Mental Health: Are we leaving it to play second fiddle?

For those of you interested in learning more about the science of mental health, how physical and mental health interact and pragmatic strategies you can implement to improve your own or clients mental state, stay tuned for our upcoming workshop with Author of this article, David Barros.

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When we think of health and what it might encompass, our attention is often directed to the realm of the physical — what you ate for breakfast, the number on the scales or whether you suffer from illness/disease. We see physical health like we do Justin Timberlake in his time as the frontman of NSYNC — the star of the show, the focal point.

One might then ask: What’s the issue with this?

For starters, mental health often becomes an afterthought (like the rest of the band). It takes a backseat to the physical, playing second fiddle to factors we can easily see and measure. I’ve discussed in a previous article that the two are not mutually exclusive. Much to the displeasure of 17^thcentury philosopher Descartes, mind and body are not two distinct, separable entities. 

It’s because we think of the two as being in their own strict categories, that we often don’t address it with the same amount of attention or gusto that we do physical health. The purpose of this article is, therefore, to highlight and describe: 

1. The importance of mental health; and 
2. How physical and mental health interact, influencing one another. 

To get the ball rolling, I think it’s important to see how poor mental health is affecting Australians today. According to Beyond Blue (2020):

• One in seven Australians willexperience depression in their lifetime.
• One quarter of Australians will experience an anxiety condition in their lifetime.
• One in 16 Australians currently experience depression.
• One in seven Australians currently experience anxiety conditions.
• One in eight Australians currently experience high or very high psychological distress.
• More than 8 people die each day by suicide.

Some harrowing figures. As we can see, many of us will experience poor mental health or high psychological distress at some point in time, which will ultimately impact our overall wellbeing. 

I’m sure many of us (especially Melbournians), are beginning to see how important mental health is in the grand scheme of things given that we’re still under relatively strict quarantine rules. While we’re all becoming increasingly aware of its importance, many still might be unsure of what exactly it entails. 

What is Mental Health

Mental health, like health in general, can often be difficult to define as it may mean something different for everyone. Ask 20 different people in a room how they would go about defining it, and there’s a good chance the group will provide some spectacularly varied responses. 

Some might suggest it relates more to cognitive performance such as attention, memory and learning. Others might suggest it has to do with the emotional side of things like coping with stress or achieving and maintaining a positive mood. 

Like with all thing’s health, the answer shouldn’t be thought of in absolutes, but somewhere along a continuum. This continuum will involve your current state, your priorities and the context you find yourself in.

When it comes to defining what mental health is, WHO describes it as “a state of well‐being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”(WHO, 2001).  It encompasses the desire of improving cognitive, emotional and social aspects of mental health, rather than just the prevention of illness.

For a majority of our recent history this is what the focus and aim has been on, to limit people succumbing to mental illness or disease. The idea is around prevention of illness, rather than the promotion of wellbeing. As we’ll come to know, the absence of mental illness doesn’t necessarily mean one is in good mental health.

A Continuum

Keyes (2007), describes mental health as being on a continuum, ranging from mental illness through languishing and moderate mental health up to flourishing.

Every moment counts

As we move to the left of the scale, those who were languishing are seen to be at greater risk of depression, heart disease and other chronic illnesses. Anything less than flourishing was seemingly met with a greater level of impairment and disability.

As we move to the right, those who were in the flourishing category were sick less often, had lower risk of chronic disease, the lowest levels of perceived helplessness and also the highest level of self-reportedresilience. 

The issue? Not even 20% of the (studied) adult population reached this ideal level of positive wellbeing. 

Huppert (2009)also discusses this idea of flourishing, describing it as both feeling goodand functioning effectively. I’ll boldly assume that this is the goal for many. We want to be in a position where our mental performance is providing some positive reward over time and on average we want to be “happy,” whatever that might mean to each and every one of you. 

Huppert also clarifies that wellbeing is not alwaysabout feeling good. We won’t always be in a “happy go lucky” state of mind, nor will life always be kind to us. It’s about being able to cope and self-manage, even if life decides to throw a curveball your way. 

So, how do we begin moving in the direction where we can reach higher levels of wellness and function? A good starting point may be around building awareness of how both the physical and mental realms of health influence one another. 

Mental influencing the physical

Psychological stress

Stress — or more specifically, psychological stress — often gets a bad rap as it’s associated with negative processes and outcomes. We’ve all felt the full force of stressful periods whether it be with your studies, work, finances, anxious social settings, the list goes on. While often seen as the bad-guy, stress can actually be quite useful. When we are exposed to a stimuli or stressor, various processes take place that make it advantageous for us to successfully alleviate said stressor. 

Heart rate elevates, respiration increases, body temperature increases, digestion slows down and glucose/fat stores are released for energy. We’re breaking resources down for fuel and making them readily available for the ever so popular “fight or flight” response. The issue iswhen stress continues to exceed our coping strategies or available resources, the responseno longer becomes favourable. We won’t go through all the changes, but some of the ones I’ve found particular interesting are below:

Learning and memory

Acute stress is seen to be beneficial and thought to enhance memory formation (Vogel & Schwabe 2016). However, when we continue to experience stress, allowing it to become chronic, it is found to reduce hippocampus size (in rats). This is the area of the brain that covers the domains of memory and learning (Mclaughlin et al. 2007). 

Immune system & illness

Acute stress aids in the effectiveness of the immune response, “boosting it” to meet and overcome a challenge presented. Chronic stress or high levels of stress results in the opposite – immune suppression, leading to higher rates of illness (Elstad & Vabo, 2008). Conversely, those who had more positive emotional styles had lower risks of developing colds, and in another study, those in the positive mental state group demonstrated greater antibody production when vaccinated (Huppert, 2009).

Wound healing

Kiecolt-Glaswer et al. (1995) saw wound healing take significantly longer (~10 days on average) with those who were stressed compared to those who weren’t. Kiecolt-Glaser completed another study in 1998 and found that students who underwent hard palate (roof of your mouth) biopsies took 40% longer on average during exams compared to those tested in the summer holidays. Walburn et al. (2009) also looked at healing times and found that you were 42% more likely to be a slow healer if stress was high. 

While excessive stress can lead to some poor outcomes, those who had higher levels of psychological well-being were able to modulate stress-induced elevations in cortisol a lot better than those with lower scores for well-being. In another study,recovery from stressful tasks is quicker in those with greater positive moods (Fredrickson, 2000).

The physical influencing the mental

While we’ve discussed how psychological factors can influence our physical state, it shouldn’t be of any surprise that the opposite is also true. One simple way the physical can influence our mental health: Exercise!

According to Mikkelsen (2017) just 20-40 minutes of aerobic exercise was shown to acutely improve both anxiety and mood for several hours (greater changes in those with acute anxiety). When exercise was performed consistently, even as short as 15 mins and performed 3x/ week, we see a significant association develop showing that aerobic exercise can lead to lower risk of experiencing depressive symptoms. 

How about resistance training? 

Pumping some iron has been shown to significantly improve anxiety symptoms (Gordan et al (2017)as well significantly improve major depression scores (Singh et al. 2005). Below demonstrates some of the ways physical activity can reduce the two.

But that’s not all, exercise can also have protective effects against neurodegeneration (Weuve et al. 2004; Larson et al. 2004), enhance cognitive function via increases in BDNF (Brain derived neurotrophic factor) and aid in the improvement of learning and memory via increases hippocampal size (Liu et al. 2019). 

Some pretty nifty benefits just from getting a jog on or shifting some tin. 

Conclusion

If you’ve made it this far, firstly, thank you. Secondly, I hope you appreciate how important it is to focus on our mental health, not just in its strict sense, but with a more global approach where we appreciate how both the physical and mental aspects of health interact and affect one another.  

Given the above, a few simple ways we could aim to improve our mental health would be the following: 

1. Manage stress and our perceptions of it;
2. Get in regular, consistent exercise, whether it be aerobic or resistance training; and 
3. Include strategies that may move you along the spectrum towards flourishing.

See the below resources for additional help:

• Positive Psychology has a tremendous wealth of articles looking at stress and stress management. See here. 
• Vanderweele has a great resource discussing strategies for flourishing.
• If you’re unsure of where to begin with exercise, hire a coach. It might seem expensive to begin with, but from my own personal experience, having someone guide you and provide you with your own tools to manage your own physical health is often priceless.

Live long and prosper!