or social activities. It also creates the belief that amongst sufferers that they will never succeed at certain challenges or that they cannot improve their situation.

Strategies for changing public stigma

Education, education, education……banishes ignorance and provides information so that the public can make more informed decisions over mental illness.  Several studies have shown that participation in education programs on mental illness led to improved attitudes about people with mental illness.  Research also shows that stigma is further diminished when members of the general public meet people with mental illnesses who are able to hold down jobs or live as good citizens in the community. 

Effects of Covid -19 on mental health

Working from home

For many people, working from home has been a blessing, not having to navigate the traffic every day, being comfy at home surrounded by pets and family.  However, for many others it has been extremely stressful, especially for 3 groups of people, namely working mothers having to homeschool their offspring, meet deadlines and do all the housework and cooking by themselves, extroverts who thrive on the company of co-workers during the day and who find it extremely difficult to be on their own and single people living on their own who used to completely rely on work for contact with other human beings.  Not to even mention the stress that health-care workers have been experiencing…. doctors and nurses having to home- school children, do the housework, have the anxiety of contracting the virus and bringing  it home to their families….

Financial stress

Financial stress has probably been the no 1 stressor during lockdown.  So many small businesses have had to close down, many people have lost their jobs and many have had to settle for a salary cut.  This has been the main cause of severe anxiety, feelings of helplessness and hopelessness and depression.

Social distancing

As far as social distancing has been concerned, extroverts have definitely been suffering more than introverts, having personalities that thrive on contact with other human beings.  Extroverts are energized by the company of others, whilst introverts need to be on their own to recharge.  Those hugely affected by the social distancing are people with elderly or ill relatives living apart or living  in other provinces or countries, feeling helpless  to support them or to connect with them.  Those people living completely on their own have also suffered hugely, the complete isolation from others taking its toll, feeling very lonely and depressed.

Measures we can take to combat these adverse effects

Owning and naming our difficult emotions

Lockdown with all its challenges and uncertainties brings up difficult emotions, since we can’t use busy-ness to run or hide from our emotions.  We have to be consciously aware of our emotions, view them as important, and name them.  When we don’t own our difficult emotions, it becomes increasingly difficult to own our positive emotions like joy, gratitude, serenity and enthusiasm.  Having the courage to be present to these emotions and naming them, help us to gain a sense of control and to feel less overwhelmed by these emotions….and as we continue to bring ourselves back to this uncomfortable space of difficult emotions, we actually start to develop our tolerance for being in difficult places….not running away or denying our difficult emotions, but facing them, understanding them….this is what is known as resilience.

Reaching out and connecting with others

It is important, especially for extroverts and those living on their own, to reach out to other people via all the various online platforms.  Don’t just talk on the phone, have a Whattsapp video call or Zoom meeting with friends and colleagues every day.  It makes a difference to actually see another human being respond to you.  For those who thrive on social interaction, “ house party” is a lovely platform to fulfill these needs.

Self-care

During this time of lockdown self- care is extremely important.  Set some time aside every day to do what you love, and most importantly, do it mindfully.  The more this activity  involves a sensory component, the better.  Have that glass of special red wine, enjoy savouring that piece of chocolate, soak yourself in a hot tub with Epsom salts and fragrant lavender that you have picked from your garden.  Listen mindfully to every note of your favorite music.  The list is endless. 

Time for worry

Also, allocate some time everyday for the activity of worry.  Let’s say for instance between 11:00 and 12:00.  This means that you are not allowed to worry outside of this hour.  Should you catch yourself worrying at any other time, stop it immediately, tell yourself that you will be worrying during the allocated time, and distract yourself with something else.  Also, decide on how far ahead in the future you will allow yourself to worry.  Will it be a day, a week or a month into the future.

Answering your own questions

Also,  when feeling anxious, one tends to ask oneself many questions. When in anxiety, we tend to leave these questions unanswered, which just germinates more anxiety, and culminates in a spiral of negative belief.  It is very important to answer your questions.  Your answers don’t necessarily have to be comforting.  Write down your questions.  Don’t write down “What if” questions – these questions anticipate scenarios beyond what we know presently, and creates even more anxiety, like “what would I do if I lose my job?”.   Write down “what is” questions – questions based on the current reality, like “what are the various options available to me for generating additional income”, or  “ what strategies can I implement to save money”, “ what plans can I make to negotiate payments on my various policies during lockdown” etc.  Answering these questions will make you feel more settled, and allow you to see that there are options available to you.  

Daily habits to ensure sound mental health

  • Eat a balanced diet – recent studies have shown a link between depression and consumption of high-sugar, heavily processed food. For better mental health, consume more fresh fruits and veg, omega fatty acids and whole grains.  Also, limit alcohol intake. Alcohol is a central nervous system depressant. Also, the loss of hydration can have a serious effect on mood, concentration and cognitive function.
  • Many consider sleeplessness as a symptom of poor mental health, however, recent studies also suggest that it may be the cause of poor mental health. Deep sleep is crucial for maintaining a healthy mind
  • Performing high intensity cardio exercise for even just 30 min a day releases powerful endorphins that boost mood. Long term low intensity exercise has also been linked to the production of neurotrophic proteins which improve brain function and alleviate depression.
  • Meditation and practising mindfulness alleviates symptoms of mental illness like anxiety and depression, by allowing those who practice it to clear their mind and focus on the present.
  • Taking a break from social media is NB as it has a negative effect on mental health. Recent studies show a link between social media use and symptoms of depression and anxiety.
  • Open up to people close to you about your struggles. The build-up of suppressed feelings  often leads to depression.
  • Spend more time in nature and with pets. When engaging with nature and with our pets, we are practising mindfulness– we are experiencing life in the moment, which alleviates stress and anxiety.