One in six Americans suffers from mental illness. Anxiety and depression encompass the bulk of these cases, but that is only the tip of the iceberg. There are likely more people with undiagnosed mental illnesses than diagnosed ones. These folks have fallen through the cracks of a system that was designed to help them. The mental health industry in the United States is severely underfunded thanks to the process of deinstitutionalization that started in the 1960s and continues today. Doctors are quick to prescribe spurious medications that create more problems than they solve. Furthermore, social isolation and familial diaspora have created a breakdown of the community structures that have historically been both buffer and balm for mental illness.
Mental health is simultaneously an individual and collective endeavor--a product of a well functioning system and also its source. Mental, physical, and spiritual health form a triad. One cannot exist without the other two to support it. We will dive move deeply into this triad in this post, as well as look at how Chinese medicine can provide insight into the subject.
Mind: The Audience
We often think of mental health as being completely in the domain of the mind--the mind being the collection of thoughts, emotions, motivations, memories, and behaviors that we experience. This includes both conscious and unconscious processes.
Study of the mind dates all the way back to the ancient Greeks (who called it psyche), but psychology as a formal science began in 1890 with the work of William James. Psychology has evolved considerably over the last century but is in no way as concrete as, say, physics or chemistry. Most of what we know about the inner-workings of the mind is still theoretical. This uncertainty is both terrifying and exiting.
It's terrifying because there are no definite answers to many of our questions, such as why do we dream, from whence does consciousness arise, and do we actually have free will? It's exciting because there seems to be an unlimited amount of potential future breakthroughs, like what has been happening in psychedelic assisted psychotherapy for PTSD, addiction, and other potentially fatal mental afflictions.
We can think of the mind as similar to an audience at a performance. The mind is what is doing the observing, the feeling, the applauding, and also the jeering. It is both the critic and the fan of the play of life. If undisciplined, it is prone to capriciousness. There is no crueler master than a mind turned against itself
Speaking of discipline, there is a long and illustrious history of methodologies for controlling the machinations of the mind. Clinical psychology is just one of these practices. Meditation and piety are two others. Philosophy is perhaps the oldest form of ordering the chaos of the mind through the application of axioms and theorems to thought. However, all of these only describe the map, and not the actual territory. The full depth of the mind is only understood through considering the other parts of the mind-body-spirit triad.
Descartes' "I think therefore I am," is one of the most famous quotations of all time, but it is only 1/3 of the equation. Put simply we are not exclusively our thoughts or our emotions, although sometimes it may feel that way. We are influenced by our mind but we can also influence it. The way to do this is by accessing the intelligence and strength that is contained in the body and spirit.
Body: The Cast
Physicalism is the predominant school of thought concerning mental health. It is the theory that all mental states are a product of physical processes in the body. In other words, there is a cause-and-effect relationship between what is happening in one's physiology and one's mind.
While physicalism is a tempting model, it is only half correct. The mind also has an effect on the physiology. The ability of belief to direct the body is well documented in the placebo effect. For a medication or procedure to be considered efficacious, it must pass a double-blinded placebo controlled study, meaning that it must significantly change outcomes for recipients more than placebo alone. Ironically, most of the drugs and modalities that are commonly prescribed for mental illnesses have not passed this threshold.
For example, selective serotonin re-uptake inhibitors (SSRIs) which are the most widely prescribed medications for generalized anxiety and depression, have repeatedly been shown to be no more effective than placebo alone. In fact, the medical establishment is not certain how they work exactly despite them being the de facto treatment options since their introduction in the 1980s. Not surprisingly this is also when the deinstitutionalization process reached its peak and the mental health industry moved toward a more pharmacy-centric approach to mental illness.
In his book Brain Energy, Dr. Christopher Palmer outlines a convincing argument for the power of physiology over mental health. His most remarkable case study was a complete reversal of the paranoid schizophrenia of a patient with a change of diet alone. Less dramatic, but no less significant are the hundreds of case studies documenting improvements of all sorts of other mental illnesses through improving metabolic health.
When the brain is able to access all of the necessary resources it requires from the food that we eat, then it is much more likely to work properly. So many mental illnesses have comorbidities of obesity, diabetes, and cardiovascular disease, which all create unwanted inflammation and metabolic demand. It follows that by solving the inflammation and comorbidities, the rest will fall into place.
Using the metaphor of a performance, the body is the cast. The show is only as good as the cast is prepared, motivated, and talented. Without a cast, there can be no play. There is a dynamic relationship between the audience and the cast, just as there is one between the mind and the body. One can affect the other. They depend on one other. They complete one another.
One of the most important things that we can learn about the power that physiology has over the mind is that physical states promote mental states. In other words, it is easier to act our way into a new way of thinking, then think our way into a new way of acting. By enacting a change in the body (i.e. going for a walk, sweating in a sauna, taking five deep breaths, receiving a massage or acupuncture treatment, eating some food, taking a stimulant, etc.) we produce an inevitable change in the mind. Fortunately, once the mind sees the benefit of the action, it begins to gravitate towards it.
Spirit: The Play
The etymology of the word mental derives in part from the Middle English root for soul or spirit. Soul and spirit are often used interchangeably but the major difference is that spirit encapsulates a broader scope than, and includes, the soul. The spirit is the ineffable presence of animation that is in all existence. We can only really know it through experiencing it. It does not reside in any one spot, rather it is in everything all at once.
The spirit is akin to the entirety of the play--the stage, the actors, the script, the audience, the specific time and place, and the cultural significance of the performance. It is the overarching meaning for its existence in the first place. The spirit gives form to everything below it. Without it we cease to exist.
In the context of mental health, the spirit can be thought of as the 'telos' (purpose) of the universe and the mind/consciousness can be thought of as its 'logos' (meaning). The mind is forever in search of union with the spirit, and the spirit is forever creating the mind to pursue it. The snake eating it's own tail. Yin and yang. We are reduced to using imagery, because words just don't suffice.
Viktor Frankl, the author of Man's Search for Meaning and founder of a branch of psychology called Logotherapy, was adamant that the only true solution for man's suffering is to find meaning in his life. Without a higher direction to govern actions, there is no unifying structure and nihilistic and/or hedonistic ideation will rule in its absence. Spirit is the source of meaning--where all meaning ultimately begins and ends.
Spiritual practices are becoming more and more taboo in modern Westernized cultures. Attendance in church is at a historic low, and the majority of people are unaffiliated with any spiritual discipline. It is no wonder that secular approaches to spirituality like yoga and Eastern medicine have been growing in popularity. They offer a missing and essential piece to the health of a person--a narrative of meaning, unity and transcendence. Something that is wholly lacking in Western medicine.
Mental Health and Chinese Medicine
The mind, body, and the spirit are represented by different energy systems in Chinese medicine (CM). The mind is called the Yi and is part of the Spleen system. The body is called the Po and lives in the Lung system. The spirit is called the Shen and resides in the Heart system. In combination, these three represent a triangle of interplay, with the Shen necessarily sitting at the top and the other two acting as support.
The Shen holds a special place in the Chinese medical system. It is often referred to as the emperor of the body and governs all other systems. When a person is afflicted by mental illness or a temporary pattern of shock, their Shen is said to be 'disturbed.' The Shen makes itself apparent in the eyes of a person. If they have difficulty making eye contact, or make too intense of eye contact, then some kind of disturbance is suspected.
All acupuncture points and herbs theoretically benefit the Shen, so it follows that by treating the body in general you can treat the spirit. Often times emotions and past traumas are said to be stuck in various parts of the body. These become impediments to the free flow of qi in the acupuncture channels, thus blocking normal function and leading to disease. By clearing these stagnations, these past conflicts can reach resolution. This concept is detailed cogently in Dr. Bessel van der Kolk's The Body Keeps the Score.
The Chinese also put an unusual amount of emphasis on avoiding overthinking, which taxes the Spleen. The Spleen, being responsible for transforming food into body tissue, can therefore directly affect the Po. The Yi and the Po form their own dyad, much like the mind-body connection that we have previously discussed.
Conclusion
Mental health is both a vast and deep inquiry. As a species that possesses so much power and influence over our physical world, it is essential that we develop an equal amount of prowess over our mental one. There are numerous points of entry into beginning this journey, all of them with their unique strengths and flaws. No matter where we begin, the defining characteristic of our success is how much awareness we are able to bring to the process.
It can't be stressed enough that ideal mental health is not something that can be achieved in a vacuum, nor can it be achieved without solitary work. A balance of both is necessary--a community of like-minded souls and the courage to scour the darkness inside. The most difficult things--the things that we are avoiding--are exactly the areas that we must face.
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