Discrimination Through Denial of Coverage

     We hear a lot about the importance of mental health.  However, exactly what is mental health. If one looks at the research literature there is not very much written about what constitutes mental health.  Often times, by default, mental health has been referred to or alluded to as the absence of a mental illness.  To complicate the situation further, the literature seems to be overly ripe with how to treat various mental disorders as well as how to reduce the specific symptoms a person may be experiencing. Unfortunately, our society has become overly preoccupied with treatment focusing on the reduction of a person’s symptoms as an indicator of a mentally healthy person. Although treatment and symptom reduction are important facets of a person’s mental health, neither treatment nor symptom reduction guarantees a sense of well-being.

In examining the various disorders as outlined in the DSM IV and the plethora of research that has been conducted on how to treat these disorders, there appears to be a common thread that seems to exist between all of these disorders and conditions.  The common thread appears to be an on-going interrelationship between the biological or neuro-chemical make-up of a person;  the existing stress factors that may be presented in a person’s life; and the actually coping skills or mechanisms that a person uses as a way of dealing with everyday life. Furthermore, it appears that all three of these influences have the ability to impact the other for the better or for the worse. This article will examine these various influences on a person’s mental health and how these influences are involved in maintaining a person’s sense of mental health and well-being.

     Stress is a constant in everyone’s life.  Hans Selye, the father of the stress response, defined stress as “any change.”  So the fact of the matter is that stress is a constant in one’s life.  In essence, the moment a person opens their eyes in the morning, that’s stress.  The moment that same person gets out of bed, that’s more stress.  And, the moment that person jumps into the shower, even yet more stress.  In most instances, our bodies are able to handle this stress much of which is attributed to a person’s balanced neurobiology and neurotransmission.

Much of this can be explained through the “fight or flight response” of a person. This mind-body connection, which has been a part of human evolution, has worked the same way over hundreds of thousands, if not millions, of years, the same way. Any time a person’s brain, either conscious or unconscious, senses any type of danger whether real or not, there are a whole host of stress hormones that are being released into the body (neurotransmission) gearing the person’s body up to do one of two things, to run away from that danger or to fight that danger.  In either scenario, the body has to be an efficient machine.  Although a person doesn’t necessarily have to hunt for their food any longer per se or run away from man-eating animals, a person is still faced with the everyday modern dangers of life such as unemployment, finances, marital problems, parenting, etc. The list is endless. The important point, here, is that regardless of what that perceived danger, the mind, and body via neurotransmission, kicks into action.

A problem that arises, however, is that once the mind and body have turned it up a notch to deal with the stress, it takes the body a longer time to calm down.  The mind or more specifically the neocortex (the thinking part of the brain) is able to easily dismiss stress and false alarms of stress in a relatively short manner.  A person can become instantly alarmed at the prospect of their electric being shut off from a notice received in the mail, however, instantly “feeling” a sense of relief realizing that the notice is not meant for them but for the neighbor.  Although the mind has dismissed the danger, the stress hormones have already been released to key parts of the person’s body.  Studies have shown that these stress hormones or the signaling of the mind to the body to calm down can take anywhere between six hours to seventy-two hours for the body to receive the signal of no danger.  So what can actually happen is that a person can be walking around “feeling good” and the least little thing can happen, the proverbial straw that breaks the camel’s back, that can send a person into a stressed or panic state.

    There are three key points that need to be remembered about stress.

The first key point is that stress is a constant in anyone’s life by virtue of the constant change a person is going through from the moment they wake up in the morning to the time they go to bed at night.  All too often a person thinks of stress as “nothing bad has happened to me lately.”  It is irrelevant to ask the question whether a person is stressed, it is more appropriate to think in terms of whether that person’s neurobiology is handling that stress in an appropriate manner.

    Secondly, the body doesn’t really know the difference between “good stress” and “bad stress.”  It may be more relevant for a person to think in terms of how much and to what extent has that person experienced change during the course of the week or the month regardless of whether that change has been “good” or “bad.” The more change the person has experienced, the more stress that has been absorbed into the body.

And, finally, the third key point is that the body is a very slow responder.  It takes the body a much longer time to calm down than the cognitive processes that are occurring in the brain.  A person needs to be mindful that just because they are “feeling relaxed” doesn’t necessarily mean that their body is relaxed.

It is not always feasible to assume that lowering the stressful situations in one’s life is the answer since many people may be unable to avoid a stressful lifestyle.  Firefighters, police officers, emergency room medical staff, are all faced with potential chronic conditions of stress.  It is not fair to say these individuals will be excluded from feeling a sense of well-being because they are in constant stressful situations.  It is important for a person to be aware of trying to lower stress in their life where they can, but for those individuals who are in situations where stress is a constant, it will be more important for that person to develop the necessary coping skills to deal with stress such as exercise, nutrition, yoga, or meditation.

     Research in the neurosciences in recent years has continued to shed new light on a person’s brain chemistry and how neurotransmission impacts a person’s sense of well being as well as behavior.  There have been numerous studies conducted on certain neurotransmitters of well being such as serotonin, GABA (gamma-aminobutyric acid), dopamine, and others to suggest the necessity of these neurotransmitters for the person to function at an optimal level.  This is where the explosion of new prescription drugs has come on to the market to solve the ills of the world.  Needless to say, pharmaceutical companies have long since been proponents of this neurobiological research due to the ability to develop newer and more efficient drugs to attempt to balance a person’s neurochemistry.  An important aspect that has evolved over the years, however, is the recognition of, not only the importance of a person’s neurobiological chemistry to be in balance for a sense of well-being, but also the fact that a person’s biochemical makeup can be extremely delicate and subject to a whole host of outside influences such as stress, medical conditions, nutrition, and behavior that can throw a person’s neurochemistry off creating a variety of symptoms.  As a result, there continues to be a growing movement toward alternative methods of treatment to address brain chemistry issues such as acupuncture, nutrition, or chiropractic intervention to intervene and/or to enhance a person’s brain chemistry.

Regardless of whether you are a proponent of Prozac or a devotee to acupuncture, the important point to emphasize is that a person’s neurochemistry plays an important role in a person’s sense of well-being and contentment. Furthermore, the imbalance of neurotransmission in the brain can interfere with that person’s overall level of functioning and well-being.

    Coping with everyday life situations is another area which is an important influence on a person’s ability to achieve a sense of well-being.  A person needs to feel a sense of satisfaction about how they handle given situations that confront them whether if it is with themselves or with others.  However, in order to do this effectively, a person needs to have a repertoire of coping mechanisms to choose from.  All too often, a person doesn’t develop or change the necessary coping skills needed to deal with life situations.  An interesting point to make, here, is that the human species, which is supposed to be at the top of the so-called food chain of life, is the only species that will continue to do the exact same behaviors to problem solve a situation despite the fact that these problem-solving behaviors may have repeatedly failed in the past.  For a variety of reasons, it appears that change is often difficult for a person to make. In order to effectively cope with a situation, it is of vital importance for a person to maintain a degree of flexibility, adaptation, and a willingness to change regarding any given situation.

In a sense, a person’s self-esteem can be viewed as being borne in a series of “failures.”  Once a person makes a decision to do something, it is usually followed by a series of behaviors or actions. Often times these initial behaviors and actions are not going to be a success since doing something for the first time often leads to a number of miscues or possible “failures.” However, if a person is willing to persist at following through with these behaviors and actions or be willing to try something different in an attempt to reach their goal, there is a greater likelihood the person will develop a sense of competence in that area. Once that person achieves that level of competence, a person’s self-esteem will increase.  Once a person’s self-esteem has increased, the easier it becomes for that person to make decisions and take action in other areas of life and the cycle begins all over again.

The important part of coping is that both coping mechanisms and skills need to be constantly reviewed and refined by a person.  There is no guarantee that a particular coping skill or mechanism is going to work in all situations.  As a person begins to adapt to the various complexities of life, the greater the need for a more complete range of coping skills to maintain that sense of well-being.

    In considering these various influences on a person’s mental health and well-being, it is vital to understand the interrelationship that exists between them.  One must comprehend that all three of these influences are constantly impacting one’s functioning and a person cannot focus on one of these areas without taking into consideration the ramifications it will have on the other areas.  There is a cyclical force that each area has on the other areas and vice versa.  For instance, if a person is experiencing an inordinate amount of stress, whether it is “good stress” or “bad stress,” the neurochemistry of the brain is going to be impacted.  If the neurochemistry of the brain is affected, there is a greater likelihood that this imbalance is going to affect the neurotransmission which can result in symptomatic behaviors such as panic, anxiety, depression, or other symptomatic behavior.  As a result of the symptomatic behavior the person may be experiencing, the person’s coping mechanism and problem-solving abilities are probably going to be compromised at least to some degree.  If the person is unable to cope with a given situation in an effective manner, there is the potential of the stress level increasing again. As a result, there is a cyclical process of impact.

    It appears that a key factor for a person maintaining mental health and a sense of well-being is the ability to monitor and balance the areas of neurobiology, stress, and coping.  The challenge, however, that confronts a person is the ability to maintain this balance on an on-going basis.  One of the difficulties stems from the fact that it is not always clear as to what a person needs to attend to at any given time.  For instance, let’s say that a person’s depression may simply be stemming from their genetic make-up.  If this is the case, it would probably be more prudent for that person to be prescribed the appropriate anti-depressant medication to correct the neurobiological issue as opposed to getting involved in therapy or attempting to reduce stress.  Although the latter two methods can be extremely effective in the long run, the more effective and efficient intervention may be from a pharmacological approach.

On the other hand, let’s say a person is depressed as a result of a great deal of existing stress that is occurring in their life, let’s say from being fired from their job,  or the person has limited coping skills to deal with real-life traumas like the death of a loved one.  In this scenario, a pharmacological intervention may be of little value, since the depression may be more a product of “normal” life situations that would be better addressed through support and the development of better and more appropriate coping skills for that given situation.  In these situations, yoga, meditation, and exercise may be extremely efficient in addressing stressful situations whereas psychotherapy can be effective in developing better coping skills.  In many instances, it is not necessarily the fact that a person’s anti-depressant or anti-anxiety medication is not working, the fact of the matter is that the person’s life is still a mess and they need to begin to put it in order.  Unless the person is able to address these matters, the likelihood of a person responding effectively to a pharmacological intervention is going to be minimal.It is safe to say that one’s mental health and sense of well-being is not a given in anyone’s life.  Just because a person has a positive outlook on life, doesn’t mean that their genetic make-up couldn’t play a factor in that person’s level of functioning.  Or, the person who has savvy coping skills in dealing with incredible amounts of stress, doesn’t mean that the accumulative effects of those stressors will not take a physiological toll on that person via heart disease or cancer.

Maintaining mental health and well-being needs to be worked at on an on-going basis, not too different than an athlete needs to train to maintain peak performance.  In the arena of mental health and well-being, a person needs to monitor and train how they are performing in the areas of neurobiology, stress reduction, and the development of more effective and positive coping skills.  The ability of a person to attend to these areas through the use of yoga, nutrition, exercise, diet, meditation, stress reduction techniques, psychotherapy, hypnosis, just to name a few approaches, the greater likelihood the person will maintain that sense of well-being.  A question that a person needs to ask themselves is what is it they are doing to ensure the balance of these three key areas of their life.