What does it mean to be mentally ‘well’?

Dear readers,

A few weeks ago, the For Your Mind team asked you to send us your questions about mental health. I wasn’t expecting much of a response right away, but you all came through with so many questions that were complex, heartfelt and deeply personal. Please keep sending them.

One question in particular, sent by an anonymous 26-year-old, seemed like a great place to start: “How do you know if your mental health is well vs. unwell? What’s the barometer and how do you keep yourself in check?”

Phew. What a great question. If we’re going to be talking about mental health, we need to attempt to define what it means to be mentally well — which, it turns out, is a messy endeavor. I interviewed five experts with different outlooks on the subject, and they all agreed that there is not one correct answer; the concept of mental health is subjective and depends on who’s defining it.

We’ll dive into their thoughts in a moment. First, though, some important caveats.

Ups and downs are A-OK

We all have days and seasons of life where we feel down, stressed out or overwhelmed by events in our lives. The COVID-19 pandemic has been a prime example of that. If you aren’t at least a little anxious or depressed about the state of the world, you’re probably the exception. Part of being human is responding to your environment, whether that means freaking out or shutting down.

It’s possible to be struggling with your mental health but have no diagnosable mental illness. Some people have emotional and psychological struggles that last for a long time, while for others, those resolve relatively quickly. It’s also possible to feel mentally well while living with a diagnosis — if you’ve lived with anxiety or depression or a mood disorder, you know that symptoms come and go.

What I’m trying to say is, ups and downs are normal. The fact that you experience difficult emotions sometimes is a good thing. It means you’re alive.

“We shouldn’t fall into the trap of dividing the world into two groups of people: the mentally well and the mentally not well,” said Shekhar Saxena, former director of the World Health Organization’s Department of Mental Health and Substance Abuse. “It’s not true or helpful.”

A new definition of mental health

OK — so back to the question.

Many have tried to find a definition of mental wellness or health that feels broad enough to describe the diversity of human experiences while specific enough to be helpful.

One such effort occurred in 2015 when a group of psychiatric researchers in Europe set out to create a “new definition of mental health.” They aimed to move away from Western ideas of mental health and fully acknowledge that life is “sometimes joyful, and at other times sad or disgusting or frightening; sometimes satisfactory, and at other times challenging or unsatisfactory.” They also wanted something that was relevant across cultures.

The researchers found that, in determining how mentally well you are overall, you should consider these factors:

Resiliency: When life throws you curveballs — like when you lose someone you love or experience financial difficulty — you react accordingly. You feel sad or angry or ashamed or numb. But you are eventually able to accept that change happens, and you choose healthy behaviors that help you cope.

Cognitive awareness: Your cognitive and social skills enable you to pay attention, remember and organize information, solve problems, make decisions and communicate effectively with others. Many people may have challenges in these areas, yet feel mentally well much of the time because others are supporting them, and they have effective ways of coping (for example, a person with ADHD might use organizers and timers).

Empathy: You’re able to understand and respect the thoughts and feelings of others, without being too empathetic and letting other people’s emotions hijack your nervous system, which can lead to anxiety and depression.

Daily functioning: You have the basic ability to function in your social roles, such as parent, employee, friend, partner, etc. A major note here: Social exclusion, discrimination and other systemic barriers can make it much more difficult for people to fulfill these roles.

Personal care: You have a “harmonious relationship between body and mind.” If you’re unable to care for your body — by eating nourishing foods, and getting enough sleep and physical activity — there’s a good chance you won’t feel great mentally and emotionally.

Researchers noted that these are all important, but not mandatory, aspects of mental health. For example, there have been times when I wasn’t getting the amount of sleep and exercise that felt best for my body. But I was doing great in other areas of my life, socially and spiritually, and I felt mentally well overall (but probably a bit sleepy and cranky in the afternoon).

When we need support

So, if mental health exists on a continuum and can look really different from person to person, when should we seek support?

Here are some things to look out for:

• You’re preoccupied by self-criticism and shame, or are frozen by the fear of making a mistake. “One of the biggest things people come to therapy for is their crushing inner critic,” said Marilyn Owen, a psychotherapist in Santa Barbara.

• “When you start feeling like you’re losing hope and can’t seem to access joy even in small moments, there’s probably something there that needs to be attended to,” said Tonya Elliott, a psychotherapist in Grass Valley, Calif.

• When your emotions are jumping all over the place, from extreme highs to lows “and don’t seem to go back to what feels like a good baseline, that’s an indicator something’s up,” said Lynn Bufka, associate chief of practice transformation at the American Psychological Assn.

• You’re having a hard time with daily tasks like getting out of bed or taking a shower; you feel numb or in a state of despair; you’re withdrawing from friends and family; or you’re seeing prolonged changes in sleeping or eating patterns. “Most of us feel that way at some point in our lives,” Owen said. “But if it goes on for weeks or months, you might need some support.”

• When your work, relationships, or ability to parent are being affected by the above challenges.

• You’re having thoughts of self-harm or suicide.
  

For some, making life adjustments to reduce stress levels — like leaning on family for childcare, delegating tasks at work, going on daily walks or taking up meditation — is enough to bring them back to equilibrium. But for many others, feeling better can be much more difficult, either because of the severity of symptoms, genetic predispositions to certain disorders or systemic barriers, Bufka said.

If that’s the case for you, try not to judge or blame yourself.

“When someone is not feeling their best and has no energy, it can be hard to figure out what kind of care and support you need,” she said. And that’s for someone with reasonable demands and access to reliable transportation, childcare, green space and time off from work.

“But when we’re talking about communities that have been systematically deprived of those resources, it can be a lot harder,” Bufka went on.

Help can come in the form of psychotherapy or counseling. But it could also mean attending a support group for people who’ve had similar experiences, joining a hiking group or getting involved in a cause you care about. It could mean going to a mosque or a church or a temple.

Spirituality can also play an essential role in mental wellness. This is the case for most Indigenous cultures, said Elliott, who is of Cherokee and Pawnee descent.

“It’s ultimately about tending to the relationship they have with their creator and ancestors,” Elliott told me. “This can look like spending time in nature, tending to a garden, or gathering with people whose presence you find calming or nourishing in some way. These kinds of practices, she said, allow you to access joy and gratitude amid pain and suffering.

And if you feel safe doing so, definitely let the people you’re closest to know you’re struggling.

“Talking to someone when you’re distressed and overwhelmed can be really helpful,” Bufka said. “But if that someone is a friend or family member, what you’re going through may be more than they can handle on their own.”

As someone who has wondered at many points of my life whether I am “OK,” I’ve been grateful for the opportunity to pull this question apart. I’ve found comfort in hearing from experts that we might be OK one week and not the next, and that’s just a part of being human. It doesn’t mean that the merciless arm of fate has plucked us from the “well” bucket and plonked us into the “unwell” bucket, where we’re doomed to remain forever.

It just means that we need support sometimes. Maybe if we stopped putting people in these categories, it would be easier to ask for it.

Thanks for reading. Until next week,

Laura

If what you learned today from these experts spoke to you or you’d like to tell us about your own experiences, please email us and let us know if it is OK to share your thoughts with the larger Group Therapy community. The email [email protected] gets right to our team. To view this newsletter in your browser, click here.

More perspectives on today’s topic and other resources

• Five ways to practice asking for help, by psychotherapist Meghan Watson.
• You might assume that working with a therapist involves receiving a diagnosis, but that’s not always the case. Here’s why.
• A list of multicultural support groups, crisis lines and apps for when you need mental health support, from my colleague Madalyn Amato.

Other interesting stuff

• How we can apply lessons from the pandemic to improve our happiness, in a recent episode of the podcast “The Happiness Lab” with psychologist Laurie Santos.
• California’s acting surgeon general opens up about her experience living with bipolar disorder in this L.A. Times op-ed.
• Health experts increasingly point to dialectical behavior therapy (DBT) as an effective treatment for teens who live with depression and anxiety. But it’s intensive and pricey.
• Why you should check in with the people you care about, according to a new study.
  Sometimes you just need to scream into the void. Here are a few places in Los Angeles where you can do that.
• The higher frequency of heat waves in the age of climate change could be affecting your mental health.