I am now continuing to air my views on mental health along with ideas that I have extracted from the Slovenian psychiatrist Andrej Marušič I mentioned in my last blog about depression
I have often wondered what we mean by Mental Health and was interested in his ideas but then when I read the news today proclaiming that one third of children under the age of 16yrs contemplate suicide I realised that the mental health of the nation is a serious problem and stretches deeper than one could imagine.
Mental illness accounts for 23% of the UK’s total burden of disease (compare this to cardiovascular disease or cancer which each account for 16% of the total burden of disease). Yet only 13% of current NHS health expenditure is on mental health. The World Health Organisation estimates that depressive disorders were the third biggest global health problem in 2004 and by 2030 they will be the largest.
What is important is, that when we talk about ‘mental health’ we take into account everything we see – appearance, behaviour, the way the person moves and what they say. Based on this we can assume what we think and guess which mood someone is currently in. If I was crying five minutes ago and then yelled at you in the next five minutes you would probably think my mood very unstable and would benefit from seeing a psychiatrist.
This is mental health, as we see. Psychiatrists frequently make assumptions – GPs do the same – and, actually, this is not a big deal. Firstly,what we see and assume about mental health, about the health of someone’s mind, is captured between two very important determinants – one is genetics and the other is environment.
Genetics may appear less important when it comes to mental health, but that’s not true because two thirds of our genes determine our brain function, whilst the remaining third determines all our other organs. Hence, genetics is very important when it comes to mental health, but clearly it is not the only thing that is important. Each and every one of us is like a book – full of genes that only express themselves if we allow them to do so. If you spent all your life in the same town and had the same job as your father who also lived and worked in the same town all his life, it is clear, that you will be more likely to suffer the same diseases as your father. But if you move from one town to another , or even another country, you would probably be experiencing something else as different genes would appear in your book.
But we must remember that we should never underestimate the role of genetics in mental health. For instance, have you ever heard of two elderly people in care homes been accidentally “swapped”? I doubt it. Babies, however, have been accidentally swapped. This implies that our unique genetic fingerprint becomes more defined each day and with every day we become more and more who we are, and those of you who would like to be as different as possible from your parents should be aware that we become more and more like our parents every day.
I have to say when I worked in a community in South Wales where extended families stayed in the same village or town and rarely moved away the genetic element of disease was very more obvious but when I came to London I have been aware of how the environment has more of an impact on health. I remember a type of woman who functioned reasonably well and then periodically took to her bed unable to open her eyes or respond to anyone and was often married to a doting, caring husband who waited on her hand and foot but was descibed as ‘just like her mother or aunt’ implying a genetic element. Everyone feared that if the husband died as to how she would cope but as often happened the husband did die first but surprisingly enough the woman thrived in more ways than one. If I speak to anyone from that community they know exactly what I mean. Is it depression? Is it unhappiness but whatever it is the person often female needs to withdraw or opt out to survive and in my experience survived to a good age. However,in London most people troubled by mental health problems associate it with stress or change of environment with perhaps some genetic factors.
The second very important thing to consider when assessing ‘mental health’ is that it is ‘captured’ between temperament and behavioural habits. What is temperament ? when a person attends surgery they adopt very similar behavioural pattern on each visit and it makes it virtually impossible for to say anything about a persons temperament when they are seen in surgery.
We all have a temperament which should be tested frequently to determine to what each of us is prone. When I was in a family practise with may be four generations of a family in a close community it was easier to establish the temperant as receptionists or other people gave you the ‘gossip’ “she is always the life and soul of the party” or “he nevers goes out, never has!”
We also have behavioural patterns, this is what we do during most of our waking hours depending on what our role or work is and different behavioural patterns are prone to different diseases.
The third most important thing is the fact that mental health falls somewhere in between mental health in a very narrow sense and mental illness. Whenever someone develops a mental disorder, or mental illness they can be restored to full health. When famous athletes injure themselves, their performances drops that season, but in the seasons to follow they can improve their results.
Or for example, when a manager gets depression, if he recovers he will manage his company better, I believe, because he starts to understand other people and empathises with them better.
I remember being in conversation with GP colleagues and telling them that there were some days I could get full score on depression assessment and some colleagues agreed but one colleague said “I never get depressed”. Not only were we surprised but wondered how she managed to empathise with most of her patients.
When you go to the gym you learn to lift increasingly heavier weights for longer periods of time without developing aches in your muscles. You can use the same principle to practise psycho-fitness.
In the same way that someone who regularly goes to the gym can say “I have been practising this for six months now. I can run for quite some time, I don’t feel at all tired and I am in very good shape”, someone who practices psycho-fitness can develop their abilities to put up with 8Mb of stress instead of 4Mb, or even 12Mb and still go to bed without any worries on their mind.
This makes sense as I am aware when you have a stressful job alongside personal stresses I is imperative that you practise psycho-fitness.
The best thing our mothers and teachers can give us while we are growing up is self-confidence. Self-confidence strengthens our psycho-skeleton which can then put up with more, which means that we can live more easily and are less likely to develop different mental disorders. Italian and Jewish mothers constantly build up their children’s self-confidence by telling them that they are the best looking, the smartest and so on. Whilst it can be difficult to work with such people, who are so full of themselves, you must admit they never suffer mental health problems.
You may be familiar with the phrase ‘nervous breakdown’ for depression. The best way to describe what really happens: the psycho-skeleton breaks, the psycho-muscularity breaks, and this expresses itself on the monoamine level.
Our ability to deal with problems diminishes, our hardware becomes soft. The bottom line is something breaks under the burdens we carry in our backpack, for example physical disability, diabetes or cancer. Sometimes the trigger can be a physical or mental illness which one of our parents may be suffering from.
Imagine,a newly retired lady who resolves to go to her holiday home, everyweek-end, with her husband. But then her mother develops dementia and, she has to become her mother’s carer and something she has looked forward to doing is thwarted. In short, burdens like this can break us, and when we get hit; from the left or from the right – it doesn’t matter from which direction – this hit is like a loss and when we lose something the chance of developing depression increases.
If we are afraid of something the chances of us getting anxious are greater. This is scientifically proven and this breaks us, and when it breaks us we develop depression, which usually manifests itself via biological symptoms, so even though this is a psychiatric disorder it manifests with typical biological symptoms, i.e.a person wakes up every two hours and cannot sleep and if he sleeps for six or eight hours he is just as tired because he lacks the REM (rapid eye movement) dream phase, which helps him reorganise his thoughts. Then he develops psychological symptoms, such as guilt feelings or other distressing feelings. Or the other way around: there are people whose psychological structure is so inclined to depression that they push themselves into depression. The explanation is that they have loads of negative thoughts; that they are inclined to think negatively.
In 1952 Norman Vincent Peale wrote a book ‘Power of Positive Thinking’ which was created a significant following for many years. He quoted
“The way to happiness: Keep your heart free from hate, your mind from worry. Live simply, expect little, give much. Scatter sunshine, forget self, think of others. Try this for a week and you will be surprised.”
However, as Andrej Marušič suggested it could be argued whether there are such things as negative or positive thoughts. “If I tell my children they are not going out until they have finished their homework, this is a positive thought for me, because I am raising them up to be good citizens, although it is a negative thought for them as they are not allowed to go out.
So who will be the judge of what’s positive and what’s negative? The Prime Minister? I don’t consider anybody able to judge what is negative and what is positive.”
Let me illustrate how people think. Basically, we think all the time and our thoughts usually follow the same pattern. Every initial thought is followed by a second thought, usually associated with the first, and so on – moving around universe of thoughts, quite healthily thinking both positively and negatively. This is completely normal, but what happens if a “short circuit” occurs? A short circuit can even occur with completely positive thoughts. Let’s imagine the thought “If I stop going to work, I’ll be fired”. This is a positive thought, in general, since someone who thinks like this is smart and can anticipate consequences. But if this thought is so disturbing and causes so many worries that this person actually stops going to work then this thought – due to its monotony – bears potential for depression.
Now, let’s see how I – and a few others – distinguish between the different types of depression by dividing them into three groups: Blue depression, Red depression, Yellow depression.
Blue depression is the most prevalent and this is why the circle is the biggest and that is the so-called serotonin depression, which is characterised by sleeping disorders, people wake up two hours earlier, they are tired, their appetite is weak and their libido low. A weak appetite doesn’t mean less food intake and a low libido doesn’t mean less sex.
But to me sexuality is not just lying back and thinking of England, it should be joyous.
In short, lack of serotonin reduces libido. In this picture dreams are coloured blue. Dreams are very important but not because you are explaining what you were dreaming while lying on the couch. Dreams are nothing other than recollections of what you experienced through the day put into perspective against your past experiences. This enables us to store only relevant data, as if cleaning up our computer desktop and we place these files into different directories and, according to how much we save, our day may appear long or short.
For example, if you go to Taiwan for a week, this week will appear much longer to you because you will store more data during your dreams than you would during a week at work where you’ve been employed for the last 10 years. We accumulate our memories from our dreams. As we age we experience things we have already experienced before, so time appears shorter. There is a big difference between four years at school and four years at work, when we are 40 years old. We think time passes quicker as we age, because we don’t store memories we have already laid down – we are not travelling to Taiwan.
Red depression is a lack of will, a lack of motivation and a lack of energy. This is a very important depression, so-called noradrenergic depression, and doctors know, that when they give a patient noradrenalin in intensive care, the patient suddenly wakes up, gets up and this is what a noradrenergic depression patients is lacking.
Patients with yellow depression related to levels of dopamine lack enthusiasm and “joie de vivre” or motivated behaviour- “get up and go”. This type of depression is more complex and there are still no specific antidepressants for this type of depression although those on the market do help in some situations. It can be drug induced or in diseases such as Parkinson’s disease which is classically due to severe lack of Dopamine.
With all three types of depression people develop specific psychological symptoms
People with blue depression feel emotionally empty, people with red depression become sad, I know that about I wanted you to see; and people with yellow depression feel extreme hopelessness.
All these people can develop feelings of guilt, low self-esteem and so on. A good psychiatrist, or GP, will listen to you to understand when and how your depression started. If he/she puts you on an antidepressant before you stop talking, turn around and walk out. What’s the target? Every good psycho-pharmacologist must know what he is treating. However. sometimes it is more obvious and the target is reached immediately but in more complex depression which may involve a mixture of more than one types it may changing medication until the appropriate target is met.When the correct medication is found biological depression disappears automatically within four weeks, while psychological symptoms remain. Feelings of guilt are usually the last to disappear.
In summary mental health falls somewhere in between mental health in a very narrow sense and mental illness. It must take into account – appearance, behaviour, the way the person moves and what they say. It is determined partly by genetics and partly by environment depending on where a person spends their life , either remaining in the family circle or moving away. It is also captured between temperament and behavioural patterns.
The type of depression if diagnosed properly medication can treat it effectively. Healthy mental health can be maintained by psycho-fitness which will be my next blog!
The Samaritans is available for anyone struggling to cope, round the clock, every single day of the year. Call 08457 90 90 90, email firstname.lastname@example.org or find local branch details at http://www.samaritans.org.