February 1st is 'Time to Talk' day, a project by the Time-to-Change organisation to get people talking about mental health issues, to 'break down the silence' that still hangs around mental health. Undoubtedly there remains a taboo surrounding mental health. Mention that you're a doctor to people and sooner or later someone will ask for some advice on this or that problem they have. No matter how intimate the region of the body affected, people find it fairly easy to open up about it, yet people don't tend to talk about depression. Taking time off work for a physical illness is fairly straightforward. It is a lot more difficult to say you can't go to work because you're exhausted, burned out, anxious or depressed. And of course there is the fear that it will go 'on the record'. Talking to friends, colleagues or family can be just as difficult. It is not just the stigma around mental health. The very nature of mental illness often encourages silence: the feelings of worthlessness, of negatively comparing ourselves to others, often mitigates against sharing these 'bad' thoughts and feelings. In some respects mental illness is the mind persecuting itself, and we know that persecution works best in a culture of silence.
So talking about mental health is a win-win, but it is extremely hard. Recently a colleague opened up publicly about their own mental health issues. It was unexpected but very much appreciated and took a lot of courage. This type of bravery is all the more striking because it is not the type that out culture usually feels comfortable talking about, war zones and so forth. The boldness it takes to open up about mental illness means facing up to society, your peers, everyone; yet it reaches out to and invites others to talk, it is inclusive and liberating.
We know that mental health issues affect almost everyone. You have a mind, chances are at some point you'll experience problems: stress, depression, anxiety, post-natal depression, breakdowns, rage... Have you ever felt worthless? Useless? Like your life is a waste? Had uncontrollable thoughts? Had panic attacks? Felt numb, depressed, burned out? Felt like you've had to push yourself through each day? I can tick all those boxes. I'm sure most of us can at least some.
Where these ideas, these feelings, these emotions come from is too big to go into right now. The mind is so mysterious. We can say with confidence however that 'my' mental health does not exist in isolation. My mind might be where I experience mental illness, but my mind is not confined to 'me'. My mind extends beyond me, to include the opinions and expectations of others, or what I think their opinions and expectations are. The phenomenon of 'social evaluative stress' is a key influence on our health: If I really believe others have a good opinion of me, I feel good. If I feel judged, I feel bad. In the words of Don Miguel Ruiz in The Four Agreements we are a part of 'the dream of the world', whether we chose it or not. Our problem seems to be that we take it all personally, all the negative stuff that other people say or do around us, even to us, we assume it is down to us, because of us. (In Buddhism, it is a process called 'selfing'.) But have I checked? Is it really about me?
When we feel 'mad, bad or sad' we could do with asking this. We can also try and listen to what we are telling ourselves: 'I'm worthless... I'm not good enough... I should count myself lucky... I'm being humiliated... I'm bad... etc.' These messages we tell ourselves - a form of self-hypnosis - can be overwhelming yet often happen just beneath the surface, so that we don't even know we're doing it. But if we can, for even a few moments, see them for what they are - opinions, feelings, coming from... somewhere - then we have already stopped identifying with them. To be able to ask myself 'what am I telling myself right now?' or 'what am I feeling right now?' can itself be liberating.
I read last night that the Navajo Indians in America believe that mental health can be seen as keeping a straight line between the head, mouth and the heart. If the three are in straight alignment, then there is good mental health. So for example if the head believes what the heart feels, and what you say with your mouth is the same what the heart believes, then mental well-being follows. It's a good message for Time to Talk day, and of course for everyday.
H James, 2018