What We Talk About When We Talk About Mental Health (In Search of a Definition)
Many folks are talking about mental health these days. What does it actually looks like to be mentally healthy, though?
(Side note… the title of this blog post was inspired by What I Talk About When I Talk About Running by Haruki Murakami).
It's wonderful that there are so many trending conversations about mental health. That in and of itself can be beneficial. I hope turning up the conversational volume about mental health helps raise awareness and diminish the stigma around mental health issues and their treatment. As I've been listening between the lines of these conversations, though, I notice something ironic: it's very rare to find a detailed description of what it looks like to be mentally healthy.
An Elephant In The Room
There is an elephant in the room here. More often than not, when we are having conversations about "mental health," we are talking about mental health issues, mental health disorders, chronic mental illness, mental health skills like coping, or mental health treatment—but we are rarely defining what mental health actually is. We are having conversations about psychological suffering moreso than mentally healthy lives. This would be like reading an article or listening to a podcast that purportedly focuses on physical health but the entire conversation centers around cancer.
The DSM-5 is the big book of mental health disorders commonly used by many mental health professionals in the U.S. That book is… drumroll please… 943 pages long. It says a lot about mental health disorders; and really, that's its purpose. Pathology. However, it says very little about what mental health actually is or how to be a mentally healthier human.
If an extraterrestrial landed on earth and asked us, "How can I find a mentally healthy human? What should I be looking for?" I wonder what we'd say.
A Physical Health Analogy
Let's use an easy but clunky analogy: physical health. Although the Western medical model might lead us to define physical health as the absence of symptoms, this is a reductionist, bare-bones type of view and it's very limited. Sure, the medical model might be helpful in drawing diagnostic lines around what is wrong, giving it a name, and justifying insurance reimbursement. All of these are important and can be beneficial.
However, a model that defines physical health in terms of the absence of something is pretty terrible at helping people move toward greater physical health. There's no clear vision of what we should move toward and how to get there! It is much more helpful to move toward the presence of something rather than the absence of something.
Aiming for the absence of something is like giving someone driving directions to your home by saying "The way to get to my home is… not going to the grocery store, the library, the park, or the mall." That seems absurd, and yet that is the absurdity inherent in systems that define health by the absence of something rather than the presence of something.
Extending the physical health analogy, perhaps we could still be a bit Western and look at physical health in a systematized way. We could look at the human body system by system and define what health looks like. We could define what a healthy cardiovascular system entails, for example—maybe that includes a strongly beating heart, healthy blood pressure within a certain numerical range, clear arteries, etc. We could go system by system through the human body this way. This at least paints a picture of physical health we can move toward.
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Remembering Our Roots
I wonder if one of the reasons we have such a hard time clearly describing what mental health looks like is due to the history of mental health care over the centuries. There is a dark and storied history of mental health care that involves "insane asylums," lobotomies, ineffective and inhumane treatment, warehousing the mentally ill, etc. This ugly history of mental health care in the U.S. is summarized in the book Mad in America. Due to this dark history, we have operated in a paradigm that makes "mental health" a stigmatized concept that applies only to a marginalized few on the periphery of society. We have relegated the idea of mental health to a dark corner of the universe where the term only applies if we are talking about mental health issues or mental health treatment. This creates an inherently negative connotation.
Given that mental health is currently a trending topic in the U.S. now, it feels like there is a gravitational pull to take this marginalized topic and centralize it. That's great. However, in order to do that, you have to normalize mental health: just as every human has physical health, every human has mental health.
Health as Hygiene
Many decades ago, mental health was sometimes discussed legally and academically using the old-timey language of "mental hygiene." There has actually been a movement called the mental hygiene movement, though ironically it focused mostly on "mental deficiency" or mental illness. Although the term "mental hygiene" is a bit cringe-worthy by modern norms, I think some of the concepts underlying a hygienic paradigm are profound and can greatly benefit our modern-day discussions of mental well-being.
We understand that dental hygiene involves daily habits like brushing and flossing, preventative care and maintenance in the form of cleanings, and regular check-ups for assessment. We also understand that emerging dental problems need to be proactively addressed before they get worse. We assume that most humans have some teeth and that everyone has a degree of dental health. Why are these assumptions so difficult to translate into the mental health paradigm?
Let's attempt a translation. Imagine if we had these basic operating assumptions about mental health:
- most humans have a psyche (soul) and everyone has a degree of mental health
- mental health involves daily habits like...
- emotional awareness and self-regulation
- interpersonal effectiveness
- nurturing relationships
- seeking out social support when needed
- realistic rhythms of working and resting
- aligning with meaning and purpose
- harnessing the power of choices
- focusing attention and presence
- enjoying humor and gratitude
- attunement with one's body and breath
- belonging within community
- communing with nature
- cultivating hope, peace, and joy in oneself and others
- mental health is inseparable from physical health, so a holistic approach to mental health involves a focus on nutrition, exercise, and sleep
- regular check-ins with a mental health professional can help assess any areas of concern or highlight areas of growth; these check-ins can also help identify any emerging problems that need to be proactively addressed before they get worse
Wouldn't it be wild to live in a society where health insurance covered routine mental health screenings on an annual or semi-annual basis for everyone? What if school systems routinely conducted mental health screenings of every student? Imagine what could be prevented.
Since we're just dreaming together here, we could kick it up a notch by having those mental health screenings measure aspects of mental health (such as resilience, richness of interpersonal connections, gratitude, forgiveness, joy) as well as mental health issues (such as anxiety, depression, substance abuse, etc.). Imagine what could be cultivated.
I know, I'm dreaming.
In Search of a Definition
Coming down from my dream cloud… the bigger question still looms large. How would we describe what it looks like to be mentally healthy? The characteristics in my list above are just ideas off the top of my head, like me throwing spaghetti at the wall, so I'm not satisfied with those whatsoever.
What would be a succinct definition of mental health? Sometimes the simplest definition is the most profound and cuts the deepest.
What would be a rich, robust, multidimensional definition of mental health?
There are many possible directions to go with this, and perhaps people's response to these questions reveals some of their philosophical assumptions and worldview. That is totally okay, in my book (not that anyone needs my permission).
Here are a few examples of succinct definitions of mental health I've heard people state or imply over the years. Each of these is meant to be a standalone definition.
- freedom from anxiety
- actualization of the self
- the capacity to work and to love
- well-being across relational, occupational, communal dimensions
- collective belonging within a community
- absence of mental health issues/distress
- dependence on God and interdependence with people
- having thoughts and beliefs that are accurate + helpful
- finding meaning in suffering
- human thriving
- resolving intrapsychic conflicts
- maximizing protective factors and minimizing risk factors
What do you think? I don't necessarily agree with these but am just striking a match to spark the conversation.
How would YOU define mental health?
Here are 68 coping skills to try for anxiety or depression