Just what is mental health anyway?
Simone Biles’ surprising decision to withdraw from all but one event at the Tokyo Olympics shined a bright spotlight on mental health. heightened media attention has caused a muddying of the waters, particularly in regards to the language that has been utilized. The same term – mental health – has been applied to a wide variety of situations. While not necessarily wrong, using the same catchall phrase to describe different conditions sows confusion. Further complicating the matter, the field of psychology has long operated from a treatment paradigm instead of a wellness perspective. Consequently, it identifies and defines dysfunction well, but it’s not nearly as adept at describing the positive end of the spectrum.
Let’s provide some clarity to mental health by drawing a comparison to physical health. I find this definition from Project School Wellness most functional: the state of your physical body and how it’s operating. Such a definition provides a simple framework that covers a range of functioning from disease on one end to elite performance on the other end. In the same way, we need to think of mental health as a spectrum, with mental illness on one end, mental performance on the other, and a broad range of functioning in between.
Mental illness refers collectively to all diagnosable mental disorders — health conditions involving:
Significant changes in thinking, emotion, mood, and/or behavior
Distress and/or problems functioning in social, work, or family activities
One in five Americans suffers from mental illness each year. Mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) to define and diagnose mental illness. It lists over 300 mental illnesses, including the following:
Anxiety disorders (e.g., OCD)
Behavior disorders (e.g., ADD/ADHD)
Eating disorders (e.g., anorexia or bulimia)
Mood disorders (e.g., depression or bipolar)
Personality disorders (e.g., paranoia)
Psychotic disorders (e.g., schizophrenia)
Substance abuse disorders (e.g., drug addiction)
Trauma-related disorders (e.g., post-traumatic stress disorder)
A host of influences can include genetic, environmental, personality, and lifestyle factors; brain biochemistry imbalances; the use of alcohol or drugs; and/or social isolation/having few friends. The interplay of these factors can make diagnosis and treatment challenging.
Because disorders can range from mild to moderate to severe, treatment options typically involve a psychiatrist or psychologist and may include talk therapy, medication, and/or treatment at a psychiatric hospital. The impact on day-to-day living and the ability to relate to others makes the need for treatment significant.
Now let’s look at the opposite end of the spectrum. For much of its history, the field of psychology has sought to treat individuals, restoring them to “normal.” Normal, however, is merely average, and many people are interested in how to be exceptional.
Mental Performance is optimal performance. Bringing your best to any circumstance is distinguished by:
Building assets versus remediating weaknesses
Progressing from good to great instead of back to normal
Integrating the mind and body to work together in the best way possible
Thriving, not just surviving
Thinking rationally and realistically
Recognizing and acknowledging thoughts, feelings, and emotions in a helpful fashion
Optimal performance is facilitated by gratitude, mindfulness, exercise, positive relationships, resilience, compassion, joy, optimism, and mental conditioning. Mental conditioning trains the skills and attributes necessary to be your best in any circumstance. These include focus, motivation, confidence, adaptability, mindfulness, relaxation, goal-setting, self-talk, imagery, breathing, and reflection. A Certified Mental Performance Consultant (CMPC) helps individuals and teams develop optimal performance.
Between mental illness and mental performance lies the bulk of mental health. Best described on a continuum from poor to great, it may or may not also involve mental illness. Using our physical health analogy, we might say that mental health is: the state of your mind and how it’s operating. Alternately, the American Psychiatric Association states:
Mental Health is effective functioning in daily activities resulting in:
Productive activities (work, school, caregiving)
Some organizations describe mental health as the opposite of mental illness, although the WHO calls it “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." It is a state of functioning and well-being in which individuals can handle stress, work productively, and contribute to society. Social, emotional, cognitive, and biological factors combine to promote or harm mental health.
Dr. Nicki Moore at Colgate University has created an excellent resource to describe the full spectrum of mental health. She outlines a range of functioning as well as the type of practitioner(s) best suited for working with these individuals.
As you can see above, there is some overlap in the type of professionals who work with individuals in the middle range. Professionals providing these services are trained to identify the primary need(s) of their clients. It is also why solid professionals who understand the scope of their training and their level of expertise are comfortable referring clients to specialists when the situation requires it.
Returning to the Olympics, let’s consider some examples along the spectrum. Michael Phelps’ struggles with mental illness – depression, substance abuse, and suicidal thoughts – clearly required services providing mental health restoration. In a similar vein, Katherine Nye, Olympic silver medalist in weightlifting, deals with bipolar disorder. Athletes dealing with the isolation and loneliness of the Olympics in a pandemic (Caeleb Dressel), the death of a family member (Annie Lazor), or the stress of expectations (Katie Ledecky) fall within the middle range. On the mental performance end of the spectrum, we have athletes such as golfer Leona Maguire utilizing goal-setting, Paralympic archer Matt Stutzman training with visualization, and Sydney McLaughlin saying, “Pressure is an illusion,” while setting a world record in the 400m hurdles.
As a society, we’ve become more comfortable with the conversations surrounding mental illness, health, and performance. I won’t say that the stigma has been eliminated, but there has certainly been progress. When we have open and accurate discussions of mental health, everyone is better for it. In turn, it opens the door to more nuanced discussions of mental functioning and connecting individuals with the professional who can best enhance their performance.