How do you prevent mental illness?
Prevention is better than the cure. Because there isn't a cure.
A few years ago, I attended an event in which a speaker started their presentation by asking the audience an odd question: who had brushed their teeth that morning?
A flurry of arms shot up before you could say ‘enamel wear on 19 occlusal’.
“That’s reassuring,” he cooed. “Now keep your arms up if you did something this morning to take care of your wellbeing.” Arms lowered. Brows furrowed and frowns burrowed. The point was clear.
We are OK at looking after our dental health. But less good when it comes to mental health.
It’s easy to figure out why. With our teeth, as with our physical health in general, we know what to do. Brush gently, eat an apple, have a poke around with those little sticks you sometimes get in restaurants… all of it will reduce our risk of dental problems, just as a good diet and vigorous exercise will improve our chances of staying physically healthy.
“An ounce of prevention is worth a pound of cure,” Benjamin Franklin is reputed to have said. And that holds even in the decimal era. With our physical health, even if we don’t always do it, we know what prevention looks like.
With mental health it’s not so straightforward. There is no mental health equivalent of dental floss, vaccines or statins. There is no single thing that works for everyone. You can’t see the results of prevention work like you can see a sparkling molar or a bulging bicep.
And yet, with mental illness, prevention is paramount. Because there isn’t really a cure. Because treatments are hit-and-miss. Because care is pretty woeful. Because case numbers are perhaps as high as they’ve ever been, according to data just released.
Mental health really needs a prevention framework. We’ve known this for years.1
But it remains elusive.
If you want to think about preventing mental illness, a good idea might be to start with what causes it.
One widely accepted theory is the so-called ‘bio-psycho-social’ model2: that mental ill health is caused by a combination of your biology (genes, antecedents etc) your psychology (how you think/your personality) and your socio-economic conditions (upbringing, security, housing, work, affluence).
If these are your vulnerabilities, then it stands to reason that taking action to lessen their impact will count as prevention.
If that sounds simple, it isn’t.
Take biology, for example. You cannot change your genetic heritage. If you have a lot of mental illness in your family tree, your risk factor will remain high. The only real options available for optimising the biology you have inherited are exercise and diet, but while these can have positive effects3 they cannot change your ancestry. The only other option here is to take a DNA test and hope that you are not who you think you are. Hardly a reliable strategy.
Your socio-economic circumstances can also be very hard to change, particularly if you are stuck in a war zone, an abusive relationship or a poverty trap. Other factors in this category - air pollution, the economy, crime, security - are largely the job of government, and hard to influence on an individual level. Many young people suffer from climate anxiety precisely for this reason: it is an oppressive circumstance that they can do nothing about on their own.4
But there are other elements that might be easier for us to change. Our work, relationships, community, education, our immediate environment - these can all have a telling effect on our mental health, for good or ill. Recognising when they are toxic, stagnant, or in need of effort and improvement is within our grasp. It may not be easy - to find another job, to make new friends, join a local interest group or enrol in a course. But it is possible, and often effective.
Then there is our thinking - the psycho part of bio-psycho-social. This is the most promising area for any prevention strategy. We can change the way we think; and we can change the relationship we have with our thoughts.
We can train our attention not to follow our thinking so slavishly, particularly when our thinking is unhelpful (“I’m no good! I can’t cope! I will fail! People won’t like me!”)
We can stop taking ourselves and our situations so seriously.
We can come to see catastrophic thought for what it is - pernicious, extremist, cartoonish.
We can recognise negative thinking, chuckle at it rather than buy into it.
We can share our problems rather than brooding on them.
As long as we are able to perceive when our thinking is becoming part of the problem - when it is ruminative, introspective, exaggerated, alarmist, self-obsessed, ceaseless - there is plenty we can do about it.
Are mental illnesses preventable? If you get anxiety as a teen, was it avoidable? If you are diagnosed with depression at 50, was there an alternative path by which you might have escaped it?
I think the answers to all these questions are yes. Mental illness is not a destiny. It can be forestalled. It’s just not always easy, intuitive, obvious.
In a wellbeing session I ran for a client recently, I shamelessly copied the dental-health-mental-health riff, pretended it was all my own work. I asked the 20 or so people in the room what they might do after brushing their teeth in the morning to cherish their wellbeing.
Among the answers: “watch breath for a few minutes and spend time in nature;” “get some daylight;” “go for a walk;” “scratch the dog’s belly;” “go outside”; “don’t listen to LBC on the way to work;” “leave on good terms with loved ones;” “take some time to have coffee with no noise/TV, and just sit and relax without rushing out to work…”
The list went on and on.
We do know what prevention looks like after all.
We just need to do it.
Braindrops (8)
Palindromes again this week. Which names (surnames or nicknames) from the world of sport are these?
Croatian former tennis player (5)
South African cricketer (7)
Ex-footballer, current manager (3)
Romanian marathon runner (5,6)
Do send me your favourite palindromes.
Last week
These two words differ only in the letters given. Can you guess them from the clues?
_ _ _ _ _ _ E _ S Filth (9) MANKINESS
_ _ _ _ _ _ I _ Filthy beachwear! (8) MANKINIS
Until next week
https://pmc.ncbi.nlm.nih.gov/articles/PMC6875848/
https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00278-3/fulltext
There is in fact, a cure. Probiotics are the most effective treatment for depression. Better than pharma drugs, focussed dietary probiotic supplementation, improves depression and anxiety. By re-establishing the brain-vagus nerve-gut, axis, probiotics make available some 90% of the seratonin produced in the gut. This is in turn, made available to the blood, via the intestinal wall lining. All without the side effects of pharma drugs...