Thursday, July 29, 2010

Towards a new model of mental health

This is another thing I've been thinking about for a while.  Would it be better if we thought of mental illness the same way we think of physical illness?  Some examples:
  1. Everybody gets sick.  We catch colds, sometimes we come down with more serious diseases or injuries.  It's part of life.  And it seems to me that mental illnesses are acquired in much the same way.  But the common stereotype is that everyone is always in perfect mental health, except for crazy people.  And they always seem to be incurable.  Perhaps we make an exception for bereavement - that's seen as something that pretty much unhinges people while they are grieving, but eventually, hopefully, they get over it.
  2. The importance of first aid. We all have some basic knowledge of first aid and triage (how to distinguish between serious injuries vs. minor ones.)  What constitutes mental first aid?  I don't know.  I don't think anyone else knows either.
  3. Healthy diet and exercise. I don't just mean that diet and exercise can have an effect on your moods, although that is true.  I mean, what constitutes a healthy mental diet?  What constitutes psychological exercise?  Prevention falls into this category as well.  The only form of mental-illness prevention I've ever heard of is, "don't think about bad stuff."  But in fact that doesn't work.
  4. Regular checkups.  How come we don't go for regular psychological checkups, along with physical and dental checkups?  I have occasionally had medical doctors ask me about my mental state (somehow, just typing those words makes it sound like they saw something suspicious in my behavior) but of course they were not mental health professionals, and not really qualified to diagnose or treat mental disorders.

    Might it be possible to develop tests for mental illness, to "catch these things early," the way doctors hope to catch cancers early?  There is some work being done with brain scans to detect signs of mental illness, but of course these scans are only run on people who have already flipped out.  If mental illness could be detected sooner, that would help a lot of people, and even save lives.
  5. The immune system.  As I mentioned about grief, above, sometimes we feel bad about stuff, and sometimes we get over it.  Sometimes, as with chronic depression, we can't heal ourselves without extra help.  But I do in fact believe that our psyches have a natural immune system, a natural sense of what's right, what's best for us.  It doesn't always work perfectly.  (In fact, it seems to have a tendency to overcompensate, like physical autoimmune diseases in which the body starts attacking its own cells.)  But if, as I hope, good physical health is our natural state, then good psychological health ought to be our natural state too.
Of course, the big difference between mental health and physical health is the stigma attached to mental illness.  That's why people are reluctant to seek treatment until things get really bad.  (That's why, in America, health insurance does not always cover mental health issues.)  That's why people who are seeing therapists or taking medication are often reluctant to let anyone else know.  Can you imagine not telling anyone that you had to have your appendix removed?

The other difference is that our notions of what constitute good mental health are somewhat skewed.  Our definition of physical health is straightforward: if we feel good, we're in good health.  We rely on our bodies to tell us how they feel.  But good mental health is defined, not by how we actually feel, but by how we're supposed to feel.  Certain feelings and thoughts are off limits. 

Our mental health is constrained by our culture's morality.  There are numerous examples of this:  I'll pick one that I've used before. When homosexuality was considered to be a mental illness, it didn't matter how well-adjusted you were - it didn't even matter how decent, upstanding and generally moral you were.  Homosexual equaled crazy, end of story.  (And you better not be well-adjusted either, in fact, you should be as neurotic as possible, because homosexuals should be unhappy.)

I strongly believe that our model of mental health needs to change.  And this is my suggested replacement.

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