A calm mind brings inner strength and self-confidence, which is very important for health
- Dalai Lama
Definition
From time to time, I was approached with the question, "Am I normal?", "Do you think something is wrong with me?", "Can you give me a certificate that I am sane?" On the other hand, I asked myself, "Do I know what mental health is?", "Is it enough to say that it is the absence of mental disorder?" And then I turn to the psychiatric "bible", DSM-5, and I realize that it does not mention mental health at all, but only the definition of mental disorder. Maybe that means mental health isn’t important to my job, right? I answered my own doubtful question right away – wrong! After all, I am referred to as a mental health practitioner, which means that I am responsible for mental health, not mental un-health. That seems more appealing and in keeping with my title, doesn't it? Therefore, I decided to wrestle with this topic.
Writing about mental health is not easy even though I am supposedly a mental health expert. However, I must admit that I know mental disorders better than the attributes of mental health. For this reason, I am perplexed by the titles such as mental health clinics, institutes, centers, hospitals, etc., for the places where you couldn’t “find” mental health devotees, only sufferers of mental disturbances and their dedicated treaters.
The World Health Organization's official definition of mental health does little to help. It is formulated as follows: "Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community." *
Many have criticized this definition as restrictive and culturally bound. Consequently, a group of European psychiatrists developed a new definition in 2015, which has yet to be adopted.
It is more comprehensive and reads as:
"Mental health is a dynamic state of internal equilibrium which enables individuals to use their abilities in harmony with the universal values of society. Basic cognitive and social skills; ability to recognize, express and modulate one's own emotions, as well as empathize with others; flexibility and ability to cope with adverse life events and function in social roles; and harmonious relationship between body and mind represent important components of mental health which contribute, to varying degrees, to the state of internal equilibrium." **
Sounds better? Maybe, but the emphasis on "internal equilibrium", "harmony with the universal values of society" and "a harmonious relationship between body and mind" is still unclear or not applicable in many situations. ***
Interpersonal neurobiology
So, what to do? I decided to turn to one of my favorite intellectual mentors, Daniel Siegel, who has an outstanding pedigree as a psychiatrist, professor, researcher, educator, author, and founder of the interdisciplinary field of interpersonal neurobiology. I had the opportunity to meet him at one of the conferences and witness his ability as a public speaker and master of interviews, as well as his kindness in personal interactions. I learned a lot, so I decided to consult his writings on this topic, hoping for greater clarity.
According to Daniel Siegel, mental health is dependent on the integrity of the nervous system, the self-organizing and regulating capacity of the mind, and the willingness to share information and energy with others. Let me immediately clarify the concepts of energy and information. Energy is classically defined as movement, action, from possibility to actuality. And information is a swirl of energy in a certain pattern that has a symbolic meaning. In the end, it's all about energy.
Siegel states, "Mental health emerges from a balanced and coordinated brain, empathic and connected relationships, and a coherent and resilient mind." **** I add to his statement and emphasize that the present time perspective dominates "the mind space" with a sense of calmness, curiosity, compassion, connectedness, confidence, and creativity.
Acceptance
This is not to say that we are permanently in this state because there are periods when we feel trapped, routine, and inflexible in our existence. Another time may bring an influx of overwhelming emotions, images, and memories to the point where we feel out of control. The key in such situations is to maintain the attitude of acceptance, a skill that requires observing life as a river, a big blue sky, or a guest house in which everyone is welcomed. When we are able to accept all experiences, then we open the doors of our "guest house" and welcome the watery flow of emotions, the dark clouds of thoughts, and, like the poet Rumi advises us, "a crowd of sorrows, who violently sweep our house empty of its furniture. " *****
I want to pause here for a moment to reiterate the importance of acceptance, a critical step in the development of self-awareness as an important attribute of mental health. I use Robert Cloninger's words to further illustrate the importance of this notion:
"Acceptance is being willing to see what we are in reality without wanting to become something else. We simply calm down and accept what may be painful. Do not go into an inner struggle with a part of ourselves. Struggle only divides us and leads to inner blockage. Instead, we let go of our struggles and accept the reality of experience without tension or any effort to fight." ******
Reduction of resistance by acceptance is an intentional activity, the choice we make so that we become grounded and grow in the serenity of being, which is the paradoxical benefit of letting go.
Integration
Daniel Siegal presents the concept of integration, which he considers the basic mechanism of health and wellness. He argues that integration is the process of connecting the differentiated parts of the system leading to the coordination and balance of the flow of energy and information. **** In other words, integration enables self-regulation of the mind, body, and relationships with others. It is as if we are creating the harmony of many voices in the choir, or pleasant music from many instruments in the orchestra.
The driving force behind integration and self-regulation are positive emotions which can foster a sense of vitality and connection to self and others. Emotion is the core experience in the mind. Positive mindsets build connections and alliances with their attractive force. They are uplifting. Feelings of delight, joy, love, and gratitude enhance immunity, resilience, and health. Love is considered to be the strongest of them all. Think about the loving bonds we have with our partner, spouse, children, parents, siblings, etc. Love is the enormous equalizer and dissolver of fear, egoism, and elitism. When we are in a state of positivity, our body is in physiological homeostasis, and our relations are meaningful, compassionate, and full of harmonized communications.
A second powerful force that leads to integration is immersion in the state of mindfulness. In this orientation, we nurture nonreactivity to any inner experience; practice observing sensations, perceptions, thoughts, and feelings; embrace acting with awareness and not on automatic pilot; describe and label inner experiences with words; and finally, stay non-judgmental to all experiences. According to Dr. Shanida Nataraja mindfulness enhances problem-solving ability, leads to a positive attitude to perceived stress, enlarges capacity for sustained attention, prevents a tendency for self-obsessive thinking, establishes emotional stability, creates openness, and facilitates curiosity and receptiveness to new experiences. *******
The third aspect that leads to integration, wellness, and health is the concept Daniel Siegel calls mindsight. ******** It is the ability to perceive the internal world of the self and others. Mindsight is the capacity to monitor the flow of energy and information in the body and in relationships and then to modify that flow towards integration. It is creating representations of the mind by the mind. Three such mindsight maps are of “me” (insight), “you” (empathy), and “we” (morality and a sense of belonging to a larger whole). ****
To clarify what is meant here, I give an example. A neighbor who recently lost her son approached me with urgency because she was torn by grief and guilt. I observed my emotional reaction of frustration because I was interrupted during dinner and was reluctant to continue as a psychiatrist after a long day's work. Then I paid attention to her and empathized with her emotional pain. I spoke to her calmly about the stages of bereavement and invited her to spend time with her grandchildren who lost their father by taking the opportunity to strengthen their relationship.
Mindsight is the mechanism that makes us more intelligent, both socially and emotionally. The development of mentalizing skills is a form of metacognition that has an impact beyond individual health and leads to sensitive caregivers, parents, educators, and the cohesiveness of communities making them more resilient to adversity.
Chaos and Rigidity
On the opposite side of the integration is a state of chaos and rigidity, a disintegrative process triggered by negative emotional states of intense anger, fear, or sadness. Chaos is a frenetic, frenzied, frustrated, and frightened mental/emotional state. Clear thinking and decision-making in that state are difficult or impossible. This condition can progress to intrusive thoughts, ruminative memories, unrelenting anxiety, constant preoccupations, uncontrolled impulsive or manic behavior, and even frightening hallucinations.
The mental/emotional state on the rigidity side may feel like frustration or anger but can also feel like fear and agitation if the need for control is not established. The decision-making is limited to what is known, or what worked last time. Rigidity may lead to avoidance, shutdown, disinterest, disconnection from the body, depression, and inability to adapt to changes.
When blockages in the flow of energy and information occur, chaos and/or rigidity arise, the mind becomes deregulated, and our bodies and relationships are uncoordinated and unbalanced. Mental health is jeopardized.
The healthy platter
Help in strengthening mental health comes from David Rock and Daniel Siegel in the form of what day called the healthy platter, which consists of daily mental activities that promote integration and self-regulation. So what are these daily practices? Here they are lined up on that famous tray:
1. Aerobic exercise supplies the brain with nutrients and activates proteins needed for brain growth and resilience.
2. Good sleep consolidates learning from the day.
3. Good nutrition based on whole foods and safe sources of omega-3 fats, and the avoidance of alcohol, tobacco, and other drugs.
4. Supportive relationships help us to learn how to love and live with each other.
5. Novelty brings curiosity, playfulness, and spontaneity as a needed input for the brain to remain youthful.
6. Paying close attention to selecting and importing positive experiences enhances the state of wellness.
7. Time-in means reflecting inwardly through meditation, prayer, and contemplation which facilitates the growth of self-regulatory integrative neural circuits.
8. Humor and laughter promote the release of positive chemicals and strengthen the immune system. ****
The river of integration
In my closing remarks, I report that I feel better informed to look at mental health and its disturbances from the perspective of interpersonal neurobiology. Based on the teachings from Daniel Siegel and others, I have arrived at a new definition of mental health. It is a state of wellness, based on the predominance of positive emotions, the presence of rewarding relationships, and the absence of suffering. We experience optimum mental health as a sense of well-being and as the ability to cope and operate from one moment to the next, rooted in the present time and place. It is a dynamic, interconnected, and reciprocal triad of mind, body, and relatedness to others, in which energy and information flow easily and continually. Daniel Siegel coined the metaphor the river of integration to visually represent a mentally healthy individual who successfully navigates the river between the bank of chaos on the one side and the bank of rigidity on the other, thanks to being flexible, adaptive, coherent, energized, and stable. Let us all embark on a journey in the river of integration guided by awareness, kindness, compassion, and love.
* https://www.who.int/
** Galderisi S, Heinz A, Kastrup M, Beezhold J, Sartorius N. Toward a new definition of mental health. World Psychiatry. 2015; 14(2):231-233
*** Christopher Lane. “Why Is Mental Health So Difficult to Define?” Psychology Today (June 5, 2016).
**** Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind, by Daniel J. Siegel, W. W. Norton & Company, 2012
***** Selected Poems, by Jalaluddin Rumi, Penguin Books, 2004
****** Feeling Good: The Science of Well-Being, by C. Robert Cloninger M.D., Oxford University Press, 2004
******* Blissful Brain: Neuroscience and Proof of the Power of Meditation, by Dr. Shanida Nataraja, Gaia, 2009
******** Mindsight: The New Science of Personal Transformation, by Daniel J. Siegel, Bantam, 2010
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