Thursday, September 22, 2011

New Paths to Mental Health

Depending on your preference “mental health” is either a metaphor or a contradiction in terms. Let’s be nice and call it a metaphor.

If you accept, as most philosophers do, that the mind and the brain are not the same thing you will also agree that it makes no sense to say that the mind is healthy or sick.

It’s nice to know that an entire field of supposedly scientific endeavor is directing its efforts toward curing a metaphor.

The mental health field has been divided between those who want to treat the mind and those who want to treat the brain. Some, of course, want to treat both.

In the old days therapists believed that ideas would cure. Some believed that repressed ideas were causing psychological symptoms. Thus, they imagined that treatment should consist in finding and expressing these repressed ideas.

It sounded good on paper. In reality, it did not live up to its promise.

Since mind-based treatments did not work psychiatry chose to treat the brain. More specifically, it set out to modify brain chemistry.

At the least you can measure brain chemistry. If the mind, as many suspect, is really a metaphysical entity, we cannot observe or measure it.

When we do scientific research on the brain we are really not touching the mind.

So psychiatry concocted a pharmacopeia, the better to treat every manner of emotional distress. The pills and potions made people less depressed and less anxious. Some psychiatrists even believed that medication could change your personality, to the point of making you a different person.

Unfortunately, psychopharmacology did not cure psychiatrists of their own grandiosity.

Evidence suggests that the new medications worked better than the old insights. Some have suggested that it was all a placebo effect, but someone who has been suffering from lifelong depression is not going to care very much whether his new era of good feelings was produced by a pill or a trick.

People believe in pills; they believe in biochemistry. They are more apt to feel better taking a pill than learning that they have an Oedipus complex.

Treatments that aim at curing the mind and treatments that want to recalibrate brain chemistry have one thing in common. They oversimplify what a human being is really about.

To my mind the most interesting new discoveries in the mental health field are not about mind or body. They address the way personal habits and socialization contribute to your emotional well-being.

One group feels a bit like a different way to manipulate brain chemistry. Yet, they do it with  personal habits, not pills.

Developing good personal habits requires work. It also requires that you reorganize your daily routines.

These habits run a gamut, from the aerobic exercise that is now considered to be an effective treatment for depression, to the yoga that notably helps to calm anxiety and stress, to a healthy and balanced diet.

I think we should also be heartened to see psychiatry and psychology showing a greater understanding to the importance of socialization as treatment. Many of what are called mental illnesses are caused by defective socialization.

All therapists recognize that good relationships contribute mightily to mental health, but they have seemed to believe that if you overcome your narcissism or feel better about yourself you will automatically have better relationships.

The truth is, if you have bad manners and treat people disrespectfully you will not have good relationships for very long. It doesn't even matter whether your bad behavior is intentional or unintentional.

Rudeness is not a disease. It is not a function of brain chemistry. Often it derives from not knowing any better or from finding yourself in a radically different social environment.

Therapists should know that you cannot improve your manners and conduct by plumbing the depths of your narcissism. You need to sit down with a stack of books by Miss Manners, learn the rules of good behavior, and then, practice them rigorously.

If you do, your relationships will improve markedly. The point should not even be debatable.

I don’t want to emphasize ethics today. I want to underscore the mental health benefits that accrue to those who fill their lives with routines and rituals.

I emphasize the point for several reasons.

First, therapy has made such a fetish of spontaneity and enthusiasm that it has blurred the line between obsessional symptoms and good habits. .

Second, therapy and its culture have encouraged people to avoid anything that smacks of conformity, the better to make each of a day’s decisions an occasion for creative thought.

Third, Confucian thinking emphasizes the importance of ritual and routines, and most people do not really understand the full import of this idea.

It’s easy enough to pay lip service to Confucius. And it’s easy enough to say that we all understand what he was saying, but it is far more difficult to live your life in a consistently ordered, routinized, ritualized fashion.

Recently, researchers at Tel Aviv University demonstrated that Confucius was right: “They concluded that ritualistic behavior in both humans and animals developed as a way to induce calm and manage stress caused by unpredictability and uncontrollability — heightening our belief that we are in control of a situation that is otherwise out of our hands.”

Ritualized behaviors, behaviors that are repetitive and predictable, help us to control certain kinds of anxiety and stress.

Ask yourself whether you have a daily routine, whether you wake up at roughly the same time every day, whether you have a daily wake-up ritual, whether you have roughly the same breakfast every day, and whether you organize your family life around regular family dinners.

Repetitive behaviors provide a sense of security and continuity. They provide more security and continuity that does a mental exercise that pretends to show that you have always been the same person.

Admittedly, it runs completely counter to our most cherished beliefs to imagine that eating Cheerios every morning can make a greater contribution to your feeling of being a coherent Self than can your own well-crafted life story.

Still, eating Cheerios is probably more conducive to selfsameness than is introspection.

By now, everyone should know that family dinners are one of the most important factors contributing to children’s emotional well-being.

They are cheaper than therapy and are much more effective.

More than that, research shows that rituals and routines give us a feeling of self-control.

Assuming that we all know that self-control is a good thing, and that intemperate expression is not a good thing, this research tells us that you cannot gain self-control through insight into why you are out of control.

The basketball player at the free-throw line or the golfer lining up a putt go through specific ritualized behaviors whose purpose is to focus their mind, reduce stress and gain a sense of control over the situation.

A basketball player might bounce the ball six times before taking his free-throw. In so doing is taking effective control of himself and his situation.

If you have such habits, relish them. Even if the habit seems to be as useless as a golfer’s practice swings, it is not compulsive or obsessive. It is a constructive way to reduce stress and confront a challenge. 

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