What is ‘Mental Health’ and How Do You Know If You Have It?
Today, we hear the term ‘mental health’ a lot. It “isn’t good for my mental health,” “mental health is so important,” or “I need a mental health day.” However, people rarely talk about what constitutes ‘mental health.’ Is it the absence of ‘mental illness,’ ‘absence of stress?’ Is ‘mental health’ the same as happiness?
Mental health lies on a continuum, like physical health, and there are components which can be specified and operationalized. Unlike physical health, however, it is not possible to objectively measure mental health. There are no corresponding numbers such as heart rate, blood pressure, kidney function, or body mass index. This should not deter us. Generally speaking, mental health means the ability to function effectively in the world, experience pleasure and satisfaction, enjoy positive interactions with others, adapt to change, and have sufficient resources to withstand stressful life events.
It is important to note that people can suffer from mental illness during periods of their life, and enjoy mental health during other times. People can and do recover from mental illness, and people struggling with mental illness can lead meaningful and productive lives.
Here are 11 abilities which promote and are integral to, mental health. One doesn’t need all of them, or all of them to the same degree, but the more one has, the healthier he or she will be. Many of these abilities are influenced by genes and most are developed in infancy and early childhood, but many can be developed later through positive relationship experiences, and learning.
Relationships Matter
Just about any study on mental health concludes that people who rate their relationships as supportive, pleasurable, and fulfilling are deemed to be healthier and more satisfied with their lives than people who rate their relationships as frustrating, unsupportive, or superficial. We are predominantly social creatures and we need others to feel connected, valued, and safe. A person doesn’t need a lot of friends, or a life partner to experience the satisfactions of positive relationships but it does seem to be essential that we have someone to confide in, to share our worries and joys, and to rely on for help when we need it. Isolation is highly correlated with all types of mental and emotional distress. Sometimes, the close relationship is a community rather than an individual, for instance a religious order, or commune. There is increasing evidence that pets, particularly dogs, provide enormous companionship and pleasure to healthy people across the lifespan, as well as therapeutic benefits for people with physical or mental health challenges.
Rational Thinking
Being able to think rationally and being able to control one’s thoughts are foundational to mental health. People who are confused about what is real and what is not, who believe their thoughts are controlled by forces outside themselves, or who are besieged by frightening ideas or images, have serious mental illnesses, such as Schizophrenia, and usually require medication to obtain relief. At a less extreme level, there are people who have frequent negative thoughts such as, ‘I’m no good’, ‘people don’t like me’, or ‘everything is awful’, which give rise to and maintain, depressive feelings and mood. A great deal of research has been undertaken in the past few decades to understand the relationship between thoughts or “cognitions” and mood, and how to influence thinking, in order to relieve depression. People who tend to view themselves, the world, and the future in negative terms, who anticipate serious negative consequences from routine negative events, and/or who self-blame and overgeneralize in response to failures or disappointments, are more prone to depression than people who are generally optimistic, view failures and disappointments as discrete events, and who are able to generate plans to recover and move forward.
Experiencing, Expressing, and Tolerating a Broad Range of Emotions
People with mental health do experience a preponderance of positive emotions but healthy does not mean being calm, quiet, and unflappable. Healthy means feeling and reacting in authentic ways which are appropriate to the circumstances, not destructive of oneself or others, and which feel ‘right.’ It’s important to be able to express anger when we are thwarted or betrayed, to experience and express love and joy, and to feel and express sadness when we have a loss or disappointment. It’s also important that we reach out for help and reassurance when we are afraid. It is not healthy to express the same emotion all the time, whether its anger, sadness, or even cheerfulness. The effort to be cheerful all the time is depleting and exhausting, and can contribute to depression. The effort to be calm in all circumstances can lead to a number of stress related illnesses. Being constantly cranky or fretful is debilitating, and leads others to avoid us, which results in isolation, and loneliness. A wide range of affect is healthy and invigorating, and appealing to others.
The ability to tolerate and soothe negative emotions such as anger and sadness, is referred to as emotion regulation, and it is an important determinant of mental health. Those who are paralysed and disorganized by negative emotions tend to withdraw when they experience such feelings, which tends to make things worse. Frequently, these individuals seek relief through drugs or alcohol. Sometimes, people who can’t tolerate negative emotions act out impulsively, with self-harm.
Resilience
Resilience is the ability to bounce back or recover from a disappointment, failure or loss. This is a crucial component of mental health because we all experience disappointment, failure, and loss. People who withdraw in panic or shame when faced with a challenging set back, have a very difficult time rousing themselves to get going, take new risks, and resume their lives. It’s normal and expectable to be upset, angry, fearful, even despondent when faced with a distressing event but some people emerge from this state feeling strong, optimistic, and energetic and others are cowed, diminished, and fearful. Researchers suggest that the ability to be resilient is connected to a) not attributing the set back to our own innate weaknesses or unworthiness, b) having a generally positive outlook about ourselves and the world, c) believing that we are capable of influencing the direction and outcome of events, as opposed to being the victim of events, and d) having the ability to problem-solve.
Intimacy and Empathy
The experience of feeling known and understood by others is usually deeply satisfying. Equally so, is the ability to sense what others are feeling and experiencing. Empathy is the ability to imagine what someone else experiences on a deep felt level, and to communicate that in words, facial expressions, or gestures. To experience intimacy and empathy as pleasurable, we have to feel worthy of being known, believe that the other person will not abuse or take advantage of their insights about us, and feel confident that knowing another’s experience will not confuse or unduly influence are own thoughts and feelings. Additionally, we have to feel confident that we can hide our feelings and thoughts, if we choose to do so. In other words, we have to feel in control of what is shared, and what is private. No one wants to imagine that our private thoughts, while travelling on the subway, can be read by others!
Individuals who are afraid of sharing the contents of their mind, afraid that others are dangerous, or afraid they can’t control what is shared, are terrified of such possibilities. At the other end of the spectrum, are individuals who cannot fathom that thoughts and feelings can be shared, and it doesn’t occur to them to try. Both of these types of individuals experience a lot of loneliness, and anxiety. There are also individuals who are very indiscriminate about sharing personal information and feelings, which makes them vulnerable to exploitation and abuse.
Interests
There are innumerable research studies which state that people who are mentally healthy have the ability to enjoy activities beyond their work activities and personal responsibilities; in other words, they are able to “play,” to engage in recreation. It is pretty clear that hobbies, interests, sports, volunteer activities, of whatever kind, provide joy, satisfaction, release of tension, and quality of life. People who are engaged in projects or activities purely for pleasure, experience…. pleasure. Pleasure is good for our mental health.
Physical Health
It is hard to conceive that people with debilitating physical challenges or decline could have good mental health, and most do not. It is extremely difficult to feel calm, safe, or content when struggling with physical pain. Moreover, individuals who are ill have fewer relationships, work opportunities, or hobbies which further reduces their chances of feeling pleasure, or connection. There is a strong correlation between mental health and physical health, in both directions. People who struggle with their mental health are more likely to have poor physical health and people with poor physical health, are more likely to experience mental health difficulties, particularly anxiety and depression.
There is overwhelming evidence that physical activity promotes mental health and not enough attention is paid to this fact. Doctors and mental health professionals seem reluctant to encourage their patients to exercise, for fear it might seem to trivialize their suffering, or worse, appear to blame them for their plight. Nonetheless, people who exercise report feeling less stress, less depression, and less anxiety than those who don’t.
Ability to Tolerate Conflict and Differences
Life presents conflict in the context of personal relationships, work relationships, neighbours, and politics. Where there are people, there are differences of opinion, need, desire, and motivation, and therefore, conflict. People who are able to tolerate that others disagree with them, compete with them, and ignore them, are much better off and healthier, than people who are outraged when others disagree with them, feel personally offended by a difference of opinion, and consumed by a need to retaliate. It is very hard to maintain relationships if one can’t tolerate conflict. Hence, such people rarely do maintain relationships. Mental health professionals usually ask in an assessment, how long a person has known their best friend. There is a wealth of information communicated when the answer is “thirty years” and a wealth of information communicated, albeit different, when the answer is “3 weeks.”
The ability to tolerate and resolve conflict requires the ability to take another’s perspective, to understand that other people have intentions and needs, which are different from one’s own. When people believe that others deliberately intend to provoke them, whenever they say or do anything contrary to their own wishes and needs, they will be in a frequent state of outrage. An example of this is road rage, where a distracted driver veers into someone else’s lane and the affected driver reacts as if the action were deliberate and hostile, and gets very aggressive, in response. Another example is a friend cancelling an engagement because of a sick child, and the other person reacts as if the friend is lying, exaggerating about the sick child, or even caused the child to be sick, in order to hurt and disappoint them.
Self-esteem and Identity
Having self-esteem means that you have a realistic assessment of yourself and believe that you’re “good enough.” You have decided that you are smart enough, nice enough, attractive enough, and capable enough to have a meaningful life with work, friends, and fun. People who need to believe that they are the most brilliant, or beautiful, or talented, are crushed when such beliefs are threatened, and have a tough time recovering. Healthy self-esteem is inclusive, which means you can believe that you are smart but know that you sometimes make stupid mistakes, that you are decent and kind but capable of being small and mean, that people like you but, sometimes, they don’t. People with healthy self-esteem can acknowledge their faults, apologize when they are wrong, and develop a new approach when the current one doesn’t work. People with healthy self-esteem value themselves for a whole range of attributes, not just one. They can age, change, and take a different path when necessary. Healthy self-esteem allows people to be flexible.
Identity refers to a sense of self, what people believe makes them, who they are, as a person. Identities may include race, culture, ethnicity, religion, sex and gender, or some other designation, as well as personal qualities or attributes. Identity is usually continuous and stable over time, even when roles change, such as becoming a spouse or parent, or beginning a new career. When individuals have identities which are not stable over time or situations, it causes considerable disorientation and distress, and is usually evidence of a mental illness.
Impulse Control
Impulse control is the ability to tolerate frustration, delay gratification, and not act or react without paying attention to the consequences to oneself, or others. It is very difficult to have quality of life and maintain relationships if one is unable to control one’s behaviour. There are talented and powerful people who do manage to get away with binge drinking, temper tantrums, bullying, and sexual abuse of others, but these are not the norm. Most individuals who have temper outbursts, problems with sex, drugs, and alcohol, who steal, and cheat and assault others, or who self-harm, are incarcerated or hospitalized, or homeless. At the less dramatic end of the spectrum, are those who can’t discipline themselves to study or complete work assignments, or go to bed on time or get up on time, who fail to meet their potential, and experience a sense of frustration and failure, as well as the constant disapproval of others. Impulse control is pretty essential to mental health.
Cognitive Ability
The ability of an individual to make good choices and judgments, maintain relationships, and manage difficult emotions requires that they have sufficient cognitive capacity to engage in such efforts. Individuals with significant developmental delays or dementia often lack sufficient mental acuity to reason and problem-solve, and the necessary impulse control to implement plans and meet goals. Individuals with significant cognitive impairments are prone to depression and anxiety because their lives are difficult, and they must rely on others to meet their needs. However, people with significant cognitive impairments who live in caring and supportive environments and receive protection, as well as, attention to their physical, social, and emotional requirements, often enjoy excellent quality of life.
Bonus: A Sense of Humour
Having a sense of humour attracts others and enhances a person’s ability to function, and adapt. Humour is a way of both embracing and distancing from events. Humour acknowledges the sadness, embarrassment, or fear connected with a particular event, but turns it around so that it creates laughter, amusement, and connection. The capacity to be humourous, especially to be humourous about oneself, displays an ability to see things from different perspectives, and to tolerate, even play with, distress. A person with a sense of humour can meet her need for feeling connected, validated and reassured, without directly asking for these. Rather than burdening others by asking them for comfort, the humourous person strives to unburden others, and nothing unburdens people like laughter. Unfortunately, it is very difficult to teach people a sense of humour. It seems people have it …or they don’t. A sense of humour is a valuable asset, but not a substitute for expressing distressing emotions and confiding in important others.
Factors Which Interfere with the Development of Mental Health
Genes certainly contribute to the development of mental health and mental illness. There are significant genetic contributions to depression and anxiety, as well as schizophrenia and bipolar disorder. Family histories of violence, addiction, and instability have a huge impact on child development and later adult adjustment, and mental health. Trauma, child abuse, and chronic poverty are substantial contributors to the development of mental illness in adolescence and adulthood; most mental illnesses in adulthood, have precursors in childhood.
Conclusion
Individuals seek the help of mental health professionals, or are referred for help, when they experience feelings of anxiety, sadness, or loneliness, when they can’t function at home or at work, when they can’t sleep or eat, or when they can’t control their eating, drinking, drug use, or thoughts. One in five people will experience a mental health problem over the course of their lifetime and it is vital to find ways to detect mental health problems earlier, and to provide effective treatments. It’s just as important, however, to focus on the constituent parts of mental health and to provide environments which promote the development of those constituent parts. We can’t change people’s genes or ignore the consequences of trauma, abuse, or poverty but we can help people to function better and cope, by providing skills, tools, and support, as part of basic education during the school years. Added to reading, writing, and arithmetic should be relationship building, resilience, and resourcefulness.
Resources
Helen Louise Brooks et al. “The power of support from companion animals for people living with mental health problems: a systematic review and narrative synthesis of the evidence,” BMC Psychiatry (2018) 18:31.
Patricia A. Jennings, MEd, PhD, The Trauma Sensitive Classroom, Building Resilience with Compassionate Teaching, Norton Professional Books, 2018.
Martin Seligman, PhD., The Optimistic Child: A Proven Program to Safeguard Children Against Depression and Build Lifelong Resilience, Houghton, Mifflin, Harcourt, 2007.
Anneliese A. Singh, PhD, The Queer and Transgender Resilience Workbook, Skills for Navigating Sexual Orientation and Gender Expression, New Harbinger Press, 2018.
About the Author
Janet Morrison, M.A., C. Psych Assoc. is a psychological associate in private practice and a senior lecturer at the Factor-Inwentash Faculty of Social Work, University of Toronto. Over the past 30 years she has assessed, treated and supervised treatment of children in long-term care, as well as, consulted for Children's Aid Society and group homes across Ontario.
Listen to our podcast episode on this topic: Episode 1 | What is Mental Health and How Do You Measure It?