Understanding Common Mental Health 'Disorders'
First of all, I would like to point out that in this post I will be talking about common mental health difficulties, rather than other more severe psychological disturbances like psychosis, schizophrenia, bipolar disorder, autism spectrum disorder or personality disorders (e.g., Dissociative Identity Disorder, Borderline Personality Disorder or Antisocial Personality Disorder), which could have a more biological basis. Although even common mental health 'disorders' can over time - if untreated - become a biological rather than just a psychological issue, I will be referring here to the less severe forms.
I refrain from the term 'disorders' ('diseases' or 'illnesses'), as these words seem to take one's power away. The language we use is powerful and it influences how we feel about ourselves and the world. Thus, I prefer the word 'difficulties', as it does not attach labels to us and it reflects more accurately what is going on in our internal system - i.e., that we struggle with difficult life events.
I do not wish to minimise mental health difficulties, as I know that they might have a significant impact on our day-to-day life, but I would like to share my perspective on why they make sense and why it is important to understand their existence. Let's start off with considering emotions.
We have emotions for a very good reason because ...
... they give us very useful messages. However, when they take on extreme roles, they start being problematic.
Sadly, in our western society, emotions tend to be put into two boxes - 'positive' and 'negative'. And they are the 'positive' ones (like joy, happiness, or emotions associated with success and pride) that are celebrated, while the 'negative' ones (like anger or sadness) are frowned upon. And we are encouraged to do everything to eradicate them from our emotional repertoire. Personally, I do not like to label emotions as positive & negative or good & bad. Rather, I view them all as useful messages from our internal system that lie somewhere on a continuum. Let's have a look at some examples.
The spectrum of HAPPINESS could look something like this:
Contentment --- cheerfulness --- joy --- enthusiasm --- happiness --- exhilaration --- mania
While contentment, happiness and joy are considered as useful or 'good', mania is feared because it can be very problematic.
The spectrum of ANGER would have healthy assertiveness at one end, and rage and aggression at the other end. So, on one hand, anger helps us be ASSERTIVE when dealing with a difficult situation/person. On the other hand, when it is expressed as AGGRESSION, it is often problematic, because when we are aggressive, we cannot function rationally.
Feelings of SADNESS would be at one end of another spectrum, while DESPAIR, HELPLESSNESS & DEPRESSION at the other end.
FEAR & ANXIETY not only protect us from danger, but also equip us with a rush of adrenaline that gives us the courage to do something challenging, face someone or something difficult, give performance, or engage in adrenaline sports. At the other end of the spectrum, however, is a full-blown ANXIETY that creates havoc in our lives.
Now, let's have a look at emotions (and their symptoms) that lie at the extreme ends of the continua. When we start experiencing a cluster of symptoms that are so readily labelled as mood disorders, anxiety disorders, addictive disorders, post-traumatic stress disorder, personality disorders, etc., our default feeling towards the symptoms is hatred. We despise them and wish to get rid of them. I do not want to romanticise mental health difficulties, but what if we started to treat their symptoms as helpful messages from our internal system that have only one role - to warn us and protect us? After all, ...
... all symptoms make sense!
So, let's move from pathologising to understanding.
When we look at symptoms more closely, we might start seeing that they all make sense. For example, when we fall into depression, we have the need to de-press something unbearable, to numb ourselves, to isolate ourselves, to withdraw from others and the world. Why? Because for whatever reason (and there is always a reason), we started perceiving others as unsafe and the world as an unsafe place. And although our isolation can be a source of safety initially, the deeper we go into our cage, the more disconnected from others we become. And when there is a deep disconnection, there is also suffering because we are relational beings - hardwired for human connection. And then we start numbing ourselves emotionally because it feels better to be numb than to feel pain. Emotional numbness is a protector, but unfortunately, after a while, it takes on an extreme role and we stop feeling all emotions. The brain does not shut off just the difficult emotions, it dampens all emotions.
With regard to anxiety, when we experience its symptoms, our system is warning us that there is a threat in the environment. If we have repeatedly experienced actual or potential threat from the environment, we have conditioned our body to be over-vigilant and our nervous system to be always ready for action. The more often we get fearful, the more activated the fear center in the brain (called the amygdala) gets. And with time, the overactive amygdala starts reacting to the slightest trigger in the environment. When any kind of threat is detected, we start breathing fast (sometimes we breathe so fast that there is too much oxygen going into the brain and we start feeling dizzy), our heartbeat increases, we start sweating (to cool down the system), our sugar level goes up so that we have more energy, and all our energy goes from internal organs to the muscles. All of this happens so that we can either fight whatever is threatening us, or run away (flight) from danger. Fight or flight are not the only stress responses. We can also freeze, faint, flop, fawn (fall asleep or submit ourselves to the threat or captor), or friend (become very friendly or submissive towards the threatening person).
Although the amygdala is clever at detecting a threat,
it is not clever at telling the difference between an actual and potential threat.
Therefore, the amygdala treats threat to our identity (e.g., when someone yells at us) in the same way as when we encounter a bear in the woods. It sets the whole system in motion in readiness for fight or flight, even when it is not necessary to fight or run away (that is why we might start shaking because the muscles are ready for action, but we are not moving).
In the same way that our brain cannot tell the difference between an actual and potential threat,
it cannot tell the difference between fantasy and reality, or between the past, present and future.
Whatever we think about right now, our brain translates it as something happening to us right now. So, if we ruminate about something unpleasant (e.g., loss, rejection, humiliation) that happened to us ten days/weeks/months/years ago, our brain thinks that it is happening to us in the very moment, and so we are experiencing the feelings of loss, rejection, humiliation (or other emotions) all over again. Equally, if we have catastrophising thoughts about the future, our brain translates the thoughts as actual, rather than hypothetical and we start feeling anxious.
As for social anxiety, this is very common and it is increasing with the usage of social media that promotes comparison & competition. We develop social anxiety as a result of repeated messages from the environment that we are not good enough in some way. These messages are in the form of judgements from others or the portrayal of what is 'ideal' by social media. The more we hear and repeat these messages to ourselves, the more we internalise them and start believing them. Consequently, being with others while not feeling 'on par with them' feels very uncomfortable and makes us avoid social situations.
With regard to post-traumatic stress disorder (PTSD), we might develop it after experiencing something highly traumatic, something well beyond the boundaries of the normal (e.g., being in a car accident, natural disaster, war combat, being abused or severely bullied). We get emotionally dysregulated, have frequent flashbacks, nightmares, panic attacks, feel ‘on edge’ or depressed. Our brain is continuously trying to make sense of the situation/s (through flashbacks) and our nervous system is constantly on alert in anticipation that a similar situation might occur again. In short, we are struggling with unresolved stress.
Could we view also addictive behaviours as our coping strategies (and protectors)?
Why do we resort to addictive behaviours like drinking, smoking, taking drugs, engaging in excessive sexual activities, gambling, excessive shopping, over-eating or under-eating, over-exercising, self-harm or suicidal ideation? We do this again to protect ourselves - to numb our pain or to distract ourselves from uncomfortable feelings. Although these behaviours might not be optimal coping strategies, we resort to them because we are not equipped with the right set of skills that would help us cope with difficult emotions in more optimal ways.
One of the aims of therapy is to learn to cope with past and present adverse life events in more optimal ways.
I hope that the above has illustrated why understanding what is going on in our internal system is much more helpful than pathologising, labelling, feeling like a helpless victim, or feeling that there is something wrong with me.