No. 1: What Does ‘Mentally Healthy’ Look Like?
I recently spoke at Morgan Stanley, as a panelist, for an event called “Mental Health Awareness in 2019.”
This seems to be part of an overall (and super-positive) trend in Corporate America, expanding the notion of wellness to include mental health.
Many questions were asked but there was a fundamental question lurking behind the others:
“What does mental health actually look like?”
Seriously. We speak increasingly freely about mental health, but do we really know what it is? Can we judge this type of health with any objectively? Or, is it not-so-simply like pornography whose definition defies words yet “we know it when we see it”?
I bet everyone has a picture of mental health, but it’s likely incomplete. I’d imagine most licensed clinicians (myself included) don’t keep a checklist in hand; instead, we diagnose based on an ongoing assessment of the person we’re with.
In hindsight, there was another too - a question behind that other question:
“How do I know if maybe I should talk to someone?”
Great questions both, and the latter has become the title to a wonderful book. Neither are easy to answer yet neither are that difficult to contemplate at the very least.
Let’s start with a mildly edited, 23-point list of attributes from Jonathan Shedler’s “Shedler-Westen Assessment Procedure (SWAP)” that comprehensively captures what mentally healthy people exhibit.
A mentally health person:
Uses talents, abilities and energy effectively & productively.
Enjoys challenges and takes pleasure in accomplishments.
Sustains meaningful love relationships involving intimacy & care.
Finds meaning in belonging, and contributing to, a community.
Experiences purpose guiding, mentoring & nurturing others.
Is empathic: sensitive and responsive to other’s needs & feelings.
Is appropriately and (not or) effectively assertive.
Appreciates and responds to humor.
Is capable of tolerating emotionally-threatening criticism.
Grows from painful, negative past experiences.
Is articulate, expressing oneself via words.
Has a sufficiently active and satisfying sex life.
Appears comfortable and at ease in social situations.
Finds contentment and happiness in life’s activities.
Can express affect appropriately in quality and intensity .
Can recognize alternative viewpoints.
Possesses and strives to live up to morally and ethical standards.
Is creative, sees things and/or problems in novel ways.
Tends toward conscientiousness and responsibility.
Is energetic and outgoing.
Is psychologically insightful: understands self and others.
Finds mean and satisfaction pursuing long-term goals.
Forms close, lasting (mutually supportive & sharing) friendships.
When I first saw this list in a class, years ago, I wondered aloud, “Yikes! How many of these attributes must be true to consider oneself mentally healthy?”
“All of them” my professor responded.
“All at once?” I asked, sheepishly.
“Uh huh” was the response.
“Uh oh” I gasped, audibly.
It’s a long and often overwhelming list, but it needs to be long because being mentally healthy is multi-faceted, multi-dimensional but it’s not multiple-choice.
You might look at each attribute as binary; it’s either yes or it’s no. That is, you either possess each attribute or you don’t (in which case there’s a deficiency which might rightly strip you of your desired ‘mentally healthy’ mantle).
But another way of assessment could consider the frequency of each attribute being true with a quick look as to why. This offers a greater tolerance for things not being binary but, instead, existing on a continuum. That is, the answer can vary a bit depending on where you are whilst contemplating. If, at the end of the evaluation period, an attribute is more true than not, give yourself a check and move on.
Now to the next question (How do I know if maybe I should talk to someone?).
What if the answer to any - or many - of these 23 attributes is not true or not true enough for you? For example, let’s say you are not typically ‘appropriately and effectively assertive (see #7)’ or that you’d like to be more typically ‘appropriately and effectively assertive’?
Well, then maybe you should talk to someone!
Before you do begin considering your options, consider your context - your circumstance.
It could be you are indeed suffering from some type of disorder (e.g., depression). Most have features, or symptoms, that include the converse of many of these aforementioned 23 attributes (e.g., not using talents, not enjoying challenges, etc.). If that is or you think it might be the case, going to a professional - a licensed psychotherapist or psychiatrist to be diagnosed and treated makes great sense.
It could be, however, you are experiencing grief due to a non-positive life event (e.g., dealing with disease, death, divorce) in which case having some or several attributes being not true might be a temporary thing. 100 years ago, Freud wrote “Mourning and Melancholia” noting the difference between feeling bad (and needing time) versus being depressed (and needing treatment). If you’re down, give yourself time, talk to friends, exercise, and soon you’ll likely be better (remember: you don’t get over big losses; you get through them).
If you’re down, but unable to get up again (or to shake it off) after what is a reasonable amount of time, then maybe you should talk to someone.
While many in therapy have a diagnosed or diagnosable disorder, others come because one (or more) of these attributes aren’t true enough for them. It’s not that anything’s wrong per se; it’s that things aren’t right enough. They want more. Nancy McWilliams, another beautiful mind in this field, wrote about why people seek therapy. The non-clinical reasons cited move me, weekly, from my own chair to an analyst’s couch:
Development deeper Insight
Increasing one's sense of Agency
Securing/solidification one's Self-Identity
Growing of (realistic) Self-Esteem
Recognizing/handling one’s Feelings
Enhancing one's Ego Strength/Self-Cohesion
Expanding the capacity to Love, Work and Depend on Others
Experiencing greater Pleasure and Serenity
These 8 therapeutic gains are exquisite by-products of therapy and are compelling reasons to go. They, together and alone, deepen and widen the experience of those 23 attributes we began with.
So, in closing this post, I’ll summarize by saying that mental health is a composite of many different attributes that will vary in terms of how true they are at any moment in time, but that they (all) need to be true enough, most of the time.
If one or more attributes of the mentally healthy isn’t true (or true enough) for you, consider the context. If it’s due to a short-term setback, give it time; if it doesn’t get better with time or if you think there’s something bigger (and diagnosable) at play, by all means: talk to someone.
Clinicians are trained to help folks of all shapes and sizes, no matter what ails them, get better - no matter where they’re starting from, no matter the reason.
There’s never been a better time to think about one’s health, especially now that its definition has expanded to include all of it.