From Hygiene to Wholeness: A rough guide to Mental Health

Photo by Natalie Bond

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Hello once again. So this May, as every May in recent times, the month of May is Mental Health Awareness Month in certainly the UK, North America, I am imagining also in other places, certainly in the English speaking world, potentially beyond through the influence of things like the World Health Organisation. So I thought I’d take the opportunity with that being the case to reflect a little bit on what we mean, or what we think we mean, what we have meant by this almost ubiquitous phrase that we see everywhere these days of “mental health”. Seems innocuous and self explanatory enough, but let’s give it a little bit more attention and reflection, and see what we might be able to tease out from within it.

So to begin with Mental Health Awareness Month, day, week, year, and so on, but May is Mental Health Awareness Month, just to pick on one way in which that’s represented. So this comes from information put out from the American Hospital Association, who have put a big focus upon behavioural health, as they identify it, and they say about Mental Health Awareness Month that these are the areas in which overlapping concerns and areas in which the awareness is to be increased, are described. So we have here, loneliness prevention, elder health, child and adolescent health, maternal mental health, words matter – language use and respect, opioid stewardship, suicide prevention, combating stigma, and on and on goes the list. So these give you a little bit of a beginning insight or clue into the areas that overlap, and that command the focus and the attention of this overarching mental health awareness.

The Mental Health Crisis

Also, if you look at some of the data that one can find; for instance, there’s a piece of research under the Pew Research Institute in North America which quotes are very recent CNN poll. Who knows how this poll was conducted, or the questions that were asked, but the takeaway figure, the headline figure from the poll is that 90% of Americans feel that the country is in a mental health crisis. So that’s an extraordinary number, isn’t it? 90%, if that’s true and accurate, of Americans feel that their country is in a mental health crisis. And I’m sure we could produce figures that would be similar, comparable in most developed countries.

But what does this actually mean to feel that the country is in a mental health crisis? Well, the Pew paper that I’m thinking of and quoting here goes on to do a very predictable manoeuvre these days, and to point at a 38% increase in demands upon mental health care since the COVID pandemic. So linking this crisis, as it’s been identified, to somehow an upsurge in need, or demand, you might say, roughly 38%, since the COVID pandemic. So it’s almost establishing a chain of causality that because there was this event, the COVID pandemic, there is now this upsurge in the demands upon mental health services, which itself is an expression of a crisis underlying it.

And they go on in their way to outline three areas specific to the crisis or three areas in which the crisis is specifically identifiable. So this is very much focused on North American US context. And the three areas they identify are youth, which is very broad, but that’s what they say – youth mental health crisis. Second one is a serious mental health and mental illness crisis, by which they mean conditions such as schizophrenia, bipolar disorders, so forth, psychosis of varying kinds. And the third category they refer to in which the crisis is visible is substance abuse. So in particular, the opioid epidemic focused largely around things like fentanyl. So those are the three elements that they extract from their thinking on the matter.

And, of course, these are the things that are the fuel for many a media campaign, an awareness raising campaign, news stories, headlines, articles, blog posts, YouTube channels, Tik Tok posts, and on and on and on and on. This is what we tend probably to think of when we hear the headline thing about mental health awareness. It’s that kind of strain, and it’s that kind of newsworthiness and headline grabbing quality that is being spoken about. But let’s pause or pull back a little bit and think just in really basic terms about the phrase.

Breaking Down Mental Health

So “mental health,” two English words that we’re very familiar with hearing put together. And I have a certain sort of pedant aspect here for me, a pedantry in that I hear and have heard for years the phrase “mental health” being used as if itself, it was a condition. So people saying things like, “I can’t come to work, I’ve got mental health,” meaning, presumably, I am mentally unwell today, I’m feeling anxious, I’m feeling stressed, I’m feeling overwhelmed, whatever it might be. But it gets condensed into, “I’ve got mental health”, which is a curious formation of the words. It makes me think, “Well, good for you! We all have mental health”. “What’s the state of your mental health?” would be a more useful calibration.

But pedantry aside, to come back to the words “mental health”. So we’ve got two words there. The mental word derives, of course as so many English words do, from Latin originally where the word would be mens or in late Latin mentalis. And those literally can be translated as “mind”. Although mental, in the English sense, particularly in Middle English, Thausarean English, also had the meaning of “of the soul,” what we today would call “spiritual”. So that’s interesting, at least in the English, Middle English context, that the word mental carries that additional meaning or layer of meaning that pertains to the soul or the spiritual.

Health to come to that word, is a much more Germanic word in its origin. So you see cognates of that in all the Germanic and low German, Dutch, old Dutch, even the Norse and Scandinavian languages, and indeed, in our old English, where the word literally means “whole” – whole, sound, well. It’s cognate with words like, heal, healthy, holy, hale, as in hale and hearty. And it also can mean “uninjured” or “pertaining to a good omen”.

So if you put these things together, “mental health,” you have something like the activity of the mind that is whole, the activity of a whole mind, or the dynamics of the the mind remembering soul that is uninjured. It’s a metric of wholeness and of activity – thinking, literally the process by which thoughts arise and pass. I think this begins to move us into a more productive way of thinking about the thing.

The Mental Health Movement

It’s also worth us just taking a moment to think about where does this mental health movement, if we can call it that, come from? And I mean, clearly, these are things that have existed as long as the human mind and the human condition has been prevailing on Earth. But the roots of Mental Health basically derive from prior movement which was typically known as “Mental Hygiene”. So not a combination that we’re familiar with hearing in contemporary usage, but all the way up to the immediate post Second World War period, Mental Hygiene was very much the phrase to be used.

You see it quoted in parliamentary texts in the British context in 1843, and again in 1849. There’s a movement within psychiatry, particularly in North America in 1908. But they all traffic in this phrase “Mental Hygiene”. And this is a sort of campaigning position, really, to improve the lot of patients within broadly speaking mental health contexts. So, we find that the aim is to humanise the care of the insane for example, that’s one of the soundbites that was used at the time – to humanise the care of the insane to eradicate abuses, brutalities and neglect, which the mentally sick have traditionally suffered.

So this is the mental hygiene movement, something that caught on, that got attraction, and that by the time of the establishment in 1948 of the World Health Organisation (WHO), there was a founding conference in New York and then following conferences in London. Very quickly, the World Health Organisation developed an expert committee on mental health. And this had its second and pivotal meeting in London, between September the 11th and 16th of 1950. So, you know, within a few years of the WHO being formed, this expert committee on mental health has already began reporting on its initial work under the guise of the headline flag of “Mental Health and World Citizenship,” which is not a way that we would speak about those things today.

Mental Health and World Citizenship, and by World Citizenship, we should be quite clear, what was really meant at the time was Western values. So world citizenship, notably, did not come strongly represented by Asian, African, South American and indeed, the Soviet bloc countries at that time, and was mainly the work of Anglophile doctors and Europeans. So “World Citizenship” slightly standing in as a mask, as the sort of assumed universality for Western thoughts and values in terms of mental health. So that too, is noteworthy.

Just to hurry us through this, not to get bogged down, but the early going here focuses upon the fluctuations due to biological and social factors, and has as its aspiration, “enabling an individual to achieve a satisfactory synthesis of his own potentially conflicting, instinctive drives; to form and maintain harmonious relations with others; and to participate in constructive changes in the social and physical environment.” (reference https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2408392/)

So mental health, they’re seen as a process, dynamic, a way of measuring engagement; hence the world citizen aspect. And of course, we should bear in mind this is a time of great hope and aspiration in the immediate post war years. There’s both the exhaustion of the endeavours of the Second World War, but also this slightly idealistic, almost even Utopian vision that is there at the founding of the United Nations and its bodies – particularly things like the World Health Organisation, of progress – let’s not have further conflicts and wars, let’s project a better future. And so it’s a part of that process. And over the years, this has continued to be the case and that these things will continue to form. Really quite a direct and central theme running through mental health.

From Awareness to Action

You could also see mental health as both a discipline and a movement. So mental health encompasses psychiatry and psychology, and so forth. Psychiatry being seen as the medical speciality that studies and is interested in the prevention, diagnosis and treatment of mental disorders or diseases. Whereas mental health in the way we’re used to hearing it today, as this wider overarching conceptual kind of level here, encompasses psychiatry but it’s distinct from a medical model; it has much more of a social and organisational and indeed individual aspect. So mental health and latterly, public mental health because that’s the addition that is made to it in more recent times, pertains to things like departments in hospitals, or health commissioning bodies, or government ministries, or regional administrations or university departments, courses, and so forth, academic disciplines. This catchall term of “mental health” becomes the umbrella for it.

And it has enlarged in particular to encompass what is, again, rather euphemistically called the milder forms of mental disability, mental discords frequently beginning in childhood and youth. So you can begin to see the drives towards this notion of awareness raising. So is Mental Health a state? As in a kind of description of a condition or a state, or is it a movement, or is it both? And I would direct you towards the summary paper in the National Library of Medicine, which I’ll provide a link for if you wanted to kind of read more of the detail of the history of this fascinating term.

As I say that and use those words about awareness raising, what’s also called to mind for me is a famous stand up comedy routine by the American stand up comic, Doug Stanhope, who some of you may know his work. And in a very famous solo show, he goes deeply into this sense of raising awareness for various causes, be they medical or mental health or anything else. And in a general sense, he dismantles and deconstructs that, I think in a pretty hilarious way. But the clinching line that he comes back to again and again, is that raising awareness is just another form of doing nothing. So perhaps it’s worth us bearing that in mind, as we consider Mental Health Awareness Month. In what way is it actually lip service or an avoidance of action? Is it just words of a talking shop, rather than the movement towards change in that sense? And do look up, Doug Stanhope, if you’re in need of some laughter, which of course is also to be regarded as the best medicine in these respects.

Measuring Our Mental Health

So just carrying on the history lesson for a moment, there’s something else I’ll provide a link to, but you can find it for yourself on YouTube, if you’re so minded – a programme that was made in 1960, broadcast in 1960, hosted by the American academic writer, thinker, and later author about religion, and the anthropology of religion, Huston Smith, called “In Search of America”. So this is again, sort of postwar, pre-60s, so it’s like the summation of the 1950s, really. Already the question was being asked then, what’s gone wrong with the American dream? And what’s the implications of this for mental health? And this is the basis on which this programme is made. And Huston Smith goes around researching, interviewing and pontificating on various things. But the bit that I would direct your attention to is a conversation he has with the German psychologist, psychoanalyst, psychiatrist, Erich Fromm, who escaped Nazi Germany via Switzerland, and ended up settling in New York, and then later moved to Mexico City.

So Erich Fromm in this interview, is being asked again and again about the state of the nation, you might say, the state of America’s mental health in 1960. And already is talking in terms that we would recognise today. So to just cherry pick some parts from there, he highlights the distinction to be made between people experiencing symptoms and seeking help, support, and treatment, having insight into their suffering at the level of mental illness, and those who aren’t. And yet, according to him, are still diagnosable. So as he says, “Normal people unaware of their symptoms,” and Huston Smith asks him very specifically, “How can this be?” And he points out that the specialism of the culture, and this is certainly in no way confined to the United States, the specialism of the culture is distraction – busyness, entertainment, distraction, escapism, as Erich Fromm labels it.

And he suggests that a good way of measuring mental health is to imagine three days being spent completely alone with no TV, no caffeine, no cigarettes; we might add to that no TV, no media, no Wi Fi, no phones, no social media, no contact. And he says “How big would the figures be for people experiencing a breakdown if they were to experience three days alone without the distractions?” I think that remains a useful thought exercise. How would that feel? What would that be like? Maybe we notice ourselves craving it, which would be an interesting response too.

Erich Fromm’s Definition of Mental Health

But to define mental health, as he’s asked to do, Erich Fromm takes a three pronged approach. So he says there are those who would described mental health as adjustment; that the capacity to adjust to the current baseline of unhappiness, which is a bleak way of saying it, a very Freudian way of saying it – ordinary unhappiness. What’s the measure in my society of unhappiness? And can I be that or just above that? So as he puts it, not being sicker than the average guy would count as mental health from that perspective. Or, in his second point, merely the absence of symptoms; “Well, I don’t feel depressed, I don’t feel anxious. I don’t feel like there’s a problem in my life, therefore, everything’s fine”.

Or, and this is the third point and clearly the one Erich Fromm is emoting and exploring in most detail, can we hear that phrase “mental health” actually as well-being? Which interestingly, is more the root of the health aspect of that word, wholeness. So wholeness of mind and soul, well-being. And he would argue that the components are the aspects of well-being would include vitality and energy, the capacity to be alone with oneself, to be available and responsive, to experience with intensity and clarity our own thoughts and feelings, and in particular, our capacity for awareness.

And that the ultimate sort of clarification, the bumper sticker or T-shirt slogan level of this is that you could understand true mental health to be our capacity for realism. In other words, our capacity to be aligned with what is rather than our distractions and spin around it. 

Being a psychoanalyst and being a kind of post-Freudian, again, there’s a kind of slightly bleak view of that coming from Erich Fromm, where he says that if you ask people what they think and feel, most of what you will hear in response is delusion. It is mediated through the parts of the psyche, the part of the ego, that is actually the part that is sick. So it’s commentating on itself. It’s investigating itself, and it’s coming out with, unsurprisingly, a clean bill of health. Whereas actually, that’s far from the case. So a sick society would create those conditions. And he summarises that both by reference to the still current and yet also now 60 odd years into the currency, fear of complete Armageddon, species suicide, as he calls it, the nuclear war conundrum. How can a man be sane? How can a human live a sane life? How can mental health have meaning in a world where we’re juggling our own imminent extermination through atomic warfare?

Well-Being as a Whole

So that’s one element and the other one that he focuses on, and I would certainly agree wholeheartedly with this, is that we suffer from turning ourselves into things. Huston Smith summarises it as, “Human beings do well when they love people and use things, but they do very poorly when they love things and use people”. So that could be echoing around as a rather damning indictment in that the thing-ification of our own inner lives, and the ways in which we are commodified and turned into things for use, rather than beings in their own right.

So there’s an aspect of this that reminds me as well of a quote that is attributed to Krishnamurti. Although he never actually said it in quite the form that it’s usually attributed to him, he clearly meant it and implied it and spoke it in many other ways, particularly in things like his book, “Commentaries on Living Series 3”, which again, comes from 1960. But the point being, what is said there is that it’s no measure of health to be well adjusted to a profoundly sick society. It’s no measure of health to be well adjusted to a profoundly sick society, which is a very radical point of view. It undoes the absence of symptoms argument, because what are the absence of symptoms if not being well-adjusted to the sick society? If the society itself is our metric, but it is the vector for the ill health or the imbalanced, then that absolutely doesn’t guarantee health. So that’s worthy of reflection as well.

We could think here as well in terms of homeostasis; the capacity of our body at any scale, an individual human body, or indeed any system to have within it mechanisms and processes that return it to a state of balance. So if it becomes too imbalanced in certain ways, e.g. your body overheats, you get a fever, it kicks into certain behaviours and patterns that reduce that fever, you disperse the heat, and you cool down. What would the equivalent look like from a mental health perspective in a whole society? And even within that, but for homeostasis to work, and for any biological, physiological, psychological, spiritual system to work at the human level, there needs to be a tension within the system. So a tension usually between forms, structures, things that have a certain rigidity to them, and energy, movement, flow. So how do these things maintain something like a homeostasis balance, so that the rigidity and the flow are optimised and the tension becomes a useful one?

Tuning Our Mind Into Balance

In the famous image in one of the sutras spoken by the Buddha, the image that’s used very much plays with that. So it’s speaking about the mind, and the image is that of a string on a musical instrument. So a veena in the original, an Indian instrument, but we could think of a guitar, would be an obvious example, or a violin, or any stringed instrument that you’re familiar with. And noticing that the string has to have tension applied to it. It has to be stretched to the point where it is playable. If it’s too loose, i.e. there’s not enough rigidity and structure, the string just flaps around. You can’t get it to produce a sound. There’s an overrepresentation of slackness, you could say, or rest within the system.

Whereas if you turn the tuning peg, and make the string too tight, it’s now both very difficult to push down on the string with your finger to make the note or the chord that you’re attempting to make, but it’s also of course, risking the string snapping. So there’s a an overrepresentation of load or tension; it’s too tense. So the Buddha says, you know, just like a musician has to tune their instrument, so you have to attune your mind, your psyche, your being to the conditions you find yourself in. And it’s a really great metaphor, because of course, you don’t just tune an instrument once and for all time. Anyone who’s ever played a guitar or any stringed instrument knows it will go out of tune. If you leave it overnight, or you put it by a radiator, or you go to a performance and you’re playing in a damp room, or a church that’s cold, the tuning will change. And if you try and play with other musicians, you will have to tune to one another. So that actually everyone’s tuning is in accord, is able to be harmonious, and to work in that way.

So this is a really good image for the dynamics of maintaining our personal responsibility, and then at different scales, our community responsibility, our social responsibility, and so on all the way up to the levels of global citizenship to put it in those grandiose terms. There’s a tuning job to be done; can’t be taken for granted or assumed.

The Core Value of Mental Health

So a couple more thoughts and perspectives before we bring this to close. So we might think about mental health in terms of values, for example, and I would argue that perhaps if we do that, we will come to see that the core value at the heart of the wellbeing wholeness that mental health might be pointing at, has to do with the fulfilment of truth. Or to put it in even more simple terms, alignment with reality, that the ultimate value is simply reality itself – what is and how what is is. 

We might also, and I’m here linking back to the last of these blogs where we focused in on time and the experience of time, it’s worth noticing that mental anguish, let’s call it, that comes through our thinking processes and our emotions and so forth, is entirely embedded within time and causality. You know, you really cannot make yourself suffer minus reference to causality and time. 

To suffer is to say, “I’m angry because this happened to me. I’m hurting, I’m upset, I’m depressed because of this thing that happened to me then, or this person that did that thing to me then, or this thing that might happen to me in a time yet to come”. So the elimination of thoughts, of time and causality, is the end of suffering. To put it in really simplistic terms, whatever you’re experiencing right now, in this specific moment, is simply what’s happening right now in this specific moment. It actually is instantaneously emerging. It has nothing to do with what happened yesterday, or 10 years ago, or in your infancy, or in the future actually.

When you really get down to looking at it, there is a moment by moment arising; an instantaneous realisation and a breaking of that very compelling human illusion of temporal continuity, the temporal continuity of sensation. So we’re not continuities in time. Although we most certainly experience ourselves as if we were, we are more accurately, absolutely instantaneous emergence at the level of bare awareness, bare consciousness. And if we can stay with that bare consciousness, that’s what we begin to notice – the flow and awareness. The flow and the awareness of the flow are simultaneous, they happen together at once. So we can be aware, without trying to figure out what it is we’re aware of, to put it that way.

Another thought, on a similar line but moving away from the specifics of time, the mind itself is always occupied with a whole host of things. You know, it’s a busy mind, the monkey mind as it’s often characterised. And that busyness usually has within it a whole load of reactivity and judgments. There might be lines of questioning, there’ll be a whole array of associations, correspondences, energies of desire and aversion, hatreds, attractions, attitudes and positions. And we become very accustomed to that noise, that sort of white noise. And we basically mistake that noise for reality. We take the contents of our mind and their interactions and dynamics with each other to be what is real. And yet we do not therefore feel and experience ourselves in that very direct, intimate, simple, relaxed, flowing way.  

Is a Mental Health Retreat Really What We Need?

We’re caught up in the contents as it were, rather than with the context in which all of this is arising. And this is to go back to Erich Fromm’s point why the thought of spending three days alone with no distractions is so perhaps compelling and terrifying in equal measure. Because what that would lead to is a confrontation with the white noise of our own minds, and potentially what lies beyond and behind that. Hence, people going on retreats, and so forth. Although at the level of living these experiences, one is always then challenged with how to integrate the experience into the rest of life and not simply reengage with a splitting behaviour that says, “I can have that whilst I’m on retreat, but as soon as I’m back in the office, or as soon as I’m back in my family life, it all goes to hell, in a handbasket. And I’m back to the crazy monkey mind”. There’s limited value in that experience because it is unintegrated, and because it tends towards feeding the splitting that is itself a symptom or an index of mental unease rather than mental health.

Letting Go by David Hawkins

So to put this in an even simpler form, and here I’m drawing on the work of David Hawkins which may be well known to some of you, there’s an idea at the core of some of Dr. Hawkins’ work on these matters and in particular, his calibration of the levels of consciousness and the levels of awareness, and their energetic relationship, one to another. And also, indeed in works such as his book, “Letting Go”, which is his methodology for, well as the book title would suggest, letting go, releasing, and freeing or liberating oneself from various layers of this mental anguish and suffering. At the core of that is the realisation, as he says, that all our suffering, all of the pain we experience, particularly at the level of the mind, but all of it is due to resistance. So wherever pain arises, or anguish or discontent arises, it’s a clue that we’re participating in resistance. So we could begin to inquire, “What is it I’m resisting? And how am I resisting it? What is the habit of this resistance?” 

And he goes on to say, The inner process is primarily one of deenergising illusions, rather than of acquiring new information. Awareness is predominantly revealing in nature rather than a private acquisition. The self is already aware of reality, and does not need to learn more about it. So that’s a very pithy and radically put together way of summarising much of what I’ve been speaking about for the last 30 minutes or so, that the inner process is really one of de-energising illusions rather than acquiring new information. So it’s a demolition job much more than it is a building job. And that this very thing itself, awareness, is already completely aligned with reality. In other words, as we come into relationship with the Self, and for those of you who know Psychosynthesis, thinking of the relationship along the I-Self axis to the star at the top of the egg diagram, the Self, this is already embedded in reality. It’s nothing other than reality. So there’s nothing it needs in addition to that. It doesn’t need to learn anything more about it. It doesn’t need to have a certain position about it. It simply needs to be allowed in to the moment, the place where the current experience is located.

“Come, let me write…” by Sir Philip Sidney

So this is something we can most certainly return to, it being such a vast subject, but I thought it was timely to inquire into the phrase “Mental Health” and mental health awareness. And May once again being Mental Health Awareness Month, you will undoubtedly bump into that theme represented around the place in different organisations, online, in the media, and so on and so forth. So just inviting us to reflect a little more deeply about the roots and the contours of that. And I’m going to finish with a poem and this is a poem by Sir Philip Sidney, the Elizabethan poet. So this was written in the mid-1580s in England.

Astrophel and Stella by Sir Philip Sidney

And this is sonnet 34 of a cycle of sonnets that Sir Philip Sidney gave the title, “Astrophel and Stella,” its two characters. This one is usually known by its first few words. So it’s usually known as, “Come let me write,” a thing that a poet would be happy to say of course. There’s lots of layers being played with here, but you will – I think even through the Elizabethan language, that almost sort of Shakespearean style and aesthetic of the of the thing, and bearing in mind this is the sort of high points of the English Renaissance certainly in literature, in letters, in writing and in poetry – you’ll hear the convolution, the complexity of words being turned back on themselves and their self-awareness, you could say, beginning to take form. It’s what used to be called “Renaissance Self-Fashioning” – the author and their characters dynamically revealing more about themselves, like a great Shakespearean hero or indeed villain.

There’s a psychological edge and sophistication coming to bear. And bearing in mind that the sonnet sequence, the love poems where the love is not flowing easily and there are all sorts of impediments to it, there are all sorts of tortures and pains that the unrequited love gives rise to, that’s part of what’s in the mix here as well. So, with apologies for my untrained, not a Royal Shakespeare Company rendition of classic iambic pentameter and blank verse in the Elizabethan style. So I will make my amateur way through it as best I can, but just inviting you to let the words flow. Hear them like you might hear rain on the window pane. Don’t think too much about them. Just see if any images speak to you or relate to you. And I will see you again next month for further musings and reflections on a “as yet to be determined” subject.

So, I will leave you for this month with “Come, let me write…” by Sir Philip Sidney.

Come, let me write. And to what end? To ease
A burthened heart. How can words ease, which are
The glasses of thy daily vexing care?
Oft cruel fights well pictured forth do please.
Art not ashamed to publish thy disease?
Nay, that may breed my fame, it is so rare.
But will not wise men think thy words fond ware?
Then be they close, and so none shall displease.
What idler thing than speak and not be heard?
What harder thing than smart and not to speak?
Peace, foolish wit! with wit my wit is marred.
Thus write I, while I doubt to write, and wreak
My harms on ink’s poor loss. Perhaps some find
Stella’s great powers, that so confuse my mind.

– Sir Philip Sidney, Astrophel and Stella, sonnet 34, circa mid 1580s

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