What do we mean by good mental health? Good mental health isn't something you have, but something you do. To be mentally healthy you must value and accept yourself. This means that: You care about yourself and you care for yourself. You love yourself, not hate yourself. You look after your physical health – eat well, sleep well, exercise and enjoy yourself. You see yourself as being a valuable person in your own right. You don't have to earn the right to exist. You exist, so you have the right to exist. You judge yourself on reasonable standards. You don't set yourself impossible goals, such as 'I have to be perfect in everything I do', and then punish yourself when you don't reach those goals. If you don't value and accept yourself, you are always frightened that other people will reject you. To prevent people seeing how unacceptable you are, you keep them at a distance, and so you are always frightened and lonely. If you value yourself, you don't expect people to reject you. You aren't frightened of other people. You can be open, and so you enjoy good relationships. If you value and accept yourself, you are able to relax and enjoy yourself, without feeling guilty. When you face a crisis, you know that, no matter how difficult the situation is, you will manage. How we see ourselves is central to every decision we make. People who value and accept themselves cope with life. Why do some people become mentally distressed when others don't? All of us grow up with a set of ideas about who we are, what our life was and will be, and what the world is like. These ideas come from our past experience, and, because no two people ever have the same experience, no two people ever see things in exactly the same way. Our ideas aren’t an exact picture of what’s going on around us, but a set of guesses or theories about what’s going on. If we grow up with certain views or beliefs about how life is or should be we can then be greatly shocked if we discover that things aren’t the way we thought they were and that we’ve made a serious error of judgement. Whenever we encounter some unexpected disaster or setback, we discover that there's a serious discrepancy between what we thought our life was and what it actually is. Perhaps we thought our life was safe and secure, and then we suffered a terrorist attack. Perhaps we thought we were going to spend the rest of our life with one special person, and then that person left us, or died. Perhaps we'd grown up believing that if we were good, nothing bad would happen to us, and then something did. Whenever we discover we've made a serious error of judgement, we may start to doubt every judgement we've ever made. Then we start to feel very unsure of ourselves. If we value and accept ourselves, we have confidence in ourselves, and, even though we're frightened, we tell ourselves that this feeling will pass, that we'll be able to meet the challenge and cope with whatever follows. If we don't value and feel positive about ourselves in this way, we may feel that we're about to beak down, and so we have to find some defence to hold ourselves together. The less good we feel about ourselves, the more desperate the defence we resort to. These defences might include: harming our body by injuring it or by starving it blaming ourselves for the disaster or setback, and so becoming depressed locating the cause of our fear in the world around us and becoming too frightened to venture out getting busier and busier to avoid thinking about any problems trying to make everything secure by obsessively cleaning and checking retreating into our own inner world and giving up trying to make sense of the world around us in the way other people do. We don't consciously choose a particular defence. Instead, we unconsciously and quickly resort to the one defence available to us because of the way we see ourselves and our world. For instance, if you are well practised in blaming yourself for everything that goes wrong, you’ll blame yourself for any crisis or bad luck you have. Why is attitude so important? Mental distress is not compulsory. However, if we don't value and accept ourselves, we're making sure that we will feel mental distress when life is difficult. If we do feel positive about ourselves, then when we suffer loss, we feel sad, not depressed. So, when someone treats us badly, we feel angry, but not guilty because we feel angry. When someone or something threatens us, we feel frightened, but we're not overwhelmed, because we look after ourselves and make ourselves safe. What causes us to become mentally distressed is not loss, or poverty, or sickness, or people treating us badly. It's how we interpret our loss, or poverty, or sickness, or the fact that people are treating us badly. Many people defeat themselves by interpreting what happens to them in way that makes suffering inevitable. If we see ourselves as being bad and unacceptable, and we believe that we live in a 'just world' where goodness is rewarded and badness punished, then, when we suffer a disaster or setback, we interpret the event as being the punishment for our wickedness. If we see ourselves as being insignificant and worthless then, when the chance for happiness comes along, we say to ourselves, 'I wasn't meant to be happy.' If we are frightened of other people, when other people treat us badly we feel we've no right to stand up for ourselves. If we desperately need other people around us, but see ourselves as unattractive and unlovable, we bury our anger. We let other people walk all over us, because we dare not show our displeasure in case other people reject us. If we believe that it's inevitable that other people will let us down and everything turn out badly, we'll not do anything to improve our life. So we suffer. Isn't it all genetic? Some people like to blame their genes or their fate for their misery, because then it seems that they're not responsible for what has happened to them. Many doctors like to blame some undiscovered gene or biochemical change for their patients' misery. This is because such doctors feel more comfortable with medical interpretations of events than with psychological interpretations. However, genes are very much affected by the environment, and despite the huge amount of time, money and effort that has been spent in the search for the genes that directly cause mental disorders, none has been discovered. Serotonin levels Changes in the levels of the chemicals (neurotransmitters) serotonin and noradrenaline have been found in the brains of people who are depressed - but not always. The biochemical changes that are associated with depression may be the result of the mood change rather than the cause of it, and no biochemical change has been found to precede the onset of depression. It is not correct to say that depression is caused by a chemical imbalance in the brain. Genetics It's often claimed that research shows that depression runs in families and is therefore genetically inherited. But analysis of this research still leaves this open to question. We usually inherit a lot about our environment from our parents as well as our genes. Much of what we get from our parents, is through learning. We can learn, from our family, ways of thinking that lead to distress. If a parent is constantly frightened and pessimistic, their child is likely to grow up believing that the world is a terrible place, and so the child becomes frightened and pessimistic. What can I do about it? Accept that you can change. Nobody stays the same, so you may as well change for the better. The big change that you need to make is to come to value and accept yourself. If you've spent most of your life believing that you're unacceptable and of little value, it's hard to change, because all your ideas and ways of behaving are based on that assumption. The trick is to say to yourself, 'I don't think much of myself, but from now on I'm going to act as if I'm my own best friend. I'm going to be kind to myself, look after myself, and stop criticising myself and putting myself down.' Acting as if you're your own best friend will lead you to become that. You need to be very aware of how you talk to yourself. Listen to the voice in your head. Write down the hurtful, critical things that voice says to you, and then think of better, kinder, more encouraging things to say to yourself. For instance, when you have to do something, if you always say to yourself, 'You're sure to fail. You always make a mess of everything you do', write that down, and then beside it put, 'You're going to do the best you possibly can. It doesn't matter if you don't get it perfectly right, because the good thing about mistakes is that you learn from them.' Practise saying encouraging things to yourself. Question the assumptions on which you base your ideas. Is it really true that everybody in the whole world hates you, or that everything you've ever done has turned out badly? Is it really true that every unfortunate thing that happens to you is your punishment for being such a wicked person? Look at the consequences of your ideas. If you don't get close to anyone because you fear being rejected, doesn't it follow that you will always be lonely? If you think of yourself as bad try to remember how you came to think of yourself that way. Is this what your parents or spouse always told you? Were you really bad, or were they taking their bad feelings out on you? Writing these things down puts what you're thinking and feeling outside of yourself, and you can see it more clearly. Talk it through Talk about these things to other people and find out how they see things. Talk to friends, call at a local drop-in centre, join a self-help group. Talking to a therapist or counsellor can be very helpful. There are many different kinds of therapies, but they all fall into one of two groups. There are prescriptive therapies and exploratory therapies. Prescriptive therapies, such as cognitive therapy, teach skills to overcome specific problems. Exploratory therapies, such as psychotherapy, explore your ideas and your experiences. Most therapists and counsellors use a bit of both. Finding a therapist or counsellor can be difficult. Ask your GP whether there's a counsellor at their practice or whether she or he can refer you to an NHS psychologist or psychotherapist. See what your local Mind association has to offer. Look through the registers of psychotherapists and counsellors at your local library or on the internet (see 'Useful Organisations'). The fact that a psychotherapist's or counsellor's name is on a register isn't a guarantee that the person is an effective psychotherapist or counsellor. But it does mean that if something goes wrong, you can complain to that person's professional organisation. No therapist or counsellor can wave a magic wand and make you better, but they can act as a guide on your journey of self-discovery. What can I do about the things I can't change? Remember, it's not what happens to us that causes our distress, but how we interpret what happens to us. For example, if your mother always belittles and hurts you, and if you believe you have to visit her every week, then you make sure that you suffer. If you decide that it isn't strictly necessary to see her every week and it's your responsibility to look after yourself, then you can control how often and for how long you see her. You'll create an emotional distance between yourself and her by seeing her not as your mother, but as a woman who prefers the immediate satisfaction of taking her bad feelings out on someone to the long-term satisfaction of having a loving child who wants to be with her. This is what you need to do with all the things in your life that you can’t change: find an interpretation of events that you can live with. Don’t let these things dominate your life, taking up all your time and effort. Even when life is at its most difficult, make sure that, every day, you give yourself something nice. This could be a treat, or time to do nothing but rest, chat with a friend, look at nature, or listen to music. Even if nobody else is looking after you, you can look after yourself. (See Mind's booklet How to look after yourself.) How can I stay well while caring for others who are in mental distress? People who have gone through a period of mental distress will often say afterwards how much they appreciated having someone who was there for them, who encouraged and supported them, even though they did not show their appreciation at the time. People in mental distress are struggling to hold themselves together as a person. It’s a fight for survival, and so often people in this situation become extremely selfish. Sometimes they can’t see anything of what other people are going through, and so they may become very difficult to live with. They may see everything in stark terms, as good or bad, or as right or wrong. Their sense of humour vanishes, and the most ordinary things become sources of anxiety, even terror. They may be quite reasonable one minute and totally unreasonable the next. Friends and family, no matter how loving and concerned they are, must take care of themselves. If you're looking after someone in mental distress, it's vital that you have time to yourself to recover, to rest, and to enjoy some recreation. You shouldn't feel guilty about this. If you don't look after yourself, you'll be unable to look after anyone else. When we see someone suffering anxiety, fear and despair, or being depressed, or hearing horrible voices, we long to take their suffering away from them. However, we shouldn't feel that it's our duty to make the person better, and that if they don't get better that we have failed. The truth is, only one person has the power to make that person better. We can give support and encouragment, we can give love and comfort, we can listen and try to understand, and all this can help the person. But it's the person who has to decide to change. The person has to accept that they can change, and then to risk changing; that is, to act without guarantees or certainty about what change will mean. This isn't easy. Many of us decide to stay with the devil we know because, painful though that is, we feel secure in our misery, because we know what it is. It takes courage to decide to change. I know many people who found that courage and now enjoy their life. All of them were very different people, living in very different circumstances, but each of them can say what was the important wisdom they learnt. It was, 'I am responsible for myself. The only person who can save me is me. I value and accept myself, and so I look after myself.' Useful organisations British Association for Behavioural and Cognitive Psychotherapies (BABCP) tel. 0161 705 4304 web: babcp.com Can provide details of accredited therapists. British Association for Counselling and Psychotherapy (BACP) tel. 01455 883 300 web: bacp.co.uk For Information about counselling and therapy. See website or sister website, itsgoodtotalk, for details of local practitioners. The British Psychological Society tel. 0116 254 9568 web: bps.org.uk Produces a directory of chartered psychologists. Carers UK http://www.mind.org.uk/help/diagnoses_and_conditions/mental_wellbeing