I recently saw a patient whose lab work was amiss at her annual checkup. She reported being off her usual exercise and eating routines. She hadn’t refilled her thyroid and heart medications in months. However, the real problem wasn’t her abnormal blood tests. She was struggling with debilitating anxiety.
It turns out that taking a new position at her company had rekindled some deep insecurities about competency and belonging. Anxious thoughts not only occupied a significant amount of her brain space, impairing her ability to sleep and maintain focus on the job, they were negatively affecting her health.
So, today I am going to talk about mental health: what it is, why it matters, and what to do about it when it’s on the fritz.
Why Mental Health Matters
Everyone has mental health. Whether you like it or not, each of us has anxieties, fears, moods, and relationships with food, other substances, money, work, and other people. Each of us has a story and a past that form the way we conceptualize the world around us and how we handle adversity. Some of us have genetic predispositions to anxiety, mood disorders, or addiction. All of that is relevant to our mental health today. And mental health matters in all sorts of ways.
It affects the way we think and feel. It informs how we parent, caregive, work and play. It directly affects our physical health.
For far too long, mental health has been treated like the step-child of physical health—something that only applies to a small percentage of individuals, an organ system not worthy of attention like a heart or liver is—when, in reality, mental health is the ground zero of health. Without it, our cholesterol and liver tests are meaningless.
Mental health is also having a cultural moment. Medical experts and the popular media are finally shining a light on it. Books are being written about it (by Nedra Glover Tawwab, Lisa Damour, Dr. Aliza Pressman and the U.S. Surgeon General, to name a few). The U.S. Preventive Services Task Force has even started recommending screening for anxiety among adults in primary care practices. And people are paying attention.
What is mental health?
Let’s start with what mental health is not. Mental health is not about being happy. It’s not about a stress or anxiety-free life. It’s not about sobriety or yoga. It doesn’t require a certain lifestyle or social status. It is also not fixed; it’s dynamic. Mental health includes our ability to meet the moment with an appropriate emotional, behavioral and physical response.
Mental health is a lifelong process. It starts with awareness of the facts of our story—past and present. It is predicated on acceptance of the facts of our story we cannot control. It includes agency over the thoughts, feelings, habits, and relationships we can change.
So the question isn’t, Do you have mental health? It’s a set of questions:
How aware are you of your own mental health—fears, worries, moods, habits, and relationships?
Where do you “live” on the continuum for each one?
How honest are you about the facts of your story and your life—and how willing are you to accept the parts you cannot control?
What tools do you have to manage the inevitable stressors and uncertainties of life?
Let’s take my patient as an example. Her mental health is obviously on the fritz. It is negatively affecting her health. To address it is to embark on a process.
To begin that process, my patient needed to have:
Awareness of the facts. On the resume side: She has an advanced degree in her field. She has repeatedly been promoted at her current company. On the social-emotional side: She has suffered from self-esteem issues since her young adulthood and was fired from a job in her 30s, which continues to inform her current thoughts. Why? In part, her underlying anxiety causes her to catastrophize, dwell in the “what ifs,” and chip away at her self-worth. Her anxiety also tends to be somewhat paralyzing, interfering with her routines and compliance with medications.
Acceptance of the things she cannot control. She cannot change her past. She cannot change that she was raised in an anxious family where dinner table conversations centered on worst case scenarios. She must work on accepting that competent people like herself make mistakes. They mess up at work. They avoid going to the doctor. They have high cholesterol readings when they stop exercising and quit taking Crestor. Accepting her imperfections and the parts of her she cannot control would be the hardest part of this process.
Agency over the areas she has control. The cool thing about acceptance is that it frees up brain space. Instead of spending time and energy on the things we cannot control (e.g., our past, other people), we can lean into the areas we do. For her, once she was able to better accept her flaws and practice self-compassion, she had the mental capacity to talk back to anxious thoughts, putting herself back in the driver’s seat of her health.
How to apply this to your everyday life
Let’s start with my patient. How can she be helped? Does she need medication? Therapy? A firm talking-to? A mindset change?
You might ask: Is she mentally ill? Or is her anxiety simply the normal consequence of a job change?
It’s neither. She is suffering, mentally and physically. Some elements of her anxiety response are entirely normal; some are out of proportion to the facts. Labels are immaterial (except for research and insurance coding purposes) when the goal is the same: to help her feel more in control of her health, physical and mental.
You also might wonder: Does she need anti-anxiety medication? Does she need psychotherapy? Or: Can’t she just get herself together, pick up her prescriptions, and remind herself she’s okay?
It depends. The reason you can’t find a single expert or “how to” guide on mental health is because addressing it appropriately is an art, not a science. For example, Zoloft is an effective medication to help quiet anxious thoughts when needed, but there is no pill for insight, no elixir for the process of self-discovery. Similarly, psychotherapy is a powerful tool to help people improve self-awareness; however, there’s no amount of therapy alone that can reverse a spiral of anxiety that is negatively affecting one’s health.
You also might wonder: If your patient did require medication, wouldn’t that mask her symptoms or commit herself to a lifetime of meds and mental illness? Or: Wouldn’t it be best for your patient to change her mindset on her own?
It depends. Just as I prescribe cholesterol-lowering medication to patients at high risk for coronary artery disease alongside exercise and a low-cholesterol diet, medication for anxiety is an essential tool in the toolbox for the appropriate person. Whether we’re treating anxiety or Alzheimer’s, it’s critical to address the bio-psycho-social elements, which often involve some combination of medication, lifestyle and behavioral treatments.
And sure, a mindset shift can bring rationality back online, but anxiety often denies us that choice.
The upshot
Awareness about mental health is important. Whether it’s the Surgeon General or Selena Gomez, I will always cheer on “Raising Awareness” about mental health.
But awareness—whether it’s on an individual or societal level—is only just the beginning. Specifically, awareness without acceptance leaves us stuck trying to control the uncontrollable. Take, for example, my patients with alcohol addiction. Insight is only step one. It’s only by accepting their powerlessness over alcohol that they can begin to take back control.
Awareness without agency is also problematic. Increased insight into one’s social-emotional-behavioral health problems in the absence of appropriate supports can allow mental health problems to fester. Perhaps even worse, societal awareness about mental health without fact-based information and appropriate educational context can lead to a whole lot of misinformation. For example, newfound awareness about anxiety and ADHD has spawned an industry of TikTok influencers for whom their diagnosis (sometimes self-proclaimed) has become an identity. On the other hand, Instagram has birthed an industry preaching lifestyle optimization (e.g., fitness and mindfulness) as the balm for mental health problems.
While I wholeheartedly endorse the destigmatization of mental illness (yes!) and the utility of mindfulness techniques and exercise for wellbeing (indeed!), we run the risk of pathologizing normal human experiences while simultaneously suggesting we can meditate our way out of a serious mental health problem.
I hope mental health stays in the news. I also hope that we can do more than pay it lip service, but rather help people understand the complex roots of mental health and the nuanced ways of addressing it.
Dr. Lucy McBride
