Mental health has taken on a new importance over the past few years, and there are some surprising new ways to take control of one’s mental balance.
The general population is more understanding about mental health than it was 40 years ago when Cliff Saper began his career in psychology, but he’s found the negative connotation associated with the phrase “mental health” has never fully dissipated. The pandemic may have helped to shift the needle.
“‘Mental’ has a stigma attached to it that, over the past 40 years, we’ve never really been able to conquer,” says Saper, lead clinical psychologist for Ascension Illinois Behavioral Health. “People are hesitant to ask for help or therapy. That’s a stigma that remains.”
There have been some positive changes to fight the stigma, he says. Facilities that help those working through serious mental illness, for example, are no longer called mental hospitals, but instead referred to as behavioral health or psychiatric hospitals.
The last two years, in particular, have helped change many people’s thoughts about mental health disorders, and the terms that umbrella those disorders are changing to reflect that.
“During the pandemic, folks realized there was, initially, no medical cure for COVID, so they were seeking treatment for anxiety, depression, exhaustion, burnout,” Saper says. “We noticed the stigma was starting to decrease, but rather than say we were concerned about your mental health, we said we’re concerned about your brain health and it’s OK to not be OK and to ask for support.”
What most doctors working in the field of mental health want patients to understand is that “mental health is physical health,” says Zachary Sikora, a clinical psychologist at Northwestern Medicine Regional Medicine Group in Huntley.
“Those are not two separate things,” Sikora says. “Philosophers have studied for hundreds of years the connection between the mind and the body, and what we’ve found is there is a tremendous and significant connection between the two. But as a society, we continue to believe those two things are very separate: my medical health is separate from my emotional health.
“But if we really think about it, our emotions originate in our brain,” he continues. “Our brain is the epicenter of our body; our brain controls our entire body. So, if our emotions are unhealthy, then our body will likely be unhealthy – our blood pressure changes, our appetite changes.
So, the brain and body are connected, and we need to remember emotional health is not separate from the rest of the body. It’s part of the same package.”
What is Mental Health?
The definition of mental health is broad, says Sikora, but it basically encompasses three aspects of a person’s well-being: emotional, social and psychological, the latter of which means “how we think and behave, in addition to how we feel,” Sikora says.
Most people often emphasize the emotional segment of mental health, and when someone’s emotions seem off-kilter a mental health disorder could be the reason why.
“In clinical psychology, we classify the mental health disorders into different categories,” says Sikora. “It spans from anxiety and depression to the psychotic disorders like schizophrenia and everything in between.”
Anxiety disorders are by far the most common mental health problems in the U.S., Sikora says.
In a given year, 19% of Americans will be diagnosed with an anxiety disorder – almost 1 in 5, Sikora says.
The most common form of anxiety disorders is phobias, which are intense fears around specific objects or situations and cause significant problems in functioning, he says. Claustrophobia – an intense fear of being in tight or enclosed spaces – is a common phobia, as are trypanophobia (fear of needles) and hemophobia (fear of blood).
In addition to phobias, anxiety disorders also include panic disorder, obsessive compulsive disorder, post-traumatic stress disorder (PTSD) and generalized anxiety disorder, which is a worry-based disorder.
After anxiety disorders, mood disorders – particularly depression, which affects 8% to 9% of the American population – are the most frequently diagnosed mental health disorders, Sikora says.
Serious Mental Illnesses (known in the medical community as SMIs), such as psychosis, schizophrenia or bipolar disorder, occur much less frequently, says Sikora. Less than 1% of the American population – roughly 1.5 million people – are diagnosed as schizophrenic. Bipolar disorder is just slightly more common, affecting 2.8% of the population, or about 7 million people.
Fortunately, the medical community “has made great strides in terms of medication so people with those disorders can live in the community,” says Saper, who also is director for clinical services for the behavioral medicine service line across Ascension Illinois. “Plus, we’ve designed these intensive outpatient programs so they’re actually living back home so they can try out these new skills they’ve learned. Forty years ago, we were putting them in state hospitals. That’s changed. But overall, most people coming into treatment these days are coming in because they have a difficulty managing overwhelming feelings.”
What to Look For
If you have feelings of anxiety or depression, that doesn’t necessarily mean you have a mental health disorder, Sikora says.
“To tell if someone is struggling with a mental health problem, we first have to realize that, as humans, all of us are going to have a wide range of emotions and experiences,” Sikora says.
“Everyone is going to experience anxiety from time to time. Everyone is going to experience depression from time to time or not be able to sleep for a night. When they become more frequent in nature and more intense and impact functioning in a negative way, that’s when it turns into a clinic problem, a mental health problem.”
A person who gets anxious about new social situations but is still able to participate and communicate with others doesn’t necessarily have a mental health problem.
“But maybe that anxiety starts to increase in intensity, and they start to avoid those social events altogether,” Sikora says. “We would consider that a problem then.”
Any significant change in a person’s day-to-day behavior could indicate a mental health problem, he says. Mood changes don’t have to look like extreme depression; they could simply register as frequent irritability or being “on edge” more often.
Having difficulty with falling asleep, staying asleep or oversleeping is another example, as is a new or increased use of substances, such as alcohol, as a coping mechanism.
Loss of appetite, overeating, or significant lost or gained weight also could indicate an emotional problem, Sikora says.
Some people may be resistant to the possibility that they could have a mental health disorder, he adds. If they’re able to overcome their overwhelming emotions without medical assistance, sometimes that’s just fine.
“I think there’s something to be said for perseverance,” Sikora says. “That can be a sign of strength in people. However, if that perseverance is leading to persistent avoidance of a problem, including mental health issues, that problem can grow bigger and bigger over time. Research tells us that the earlier we intervene the better the prognosis over time.”
Any time a person experiences a significant change in his or her mental health, it’s important to address it in some way, he says.
“For some people, that might not mean they’re ready to call a psychologist or a psychiatrist and start with medication,” Sikora says. “Maybe that person needs to talk to a loved one or friend about that particular issue. Or, that person needs to talk with their general physician, who they have a relation with already, about that issue. That’s where most people start; they talk to their general practitioner. Then they can refer a specialist as they see appropriate: a psychologist, counselor, psychiatrist for medication.”
What Does Therapy Entail?
Forty years ago, people who experienced mental illnesses weren’t provided much support.
Psychiatrists used to look at the psychodynamics of a patient’s situation, focusing on the psychological roots of emotional suffering, Saper says. A patient’s mental illness may have been blamed on the fact that the patient’s mother wasn’t nurturing, or the father wasn’t in the picture.
Today, psychologists and psychiatrists understand that people need tools to better manage those overwhelming emotions, not just receive and live with a diagnosis, Saper says.
“They need tools to change the ways they’re thinking; they need tools to become better aware of their emotions and when it is they need support and health,” Saper says. “Forty years ago, we were into telling people to avoid situations. For example, if you’re fearful of flying or going into elevators or going into a bar, we used to say don’t do those things. Just avoid them. But if you avoid going into an elevator, you’re never going to get over the fear of elevators. Nowadays, we’re much more interested in exposing people gradually to the things they’re fearful of rather than avoiding them.”
Often, speaking with a psychologist can help a person figure out why their brain is working the way that it is, Sikora says.
In fact, 90% of his job as a psychologist is comprised of psychotherapy with patients, he says.
“Therapy is nothing more than sitting in a room with another individual who is asking you questions and helping you discover the underpinnings to your problems and helping you find solutions to those problems,” he says.
A big barrier for those interested in therapy is the issue of confidentiality, Sikora notes.
“It’s very difficult for people to be vulnerable, to start, and then to come to a stranger and talk for 45 minutes about very intimate and very vulnerable things. That’s scary for a lot of people,” he says. “I think it’s normal to feel that way. But it’s important to remember that we’re licensed clinicians, and one of our primary responsibilities, if not No. 1, is to maintain confidentiality of the patients or clients we work with, so nothing ever leaves the office once it’s spoken there.”
Today, patients can even engage with a psychologist through teletherapy – mental health counseling via phone or videoconference – and that also is safe and confidential, Sikora says.
Culinary Medicine as Treatment
For decades, many people – like integrative medicine proponent and physician Andrew Weil – have known that certain foods have the capability of directly affecting mood, brain chemistry and more, says Lori Walsh, medical director of the Center for Health and Integrative Medicine at Advocate Good Shepherd Hospital in Barrington.
Now, Walsh says, the data is there to back it up.
She’s a strong supporter of the research of not only Weil, but also Bonnie J. Kaplan and Julia J. Rucklidge, authors of “The Better Brain: Overcome Anxiety, Combat Depression, and Reduce ADHD and Stress with Nutrition.”
The two doctors have “robust data” that show how food and nutrients can successfully treat mental disorders, Walsh says.
“They provide evidence on a couple of fronts that the lack of micronutrients over time has been shown to change the chemistry of the brain,” Walsh says.
People who eat more brown foods generally aren’t getting enough micronutrients, she says. That’s because vitamins and minerals that are essential for good health come from the many colors within our fruits and vegetables. Improving micronutrient intake can resolve irritability, explosive rage and unstable mood, write Kaplan and Rucklidge in a recent article on theconversation.com.
There’s been a recent shift toward culinary medicine as a more holistic way of treating a person’s overall health. Walsh says she’s excited to see this shift, especially considering that aspiring physicians are only taught 25 hours of nutrition in medical school, and most of that is comprised of biochemistry.
“Culinary medicine is using this idea of how we can combine food and flavor to create nutritious foods and have people learn to make it themselves, to promote health,” says Walsh.
Helping people understand which foods promote the best health is one of Walsh’s passions.
She notes that the Food Pyramid – a U.S. Department of Agriculture nutritional diagram depicting serving sizes of the basic food groups – has changed over the years.
“When I was practicing 20 years ago, the bottom was bread,” she recalls. “Now, it’s vegetables as the anchor. The king and queen are the most important, where the king is veggies and the queen is fruits. Then, you move up to whole grains and everything else.”
Often, once people understand the importance of eating healthy for their physical well-being, it’s easier to explain how it also can improve their mental health, Walsh says.
Omega-3 fatty acids, for example, may help relieve depression, she says. These are found naturally in fish oil, flax, wild sockeye salmon and even some veggies.
Walsh hopes patients will eat the foods that provide benefits to their health. But she realizes people don’t always enjoy healthy foods, and “certain times of your life you can’t absorb nutrients as well, so using supplements is the way to go,” she says.
“When I’m working with someone who has anxiety and depression, I’ll talk to them about omega-3 as a supplement,” Walsh says. “We also discuss ways to reduce unneeded sugar, usually from sweetened beverages. It’s really difficult to the system to have sugar coming in daily. And I encourage people to add a little more veggies to their plate each meal in any way they can.”
Like omega-3s, herbs and spices are anti-inflammatory foods that may help with depression. For example, turmeric – which appears in a lot of Indian food – is an anti-inflammatory, anti-cancer food, Walsh says.
“If you have garlic, take it and cut it up and let it sit for about 5 minutes,” she says. “It activities the allicin – a compound that may prevent certain cancers and may lower blood sugar, cholesterol and blood pressure. It’s a huge benefit for health. Gently put it into your meal at the end of cooking. You’ve now made that dish even more beneficial to your health, and it’s delicious.”
Not to mention, it’s also good for your mental well-being.
Boost Your Mood with Food
The field of culinary medicine is linking food and medicine by improving eating behaviors and the skills to prepare healthy meals.
This pesto recipe, created by Lori Walsh, medical director of the Center for Health and Integrative Medicine at Advocate Good Shepherd Hospital in Barrington, highlights how food can help boost mood and brain power. Walnuts have been shown to improve cognitive function and reduce the risk of depression and other diseases. Olive oil has been shown to have antidepressant properties.
2 handfuls basil or assorted herbs
2-3 cloves garlic
¼ cup shredding parmesan cheese or nutritional yeast
½ cup walnuts, soaked and roasted
½ cup olive oil
1 tsp salt
1 tsp lemon juice
Combine herbs and walnuts in food processor and pulse several times. Add garlic and cheese/yeast; pulse several times more. Scrape sides of the food processor with a rubber spatula. Slowly add the olive oil, pulsing occasionally. Add salt and lemon juice and pulse until combined. Pour prepared pesto into ice cube trays to freeze small amounts that can be used throughout the winter months.