Mental Health and the Brain: Adolescence, Attachment

My definition of mental health – is agrowing moment-to-moment awareness of the three loops (self-world, conscious-unconscious& intrapersonal) coupled with an ability to effectively integrate insightgained from the three loops into over-arching narratives – without sacrificingthe constant access to new insight brought by moment-to-moment awareness.  I also believe that compassion (love) for oneself and others is both a natural outgrowth of this type of awareness as wellas a useful tool for achieving it.

This definition is not prescriptivein nature. We don’t have an end goal – or a platonic vision of health to whichwe aspire. 

Let’s use Ryan’s example of the bankerwho had a psychotic break and started drinking. Perhaps the banker had spent alifetime repressing his desire to be a kindergarten teacher. Perhaps losingmoney in the market put him in touch with this deep desire. Perhaps drinkingwas the only way to avoid dealing with the fallout that would cause in hiscurrent life. Or perhaps he his father was an alcoholic and he spent his wholelife running away from the emotional pain caused by their relationship – only tohave it catch up with him when the market crashed. Perhaps he was cheating onhis wife and the guilt drove him to drink.  

The point is I don’t know any ofthis when he walks in my door asking for help. Nor can I know what he should doto improve his life. My sense is that often in these types of situation theperson asking for help doesn’t know either.

So how can we help?  As a mental health practitioner I would twothings. First if I thought he was an immediate danger to himself or others Iwould intervene.  If that wasn’t the caseI would try to help the banker find the moment to moment awareness to engagehis three loops.

Can he become more aware of hisemotions – especially prior to drinking? What can he learn from the conflictgenerated by his drinking?  Whatconflicts are going on in the interpersonal realm? 

Built into this approach is anassumption that people are trying to do the best that they can with the toolsand information that they currently have at their disposal. The idea is that byenhancing their capacity to closely observe the loops we give them a chance tosearch out alternative solutions and meanings. These are not our solutions andmeanings for them, but the outgrowth of their ability to know themselves in a deepand powerful way in each moment. 

 I will also add – that as a practitioner – I wouldtake seriously the idea that I should constantly be engaging in the three loopsand open to all the new information that they offer me – both as a person andas a practitioner.   

Maybe mental health is a human project and not a healthy/ill dichotomy. Maybe we should operate on the premise that everyone needs “help.” If there were consensus that everyone has the potential to be a “better” version of oneself than some of the stigma associated with experiencing distressing mental states and seeking help would dissipate. If mental health is not static, but a process of a ever-refining one’s story, so as to maximize one’s potential then the necessity of reducing a person to her behavior, her symptoms, her “limitations” would cease to be relevant and each of us would be less inhibited in the process of honing our skill sets, coming up with a “tool kit” of sorts that is tailored to our individual genes, our individual experiences.

I found the discussion about “reciprocity” in health care intriguing. I think, too often, the inherent dynamism of the doctor and patient relationship is not acknowledged and utilized to its fullest. It was suggested in class that the patient affects the doctor, who affects the patient and then back around… If mental health were less geared towards the mental health worker “affecting” the patient, changing her, there might be some room left over for the reality that we are all affected by each other. I don’t think the goal of mental health should be to “change” someone, but to facilitate exploration and enable agency, choice, by unburdening the individual of story-telling features that may not be constructive for that individual. “Help” does not have to come in the form of a defined beginning and set of endpoints to measure “success,” rather can be an ongoing process or project. Sometimes people may not “want” help or even be aware that they are experiencing internal conflict, in which cases, it is ever more necessary to employ the dynamic relationship between mental health worker and patient, in order for the mental health worker to assist the individual in achieving goals that she herself may have yet to articulate. We trust physicians to be “experts” in other areas of the body, where symptoms and treatments are equally vague as with mental health. Why can we not trust that sometimes someone on the outside has a clearer vision than the person on the inside?

 

I think that in our search for a definintion of mental health we are ignoring something critical. A great number of us assume that the individual in question KNOWS what their life goal is and better yet, has a more complete understanding than anyone else out there (doctor, friend, family).

The 'ideal' of health is by nature an aspiration and many people live their lives aspirationally. We live trying to be the best in a highly competitive society and competition would not function without the notion of some 'ideal'. It may take an individual years, if ever, for them to really listen to what they want and then to take charge of that feeling and channel it into a way of life. What I'm trying to say is that asking someone to listen to their storyteller may be easier said than done and constructing a mental health system based on this notion overlooks the complex way that people understand themselves. So yes, from a perspective of a mental health professional it would be ideal to judge each case from a unique perspective with the interests of the patient as the number 1 priority. What happens though, when the interests of the patient are conflicting and unsure? When even they do not understand what it is they want.

I just want to argue against putting too much pressure on any one individual or groups of individuals. That the dichotomous relationship between patient and doctor, individual desire and societal desires, should be challenged because putting too much trust in one negates the presence and possible benefit of the other.  I don't believe notions of mental health can be entirely individualised because, as we have discussed previously, nobody lives in complete isolation. We are constantly interacting with eachother. Yet, as we have also discussed indepth, society can damage the ways in which we relate to ourselves and to others and social norms can prevent individuals from living in the best possible way for themselves. So each relationship between doctor and patient may have to be unique, but I do not believe that a person, by benefit of being the one in control of his/her life, necessarily has the ability to understand themselves better than someone on the outside.

One of the definitions Adi lent us was, ""A desire to be in charge of our own lives, a need for control, is born in each of us. It is essential to our mental health, and our success, that we take control."  I thought that it is this desire for control, and the ability to control, that really defines true mental health.  I also think that a lack of control is where the stigma for mental health comes from... the fear of the uncontrollable.  I think it's the surprises and the unpredictability that can make something uncontrollable so scary.  If our brains can control our subconscious and our conscious, but we're only aware of our conscious, is the subconscious what really defines us? Our conscious' are out there, exposed to the world. We're functionally in society as a result of our conscious'.  But, our subconscious, how controlled it is, how much unpredictability lies there, how much crosses over to our conscious state- could that in part define the role we play in society, and how likely we are to be "uncontrollable?"

I agree that this definition (that health is individual etc) is probably the least wrong definition that we have come up with this semester, but I'm not sure if it helps our broken mental health system at all. If everyone is individual, how do you help them cost effectively? How do you know how to help them at all? How do you even know WHEN they need help?

I understand and agree with the logic that what is (mentally) healthy for one person could be unhealthy for another, but how can we change the current system to be able to work in this new paradigm? 

About H.M., who lost the ability to form new (conscious) memories in his 20s ... though his ability to learn things in "unconsciously" remained.

 H. M., an Unforgettable Amnesiac, Dies at 82

"Every time H. M. performed the task, it struck him as an entirely new experience. He had no memory of doing it before. Yet with practice he became proficient. 'At one point he said to me, after many of these trials, ‘Huh, this was easier than I thought it would be,’ ' Dr. Milner said."

Here is someone who lived almost an entire lifetime without the ability to form any sort of coherent narrative ... 

 

Diseases of the soul are more dangerous and more numerous than those of the body. ~Cicero

... I love this quote…. Our ability to get things wrong intellectually is infinitely greater and more probable than for us to get things wrong physically… It is just easier to ignore the intellectual failings. Unrelenting Skepticism, in my understanding is a denial of our ability to recognize that we have a disease of the mind. Which leads me to a quote from one of my favorite films. “The greatest trick the devil ever pulled was convincing the world he didn’t exist.” This is all akin to a point I made earlier about calling things that are problems, not problems; and then saying we have dealt with the problem.

1) Certainly, what each person himself thinks of (his personal phantasm) as the tea-kettle reality is nothing more than “a set of unconscious understandings that also varies from person to person”. BUT that does not mean that the ontological reality to which the person is pointing with these personalized thoughts, ideas, and descriptions is itself nothing more than these personal thoughts, ideas, and descriptions.

So, my ideas and descriptions of the “teakettle” might be different from yours but the tea kettle we are both failing to describe is the same and it can’t be anything but that or else when we talk to each other about the world we are speaking of ontologically different things by using similar names when what we think we are doing is using different names to describe the same ontological reality.

To give up the notion that we are all pointing at the same thing is, in my mind, to acknowledge that there is no reason for us to talk to each other at all since we have nothing in common with each other.

 

2) Health, either bodily or mental, is best described as an activity and not a static state of being in a particular disposition or orientation. I think our discussion thus far has led us to that fact, unambiguously. But, the path we have taken to get there has diverged into the “teakettle people” and the “no teakettle people”. That difference does color the meaning of our definition as health as an activity. 

What this means coming from a teakettle person’s perspective is something like this:

Health, as an activity, is an excellent activity/ a virtue. (See Aristotle’s Ethics, book 2 or 3 I think) Virtues/one’s degree of excellence is measured by growth. For example, a fat slothful person who learns to exercise has cultivated his health in a way that an average person (Just because you're not sick doesn't mean you're healthy. ~Author Unknown) who does not exercise has not.  Repeated activity/formation of a habit leads to “healthy activity” or “well functioning” in a way that is not characteristic of individual acts/ or states.  This view of health allows us a tremendous amount of leewaywhen we are naming things healthy or unhealthy. We need not even say that allfat people are “unhealthy”. 

This definition of health I think is legitimate fruit of our semester's labor and certainly less wrong than most of my earlier thoughts.  

The list...a bit overwhelming...about how I feel of the definition of mental health. Thanks Adi for the post. I think I am more confused now than I was to begin with and that is ok...

"Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place." ~Susan Sontag, Illness as Metaphor, 1977

 

like this one...speaks to culture, the individual, the relationship of self to other...self to unconscious...etc...