The Myth of Mental Health

by Dr Helen M Stallman

Health and Wellbeing

The brain is part of the body. Just like any other organ, it can be affected by illness and injury. If you have a brain illness (e.g., psychosis, attention deficit hyperactivity disorder, cancer, traumatic brain injury, dementia), it’s just an illness or injury like other illnesses and injuries. There is no “health of the brain” (i.e. mental health) separate from health.

The language that perpetuates the stigma of brain-related illness and that the brain is separate from the rest of the body includes “mental health problem”, “mental health”, and “mental illness”. Indeed illnesses that were once thought of as “mental”, (e.g., chronic pain, chronic fatigue syndrome) are now understood as illnesses of the body (like appendicitis, broken hip or stroke). Some normal behaviours were previously considered mental illness (e.g., homosexuality).

Coupled with our health is our well-being this is our subjective overall experience of being at the moment. Well-being can be affected by biological, social, or psychological problems. 

Biological problems include

• effects of inadequate sleep, nutrition, or physical activity.
• illnesses and injuries
• inadequate treatment for illness
• side-effects of treatments for illness.

Social problems can include

• unhealthy environments (inadequate housing, unhealthy social environment, or inadequate finances to meet basic needs).
• poor sense of belonging (e.g., through isolation, exclusion)
• inadequate healthy coping support (e.g., poor social support, people who give advice, or inadequate access to high-quality professional support)
• inadequate treatment of illness (e.g., lack of access to early effective treatments of illness, stigma)

Psychological problems that affect well-being include

• unhealthy identity – not thinking you’re okay just the way you are. 
• pervasive behavioural or emotional problems – these are often learned from being in an unhealthy environment, particularly during childhood
• inadequate skills to develop and maintain relationships with others
• lack of confidence or skills to solve problems
• poor emotional literacy

Unpleasant emotions

Unpleasant emotions are normal human experiences, but we find them unpleasant (e.g., fear, guilt, sadness, anger, frustration). We don’t enjoy them and we want them to go away—they’re unpleasant. In contrast, we like pleasant emotions and want them to hang around (e.g., happiness, joy, excitement, love).

Unpleasant emotions are critical to our survival.

Fear, for example, helps us evaluate potential threats to our lives. Grief tells us we’ve lost something or someone we loved. Guilt tells us we’ve harmed someone else. Listening to unpleasant emotions tells us the problem that we need to solve to survive life.

Unpleasant emotions do not always signal a problem.

Think of them as an early warning system. They make us stop and evaluate threats. Better for our survival that we evaluate potential threats than miss real threats. So we have unpleasant emotions at times when there is no actual threat.

Emotional literacy

Emotional literacy refers to the breadth of our vocabulary to identify and describe the emotions we’re feeling. The more precise we are describing them, the better we can use them for our survival and success.  If we only have vague words (e.g., anxiety or depression) we can feel powerless and ill.

Let’s look at an example. Anxiety could include worry, fear, and apprehension to name a few. When we can accurately name it, we can use it.  Let’s see if we named it Worry.

• What am I worried about?
• Is it a real threat?
• Does worrying help me?
• Can I control what I am worried about?
• What would happen if I stop worrying about this?

Questions like these allow you to successfully use unpleasant emotions to help you live successfully.

Coping

Coping is anything we do to feel better. 

It’s often useful to cope before we solve the problem causing unpleasant emotions. The problem-solving part of our brain works best when we are calm.

Coping is not always conscious. We’ve been doing this since we were born so we can often fall into patterns of coping without consciously thinking about them.

Coping strategies can be healthy or unhealthy as shown on the coping continuum below. We are born with healthy coping strategies—they’re innate.  We always use our own personal coping strategies first (self-soothing, relaxation and distraction), but if they’re not enough to make us feel better, we’ll talk to friends and family (if we have people we trust).  If that’s still not enough we’ll talk to health professionals for some support, if we trust they’ll be helpful.

If healthy strategies don’t reduce distress, we’re hardwired to keep trying to feel better. This is when people use unhealthy coping strategies. All unhealthy coping strategies reduce distress. They are called unhealthy because, in addition to reducing distress, they may also cause unwanted problems.  People use the lowest harm strategies that help them feel better before using higher harm strategies.

Some harmful coping strategies used over time may also become illnesses and/or social problems.

• Emotional eating may lead to overweight, obesity, eating disorders and other illnesses and social issues related to those problems.
• Aggression—verbal and physical—harms relationships, can result in injury and/or death and can have legal consequences.
• Compulsive behaviours can cause social problems through inadequate time to do pleasurable and required social activities.
• Lying builds distrust in relationships.
• Alcohol and drugs can cause illnesses and social problems.
• Self-harm injures the body and can unintentionally cause death.
• Social withdrawal leads to greater isolation.
• Suicidality can cause death.

Unhealthy coping strategies are often labelled by the observer as maladaptive, when in fact they’re innately adaptive. People are also often labelled by their coping strategies or problems related to coping (e.g. addict, liar, self-harmer, suicidal person). This stigmatises people who are already significantly disadvantaged by overwhelming stressors and inadequate professional support to cope.

Stigma

There is social stigma around some illnesses which leads to people talking about “mental health” as a pseudonym for illness. Some people will say, “I’m not doing something because of my mental health”, rather than saying, “I’m ill at the moment”.

Others will use the term “mental health” to blur the boundary between unpleasant emotions and illness. For example, “I’m taking the day off for my mental health”, rather than, “I’m taking the day off because I’m ill”, “I’m taking the day off because I’m worried about the amount of work I have to do”, or “I don’t want to work today”.

Unpleasant Emotions as Illness

There is also an aim in some parts of the community to equate psychological distress—that is being upset—with having an illness. Indeed self-report measures of distress are sometimes used as evidence of illnesses in national reports of community wellbeing.

Illness can only be diagnosed by an appropriately qualified health professional. A qualified health professional will explore all the possible biopsychosocial causes for ongoing distress rather than assume unpleasant emotions and distress are caused by illness.

Your Health and Well-being

You can take steps you can take to optimise your health and well-being and eliminate the myth of mental health.

1. Use the words Health and Illness to describe your physical state.
2. Use the word Wellbeing to describe your personal experience of being at any time.
3. Write down your own healthy coping plan so you have a reminder on hand whenever you feel upset. The My Coping Plan app is a helpful tool.
4. Review your coping plan from time to time to make sure the strategies you listed are actually things you find helpful when you’re upset.
5. Notice unpleasant emotions and name them as accurately as you can. See how nuanced you can become in identifying and labelling emotions.
6. Evaluate the threat when you notice an unpleasant emotion and decide if you need to take action.
7. Use your healthy coping strategies to calm down.
8. Address the issue if there’s a problem.
9. Accept emotions that need acceptance (e.g., grief, sadness, disappointment)
10. Ignore emotions when there’s no real threat (e.g. fear about doing a presentation in front of people, doing something new, going into an unfamiliar social situation). Focus your attention back on what’s happening in the here and now.

Summary

Understanding that the brain is an integral part of the body and that “mental health” is inseparable from “physical health” and using accurate language is crucial to dismantling stigma and promoting holistic health and well-being. This includes seeking professional support when we have concerns about our health or well-being.

References

Stallman, H. M. (2020). Health Theory of Coping. Australian Psychologist, 55, 295-306. https://aps.onlinelibrary.wiley.com/doi/abs/10.1111/ap.12465

Stallman, H. M. (2018). Coping Planning: A patient- and strengths-focused approach to suicide prevention training. Australasian Psychiatry, 26(2), 141–144. doi:http://dx.doi.org/10.1177/1039856217732471

Stallman, H. M., Beaudequin, D., Hermens, D. F., & Eisenberg, D. (2021). Modelling the relationship between healthy and unhealthy coping strategies to understand overwhelming distress: A Bayesian network approach. Journal of Affective Disorders Reports, 3, 100054. doi:https://doi.org/10.1016/j.jadr.2020.100054

Stallman, H. M. (2020). Suicide following hospitalisation: Systemic treatment failure needs to be the focus rather than risk factors. The Lancet Psychiatry, 7(4), 303. https://doi.org/10.1016/S2215-0366(19)30528-0

Stallman, H.M. Hutchinson, A.D., Ohan, J.L. (2020). Coping planning to reduce stigma and support coping after suicide. Australian Counselling Research Journal, 14(1), 5-9. http://www.acrjournal.com.au/resources/assets/journals/Volume-14-Issue-1-2020/Volume-14-Issue-1-2020-FULL.pdf

Dr Helen Stallman is a leading expert in wellbeing, coping and suicide prevention. Her research has explored the intersection of health and wellbeing, challenging outdated constructs and advocating for an integrated perspective on wellbeing to prevent mental illness and suicide.