The subtle difference between physical and mental 'toughness', and why it matters for mental health.

Running out of strength. 

While running for fun is not everyone’s cup of tea, it is probably the most natural full body range of movement known to the human body, ingrained within our fight or flight response.

And, having been a competitive middle-distance runner most of my life, it has provided me a very raw understanding of what physical pain is, which I have been able to control simply by distance and speed. Yet I have also experienced several times where I have felt totally out of control and lost in a jungle of anxiety.

As a result, it has had me thinking a lot about what exactly pulls us through hard times, and whether mental and physical pain is different. 

The stigma problem and its relationship with ‘mental toughness’.

At the same time, I think about the stigma in which persists against Anxiety/Depression and that all too often, it is men that find themselves stuck between a rock and a hard place.

The formulation of such stigma goes a little something like this:

[stressful situation/s or difficult life circumstance

+ resulting anxiety/depression

= mentally weak individual.]

Unfortunately, academic and psychological literature does little to debunk this oversimplification. Numerous studies have suggested a negative relationship between 'mental toughness' and mental illness symptomology. That is, the more mentally tough a person is, the less likely they are to experience mental health issues.[1]

I suggest this link between mental toughness and mental illness is fundamentally flawed, at least to the extent that ‘mental toughness’ has not been properly defined. I believe this misconception perpetuates the underlying causes of Anxiety/Depression.

What this article is not – a contrast between physical and mental health (these are too interrelated to differentiate).

Before we begin, it is important to emphasize that I am not differentiating between physical and mental health, but rather physical and mental toughness. It is an important distinction because the former is about a person’s current and general physical and mental state, while the former is about how a person deals with life’s inevitable adversities. 

In the context of health, deploying practices of relaxation, positive affirmation, socializing, doing good deeds, and being truthful and authentic are effectively the same as going to the gym for the body.

One will also tend to complement the other – study after study has demonstrated that physical activity improves a person’s mental state through 'good hormone' rewards.[2] In fact, the most recent international acclaimed research has found that replacing sedentary behaviour with 15 minutes of vigorous activity each day can reduce depression risk by roughly 26%.[3]

So, let's now go ahead and explore what mental toughness is and some of the subtle differences to physical ‘toughness’.

In any context, most people want to be known as ‘tough’.

Just like community standards and viewpoints alter between generations, so can the impact and meaning of words. The more extreme version of this idea is that if we take away ‘meaning’, words are just a combination of letters and sounds.

It remains that the meaning of a word is entirely a product of how we use it over time - the conversations, the ideas, the things allowed to pass without correction. Linguists study this and are tasked with summarising what a word means to the people currently using it.

As a result, the dictionary is a good place to start when it comes to complex problems involving the impact of words on people. The Cambridge dictionary defines tough as ‘strong; not easily broken or made weaker or defeated’ and ‘strong and determined’. Many other definitions assert similar ideas.

Because human understanding is often a creature of relativity, it also assists to contemplate antonymic ideas – what people might consider the opposite of ‘tough’. Words such as ‘soft’, ‘weak’, ‘fragile’ and ‘unstable’ tend to lie at the other end of the spectrum.[4]

Whatever way you look at it, the study of linguistics shows that being ‘tough’ is an admirable human characteristic, sitting pretty within expressions such as ‘[he/she is] tough as old boots’. If a person is not tough, negative connotations associated with weakness and fragility are more likely to spring to mind.

Psychologists define ‘mental toughness’ as a person’s ability to effectively respond to adverse circumstances.

In the psychology world, 'mental toughness' hinges upon a person’s capacity to respond effectively to adverse circumstances and is said to gravitate around four attributes; challenge, commitment, emotional control and confidence. [5] While other models exist, they are similar and share several features, such as self-belief. It has been particularly studied in the context of elite athletes, but is now beginning to be recognized in a wide range of other domains.[6]

However, there is significant debate as to whether mental toughness can best be conceptualized as a stable personality trait or as a mindset that varies highly across situations and over time. I argue strongly for the latter (depending on you mental health).

Importantly, I have failed to find a study or psychologist that attempts to differentiate between ‘physical’ and ‘mental toughness’, or to distance themselves from mental resilience being related to ‘toughness’.

Subtle difference #1 - Physical pain and emotional pain is different – mental pain is relatively hard to treat and the ramifications are usually more profound, yet it attracts less empathy from others. 

We have identified that most people consider strength and tenacity as core elements of ‘toughness’. We have also seen that in the context of ‘mental toughness’ psychologists envisage a person armed with the ability to respond effectively to adverse circumstances.

Now, it helps to consider what that adverse circumstance usually is – pain.

While studies have shown that a similar region of the brain is activated when we feel emotional and physical pain[7] and medical professionals are starting to appreciate the holistic and interconnected nature of physical and emotional pain, there remain some important differences (see footnotes to learn more).

At a primary physiological or psychological level:

1.    A person usually knows the source of physical pain, but locating the source of emotional pain is significantly more complex. [8]

2.    In general, physical pain is more short term than emotional pain.[9]

3.    Medicine to treat physical pain is significantly more effective in the short term than medicine to treat emotional pain.[10]

In terms of how we respond to pain in ourselves and others:

4.    Emotional pain is more likely to affect our future behaviour than physical pain.[11]

5.    Physical pain attracts more empathy from others than emotional pain.[12]

6.    We use physical pain as a distraction from emotional pain but not vice versa.[13]

7.    People (particularly men) are more likely to see their doctor for physical illness or injury than psychological injury.[14]

Subtle difference #2 - Physical toughness is more conscious and more often requires our active physical efforts.

A failure to use and strain the muscles around our body or cardio-vascular system usually leads to a relatively rapid loss of fitness, strength, and stamina.[15] At the very least, maintaining physical 'toughness' requires conscious physical effort on a near day-to-day basis. Some sports scientists have even said that an athlete is “only as good as your [their] last training session”.[16]

In probably the most recognizable catchphrase of all time Nike’s “Just do it” philosophy sums this up nicely - in the pursuit of physical excellence, we choose to go to the gym, we choose to run that extra lap - physical toughness is a by-product of our active decisions.

These decisions often become creatures of habit in which we prioritise amongst the chaos of life. But at any point, we can lose those goods habits, and our physical 'toughness' will rapidly subside.

Hence, it could be said:

+ recent, systematic training

+ recent history of actively pushing oneself to physical limit and withstanding short term pain and/or discomfort

= physical toughness

Subtle difference #3 - Mental toughness is more accumulative and unconscious.

In the brain, however, learning how to respond in different situations (which as discussed above is the core basis of ‘mental toughness’) is usually accumulative - what we often refer to as 'wisdom' and 'experience'.

The neurological pathways we create (which dictate our decision-making process, thought patterns, perspective on life, and even our dreams) are difficult to alter and often last a lifetime. In any case, our neuro pathways are utilised unconsciously as we go about our daily lives (ironically coined our 'stream of consciousness’). With each stream, they are activated.

In other words, our brain goes to the gym all day, every day (sometimes without even knowing it), only that the exercises we are doing may be doing us more harm than good.

Hence, there is a notable difference in how we develop and maintain so-called ‘mental’ and ‘physical’ toughness.

Subtle difference #4 – Building mental toughness involves more variables that are outside a person’s control.

In contrast to how we deal with physical stress, I argue that our ability to respond effectively to stressful situations or psychological pain is in many respects a product of our lifetime experience, environment, and role models. These factors affect our access to coping mechanisms, the ability to see mental discomfort and grief within context, and emotional self-awareness. As we have discussed, these mental resources and coping mechanisms tend to accumulate. 

Furthermore, mental illness has proven heredity links, meaning a person can inherit a heightened risk of developing a mental illness.[17]

Furthermore, at the point of a person’s crises, the kind of assistance available and the surrounding culture is also outside a person’s control, unless you consider that not having the right social support is largely a result of poor planning and lack of effort.

Therefore, we need to start thinking of mental health differently.

Putting this together, I propose a better conceptualization of anxiety/depression which respects the accumulative nature of mental strength and the contributing factors:

[A stressful situation or a difficult life circumstance

+ heredity predispositions and environmental background (past)

+ insufficient coping mechanisms, role models (past)

+ lack of available support (present)

+ environmental, social and practical barriers to receiving support (present and future)

= likely anxiety/depression.]

But how do we overcome the riddle of Anxiety/Depression when so much of it is buried in the past? The key to this is acknowledging that the past is limited, while the future is unlimited.

Although the past may be convoluted and complex, it is nonetheless defined and stagnant. With time and patience, each point of weakness can likely be addressed. In contrast, the future is malleable and variable.

Which means that linking or associating ‘mental toughness’ with physical toughness or mental health is a bad idea on all fronts.

Most importantly, as you can see, being mentally 'weak' plays no role in this the development of anxiety/depression.

We need to stop suggesting that mental and physical ‘toughness’ is the same when it is not – it is accumulated differently, affects us differently, and is associated with different types of pain and stress.

And for many, the blur between these two concepts ultimately conveys that avoiding help for mental illness is admirable. The existence of such stigma only adds to the socials barriers to receiving support, at arguably the most crucial stage of the vicious cycle.

[1] [1] (see White (2001), Visram (2012) Gerber et al (2013), Brand at al (2014), Jin and Wang (2016) and Malhotra 2017).

[2] (Felipe B. Schuch at al. 2018) Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies

[3] Choi et al 2019 - Assessment of Bidirectional Relationships Between Physical Activity and Depression Among Adults

[4][4] Roget's 21st Century Thesaurus, Third Edition Copyright ? 2013

[5] (Clough 2002).

[6] (Lin et al. 2017).

[7] The anterior insula and anterior cingulate cortex see Alan Fogel - Emotional and Physical Pain Activate Similar Brain Regions

[8] This means that appropriately dealing with physical pain and removing whatever it is that is causing it is usually easier. It also means we tend to react to physical pain much more proactively than we do to emotional pain. The most obvious example is when you unconsciously take away from a burning hot object.

[9] This is particular so in the context of pain experienced in the context of doing ‘tough’ activities (and keeping in mind that we are not talking about pain experienced as a result of chronic physical illnesses). Similarly, memories of emotional pain are usually far more profound than physically pain. For example, the memories of feeling rejected by your high-school peers are usually far more vivid than the physical pain of breaking your leg. In most instances, the brain has a remarkable ability to forget physical pain. See generally, 5 Ways Emotional Pain Is Worse Than Physical Pain Guy Winch Ph.D. 

[10] For example, painkillers can work in a manner of minutes, as they block the pain messages being sent from nerve endings to the brain. Anti-depressants, on the other hand, work by balancing chemicals in the brain, and usually take up to 6 weeks after the first dose to be effective.

[11] For example. If you received a call at your favourite bar while drinking your favourite drink that a parent has died, it would probably be a few years before you ever return to that bar or drink that drink (if ever). Similarly, failing an exam in university can create anxiety and fear of failure, and a single painful rejection can lead to years of avoidance and loneliness. In contrast, if you broke your leg playing amateur football, most people will try to return to the game as soon as their injury has physically recovered.

[12] For example, when we see a stranger get hit by a car we wince and gasp and run to see if they’re okay. But when we see a stranger bullied or taunted we are less likely to act or react in this way. See Nordgren Lf et al. Empathy gaps for social pain: why people underestimate the pain of social suffering.

[13] Cutting one’s wrist is a case in point

[14] Sane Australian - Around 65% of people experiencing symptoms of a mental illness don’t seek help from health services. About 40% of women get help, but for men it’s fewer than 30%.

[15] See generally https://www.abc.net.au/news/health/2017-04-09/how-long-does-it-take-to-lose-fitness/8426246

[16] Ibid, sports scientist Tony Boutagy PHD.

[17] Nature Genetics (2018) Massive Study Clarifies Genetic Risks of Major Depression