I have a very low threshold for the smell of rotting food in the garbage. There are many unpleasant scents I can adapt to but that one I cannot. And so, just as I was settling in to work on this blog entry, I noticed the unmistakable putrid odor, and I got back up to take the bag outside.
The air is perfection tonight: warm but crisp. I was instantly nostalgic for football Friday nights in the marching band. Just a little cooler and I'd also have been flooded by images of Halloweens of my childhood, setting out in the twilight, clutching empty pillowcases and returning in the dark, hands now weighted down with bounty, slung over our shoulders. Yes, it's almost that kind of air tonight.
There's a crescent moon. Full moons get all the poetry, dramatic and dreamy as they are. But crescent moons are charming. Whimsical. I don't know if the one I just saw is waxing or waning. There's a metaphor there to be explored some day. But not tonight.
This post seems rambling so far, does it not? But it's actually an appropriate prelude to the topic I mean to explore. Today is World Mental Health day. Stinking garbage and la bella luna fit right in.
I am a therapist. I've been a counselor for nearly twenty years. And, in truth, I have always been one. My father used to admonish me, when he'd overhear me talking to my best friend on the telephone about his adolescent angst (wall phone in kitchen = zero privacy), "you know it's illegal to practice psychology without a license." He meant it. Heh. Well, Dad, I've got a license now. But who even knows if I'm any more skilled today than I was at 15. If I am, it's possibly owing more to 27 years of experiencing life than any formal education I've obtained.
So, World Mental Health Day. If "every day is Earth Day to a farmer," then certainly every day is Mental Health Day to a therapist. But I didn't celebrate it. I didn't even know about it until I heard it randomly mentioned on the radio. Evidently, we think the earth is in greater need of our collective attention than is our mental health. We couldn't be more wrong.
But that also is not the theme I wish to explore, at least not directly. What I thought about immediately when I heard it's Mental Health Day is how much I do not care for the term "mental health." I am sometimes accused by my sisters and the occasional observant friend that I can get bogged down a bit in semantics. And perhaps this is one of those cases. But hear me out first, before you tell me to quit splitting hairs already.
In truth I'm a little surprised it's still called Mental Health Day. It seems the current preference is "behavioral health." I work in behavioral health care now. Because we all know that mental problems are just behaviors gone all sideways, right? Depression makes it hard to get out of bed. So does arthritis. But arthritis is just an illness. Not a mental or behavioral one.
Admittedly, we've come a long way. We used to have insane asylums. Loony bins. Madhouses. People weren't mentally ill, they were crazy. Lunatics (ah, see, la bella luna!). Nut jobs. To a lot of people, they still are. And, often enough, we call them mental. "She's a mental case." "He went all mental on me." The word itself is pejorative.
So, what's my problem with it? I do believe that cognitive dysfunction is central to many of the problems that bring people into therapy. Learning to think in a different way is a key to recovery. I do subscribe to Cognitive-Behavioral Theory. And there are the two terms, side by side. Mental and behavioral. But don't let's forget about emotions. If you forget about feelings, your quest to understand or change your behaviors and thinking will be an exercise in futility.
Of course, some psychiatrists and neuro-scientists would have us believe it's all about finding the proper combination of medications to balance out a brain chemistry gone haywire. And they are right. It is about re-calibrating our chemical circuitry. But not through medication alone. Aerobic exercise re-calibrates brain chemistry. So does a welcomed hug. So can sex. So can a sunny day. So can sharing honestly. So will a massage. Or stroking a pet. Or a hot bath. Or a belly laugh. Or praying. You know what else all those things, along with the proper medication, will help improve? Diabetes. Heart Disease. Hypertension.
It's all connected. Diabetes and depression co-occur at an astonishingly high rate. And we're not sure which direction is causal- diabetes leads to depression or vise versa. So why is it less stigmatizing to admit to being diabetic, than to being depressed? Mood disorders are exacerbated by poor emotion management, poor diet, and lack of exercise along with underlying biological predisposition. So is hypertension. But it's easier to get insurance to pay to treat hypertension than depression.
Every mental health disorder I have ever treated is a bio-psycho-social phenomenon. Most "physical" disorders are too. Thinking, emotional and behavioral change is necessary for someone with social phobia to walk into a party without coming undone. And maybe a daily dose of something to keep those neuro-transmitters firing properly. Thinking, emotional and behavioral change is also necessary for a diabetic to embrace a low carb diet without coming undone. And perhaps a daily dose of something to keep that insulin firing properly.
In New York, where I started my career, at least one county calls their social service department the Mental Hygiene Department. Hygiene? No negative connotation there, no sir. No listing, however, for the Physical Hygiene Department.
Okay, so while others give me occasional feedback on my semantic fixation, my personal concern is that I may tend towards belaboring points through redundant example. And without a face or even voice to gauge whether I've reached that level here and you are now zoning out, I can only guess.
But it is late and I am tired anyway, so my own mental health is pleading with me, for love of all things good and holy, to go to sleep before midnight tonight. And so, I shall employ my cognitive, emotional and behavioral awareness to comply.
And maybe, in a half hour, that eye-catching crescent moon and I will be setting together.
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