Why I don’t like the term ‘mental health’ but use it anyways (it’s not ‘all in your head’)
Updated: May 5
I don't like the term 'mental health'. I have felt this way for a long time but haven’t voiced it because I am afraid that it is too controversial of a thing to say out loud or that it will come across as offensive, invalidating or stigmatizing, which is the last thing that I want to do. I especially do not like the term 'mental illness' but have been worried that perhaps my feelings about that mean that I am in some form of denial about my own experience and the experiences of others. I've struggled with these thoughts for a long time now.
We are living through a period of time where mental health is even just beginning to be placed on the map as a societally and culturally 'OK' thing to discuss openly, which is huge progress in comparison to how things were ten years ago. Even in the last five years I‘ve noticed huge strides in regards to how culture discusses the topic. More people seem to be open to speaking about it without shame. The idea that we should hide it is becoming less prevalent and it seems to be becoming trendy to discuss mental health struggles or the support that one is using to manage their emotional worlds. It feels to me like the onset of the Corona Virus Pandemic has pushed this a step further and suddenly mental health is a universally talked about and shared experience. Not only are we all undergoing some version of ongoing stress/trauma right now, but we are in one way or another, experiencing it collectively - though I recognize the very important role that privilege plays in regards to the degree.
But no, I don't like the term 'mental health' - I still don't. Here's why:
I am a long time anxiety sufferer and have been working with some degree of anxiety or another since I was a young child. For most of my life I didn't even know that what I was experiencing was a thing, never mind that it was an experience called anxiety that was shared by billions of people - essentially that it was a human experience. When I was a child I just thought that I must be ‘crazy’ and different from everybody else. I hid my experiences so well in isolation that not even my parents knew how badly I suffered. Then, when I went to University in Guelph, Ontario in 2003 and my anxiety became unmanageable, I saught support from my GP who referred me to an on campus Psychiatrist. The Doctor quickly diagnosed me with Obsessive Compulsive Disorder, explaining that I simply had a chemical imbalance in my brain, a lac of the neurotransmitter serotonin, that required life long pharmacological treatment to be corrected. 'Ok', I thought. 'The problem is that my brain isn't working properly and I need this chemical in order to function'. It seemed simple enough and I was grateful to receive answers. The only problem was - the pills didn't help. Not really. They certainly didn’t solve the overall problem the way this doctor seemed to suggest they would. When I went back to tell them this I was met with blank stares and a prescription to increase my current does of medication. ‘You just need to find the right medication for you. Try CBT', they would say. 'It's evidence based'. And try I did. I tried with therapist after therapist to social worker to psychiatrist. I purchased 'how to' books on CBT and self studied on my own. I even drove to Winnipeg to seek support and information from a not-for-profit organization that specialized in anxiety. There, I met a lovely peer support worker who was hugely supportive in helping me feel less alone, but wasn‘t able to give me tools or understanding outside of the realm of medication and CBT. I continued trying to seek help and support, in and out of mental health crisis, until my final experience with a Psychiatrist in 2016 resulted in their suggestion that I utilize red wine as a PRN for my anxiety. PRN (pro-re-nata) is a type of 'when needed' medication to be used in emergency situations rather than daily. 'You're not an alcoholic', he said. "If you were, you'd be one already'. I tried that and it didn’t go well. It turned out not to be the solution, either.
What I know now that I didn't know then about CBT, is that, while effective in some circumstances with some individuals, CBT focuses primarily on what is referred to as 'top down' processing, a type of tool that focuses on thought management and 'changing the way you think' which, in turn is supposed to change the way you feel. The problem with CBT for those who have experienced trauma (which I would argue is about 99.9% of the population - if you're human you've experienced trauma) is that we are experiencing #nervoussystemdysregulation. In trauma, memories are stored in the limbic system and the emergency centre of our brain, the amygdala, is hyperactive. It is as though your body is primed for threat, ALL the time. Your brain and body want to protect you from danger. They want to make sure that what happened to you in the past doesn’t happen to you again in the present. They want to do this SO badly, that when they sense threat, whether real or imagined, they shut off the 'thinking' part of your brain (the pre-frontal cortex) in order for the survival mechanisms of your brain to take over and protect you from danger. There is not much room for 'changing the way you're thinking' when the thinking part of your brain is literally turned off.
The game really changed for me when I began my training in Trauma Sensitive Yoga. The TSY training that I was doing educated me on the role of the #vagusnerve. This nerve, which begins at the brain stem, travels down through the body to the stomach and intestines . It connects to a wide range of bodily organs including heart, lungs, throat and fascial muscles. The degree of its ‘tone’ is responsible for the regulation of our bodys stress response system. If our vagal tone is high we are more resilient to stress. If it is low, we become stressed more easily. Most interestingly, in the vagus nerve’s bidirectional communication between the mind and the body, 80% of the communication occurs from the bottom up (ie. from the body to the mind), making what is going on in our bodies pivotal to our mental state. In #polyvagaltheory it is often said that 'story follows state’. In other words, the story that is being told by the mind follows the state of the nervous system. If our nervous system is in 'flight' mode our thoughts will be frightened and racing. If it is in 'freeze' mode our thoughts will be slow and hopeless. And if it is in 'fight' mode they will be defensive, fearful, aggressive and angry. Furthermore, when our stress response system is stimulated and our body is sensing threat, this means that the branch of our nervous system which helps us to feel safe, seen, soothed ane connected is not online. This 'rest and digest' branch of our nervous system, the parasympathetic branch, is what facilitates digestion and absorption of nutrients, as well as recovery from stress and safe connection in relationship. There isn’t much room to digest food or have fun with our pals when our lives are in danger, literally or imagined. This 'shut down' of our digestive system can lead to what is called intestinal dysbiosis or an imbalance of our intestinal bacteria/flora. Keeping in mind that it’s been estimated that we have more bacteria in our microbiome than we have cells in our body, I'd say that could be pretty problematic to our overall health. Add to the mix that a large percentage of our feel good neurotransmitters, such as serotonin and dopamine, are produced in the gut, it's easy to see how physiological issues in the digestive tract could lead to symptoms of anxiety and depression. Essentially, the mind and body are one. The one effects the other in a very real and significant way. So why, when we refer to emotional or behavioural symptoms do we call it 'mental health'?
I'd like to take this arguement a step further and open up about some of my personal physical health challenges that became more clear to me in the winter of 2016. For seventeen years I had a series of physical, mental and emotional health symptoms that were left unexplained by my doctors. After stumbling across an article by an MD who specialized in Thyroid Disease, I came to learn that a lot of the symptoms I was experiencing seemed to match the conditions she was describing. I begged my MD to send me to an Internist who I then asked to have my antithyroid antibodies checked and, as I suspected, they came back off the charts. I was experiencing the autoimmune thyroid disease, Hashimoto’s Thyroiditis. Numerous referals and conversations with my family doctor finally landed me in the office of an Endocrinologist in Winnipeg named Margaret England. Dr. England, who was a staunch feminist from Los Angeles, CA. (how she ended up in Winnipeg, I'll never know) was as blatant with her thoughts about the medical system as she was about her politial views. 'You're not crazy', she told me. 'You're hormonal. All over North America this conditon is being misdiagnosed and unmanaged. It's being treated with anti-depressants when the problem is hormonal. You've been misdiagnosed for close to twenty years and I'm sorry that happened to you. We're going to get you feeling like a human again'. It was one of the first times in close to two decades that I felt validated in my experiences. Dr. England went on to tell me that the medical system is slow to catch up and it takes approximately 20 years after something is 'evidenced' for it to be adopted to common practice. For years, my bloodwork that came back as 'normal' was actually not explored deeply enough to show that my immune system was attacking my thyroid, leaving my cells deprived of energy, my adrenals exhausted, my body inflammed and my brain foggy and tired. This condition was impacting my overall health - including my mental health - in a significant way. There was a very real, physiological reason for so many of my symptoms. The problem was that I had been gaslighted for so long into believing that it was 'all in my head'.
And then, two years ago, while studying the Hashimoto’s expert Dr. Izabella Wentz, I learned that a common symptom of early stage Hashimotos (even before the disease tends to show up in advanced blood work) is anxiety and depression, in particular, Obsessive Compulsive Disorder. It is also common for individuals with Hashimoto’s disease to be misdiagnosed with Bipolar Disorder or Borderline Personality Disorder due to the intense hormonal fluctuations that occur as a result of the illness, significantly effecting mood and anxiety levels. This made so much sense to me based on my own experiences.
I don't need to go into a tirade about the various reason why this might have happened to me or about how the system is broken and patriarchal at best and abusive, neglectful and harming at worst. What I do want to highlight, once again, is how the mind and the body are SO intricately linked. My learning continued as I began studying the work of Dr. Gabor Mate, Bessel Van Der Kolk and Peter Levine, and discovered the deep connection between early childhood abuse/neglect and chronic illness. I learned that my early life experiences had shaped my nervous system to a state of perpetual and chronic stress, which impacted my body in a way to facilitate the onset of a chronic illness, and this chronic illness had impacted my emotional health due to the connection between hormones and inflammation on mood and energy. It was all linked. The one played into the other and vice versa.
Back to my original point about not liking the term 'mental health'. Even if you omit everything that I've just shared and simply consider that notion that emotions express themselves in the body, it is easy to see how labeling ‘mental’ symptoms as existing only from the neck up doesn't make sense. That gut feeling you have, the flushing of your face when you feel embarrassed, the racing of your heart when you’re afraid, the warmth in your chest when you’re in love - this exists in the body. They are called feelings because we feel them, we don’t think them. Thought patterns obviously play a large role in our emotional state, but they are not the only players. Our bodies contribute so much more then we can even begin to imagine. I believe that when it comes to mental health, often what we are pathologizing is either a) normal, physiological, mammalian survival responses or b) normal, painful, mammalian emotional states that we are not taught how to process or express including fear, distress and grief. What we are labeling as disease are responses and adaptations that make perfect sense considering the impacts of our environments, early childhood experiences, relationships and even the beliefs and societal expectations of our culture. And in saying this, I by no means mean to invalidate or deny the immense pain and suffering inherent in these conditions. I have experienced it and trust me, I know, that pain is very real.
We have to start somewhere with our societal conversations around mental health. I suppose recognizing that it does exist and is as real and important as any other health related experience is a start. Maybe we‘re not quite at a place where we can recognize the mind/body connection within mainstream dialogue. Maybe just having mental health on the map is enough for now. But I know for myself that recognizing the role that my body has played in my experiences has been life altering. Working with a trauma informed therapist who understands the language of the body has been unlike any work that I've done with a therapist before. At first, it felt frightening to me as it was so starkly different than the talk therapy that I had previously experienced. So much so that it took me several years to fully trust that my therapist knew what he was doing. But the truth was that talk therapy kept me trapped in that space from my neck up - the space where I had resided in order to keep myself safe from feeling the pain that I experienced growing up. The pain that was living, unprocessed, in my body. My work now, is to connect with those physical sensations in as gentle and loving and compassionate a manner as possible, with the support of someone who I feel safe with. I have, after all, been disconnected from them my entire life. This connection is where my healing lies. It's where my relationship with myself is. Its the antidote to the running, hiding, numbing, avoiding and self medicating that I have been doing most of my adult life, unknowingly. It is foreign and terrifying. I am not able to do it on my own. I have had to get help deciphering what these sensations mean, where they live and how I can be with them, as it’s a language I’ve never learned before. This healing I'm starting to do, it has actually less to do with my mind and everything to do with my body.
So, no, the term mental health doesn't quite sit right with me. But I will continue using it because I know that we have to categorize things somehow - and I want to be a part of the movement that begins normalizing these very real, normal, brave and important human experiences. I want to be part of the movement that makes talking about the physiology of trauma as normal to talk about as the physiology of cancer or a broken bone. Because it is as normal as those conditions. It is a real, visceral manifestation of an injury - an emotional one. It is tangible, the opposite of 'woo woo', understandable, and nothing to be afraid of.
With everything happening in the world right now and the impact that it is having on us all, we need these conversations more than ever. I am grateful to be a part of the dialogue.
*if you’re interested in diving a bit deeper into the information shared I recommend reading the articles below and/or exploring the research of Dr. Arielle Schwartz, PHD. and Dr. Izabella Wentz, Pharm D.