What Exactly is Mental Health? (By Anshu Basnyat, LCPC)

     This week I had an epiphany. As I was having a conversation with an educated friend about the Sandy Hook shooting, she asked me if anger was a mental health issue. My immediate reaction was “Of course!” and then I went on a long explanation about how anger is a major mental health concern that can lead to serious, dangerous situations. She then said something along the lines of “But I thought Bipolar, Schizophrenia, Depression, etc.” are mental health.  I stopped in my tracks because I realized in that moment that this is what many people must be thinking when we refer to “mental health.”  The distinct, clinical diagnoses found in the Diagnostic Statistical Manual (DSM), the Bible of mental health disorders must pop into people’s mind whenever talks about mental health arise. 

    I have been a mental health professional for about thirteen years now and was trained in the No. 1 ranked hospital in the United States: The Johns Hopkins Hospital. It hit me that for years  I have been asking the wrong questions, always bewildered why our society does not value mental health. Then, I began to wonder. Did my friend just answer my question of why there is so much stigma attached to mental health? Is it just people's lack of understanding, which go beyond their fear of being labeled “crazy”?  This conversation with my friend inspired me to write this post.

    On a side note, I plead to my family and friends not to use the word “crazy” when referring to people with mental health issues because this is just not true and only perpetuates this vicious cycle of stigmatization. Then, people shy away from getting help until it becomes so severe or never at all. People with mental health issues are regular people who have been strong for too long and now need some support to get them through some hard times, as we are all faced in life. Also, think of mental health in this way. 

     Mental health is in a continuum and involves anything having to do with our social-emotional well-being.  Anywhere from what kind of relationships we form with others to the very mentally ill such as those with schizophrenia and bipolar disorder, which have genetic components.  It is our social-emotional health, and this range is vast and to understand it fully, one has to consider the entire person. It is very individual-specific so making such generalizations as “All people with X condition will do Y behavior” is dangerous territory and again, perpetuates social stigma. Having said that, it may be helpful to think of mental health in these terms.

     Now, close your eyes and imagine a horizontal line with three sections (the left, middle, and the right).  Let me just put a disclaimer out there that is in no way a metaphor for our political system.  This is just the best way I can describe mental health. So, the Left section is the “healthy” part where people sometimes have uncomfortable emotions such as feeling sad, anxious, fear, anger, etc. They may also have some “issues” with people. However, by and large these people tend to have good coping skills to handle such social-emotional difficulties and carry on their normal routines with no major difficulties. 

     The folks in the Middle section have more difficulty than the people in the left in terms of getting what they need to do in their lives such as going to work, school, home life, etc.  They may feel more sadness, anger, fear, sleep is affected, crying more often, turning to other means such as alcohol to feel better, having passing thoughts about suicide or homicide, and/or experiencing other uncomfortable emotions. Their relationships with their loved ones may be changing in a negative way. Grades or work performance may be slipping, but they still manage to get up most mornings and continue on with their routines. However, the quality of their behaviors and relationships with others has changed now even though they are managing.  The reasons (e.g. triggers) for these changes vary from individual to individual and so do the reactions (e.g. coping style).  For instance, losing a job maybe a stressor for some while it may be a blessing to others depending on each person’s situation and mental health.          

     Now, consider the Right section, which is the “unhealthy” part where people are struggling to go on their daily routines such as work, school, and home life. Their social-emotional difficulties are disabling them to the point where they cannot function at all or doing so in destructive ways.  These are people who have the mental health diagnoses, but also those undiagnosed because they are not seeking the support they need (e.g. many people from the Middle section can quickly end up here).  However, please understand that if these folks get the mental health services they need such as counseling or therapy and/or psychotropic medications, then they can very much function as people in the Left or some higher-functioning people in the Middle. Therefore, mental health has to be seen as being on a continuum rather than in discreet compartments.    

    There are many types of mental health professionals who can help. Some include: psychiatrists (medical doctors who can prescribe medicines), psychologists (generally these people have doctoral degrees who can do therapy and psychological testing, but not prescribe medicines), and counselors or therapists who can have educational backgrounds (at least Master's level) in social work, psychology, and/or counseling who can do therapy, but may or may not be able to do psychological testing depending on their training. 

     Life can be beautiful, but it can get quite tough at times. During such times, everyone can use a therapist or counselor to help them. After all, we are all humans and as humans, there is only so much we can take at one time. My belief is that many people want to seek mental health services, but fear that the stigma attached to it will hinder them somehow.  Ironically, I have observed that people who openly talk about “seeing their therapist” seem to be those who are most at peace with themselves and better equipped to navigate Life.

     I sincerely hope this gives a better understanding of what “mental health” is. If not, I would love to hear your feedback!

           Some Signs to Seek Mental Health Support (aka Red Flags):

·         Suicidal talk

·         Homicidal talk

·         Feelings of hopelessness

·         Excessive crying for no apparent reason

·         Changes in sleep patterns

·         Disinterest in activities that were once enjoyable

·         Excessive use of alcohol

·         Drug use and/or abuse

·         Significant drop in school or work performance

·         Engaging in high-risk or dangerous behaviors

·         Extreme irritability

·         Excessive weight changes

·         Persistent negative relationships with others

·         When a loved one expresses concerns about your mental health

Some Free National Hotlines that Can Help:

National Alliance on Mental Illness
Phone: 800.950.NAMI (800.950.6264)
Whom They Help: Individuals, families, professionals  

   

National Alcohol and Substance Abuse Information Center
Phone: 800.784.6776
Whom They Help: Families, professionals, media, policymakers, concerned individuals

National Suicide Prevention Lifeline
Phone: 800.273.8255
Whom They Help: Families, concerned individuals

    

  

        

  

     

The CT School Shooting Talk with Our Son (By Anshu Basnyat, LCPC)

     We are deeply saddened beyond words about the Sandy Hook Elementary shooting in Newtown, CT. Our hearts and prayers go out to the beautiful children and wonderful adult victims and to their loved ones. The Basnyats have been grieving ever since we learned about this horrific incident on Friday morning and the emotions are raw.  Immediately after hearing this saddest news, I emailed our 7 year old son’s school administrator requesting that they send information to all parents on how to talk to their children before the weekend. Shortly afterwards, the school Superintendent sent a mass email providing guidance on this.

     As a mental health therapist, I understand the importance of having this important conversation with our children. However, understandably many have strong feelings against having such conversations.  Some believe it will only instill unnecessary fear as my husband felt while others feel it is unnecessary altogether, as we did for our 3 year old hard of hearing child.  Yet, many want to have this conversation, but simply do not know how to.  This post is not to sway the parent one way or another, but to simply share how we talked with our son about it after giving it serious thought on Friday.

     We decided to tell him after coming to the conclusion that he will hear about it one way or another in the coming days. For example, just on Thursday, he was sharing with us that one of the older boys on his school bus was telling him that the world would be ending on December 21^st. Reportedly, our son told the boy with conviction that this was untrue and impossible. Later at home, he said that he was 99% sure that this would not happen, but there is a 1% chance that some kind of massive bomb can make it happen.  Additionally, just a few months back he heard about Joseph Kony (again on the bus), which fueled some anxiety in him. We listened to him, empathized, and comforted him as best as we could.  At the end of the day, that is all that any parent can do. This talk need not be perfect nor should the parent feel like they have to have all of the answers to their child’s questions.  Ours certainly was not perfect, but it got the job done. Here is how it transpired.

     After attuning to our own emotions all day Friday, and shielding him from any television or Internet, we decided to have the talk on Saturday morning.  I felt this would give our son time to process and ask any questions he may have before going to school on Monday and presumably hearing it there.  In other words, I did not want to have this talk before bedtime on Sunday. We distracted our 3 year old daughter with Dora the Explorer and with hearts pounding sat our son down in another room.  It was a brief conversation, but covered all of the basics.

Me: “Honey, your dad and I want to talk about something important with you. Do you have any idea what it may be about?”

Son: “No.”

Me: “Yesterday, something very terrible and sad happened where someone shot people in a school and several people died. This is not something that happens often, so people will be talking about it everywhere like at your school, tv, and the Internet. This is why we were extra careful about you not using the Internet and watching the tv yesterday.  We do not want you to worry or be scared, but it is okay if you are. How do you feel about all of this?”

Son: “I don’t know.”

Husband: “It’s ok to feel scared because we don’t know what is going to happen in the future. It’s unpredictable.”  (Mommy the Therapist intervenes here.)

Me: “It’s true that things can get unpredictable sometimes, but we will do everything we can to keep you and your sister safe.  There are lots of things we have control over in life, but there are some things we cannot control, but we will do everything within our control to keep us safe ok (he nods). Do you know what you need to do to keep yourself safe in school?”

Son: “Yes, go talk to my teacher.” 

Me: “What if your teacher is not there? Is there another adult you trust?”

Son: “I can go to the teacher who is closest to me.” (Good sign, he feels comfortable with all of the teachers.)

Husband: “Do you know our phone numbers?”

Son: “Yes.” (He repeats our home and my husband’s cell number.)

Me: “That’s great! Your school has our numbers too so you don’t have to worry too much about it.”

Husband: “We can put our numbers in your book bag too.”

Me: “Is there any questions you have right now? You can always ask later too.”

Son: “Yes, can I use your iPad now?” (End of conversation...for now).

     I would like to add that we never watch news in front of the children and actually manage our own information intake so shielding him from this type of exposure was not an issue, but felt the talk need to be had. The goal of this conversation was to set up an open communication path and take a proactive approach in reducing worry and anxiety, which I felt was appropriate in this case.  Now, when he is scheduled to get a shot at the doctor’s, he doesn’t get much advanced notice because this only increases anxiety in my kid. The funny thing about fear/worry/anxiety is that too little or too much information can ignite and fuel it. 

     Every parent knows their child the best, so they have to do what feels comfortable and appropriate to them.  I hope this was helpful to those needing some guidance as this is a tough issue to tackle.  I encourage everyone affected by this to first reach out to your family and friends to offer and seek support.  If this does not help, and if you or your child is experiencing extreme anxiety or depression, then it would be worthwhile to seek a mental health professional.  Like I always say, everyone needs a therapist at some point in their lives!