Post No.: 0175
The first step to recovery can often be realising that something is an illness rather than one’s normal or immutable personality or inevitable life trajectory. And like most health problems or diseases – getting help early is important for maximising the chances of a successful recovery or treatment plan. Recovery is seldom linear whatever the case, but prevention, or at least early intervention, should be the primary objective.
So we’ve established from Post No.: 0108 that mental health problems are essentially physical health problems, and problems with a mind are essentially problems with a physical brain. Yet this doesn’t mean that interventions like surgery, pharmaceutical medications, dietary changes, getting enough rest and regular physical exercise are therefore the only approaches to mental health care – there’s also, for example, cognitive behavioural therapy (CBT, which is a ‘talking therapy’ (usually one-on-one with a therapist) that aims to change one’s unhelpful ways of thinking and behaving), dialectical behavioural therapy (DBT, which is like CBT but also aims to help one to accept one as one is), mindfulness meditation and other psychological, social or psychosocial interventions.
Well these are all fundamentally physical approaches too when we think about it i.e. talking, listening, processing speech, seeing things, processing sights and indeed thinking in the brain are all physical processes too (e.g. producing and picking up sound waves or picking up photons, resulting in a corresponding electrochemical neural stimulation pattern inside the brain, signal interpretation, neural rewiring or reinforcement, a physical output response, etc.). And besides, helping the mind is helping the brain, just like helping the brain is helping the mind, because the mind is the output of a living brain.
And since everything about us is fundamentally physical, including our brains or minds – in principle, if something can be made then it can be broken, and if something can be broken then it can be fixed. (All diseases can in principle therefore be cured, including HIV, for instance.) Nothing in the laws of physics says we can’t. But ‘possible’ is not the same thing as ‘easy’ though. And in many ways it’s far easier to heal a broken bone than a broken mind (e.g. trying to treat the brain with medications may help with what they intend to do but they can also cause unwanted side-effects too).
Helplines are useful for many people as a first line of support – for a sufferer to just talk and have someone who’ll just listen, understand and not judge. Operators are trained and empathic, and sufferers may feel that they can confide in them more easily because the operators are not too close to them to judge them personally and precisely because they are trained, experienced and understanding. Many people find it easier to talk with empathic strangers about their mental health issues because it can feel too awkward, embarrassing or risky (the fear of losing e.g. one’s job or place in a sports team) talking to someone too close to them about such vulnerabilities. Or sometimes people don’t want to tell their friends or family because they simply don’t want them to worry.
For many mental health disorders, there are no ‘one size fits all’ solutions. Psychoeducation, addressing the current psychosocial stressors, reactivating social networks or improving support networks, relaxation training, improving problem-solving/coping skill treatments, physical activity, planning a future and having the sense of a future, interpersonal psychotherapy or talking therapies (in dyads or groups) and medications (e.g. antidepressants) are all potentially effective treatments.
Talking therapies could arguably be more accurately labelled as active listening therapies, where the therapist will listen far more than talk, and where the sufferer is heard in confidence, without judgement but with compassion, interest and warmth. CBT isn’t one specific routine so it can depend on the quality of the therapist and the specific approaches used to try to challenge and change or regulate unhelpful thoughts and behaviours, and to develop personal coping strategies. A session might take minutes or hours, talking about one’s negative thoughts in order to try to gain some insight into the causes and to crucially find a way to continue living if one has been thinking about suicide. A key goal is seeing a possible future (again) and a life worth living. Administering it is essentially about behaving like a true, understanding and compassionate friend.
Neuromodulation therapy (e.g. transcranial magnetic stimulation (TMS) or trigeminal nerve stimulation (TNS)) is currently being researched to improve the symptoms of post-traumatic stress disorder (PTSD), such as hyper-vigilance. Gradual and supported exposures, or graded exposure therapy, involves confronting one’s fears, obsessions or trauma triggers/causes and trying to resist carrying out one’s compulsive behaviours – over time, one learns that nothing bad will happen if one doesn’t hide away or carry out those compulsions. One will eventually re-associate these cues with more adaptive responses. (Sudden extreme and unsupported exposures obviously won’t work otherwise e.g. the sound of backfiring cars will eventually heal a war veteran with PTSD instead of reinforce his/her trauma memories and make his/her PTSD worse.)
Neurofeedback therapy is an intervention that provides real-time feedback on how one’s thoughts are affecting one’s brainwaves. The idea is that this feedback can be used to retrain our thought patterns (e.g. if we notice that certain thoughts cause us to be in a calmer state according to the measured brainwaves, we can practise thinking more about these kinds of thoughts until they become reinforced and more effortless and quicker to recall).
Applied behaviour analysis (ABA) is a form of therapy for autistic people based on the principles of behaviourism (rewarding desired behaviours and punishing undesired behaviours, although to a lesser degree for the latter nowadays) – but this method is highly controversial, with some critics claiming that it’s too tough on children, reducing ‘stimming’ (repetitive self-stimulatory behaviours) may be harmful because they’re used as self-regulatory or coping behaviours and the approach tries to eliminate neurodiversity (accepting some mental differences between people rather than treating all mental differences as pathologies), and some supporters claiming that it helps autistic people to become more independent and that good practitioners individualise approaches to each person.
Improving daily conditions, tackling inequity and reducing stigma will also generally help, particularly in low and middle-income countries.
Whatever the approach, solutions are not likely going to be quick-fix, they will need investment of time and other resources, and will need to be long-term in duration. People with mental health conditions will likely need to manage their conditions for life – but this shouldn’t be considered unusual because e.g. someone with a dodgy knee or diabetes will need to manage their condition for life too. Plus we all need ongoing care to look after our teeth, eyesight, general hygiene, cardiovascular health and so forth for life i.e. what really is ‘treat then forget’ when it comes to health?! There needs to be proper regulation of psychiatric services too.
Depression is fully treatable via a combination of CBT, talking therapies, group therapies, medication, exercise, receiving adequate love and support, people being understanding and there for sufferers so that they know they’re not alone, and a culture of no stigma. Some people find that writing their depressive thoughts down and offloading them onto paper is a great help – not as a cure but as a way of minimising the pains and stresses these ruminating thoughts bring. Singing (particularly socially) can also help too. And since those who have suffered from depression in the past have a substantially increased chance of suffering from depression again in the future too – all these methods, or at least what they teach, must be constantly and regularly applied to prevent or minimise future episodes (e.g. if one finds that exercise helps, then stopping exercise can massively increase the risk of relapsing, thus a routine of exercise must be kept up). In some cases it’s more about managing the symptoms than expecting those symptoms to totally disappear – well sometimes sufferers don’t necessarily want the symptoms to totally disappear because they are a part of who they are. They just want them to be manageable.
Some people find it helpful to separate the illness from themselves (e.g. calling their generalised anxiety or OCD a character with a personified name separate to themselves). Now this alone doesn’t amount to having a multiple personality disorder but is just a strategy to separate and suppress one’s maladaptive thoughts and behaviours.
This has been just a very broad and general furry overview of some of the potential services available for mental health sufferers, and merely aims to show that there are many different options. Research is ongoing too and so will the advancements of treatments and the discovery of new methods and approaches. Unfortunately, not all services are available everywhere in the world, and this post is not a substitute for consulting with a mental health professional, which I hope you do have access to where you are and that you will consult one if you feel you have, or someone you care about has, any mental health concerns whatsoever. Please remember that the earlier the treatments can start, the generally more effective they are. But even if you’ve been suffering for ages – if you’re still alive and are reading this then it’s logically not too late and there are still people who understand your position and want to help! Mental health is still very much a growing and vibrant field and lots of good people are looking for ways to make people better!
Woof. If you’ve had any positive experiences with mental health services then please share them with us via the Twitter comment button below to inspire others to seek help too.