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.

    Monday, July 12, 2010

    The Model of the World Inside Your Head

    I've been thinking for a couple years now, off and on, about the fact that we rarely interact with the real world.  Instead, we construct a mental model of the world, and base our behavior on that model.

    Here's an example:  the first time you travel to someplace you've never been before, you pay a lot of attention to the route and the things that you see along the way.  You don't want to get lost, and you have to be able to find your way back.  Once the route becomes familiar to you, however, you stop paying as much attention.  You've constructed a mental model of the route, and you follow that.

    Some philosophers have argued that, since the world only exists for us insofar as we can perceive it, the model of the world inside our head is actually the "real" world.  If a tree falls in the forest, etc.  (This is also my understanding of Buddhism:  that the world we think we perceive is only an illusion.)  It's a fascinating idea, but ultimately, I think, unhelpful, for this reason:  our model of the world is frequently inaccurate.

    In some cases, it's due to sheer ignorance.  I've never been to Australia; my model of Australia is therefore incomplete.  Not only that, but I've heard people talk about Australia, and I've seen lots of pictures, but that doesn't mean Australia is real, now does it?  It's not real to me.  In fact, our experience of the world is so very limited, in time and space, that anyone with a little intelligence must realize just how little they know.   How limited our models of the world are.

    In other cases, our false models of the world are created when we are fed false information.  If someone told you every day, for example, that you were stupid, you'd start to believe it, whether it was true or not.  If you lived in a country where black people and white people were required to use separate bathrooms, separate restaurants, even (as I learned recently) separate parking lots, and your parents told you there were good reasons for this segregation, you'd believe them.  Maybe at some point you'd start to question.  Maybe not. Your model of the world would be a segregated world.

    Is it possible to change your model of the world?  I believe so, but it is incredibly hard work.  The mind is a stubborn thing.

    How can we live with these unavoidably flawed mental models?  I've come up with two guidelines:
    1. Accept that your mental model is imperfect.
    2. Realize that, limited though it is, your mental model is actually more complex than you are consciously aware of.
    That second one may seem like a non-sequitur.  Let me talk about some of the ways our mental models are more complex than we usually realize.

    We often subconsciously notice things that we weren't aware of at the time.  We may remember them later, or we may not - but either way, they do enter our subconscious and they do form part of our mental model of the world.  To go back to my first example:  once you've created your mental model of the route you take on your daily commute, you usually notice when something has changed.  Maybe you never consciously noticed that detail until did change, but it attracts your attention because your subconscious mind is in fact keeping an eye on things.

    Another example: dreams.  Have you ever had a really weird dream?  Where did that come from?  In many cases, your subconscious assembles a number of details from the recent (or not so recent) past, "juggles" them and comes up with an amusing, or perhaps significant dream.  It seems likely to me that this mental activity is somehow related to our models of the world.

    It's because our models of the world exist largely on a subconscious level that they can be so hard to change.  The conscious mind simply doesn't have the ability to alter the subconscious.  But I also, personally, find it hopeful to imagine the subconscious mind constantly processing its model of the world.  It never stops and it will keep ingesting all the new data it comes across.  As we know, there are infinite possibilities out there . . . and infinite possibilities inside as well.

    Tuesday, July 6, 2010

    To welcome hurricane season

    Someday the marshes will return
    bright emerald green, floating land, white herons

    Someday, the trees of the upland:
    red oak, shortleaf pine, magnolia

    Someday the rain-bearing winds will come roaring, soaking the land that is already wet.  The reeds and palmettos will tremble, lie down, and come back again.

    Someday the world of water:  the swamp, full of strange noises and hot shade.

    The dry land floods; the wet lands only get wetter.
    That may sound like a joke, but it's not.
    The world of water is not our world.

    Someday all the work of the bulldozers will have been for nothing.