For many years stigma has existed around mental health; some people have been branded with a ‘mental health’ label and subsequently been subjected to discrimination as a result of derogatory associations.
Thankfully, the tide is turning and awareness of the impact of genetic, environmental, social, financial and lifestyle factors on our mental health, is increasingly recognised. The Prince and Princess of Wales have supported Mental Health Awareness Week for a number of years and in doing so, have helped to raise its profile and encourage an openness and willingness to talk and share.
The World Health Organisation definition of health highlights that ‘health’ requires mental well-being as much as physical well-being. We all need to be mentally healthy. The degree to which we are in good mental health or mental ill health varies between individuals, between different seasons of our lives and depending upon a wide range of factors, some of which are within our control and others which are not.
Understanding more about how we can look after our mental health, needs to be high on the agenda. In 2017 depression was found to be the leading cause of ill health and disability worldwide 2. Although quoted rates of mental illness often vary due to the limitations of population reporting, the trends are consistently on the increase. In the UK, a survey is conducted every seven years looking at population mental health and well being. Publication of the latest survey is awaited, but at the time of the 2014 survey around one in six adults in England were found to have a common mental disorder 3. It is likely the figure is higher, as many people are not included in the survey, including those in prisons or sheltered accommodation.
Given how common mental health disorders are, most people, even if not affected themselves at some point in life, are affected indirectly, through a close contact.
The following questions aim to provide information to give you the confidence needed to support a loved one or to recognise a need for action for yourself. The focus will be on depression, anxiety and stress, as these are most common.
- When does feeling depressed or anxious become a disorder?
- Stress: performance enhancer or problem?
- How can the other pillars of lifestyle medicine help our mental health?
- Can positive psychology help?
- If I see a doctor about my mental health, what can I expect?
- Need help now?
When does feeling depressed or anxious become a disorder?
Life is full of ups and downs. Even those around you who might appear to have it easy, will most likely have their own set of worries or insecurities. Life events, illness, bereavement, job insecurity, financial burdens, moving home and relationships can all rock the boat. Our reactions to such trials vary from person to person. Some will find it comforting to share with loved ones, others would rather not give it air time. Some will shed tears, others might appear unfeeling. Some might shout or seem angry, others might become quieter than normal. Some might experience physical symptoms: heart racing, sweating, numbness, various pains. There is no right or wrong reaction to difficult times in life, we all cope with things in different ways.
Most of the time the strong emotions that we feel are reactive. Something in our lives has led to an emotional response. Take an extreme example, such as the death of a loved one. Most people would be unsurprised to experience in themselves, or witness in someone else, a strong emotional response to this. The type of response, as we’ve already considered, will be variable. It can be the case for some, that they don’t appear to be having what might be deemed a typical emotional response, but instead experience unusual, normally medically unexplainable, physical symptoms. Such is the strong link between our physical and mental wellbeing.
Continuing with this example, in the event of the death of a loved one, how long might you expect to experience this reaction? Well, how long is a piece of string? Again, we are all different. Our relationships differ, the loss for one will be different to another. The bereaved might describe feelings of sadness, frustration, reduced appetite, and not enjoying things as much as usual, all of which are symptoms of depression. They might be experiencing feelings of irritability, being easily tired, struggling to control worries and difficulty sleeping, each of which are symptoms of anxiety.
So, how can we detect when our, or another’s, emotional response is leading to or has become a disorder? Some key questions to help us consider this include:
- Are the feelings present most of the day, nearly every day?
- Have they been persistent for at least two weeks?
- Are the emotions interfering with the ability to do what is needed during the day, eg work, caring for children or eat?
- Is there any concern for the safety of anyone?
You do not need to be able to self diagnose or diagnose someone you know. If you feel concerned or answer yes to the above questions, it is always appropriate to seek advice and assessment from a GP or other medical professional.
Going back to our example of the person who is grieving the loss of a loved one. Let’s suppose the answer to the above questions is no. It has been over two weeks since their loss and though the feelings are frequent, there is still some enjoyment in certain things, at various points in the day; they are still able to function and do their job; they’re eating normally and have had no thoughts of wanting to hurt themselves. When symptoms of depression and/or anxiety are being experienced, but you are still able to contend with the day ahead, now is an opportunity to take extra care of your mental health, to prevent any deterioration to the point of disorder.
Stress: performance enhancer or problem?
In the early 20th century, psychologists Robert Yerkes and John Dodson recognised a relationship between pressure and performance; to perform optimally you need a certain amount of pressure (4). Without this, there is a risk of boredom, which can lead to under achieving.
Society often encourages us to believe, the busier the better. A lack of sleep, juggling many balls or overdoing it, are often greeted with kudos. But, many have experienced the fine tipping point where peak performance gives way to problematic stress.
