MIND MOVES:Mental illness is not the only factor of mental health worth considering, wrties Terry Lynch.
WITHIN THE spectrum of mental health, the emphasis has primarily been on mental illness. Mental wellness has received relatively little attention. A comprehensive approach to mental health requires an in-depth understanding of both ends of the spectrum and the stages in between.
All human beings share similar dietary requirements and needs. Irrespective of the person's dietary habits, culture or country of origin, protein, carbohydrates, fats, minerals and vitamins are required for healthy functioning.
Similarly, while mental wellness is influenced by a wide range of personal, emotional, psychological, social, relational, circumstantial and cultural factors, certain elements have a universal importance to mental health.
Two vital elements are what I refer to as "selfhood", and dealing effectively with the world, within communities supporting mental wellness.
I think of selfhood as encompassing all aspects of being a person - a self - just as other terms such as childhood, womanhood and manhood encapsulate the characteristics and experience of that particular state.
For me, selfhood refers to all that applies to being a person, the inner, private world of the individual as they go through their life journey. Effective dealing with the world involves how we handle issues such as communication, relating, change, loss, failure, conflict, choice and decision-making, the unexpected, hopes and dreams not working out, and how well our needs are met throughout our experience of living.
The importance of selfhood and effective dealing with the world is echoed both nationally and internationally. According to the 2006 Irish mental health policy document A Vision for Change, components of mental health include an inner-felt sense of subjective wellbeing, personal autonomy, the ability to reach one's potential, the ability to cope with and manage our lives, resilience, coping with change and stress, participating fully and satisfactorily in life.
According to the World Health Organisation, key aspects of a person's quality of life are their perceptions of themselves and of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns and their experience of their interactions with the world in which they live.
Preceding the onset of major mental health problems there is often a gradual, extensive loss of selfhood. The person's methods of dealing with their world become increasingly frantic and compromised as they become increasingly overwhelmed.
People diagnosed as having schizophrenia have generally experienced extensive loss of selfhood, often unnoticed and unresolved. It manifests as a major loss of identity and self-confidence, severe withdrawal and major perceived inner powerlessness.
Hallucinations, delusions, severe anxiety and other experiences associated with schizophrenia can be understood within the context of catastrophic loss of selfhood, subsequent diminishing of effective dealing with one's world and, consequently, vast unmet need within one's life.
People diagnosed with anorexia, manic depression and depression tend to have a low sense of selfhood which contributes to the frequently experienced anxiety. A person's sense of selfhood can improve if it is recognised and worked with appropriately.
Mental health can be understood as a continuum between mental wellness and mental illness. An approach to mental health which does not sufficiently prioritise mental wellness. It lacks cohesive pathways and connections with mental wellness, akin to a railroad track between two destinations which either ends suddenly in the middle of nowhere or has several stretches of track missing.
The mental wellness-illness spectrum approach overcomes this vacuum, enabling us to see mental health as a continuum between wellness and illness, facilitating the creation of pathways back to mental wellness.
Utilising this spectrum provides bridges and pathways, signposts for people to edge their way back towards recovery of selfhood and effective dealing with the world at a pace that works for them - not merely the easing of symptoms, though this too is important.
The individual's life, experiences, needs, struggles, worldview, their sense of selfhood and how they deal with the world need to be routinely included within mental health assessments and interventions.
A central aim of mental health interventions is to restore mental wellness to the highest possible degree. A comprehensive understanding, clarification and description of mental wellness and the mental wellness-illness spectrum is a prerequisite to the development of effective interventions for mental health problems: clear road-maps to mental health promotion and the prevention of mental health problems.
An understanding of the full spectrum, ranging from mental wellness to mental illness, enhances understanding of where on this spectrum an individual might be, clarifying appropriate next steps, reducing the risk of employing interventions which either impede recovery or are too many steps ahead for that particular person at that time.
A well-developed sense of selfhood greatly enhances our ability to deal with the realities of today's challenging world such as change, relating, growth, loss, the unexpected, healthy boundaries and carving out a fulfilling and meaningful life.
Terry Lynch is a psychotherapist, GP in Limerick and author ofBeyond Prozac