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EOV Wellness Project: Healthy Minds

Re-written version 3 by Sirish Rao following editorial inputs from Rob Sutherland, Dr. Chris Stewart-Patterson and Dr. Daniel Stone Aug 29, 2022

Readers note:

3542 words (text excluding resources)

In this version, I have made the following changes in response to feedback:

  • Shortened the institutional stigma section.
  • Fixed typo pointed out by Dr. Stone
  • Added mention of Toxic coping section per Chris’ suggestion
  • Added links in the Resources section for topics not discussed in detail in the main text: schizophrenia, bipolar disorder and eating disorder.

EOV WELLNESS PROGRAM: HEALTHY MINDS

“There is a crack in everything, that’s how the light gets in.” – Leonard Cohen

“What mental health needs is more sunlight, more candor, more unashamed conversation about illnesses that affect not only individuals, but their families as well.” – Glenn Close

When you think of a human life, what comes to mind is a complex ecosystem. Every day, minute and hour, we experience life and organize these experiences in our brains through a highly complex set of interactions.

One Vancouver-based counsellor describes humans as animating and experiencing life through our senses – touch, smell, hearing, sight, sound, as well as our thoughts – perceptions, emotions, memories, language and expression. We simultaneously travel through our pasts, experience the present, and dream of our futures. He points out that our minds are constantly working with this incredibly rich material – responding to sensations from the outside world, and from our inner worlds to create a sense of self. A self that is in a continuum, in constant motion, undergoing revision and reinvention every day, and throughout our lives.

In short, our experience of life contains multitudes. And good mental health means living it in a state of wellbeing that enables us to take pleasure and satisfaction from life, and to be able to adapt and bounce back from adversity. Having good mental health doesn’t necessarily guarantee that life will be easier or simpler, but it enables one to be more resilient and deal better with stress, change, and setbacks. Because no two people are the same, there is no single definition of good mental health that will apply to everyone. Some general indicators of good mental health are higher levels of emotions like happiness, joy, satisfaction and confidence and lower levels of emotions like anger, melancholy, anxiety and depression. Experiencing a full range of emotions (at varying levels depending on the situation) is absolutely natural. It would in fact be of concern if a person were not to feel anxiety or sadness.

To speak of mental health, perhaps one analogy to use is that of the garden. Some of the most sustainable and healthy gardens strike a balance between a kind of wildness and stability. A garden, if overly manicured, with rowed hedges and every leaf in place, can be impressive, but quite rigid, and requires extreme discipline and attention to detail to keep it in shape. On the other hand, a garden that has been ignored will soon be overrun by weeds. A garden may also just have soil that makes it hard to yield fruit. Gardeners who work in harmony with nature know that it requires great attention and a daily practice to achieve an ecosystem that is not so controlled that it is unable to adapt and be natural, yet tended and nourished enough that it is not in a state of disrepair or chaos.

Interestingly enough, this is exactly how trauma expert and somatic therapist Peter Levine describes mental health: “We require dynamic equilibrium and relaxed alertness between stability and change.” Too much Stability: rigidity, fossilization. Too much Change: dis-integration, chaos.”
Everyone can relate to feeling the ups and downs of life, and just like with our physical well-being, most people will have experienced a period of struggle with their mental health at some point. This can be related to a variety of factors – discord in a close relationship, financial pressures, stress at work, are all common reasons. Sometimes all that one needs in such situations is to take a rest day from work, go for a walk in the park, or have an uplifting conversation with a friend. These are usual experiences of negative emotions, and all of us have different thresholds for coping with these emotions. But there are also mental health illnesses that are complex challenges that aren’t just part of everyday life. What may be considered acceptable levels of distress if unaddressed and untended, have the potential to develop into more formal mental disorders, and these need to be addressed in a more comprehensive way.

The first thing to know is that if you are experiencing mental health issues, you are by no means alone. According to the ADAA (Anxiety and Depression Association of America), anxiety disorders (generalized anxiety, social anxiety and panic) are the most common mental health issue affecting 18% of US adults every year. Mood disorders – which include major depressive disorder and bipolar disorder – are the leading cause of disability. We provide some information about these disorders in our resources section. What is interesting, is that these statistics are applicable on a global scale as well. Which tells us this is just part of being human. You can be sure many people around you have shared the same experience, and have walked the same road. You are not alone.

Secondly, it is wise and proactive and healthy to reach out for help – whether to a friend, family member or healthcare professional. Just as if you suspect you have fractured a limb, or persistent chest pain, you would seek medical attention, so it is with mental health conditions. Unfortunately, in many cultures there is a societal stigma surrounding mental health, and many people avoid or delay seeking medical help for fear of being treated differently by their loved ones or their colleagues at work. More than a staggering 50% of people with mental health conditions in North America don’t receive help. In some countries, it is as high as 90% Suppressed and hidden, their mental health concerns become internalized shame, and are likely to exacerbate and delay healing.

Stigma – in all its forms – often comes from a lack of understanding or fear. People are afraid of those who don’t look like them, of those whose political or religious beliefs are different, and of those whose behaviour they can’t understand or doesn’t fit into a definition of ‘normal’. When there is little understanding about another person, there is room for preconceived notions, stereotypes and fear to dominate rather than compassion, engagement and dialogue. In the case of mental health issues there are negative attitudes and beliefs toward people who have a mental illness. This may lead some people to treat others differently simply because of their mental illness or struggles. Some people may be afraid of those experiencing mental illness and fear for their own safety. This could be because they had a negative past interaction with someone experiencing mental health issues or because they simply do not have the tools or understanding to know how to deal with it. As an example, if you know how to administer CPR, you would be able to apply it when you see someone suffering from cardiac arrest. If you don’t have that tool, then your lack of knowing what to do can more often than not result in panic, rather than a useful response.

Since stigma often stems from a lack of knowledge, or a lack of empathy, the best way to overcome stigma is often conversation and education, to normalise talking about mental health, and to bring people to a place of understanding. Educating oneself and others about mental health is a powerful tool. Whether or not one is experiencing mental illness oneself, it is important to correct rude remarks about mental health in the course of conversations, or jokes made at the expense of those experiencing mental health issues. Moments like these are learning opportunities, and require gentle intervention and explanation. In many cases, when people understand the facts about a mental health issue, and what the daily experience of it is like, they may think twice about making such comments – just as you would not mock or discriminate against someone with heart disease or cancer. For those experiencing mental illness, seeking help is a very powerful way of addressing stigma. Not only does treatment bring you relief, and reduce symptoms that interfere with interactions with others, it also educates you about the illness, and gives you the tools to educate others around you, from family members, colleagues and others you interact with. Knowledge is indeed power. People can also help address stigma with a more public level of engagement, from supporting mental health organizations, petitioning businesses and elected representatives, and having open and positive conversations on media and social media channels.

One result of the isolation experienced during the Covid-19 pandemic, and widespread remote-work arrangements, is that many workplaces now better understand the crucial role that mental health plays in the productivity and wellbeing of the company.

With that context in place, it is time to define mental health issues and dig into some details. Dr. Tim Sharp of the Happiness Institute in Australia says the difference between a mental health struggle and a mental health disorder often lies in the extent to which these emotions impact on our lives. “If depression or anxiety or any other form of distress is having a significant impact on one’s ability to function, to work or study or socialise, especially over a prolonged period of at least one or more than two weeks, then that’s when we might consider a more formal diagnosis of mental illness and when seeking professional help would be very much recommended.”

Just as there is a huge variety of human personalities, there are also a range of mental health issues. In this module, we will focus on the two most common ones: Anxiety and Depression and discuss some tips to help manage those. Our resources section will offer some links and additional resources to go into disorders like schizophrenia, eating disorders, bipolar affective disorder, but those subjects are too vast to cover here, and are best discussed with a mental health professional.

Depression is a common mental disorder. The World Health Organization describes depression as being “characterized by persistent sadness and a lack of interest or pleasure in previously rewarding or enjoyable activities. It can also disturb sleep and appetite. Tiredness and poor concentration are common. The effects of depression can be long-lasting or recurrent and can dramatically affect a person’s ability to function and live a rewarding life. The causes of depression include complex interactions between social, psychological and biological factors. Life events such as childhood adversity, and unemployment contribute to and may catalyse the development of depression.”

Anxiety is described by the American Psychological Association (APA) in this way: “Anxiety is an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure. People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness, or a rapid heartbeat. Anxiety is not the same as fear, but they are often used interchangeably. Anxiety is considered a future-oriented, long-acting response broadly focused on a diffuse threat, whereas fear is an appropriate, present-oriented, and short-lived response to a clearly identifiable and specific threat.”

While these two disorders are quite different from each other in definition, it is also quite common that someone with an anxiety disorder will develop depression, and similarly many people with major depression also suffer from severe anxiety. The National Alliance on Mental Illness (NAMI) estimates that 60% of people with anxiety will also have symptoms of depression.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), anxiety and depression can share several common symptoms, including, but not limited to:

  • Being easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Sleep disturbance (difficulty falling or staying asleep; restless, unsatisfying sleep)Other signs that a person may suffer from both anxiety disorder and depression include:
  • Constant, irrational fear and worry
  • Physical symptoms like rapid heartbeat, headaches, hot flashes, sweating, abdominal pain, and/or difficulty breathing
  • Changes in eating, either too much or too little
  • Persistent feelings of sadness or worthlessness
  • Loss of interest in hobbies and activities
  • Inability to relax
  • Panic attacks

When to get emergency help
If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. Also consider these options if you’re having suicidal thoughts:

– Call your doctor or mental health professional.
– Call a suicide hotline number
– Reach out to a close friend or loved one or contact a spiritual leader or someone else in your faith community.

It’s important to remember that a mental illness rarely manifests the same way in one person as it does in another. Depression can look and feel very different to different people, and their signs and symptoms may differ.
All of this is not to suggest that you should self-diagnose, or come to any conclusions based on how you feel. What we do want to convey is that if you are struggling with your mental wellbeing and experiencing some of the symptoms mentioned above for a period of more than two weeks or on a recurring basis, we would recommend that you reach out for professional support from your GP, a counsellor, psychologist or psychiatrist.

It should also be noted that in some contexts, and in some countries accessing professional help is not easy. Dr. Vikram Patel, Director of the Mental Health For all Lab (a link is provided in the resources section) works to ensuring that people have access to mental health experts. Members of the lab, and partner organizations worldwide leverage digital technology and train non-specialist community providers to detect, assess, care for and prevent mental health problems. Tele-health has made it a lot easier and has reduced wait times for people to make an appointment with a mental health professional.

Most importantly – depression and anxiety aren’t a weakness. You also can’t simply “snap out” of your state or “cheer up” as people sometimes advice. Depression may require long-term treatment. But that’s the thing to keep in mind – it can be treated. Most people with depression feel better with medication, psychotherapy or both.
There are a few lifestyle changes and coping strategies we’d like to share with you though, that have been found to be beneficial in addressing anxiety and depression, and for your quality of life in general. We’re going to provide you with 12 tips, knowing that you will not be able to implement all of these things, but even a few will make a difference.

1. Socialize and stay connected.
Don’t isolate from your loved ones. One of the most common things when one experiences depression or anxiety is to withdraw socially and keep to yourself. But your friends and loved ones are hugely important to your healing and to get you ‘out of yourself’. In fact, social connections – whether just a walk with a sibling, or a joint grocery shopping expedition with a neighbour, or a watching a film with a friend can help. We are social beings, and we are interdependent – our health and our joys are dependent on others.

2. Make sleep sacred.
Few things can be more important to your health than good sleep. Most people experiencing depression or anxiety either sleep too much or not enough. Take all the proactive measures you can to go to bed and wake up on a regular schedule and give yourself a good eight hours.

3. Keep moving.
Exercise is a powerful antidote to stress. Our prehistoric selves would have responded to negative situations (say, an attack from a sabre-tooth tiger) by running as fast as we could away from danger. Today, we remain sedentary through many stress signals and negative emotions. Exercise is not only good for your body (and therefore self-esteem) it can also improve your mood, and give you the satisfaction of completing a challenge. No matter how much time you can give it (even 7 minutes a day!), make it a regular part of your day.

4. Avoid stimulants.
People experiencing depression and anxiety often reach for substances as a crutch – alcohol, cigarettes, caffeine, or drugs. These can worsen the situation. If you can’t quit on your own, see your health care provider or find a support group to help you. Quit or cut back smoking, drinking alcohol and caffeinated beverages.

5. Practice relaxation.
Relaxing is an art. It takes some learning, but meditation, yoga and other dynamic relaxation practices can greatly ease anxiety. Many of these practices also encourage you to centre compassion. Buddhist teachers advice that when one is fearful or despairing, one should recall examples of kindness, compassion and empathy to break the pattern of fearful thoughts.

6. Eat healthy
You may be tempted to binge-eat junk food to take your mind away. Keep healthy snacks around instead – carrots, fresh fruit. If you make sure your fridge has lots of vegetables, fish and you accompany that with whole grains, you’ll be doing your body and your mind a favour. A healthy bodied you will make you feel more fit and can improve your self-esteem.
7. Identify triggers.
Understand what situations increase your anxiety cause you stress. This not only helps develop awareness of your own feelings and emotions, you can prepare tools and techniques with the help of a mental health professional to better manage situations that cause you anxiety.
8. Get close to nature.
There is increasingly more empirical evidence that reveals how important experiences in nature can be for mental health. Being outdoors can improve cognitive functioning and emotional well-being. In Canada, a new initiative called PaRx has been implemented at the BC Parks Foundation, driven by health-care professionals who want to improve their patients’ health by connecting them to nature. Featuring practical resources like quick tips and patient handouts, its goal is to make prescribing time in nature simple, fun and effective. https://www.parkprescriptions.ca

9. Keep a journal.
Writing your thoughts and feelings in a journal is not only a wonderful way of expressing yourself, it’s great therapy and helps you better understand and manage your feelings. In some cases, it can offers catharsis. It can also be a way of identifying and sharing with your mental health provider the things that cause you stress, and what can help you feel better. The knowledge of the person experiencing the disorder is of great value.

10. Help others.
When one is depressed or anxious, it is hard to feel good about oneself. More often than not, we see our own limitations and ignore our strengths, and we don’t feel we are able to help others. But striving to help others even when you’re experiencing depression or anxiety, can in fact be a way of being part of something bigger than oneself. It reduces the focus on the self, and links you to other people in a compassionate way. You could do this in a structured way – such as volunteering to help a charity, or simply by treating a colleague to lunch, or complimenting a stranger. Brightening someone else’s day inevitably brightens yours, and investing in relationships is certainly a huge factor in long-term health and happiness. For people more inclined to take an advocacy role, petitioning local and federal elected officials is one crucial way of helping the cause. For those with the means to do so, donating to a mental health charity is a way of showing support and enabling their work. Helping others can take a wide variety of forms, and you can find the one best aligned with you. Importantly these ways of helping lead to your own continued learning, of individual, local, and international efforts.
Many of these tips above are expanded and more fully explained in the various modules of the EOV Wellness program, if there is a particular area you wish to tackle. For instance, the Sleep module will give you lots of suggestions and resources to get quality sleep. Similarly, tips on avoiding stimulants are available in EOV’s Toxic Coping module.
An important part of mental health is to reduce the dualistic thinking that separates oneself from the other, or one’s self from society, or humans from nature. Instead, it is to nurture interconnection – whether with other humans, or with the natural world. Another part of the work is to normalize the conversation around mental health for ourselves, and for society at large. As Thomas Insel, Director of the National Institute of Mental Health argues – all chronic diseases have behavioural components as well as biological components. He says “The only difference here, is that the organ of interest is the brain instead of the heart or the pancreas. But the same basic principles apply.”.
We have, at this moment in history, an opportunity to address mental health in a meaningful way – for ourselves, and for society at large.
To return to the garden metaphor, good mental health is an act of cultivation, of taking care of your mind – just as good physical health involves eating healthy food, having an exercise regimen. As with gardens which exist under the soil and atmospheric conditions of their location, there are some factors that are pre-existing, such as our genetics, and our upbringing, but there are things that require active work to sow seeds (cultivating curiosity), water the plants (grow your knowledge), weeding (letting go of negative behaviours) and produce fruits (creativity). This work requires daily attention and patience. Caring for your mind garden can look like finding new ways of coping with situations or learning new perspectives by engaging in conversation with others. The renowned Zen master and teacher Thich Nhat Hanh said of the mind “The seeds that are watered frequently are those that will grow strong.”

 

RESOURCES and ADDITIONAL READING/VIEWING

  • A list of 10 great TED talks on mental health
    https://www.elisplace.org/10-powerful-ted-talks-about-mental-health/
  • Mental Health Innovation Network (MHIN is a community of mental health innovators – researchers, practitioners, policy-makers, service user advocates, and donors from around the world – sharing innovative resources and ideas to promote mental health and improve the lives of people with mental, neurological and substance use disorders.
    https://www.mhinnovation.net
  • The Mental Health For All Lab at Harvard Medical School promotes the generation of knowledge and its effective utilization with the goal of contributing to the reduction of the global burden of suffering of mental health problems. The specific emphasis of the Lab’s efforts is to leverage digital technology and task-sharing to scale up interventions for the prevention and care of mental health problems.
    https://mentalhealthforalllab.hms.harvard.edu
  • Example of a well-expressed first aid guideline designed to help members of the public to provide first aid to someone who is at risk of suicide.
    https://www.mhinnovation.net/resources/suicide-first-aid-guidelines-japan
  • Founded in 1913, Gould Farm is the first residential community in the United States dedicated to helping adults with mental health challenges move toward recovery, health and greater independence through community living, meaningful work, and clinical support. https://www.gouldfarm.org/our-program/
  • National Association of Mental – battling stigma
    https://www.nami.org/Get-Involved/Pledge-to-Be-StigmaFree PaRx is an initiative of the BC Parks Foundation, driven by health-care professionals who want to improve their patients’ health by connecting them to nature. Featuring practical resources like quick tips and patient handouts, its goal is to make prescribing time in nature simple, fun and effective. https://www.parkprescriptions.ca
  • Sapiens Lab is based in India works to measure, monitor and understand the interplay between life experience, brain physiology and our cognitive and mental health outcomes across the globe. They put forth insights that can help more positive outcomes. Their annual Mental State of the World Report provides a view of the evolving mental wellbeing of the global Internet-enabled population.
    https://sapienlabs.org/mental-health-million-project/
  • SANE is the leading national mental health organisation for people with complex mental health issues in Australia and for the families and friends that support them. Their website has some resources, tools and information relevant to people anywhere in the world.
    https://www.sane.org
  • An overview on bipolar disorder – symptoms and treatments from the National Institute of Mental Health
    https://www.nimh.nih.gov/health/topics/bipolar-disorder
  • The American Psychiatric Association advances mental health as part of general health and well-being. This is their resource to understand schizophrenia for patients and families.
    https://psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia
  • The National Eating Disorder Information Centre provides information, resources, referrals and support to Canadians affected by eating disorders through our toll-free helpline and live chat. Outreach and education programming focuses on the awareness and prevention of eating disorders,  https://nedic.ca/eating-disorders-treatment/