Yesterday 10.10.2020 was the World Mental Health Day with the theme “mental health for all”. I sent this note to a few friends and they suggested I should share it with a wider audience because other people might find it useful.
Disclaimer: I’m not a doctor. I’m just passionate about this topic, because in the last 10 years, I have personally seen the human mind break before my eyes - and sometimes behind my eyes - in the most frightening ways imaginable. So here are 10 random things I have learned about mental health in the process of educating myself.
1. Mental health issues cast a long physical shadow
Apart from actual behavioural changes and full-blown panic attacks, there is an incremental accumulation of real, hidden shifts occurred in your brain and your body under prolonged negative mental conditions. For example, a random fact that I hate is when you feel an acute sense of loneliness, your body releases as much cortisol (the stress hormone) as when you are punched in the face by a stranger. Another random fact that I hate is when you experience social rejection, even from strangers that you dislike, your body temperature drops due to vasoconstriction. These are just two of the million little, sometimes utterly bizarre, ways your body responds physically to a mental state. Now imagine the consequence of these changes adding up. If a kid isn’t well-socialised at a young age, for instance, being a chronic loner from childhood to adulthood would be akin to waking up and being punched in the face day in and day out through his or her formative years. This is misery, memorised. Even if your mind doesn’t remember the specific circumstances, your brain and body will remember the outcomes.
Treating physical symptoms helps in moments of crisis. It can be as simple as giving someone a cup of hot water with some lemon or ginger thrown in when they are highly anxious. I love telling whichever on-call team I’m in that we need to stabilise our body temperature before we stabilise those databases and servers.
Book recommendation: Why zebras don’t get ulcers, written by Robert Sapolsky. Sapolsky has a much newer book on the same topic called Behave, but I haven’t read it yet.
2. Misery loves company, but has no hierarchy: You can’t compare pain
There are two dimensions to this. The first dimension is within us. Our brain processes psychological pain and physical pain in similar ways. Another random fact that I hate is under fMRI, the same brain region activates when we feel social exclusion as when we feel physical pain. That’s why Acetaminophen actually helps alleviating both kinds of pain according to some clinical research. I’m NOT saying you should drug yourself when your friends stop hanging out with you because you are giant pain in the ass. But then again, how different is it from smoking and drinking alcohol anyway. Our languages don’t bother differentiating between the two categories either. In English, it’s just hurt and pain. In Vietnamese, it’s even worse. There is only ever 1 word: đau.
Consequently, a very depressing but highly probable cause behind self-harm is that the self-harming individual is trying to reconcile and alleviate psychological pain through physical one because they share the same mental resources. Imagine cutting yourself deep into the bone just so you could locate the pain that is already there. Suicide rates are also significantly higher in the setting of grief and depression than they are in the setting of physical pain. Some of the most heart-breaking stories I have read from only suicide bereavement communities are about the intense guilt some suicidal people feel because they think they are throwing away their otherwise perfectly healthy body when so many others are suffering from physical defects. Please don’t beat yourself up. Don’t trivialise your psychological pain by comparing it to physical one. When it hurts, it hurts all the same.
The second dimension to this is without us: you can’t compare your pain to others’. The reason is because as a population, we obey statistical laws. That means, for example, even though on average, loneliness might feel like being punched in the face due to similar amount of released cortisol, it might be extremely different on two ends of the spectrum. To some people, it might just feel like a light tap on the shoulder. To some others, it might feel like having a big dude with a baseball bat repeatedly smashing their heads while screaming: “This is 3 standard deviations above the norm, you wimp”. As a more serious example, there is strong evidence to support that hyperactive dopamine system in the brain causes schizophrenia, while a severe reduction of dopamine causes Parkinson’s. The point is loneliness is just one emotion, cortisol one hormone and dopamine one neurotransmitter. As human being, our body produces 50+ hormones, 60+ neurotransmitters and thousands of different emotions. To be perfectly “normal”, you need to be perfectly average on all of these different dimensions. So unless you are extremely lucky, or unlucky depending on how you choose to look at it, you are weird in your own unique way, just like everyone else. So allow yourself to feel and deal with psychological pain in a way that’s natural to you. Don’t trivialise it by comparing it to others’ and don’t trivialise others’ pain by comparing it to yours. No one knows what it’s like to be you, just like you don’t know what it’s like to be everybody else. The best we could do is empathy.
Book recommendation: The Language of Pain by David Biro. He also published a paper with the same idea, which cited a bunch of classic papers in this area.
3. The way in isn’t the way out
I can’t remember from where I stole this phrase, but I have always attributed it to David Foster Wallace, because the first time I used this phrase was exactly 10 years ago in an email sent to a friend discussing Wallace’s speech “This is Water”. I still believe in what I wrote back then:
- [The speech] argued that “None of this is about morality, or religion, or dogma, or big fancy questions of life after death. The capital-T Truth is about life before death. It is about making it to 30, or maybe 50, without wanting to shoot yourself in the head. It is about simple awareness - awareness of what is so real and essential, so hidden in plain sight all around us, that we have to keep reminding ourselves, over and over: “This is water, this is water.” It is unimaginably hard to do this, to stay conscious and alive, day in and day out.”
- Wallace never made it to his 50; he killed himself shortly after delivering this speech. In retrospect, many readers realise that this supposedly motivational speech targeted at the Kenyon Graduation Class of 2005 is actually a giant suicide note from a desperate man. Wallace talked repeatedly about what he called “conscious freedom”, about breaking yourself from the act of unconsciously worshiping, and about the power to choose to think in others’ shoes. None of his friends and family picked up the clues to get in his shoes, grabbed his hands and yelled at him “Wake up, son. THIS. This is water”. It’s a pity, but also a lesson. One cannot attain conscious freedom using the same philosophical doctrine that leads one to it; Wallace didn’t. It’s like getting lost in a maze of thoughts. The way in is never the way out.
I recently encountered the same phrase in Lori Gottlieb’s Maybe You Should Talk to Someone. The idea is exactly the same: if a mental health issue is a dark tunnel, the way into the tunnel isn’t the way out of it. If you have thought yourself into misery, the same thoughts pattern won’t get you out. That begs the question: what can? I suspect there is no one-size-fits-all answer.
Books recommendation: This is Water by David Foster Wallace & Maybe You Should Talk to Someone by Lori Gottlieb.
4. Dear Mr. Nietzsche, God isn’t dead
The most remarkable transformation I have personally seen in people in the last decade, without fail, all came from spiritual awakening. Some found God. Some found the ancient Tao. Others found yoga and meditation. One particular dude found DMT but let’s not talk about him. Discussing spirituality would take another 10 years, so I will skip it. Nevertheless, I believe that cultivating a spiritual life has been humanity’s antidote to inner turmoil for millennia before our recent obsession with the happy pill. Some spiritual rituals have been confirmed through psychological experiments to increase happiness as well. My favourite is the practice of expressing gratitude in prayers. In positive psychology research, gratitude is strongly and consistently associated with greater happiness. Gratitude helps people feel more positive emotions, relish good experiences, improve their health, deal with adversity, and build strong relationships. It also helps people connect to something larger than themselves as individuals - whether to other people, nature, or a higher power. The founder of modern positive psychology, Martin Seligman, recommends the practice of writing down three things that you are grateful for the most everyday. However, this is essentially what Christians have already been doing for thousands of years through their daily prayers. So as written in Matthew 7:7, “Ask, and it will be given to you; seek, and you will find; knock, and it will be opened to you”. God is within one of us, so who do you think you are to torture yourself?
Books recommendation: The Bible & The Tao Te Ching
5. We are the stories we tell ourselves
Steve Jobs once said: “The most powerful person in the world is the storyteller. The storyteller sets the vision, values and agenda of an entire generation that is to come”. That is still an understatement. The Bible, which is probably the greatest story ever written, set the agenda for the entire modern Western civilisation until very recently. There is no doubt that homo sapiens is a story-telling species, and we are the stories we repeatedly tell ourselves. Unfortunately, stories are incomplete reports of the truth at best and complete fiction at worst, because every story is told from a biased point of view. When some of these stories go sideways, they can turn into deadly nightmares. If you go to r/depression and r/SuicideWatch on reddit, you will encounter pages upon pages of devastating stories people tell about themselves. I’m not suggesting these stories are not true and the pains aren’t real, but they are stories regardless. The most predominant word in all those stories is “I”. For r/depression, one of the most frequent phrases is “I feel”, and for r/SuicideWatch, it’s “I want”.
If the way in isn’t the way out, maybe the best way to get out of these stories is instead of struggling to find a final resolution, let’s stop authoring them altogether. Let’s satisfy our deep-seated need of storytelling by telling other stories instead. Let’s tell stories about the sky, the earth, the birds, the bees, the trees and the oceans. Let’s tell stories about how the universe came to be and how freaking much it is still left for us to see. Or maybe join me and let’s write some comedy together. I have an app that generates 3 random words at a time. Whenever I feel lost in a destructive story, I generate three new words and try connecting them into a joke. My best one so far includes the following: “Apple, Maths and Cocaine”. Anyone recognise that joke?
Book recommendation: Happy by Derren Brown.
6. Books don’t change life; sentences do
Sentences describe values, form principles and group into mindsets that orient us through life. That’s why people memorise verses from the Bible and preserve proverbs from their ancestors. Knowing tactics to deal with harmful sentences that we have internalised, therefore, can be very useful in improving our mental state. One tactic is to add certain adverbs of time into our sentence to reduce our suffering from permanent to temporary, from forever to right now. For example, the entire growth mindset can be summarised in one single word: Yet. Consider the following sentences: “I can’t stay calm under pressure” vs. “I can’t stay calm under pressure…yet”. The former reflects an identity, while the later reflects a concrete state in a long journey. One is final, the other temporary. Removing finality from a negative situation gives rise to hope, and “remember Red, hope is a good thing. Maybe the best of things…”.
Another tactic is to limit the use of “to be” when talking to yourself. As far as mental health is concerned, “to be” is usually featured in evaluations such as “You are terrible. This situation is bad. She is careless. He is clueless. I am an idiot”. Evaluations help no one, least of all yourself, because they are not actionable. No amount of judging yourself as an idiot will make you smarter, just as no amount of reminding yourself a situation is bad will make it any easier to deal with. On the contrary, both are guaranteed to stress you out even more. At the very least, consider changing “to be” to “can be” or “could be”, so we remove the finality out of the evaluation: “I can be an idiot, sometimes. But I can also be smart, some other times. The situation can be bad, right now. But it could certainly be improved”. A more effective tactic to deal with evaluation is to change them into observation. Instead of evaluating a situation as good or bad, observe it and observe how it makes you feel. Instead of beating yourself up with a stick because you don’t live up to often unreasonable standards, take away the stick and get a pair of binoculars instead. For more serious trauma and distresses, there are psychotherapy treatments such as EMDR that exclusively focuses on helping patients to reach an observing mental state in order to process negative beliefs about themselves and related body sensations.
Book recommendation: Mindset: The New Psychology of Success by Carol S. Dweck.
Disclaimer: This section contains some sensitive / personal information so I’ve redacted it before posting.
8. It’s about accepting what-was to manage what-is
Many mental health issues result from past trauma. I have read that when people seek out therapy, they often want to fix what happened in the past so they could reclaim a life that they never have. Unfortunately, the arrow of time only flies one way. What is done is done. The only way to move on is to accept what-was so we could learn to manage what-is. Interestingly enough, managing what-is can sometimes be done without involving the past by choosing activities exclusively confined to the present. Exercising, dancing, drawing, cleaning, cooking, etc. are all examples of common day-to-day activities we can use to glue ourselves to the moment. Sure, meditation works too, but can meditation make dirty dishes disappear as well? And in the end of the day, life is exactly just that: one thing at a time, then one day at a time.
Book recommendation: The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing by Marie Kondo. There are two sides to this recommendation: First, cleaning up is in itself therapeutic and directly helps us manage our present lives. Second, it’s a metaphor for decluttering our own memories and emotions. Maybe accepting the past means emptying the basket and only bringing what sparks joy back in.
9. The Pareto rule applies here, but in the inconvenient direction
Human being has evolved to be much more sensitive to negative emotions. This negativity bias is argued to serve critical evolutionarily adaptive functions, since back when we were still running away from predators on barefoot, negative emotions like fear often preceded being eaten, and negative social interaction such as tribal rejection was also a likely death sentence. Speaking in terms of Pareto rule, even if only 20% of our emotions are negative, they can still grab 80% of our attention. There are many interesting implications of this fact. One study has shown that you need a 5:1 positive-to-negative ratio of interactions in a romantic relationship for it to be sustainable. Only positive interactions lead to boredom and no tension. Too many negative interactions, well, we have all been there, haven’t we?
I believe this rule extends to the relationship we have with ourselves as well. Maybe we don’t need to feel so guilty about treating ourselves nicely occasionally. In fact, when we negotiate with ourselves, we should remember that the scale tips to the side of negativity naturally, so it takes extra efforts to return to balance.
10. My door is open
Human is a social creature. We evolve that way. There is no use denying that fact - believe me, I tried. So if you are going through a tough time mentally, having someone there for you could make a tremendous amount of difference. And it’s okay to be selective about whom you share your misery with. We all need the strict, judgemental, take-no-bullshit friend who will keep us accountable. But in moments of crisis, it’s also a good idea to call up the friend who will turn on non-lyrical Lofi beats, make two cup of teas, put on a 12-hour long video of cows eating grass and just sit there watch it with you until kingdom come. Once in a while, you might want to name the cows and start writing their backstories. To this end, my door is always open.
Cheers 🥂 to the next 10 years of being human together :)