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What Happened To Our Shared Understanding of Mental Health? Thoughts From a Preeminent Psychologist

Illustration of man with brain showing | Berkeley Therapist Jesse Whittle-Utter

·Early in my training as a therapist I attended a workshop by psychologist, professor and author Nancy McWilliams. The subject (What Happened To Our Shared Understanding of Mental Health?) took aim at how the mental health profession has largely embraced the medicalization of human problems, with a much greater emphasis on what can go wrong—disorders—than on what a healthy psyche consists of. As a result, mental health treatments tend to focus on the removal of the disorder, rather than the cultivation of the whole person. The absence of pain, she argues, is not the same as being mentally healthy.

This idea has stayed with me over the years as I work with clients who struggle to feel alive and fully themselves, even when there is no disorder to point to. It is so easy for our modern lifestyle—with the demands of work, constant technological connectivity, and unfettered busyness—to gradually numb us to our inner vitality. It is nearly inevitable. And as many mental health professionals (particularly psychiatrists) focus on zapping symptoms, the underlying lack of general mental health goes unaddressed.

Clients often ask me whether a certain thought, feeling or behavior is “healthy” or not. This question indicates how far we as a society have drifted from a shared understanding of what mental health is, so much that we have to ask experts to guide us back. What McWilliams outlined in her workshop the major components of what mental health consists of, and I have laid them out simply below, with my personal reflections on what they mean:

Love, Work & Play

As human beings we need all of these in equal measure. Without loving relationships, we become depressed, anxious and bitter. Without work, we feel listless, disempowered and often purposeless. Without play, we accumulate toxic stress and cut off a huge part of our social selves. In American society, and especially in professionally competitive and economically powerful places like the Bay Area, work ends up taking the lion’s share of people’s time and energy, to the exclusion of love and play.

Secure Attachment

Secure attachment refers to our ability to connect to and trust important people in our lives; to give and receive love without anxiety or fear; and to be vulnerable with trusted others. Without secure attachment, we cannot benefit fully from the richness of human relationships. Many people who have had difficult childhoods or have suffered abuse struggle with secure attachment, because trust in others has been so damaged in the past. Developing a more secure attachment style is one of the potential benefits of psychotherapy.

Autonomy/Sense of Agency

Feeling that we have the power to make choices and shape our lives, and to be free from the control of others, is a potent ingredient of mental health. This is one reason why adolescence can be such a difficult period: it is the time when children transition to adulthood and experience conflicting needs for both dependency and independence. It is also why high-pressure jobs (like so many in the tech industry) leave people feeling anxious and exhausted: these work environments and power structures strip away, to a grotesque degree, one’s agency over how they spend their time.

Self and Object Constancy / Identity Integration

Here McWilliams is referring to our sense of ourselves and our identities as stable and constant, as well as trusting that important others in our lives will also remain stable and reliable. If not right now, can you think of a time in the past when you felt you didn’t know who you were (what qualities, values and identities reflected your unique personhood?) Or when you didn’t know that the people around you would continue to show up for you in the ways that mattered? This kind of insecurity is stressful and generates fear and unhealthy coping behaviors.

Ego Strength and Resilience

“Ego Strength” sounds like clinical jargon, but refers to something any therapy client can recognize: the ability to tolerate a wide range of thoughts and feelings, especially the more difficult, painful or disturbing ones. The “ego” is the part of your psyche that is the “I”, the part that consciously witnesses and experiences life. I like to think of it as a tree: while what happens in the earth and sky are separate from it, the tree is vitally connected to both. A strong ego would be like a tree that can endure a terrible earthquake or hurricane (powerful and scary thoughts and feelings) and remain standing. A weaker ego would break under the pressure, which usually is experienced as incapacitating overwhelm or dissociation (“checking out” or going numb).

Realistic And Reliable Self-Esteem

It is essential to mental health that we like ourselves, while also remaining aware and tolerant of our shortcomings. This can be a difficult endeavor, especially if we were shamed, criticized or abused in our past—in which case we may think we are all bad or “more bad than good”, unloveable/unlikeable, unworthy, or an impostor. On the other hand, we can develop an unrealistically positive view of ourselves, without humility or self-reflection. This tends to happen as a way of overcompensating for deep shame, and is a hallmark of narcissism. Each extreme represents an inflexibility in our self-perception that is at odds with reality. Being able to like ourselves without needing to be the greatest is an important pillar of mental health.

I will post another entry soon with the remainder of McWilliam's major categories.

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