The changing definition of mental health

“She’s a strong woman. She knows what she wants and she goes after it. She doesn’t take crap from anybody.” This was how a young female patient described a friend.

“And that’s what you consider a mentally healthy person?” I asked.

“Of course. Don’t you?”

“Not necessarily. A person who doesn’t take crap from anybody might be a defensive person.”

This woman assumed that her theory about what constitutes mental health was the one and only theory. In fact theories about mental health differ from society to society, and have changed from one historical period to the next. As fashions change from time to time, so do the characteristics that are valued.

During the later stages of the Roman Empire, mental health was seen as being open-minded to any and all forms of sexuality, from beastiality to incest. Those who did not subscribe to this “civilized” open-mindedness were considered old-fashioned and, of course, not well adjusted mentally.

During the Holy Roman Empire, mental health was linked to one’s devotion to God, the Father, and the Holy Ghost. Those who were not believers were “heathens” and were seen as mentally disturbed and possessed by the devil.

During the communist revolution in Russia, rich capitalists were seen a mentally ill while revolutionaries like Marx and Lenin viewed themselves as mentally healthy people who would restore sanity and equality to humanity.

In Nazi Germany, the Nazis regarded themselves as mentally healthy people who wanted to return their beloved Germany back to a state of health; this meant ridding Germany of the mentally ill people (the Jews, etc.) who had brought Germany down.

In our own era we have many standards of mental health from the mainstream to the extreme. Those who practice a fundamentalist religion believe that devout practice of their religious rituals constitutes mental health, and they consider all who don’t practice these rituals as unhealthy. Those who subscribe to today’s liberal ideology equate mental health with fighting for liberal causes and mental illness with opposing liberal causes. Those who subscribe to conservative ideas equate mental health with fighting for conservative causes and mental illness with opposing conservative causes.

There is one standard of mental health that has been around for more than two thousand years. It is the standard associated with certain aspects of Eastern and Western philosophies. One thinks of Buddhism, Zen Buddhism and Taoism. And one thinks also of Socrates, Plato and Sigmund Freud.

This standard of mental health focuses not on having the right belief or the right cause, not on being morally superior or defeating those who are inferior. Rather it concentrates on self-knowledge, on being in tune with one’s feelings and in harmony with others and the world. It concentrates on a life focused on service to others, rather than on gratifying the self.

This standard of mental health, of course, has never appealed to the great majority. Because it’s only reward is inner peace. Who cares about that?

Brain Study: Psychotherapy works

Psychotherapy really works! This is according to new brain studies that show psychotherapy induces changes to brain function in the same way that drug treatments do.Veena Kumari conducted the studies at the Institute of Psychiatry and later published her results in a 2006 issue of the journal, Acta Neuropsychiatrica.

With regard to depression, her recent brain imaging study found recovery was associated with decreased metabolism in a part of the brain known as the ventrolateral prefrontal cortex, both in patients who had improved after taking Seroxat, a medicine for depression, and in patients who had undergone cognitive behavioral psychotherapy. Successful therapy was also associated with brain changes that were not found after using Seroxat, including increased activity in the cingulate, frontal and hippocampus regions of the brain.

Similarly, in a study of obsessive compulsive disorder, a disorder in which people become obsessed with certain fears and perform compulsive rituals to prevent them, both cognitive behavioral psychotherapy and the use of Prozac were linked with brain changes Kumari referred to as “the right caudate metabolic rate.”

Cognitive behavioral therapy is known to be beneficial to schizophrenia patients who don’t respond to antipsychotic medication but no research has yet been published on its effects on the brain.

“The reviewed studies clearly demonstrate that psychological interventions, such as CBT, are able to modify activity in dysfunctional neural circuitries linked to the development of various psychopathological conditions,” Kumari concluded in her comparison review.

She added that psychotherapy may provide a clearer insight into the brain changes associated with recovery from mental illness because “it has minimal side-effects (if any) and [unlike drugs] lacks direct pharmaceutical actions to obscure brain changes directly related to behavioral change….”

The comparison of the effects of drug therapy and psychotherapy, however, only goes so far. Even if both have the same effect on the brain, psychotherapy does something that no drug can do: it allows patients to form an attachment with another human being, and through that attachment to understand themselves.

Common to all mental disturbances is a problem in relating to others. No medication can adequately address this problem, although drugs can make a person feel generally calmer about things. Psychotherapy provides a transitional attachment in which persons can learn about their relationship issues, trust or lack thereof, fear of intimacy, anger, jealousy and suspicion.

However, this study does manage to provide a scientific evidence of the effects of psychotherapy—something that has long been needed.

Now if only the whole world would go into psychotherapy.