Mental Health Issues are a Choice - True or False?

A few weeks ago, I asked a broad range of people across different social media platforms a simple question:

Mental Health Issues are a choice – true or false?

Firstly, I would like to thank everybody who contributed their thoughts, opinions and experiences. I had a fantastic response and, in this blog, will do my very best to represent the cross section of opinions coupled with my own knowledge and experience….

Poor Mental Health – Is it a Choice?

At this moment in time, in the UK, one in four workers suffers from at least one psychiatric disorder (CIPD August 2016). Stress induced illness is the number one cost to business (at ￡26 billion per annum) and is also the number one cause of teenage illness.

This is a problem that now touches almost every family in the UK in one way or another and there are no signs of the situation improving – quite the opposite, in fact. It is my goal, through the workshops that I run, to eradicate the stigma and misunderstanding associated with poor mental health and to encourage open and honest communication. By improving our understanding, we could help many thousands of people to get the support they need, as soon as they need it, leading to lower costs for business, improved happiness for teenagers and a more productive society overall.

Firstly, let’s look at the results from my question. Out of all those who responded:

·      42% felt that poor mental health is sometimes a choice, and sometimes not

·      40% felt that poor mental health is NOT a choice

·      18% felt that poor mental health IS a choice

Without exception, everyone agreed that this is not a simple question and there is no simple answer.

Where there is no choice

In the same way as genetics (including disorders such as autism, ADHD etc.) can influence physical health, they can also influence mental health. In this case, there is no choice.

A sudden, traumatic event (or sustained abuse) can also trigger poor mental health in the same way that an accident could suddenly affect physical health. Again, in this case, there is no choice.

Nurture also has a major impact - good mental health starts with secure bonding, a loving environment and security of attachment especially during the pivotal first 1000 days after birth. The key neural pathways are laid down at this time especially around emotional control and response. Interventions later on in childhood can repair some of this but not all (Helen Turier). Similarly, if we do not receive the correct nourishment in early childhood we may go on to develop physical health issues. Once again, in this case, there is no choice.

So, placing genetics, trauma and early nurture to one side, is everyone else with a mental health issue choosing to feel this way?

In all the examples above, there is little to distinguish between physical and mental health and the reason for this is ridiculously simple; the brain is a part of our physical anatomy. It also controls our ‘mental’ functions though so it is impossible to separate the two. I might even go as far as to say that poor mental health is just another form of poor physical health.

Mind and body are so intimately, inseparably interwoven that even specialists in the fields are not always clear as to whether a disorder has roots in the body or in the mind. Physical illnesses often have mental symptoms and mental illnesses can have bodily symptoms. Even more telling of the closeness of the two, the physical illnesses can have mental causes, and mental illnesses can have physical causes (Robert Stannage).

Mis-used language adds to misunderstanding

Depression and Anxiety are the two most common mental health issues. But, does this mean that if you are feeling very low, for a prolonged period that you are depressed?

No. Depression is a diagnosable illness, a clinical state that may require medical intervention before recovery is possible.

Every office/family/friendship group has what Andy Cope (The Art of Being Brilliant) refers to as ‘mood hoovers’; those who delight in sucking all the good mood out of others. They regularly complain about everything and words like depression incorrectly litter their conversation.

It is also normal to refer to yourself as ‘anxious’ or to describe someone you know in the same way, but this does not mean that you, or they, have an anxiety disorder. Being a little anxious is our mind’s way of naturally protecting us from danger.

These days, doctors will sign you off with ‘stress’ but this is a misnomer too. Stress is not an illness, it is a chemical response in the body that can lead to either physical or mental health issues.

There is a significant difference between someone who becomes ‘stressy’ under pressure and runs around like a headless chicken and someone who is unknowingly but constantly triggering their natural stress response because of many daily triggers. It is often the ‘copers’ and the ‘do-ers’ who just get on with things who end up triggering the stress response too many times leading to physical and mental health issues.

Rarely is it the ‘weak’ person that many associate with mental health issues.

So, what is stress then?

As I said earlier, stress is a chemical response in our body that is triggered when we are in (or perceive that we are in) danger.

The brain comprises many parts but the one that is the most relevant to understanding stress is the Amygdala. This resides in the oldest part of our brain and it behaves as our body’s alarm system. When we are threatened the amygdala puts us into fight or flight mode.

Our brain and our body prepare for danger. You may notice things like a raised heartbeat, faster breathing, sweating or maybe more serious symptoms like chest pains or palpitations.

At the same time though, and invisible to us, is the release of chemicals into our body… adrenalin is released to give us strength and agility, glucose is released to give us energy, cortisol is released to suppress our immune system, our blood pressure rises and our digestion system all but shuts down.

This is a natural process, developed when we were cavemen and designed to protect us from danger.

The difference with today’s society is that, unlike in our cavemen days, most of the threats we face are not physical; there’s pressure at work, relationship/family issues, money worries, omnipresent technology and even social media which is rapidly becoming one of the biggest causes of stress.

The brain does not differentiate between physical and emotional threats and consequently our fight or flight response can be triggered many, many times in a single day – flooding our body with chemicals all the while.

The irony is, that because today’s threats are not physical, we do not burn off these chemicals and, eventually, they build up inside our body, become toxic and start to attack our organs. The brain is, of course, one of our most important – and most vulnerable – organs. A process that was designed to protect us can now cause untold damage.

This is what stress induced illness is and… this is what can ultimately lead to mental and/or physical illness.

Early warning signs of stress induced illness can include: dizzy spells, blackouts, panic attacks, loss of appetite, inability to concentrate and inability to sleep. However, when these perceived threats happen often enough we can get ‘stuck’ in fight or flight mode and the longer term physical impact can be quite severe including heart problems, gastro intestinal problems, weight gain, addictions, insomnia, anxiety, depression, premature ageing and infections. There is even some research now that suggests stress can lead to cancer.  

Isn’t it strange that if someone has heart problems or cancer we don’t tell them to just ‘snap out of it’ but when they have anxiety, many people do and yet they are often caused by exactly the same chemical imbalances.

NB. In adults a real tell-tale sign of dangerous stress levels is that whenever we have a holiday, we get a cold or an infection or some other kind of virus. If this happens to you, you may want to look into it a bit further…

Back to the main question – is poor mental health a choice?

So, now we have established that genetics, trauma, nurture and the human fight/flight response can all cause mental (and physical) health issues does this make the answer to my question any clearer?

Sadly, not really.

Now we begin to get into the realms of environment, mindset, self-help and education.

For sure, there are a number of things that we can do to build up our resistance to the onset of poor mental health but, like any illness there can be a degree of injustice about it: a little bit like the fit teetotaller who gets cancer vs. the unfit smoker who doesn't. The real issue therefore is working out what is within our control and what is beyond it (Ian Morris).

Key to understanding mental health issues is the absolute knowledge that neither money, position, fame, material possessions, loving relationships nor any other lifestyle advantage will protect you from the development of mental health issues.

Perhaps the next step then to answering this question would be to look at what happens to the brain under stress.

Not only is it vulnerable to the build up of toxic chemicals in the body, the brain also has its own set of chemicals and neurotransmitters to deal with.

Understanding brain chemistry is in its infancy and there is a great deal of debate about whether poor mental health is caused by a chemical imbalance. However, at this point in time, this is the strongest theory and is borne out by the fact that most mental health conditions can be helped with medication that adjusts the chemical balance.

Two of the key chemicals in the brain are cortisol (our stress hormone) and serotonin. In a normal situation our brain produces cortisol when it is bored, scared, stressed, upset etc. The cortisol slows down communication between brain cells making it harder to think quickly and clearly. Conversely, when we are happy, engaged, excited our brain produces more serotonin which speeds up communication between brain cells.

Perhaps this is oversimplifying the situation but, it would be fair to say that someone with mental health issues will naturally produce higher levels of the stress hormone – cortisol – thus making it harder to think and to focus. Medication is often used to increase levels of serotonin allowing the brain processes to regain clarity of thought. In this state the sufferer is then more able to take control of their recovery – which may still need professional support.

So, do we choose to produce cortisol?

Absolutely not.

Many people feel that positive thinking can help you to avoid mental health issues. I agree and disagree with this.

If you are educated to spot the signs early enough then there are certainly some practises that will help you to build up natural defences. However, even with these practices in place many things can happen that will trigger our fight/flight response regardless of how positive our approach is.

Practising mindfulness or meditation can certainly help us to be calmer in difficult situations, but no-one can control everything that life throws at them and, if life is throwing many things at you all at once then the chances of your fight/flight response being triggered are high.

In summary

I firmly believe that mental health issues are not a choice.

I also believe that there are steps we can take to minimise our personal risk – including educating ourselves and putting some regular practices in place (see below).

I believe that early education for children and young people would help in the fight against poor mental health.

You categorically do not develop mental health issues because you are weak – often it is precisely the opposite.

Nowadays, staying late at work, or working from home in the evenings, seems to attract a theoretical badge of honour. I would suggest that this is a major contributor to today’s alarmingly high rates of mental health issues. Having a healthy work/life balance allows us time to rest and relax. This reduces our stress levels and allows us to spend more time doing the things that make us happy. Happier people are 12% more productive so employers will benefit anyway.

Giving children homework affects their own work/life balance. I believe that children should work at school and relax at home – making them happier, more relaxed and more productive.

Once you have a mental health issue it is likely to affect all aspects of your life and your personality, so it is vital that you speak out early to minimise the damage that could be done by this.

Not speaking out or fearing negative consequences at work will ultimately lead to significantly higher cost to businesses. I feel very strongly that employers should actively educate their staff and encourage an open and honest culture that supports mental health issues in exactly the same way as physical health issues would be supported. You will reduce costs and increase loyalty at the same time.

Someone with a mental health issue may still be more than capable of doing well at work. However, certain coping strategies may need to be adopted (Barbara Streisand suffers from an anxiety disorder that manifests as chronic stage fright. This was triggered by a single event where she forgot the lyrics of a song. She did not appear live on stage again for 30 years. She now manages this condition by using giant screens that show her the lyrics. Did this affect her ability to succeed? No. She is one of the world’s greatest female singers, a world renowned recording artist and a successful film star). It is perfectly possible to recover 100% from most mental health issues (even psychosis if it is caught early enough).

Once recovered, the individual is often a stronger, more confident, more reliable employee who knows how to look after themselves properly and can also be key to supporting others in the workplace.

The last bit

I hope you have enjoyed taking part in and reading this blog. If you have any comments I would love to hear them – good or bad.

For me, the number one priority is to get the conversation going.

Below are a few tips to help you keep physically fit with a healthy mindset:

·      Regular exercise has been proven to reduce the risk of developing depression by 30%. Regular, in this case, means 20 minutes, 5 times a week. It doesn’t matter which type of exercise you do as long as it raises your heart rate enough to leave you slightly out of breath. Essentially, this works because it burns off the build up of chemicals reducing the chance that they will become toxic.

·      Talk, talk, talk!!! If you’re feeling low or are worrying about something, then talk to your family/friends/colleagues/professionals (as appropriate). Don’t allow things to build up in your head. They will almost always grow out of proportion. This is an issue for many people but is a more prolific problem among men. As a consequence of this, suicide rates are much higher in the male population.

·      Meditate – science has proven that regular meditation has a huge number of benefits – both mental and physical. I’m not talking about chanting in the lotus position! Meditation can be done sitting in a chair, lying on the floor – I do it lying on my bed and I’ve never chanted once. Meditation provides the space your brain needs to fully relax and repair. It also provides an opportunity for self-reflection and for assessing issues in a logical, detached manner leading to a calmer, more constructive approach to difficulties. Mindfulness, Yoga and Tai Chi all use forms of meditation and have very significant health benefits.

·      Put yourself first – taking time out each day to look after yourself is vital. We often sacrifice our own needs for those of other people. If you are not physically and mentally fit and able to look after yourself then you are equally unable to properly look after those around you. Also, if you constantly put others first you are teaching them that they matter more than you do.

·      Control your inner chatter. This may be what some people refer to as a positive mindset. It is easily possible to create mental health issues through negative internal chatter. Learning to recognise when your words or your thoughts are cutting you down – and learning how to reframe these thoughts is key to healthy feelings of self-worth, self-confidence and self-belief. Sadly, this is the area where most teenagers struggle leading to high levels of anxiety, self-harming, eating disorders etc.

·      Be grateful. In today’s society it is normal to want more and to keep aiming higher. The downside of this is that we often feel as if we are not good enough or that we never have enough. By reflecting daily on the things in our life we are appreciative of, we reduce these feelings of inadequacy and build, instead, feelings of contentment.