Part 1: A Beginner’s Guide to Mental Health & Mental Illness

Editor’s note: The information contained in this series is based on reputable medical studies, training and knowledge gained supporting others, and the authors’ own personal experience. However, we advise readers to call a crisis hotline or seek professional help to address their unique personal circumstances.

We’re so glad you’re here. 💛

Anxiety. Depression. Stress. Uncertainty. Sleeplessness. Isolation.

Mental health and mental illness are tough subjects to talk about, especially in the midst of a global pandemic. Like the emotionally charged debate about how to pronounce GIF¹ (“gif” or “jif”?) there is much debate about mental health, what it is, and how to improve it—not the least of which is how to talk about it. And it’s far more serious than a silly pronunciation debacle.

Performant Mental Health is a five-part series designed to ignite greater awareness of mental health issues at home and at work, encourage more candid conversation on the topic, reduce the stigma associated with mental illness, and improve mental performance at home and at work. Written for everyday people by everyday people.

We, your authors, are everyday people just like you. We’ve been impacted directly or indirectly by mental illness, misperceptions, and misinformation. Yet we’re fortunate to have had experiences that uniquely position us to write this series. For example, we have years of professional experience in some of the most demanding corporate tech environments, behavioral and mental health experience counseling adults and juveniles impacted by mental illness, and nearly 40 years combined experience raising children (10 kids among us!).

We’ve also invited more than a dozen guest authors to share their insight and personal experience. You’ll hear from them later in the series.

Ready? Let’s do this.

Mental health = mental performance managed well

For the purposes of this series, we will use “mental health” to refer to a relatively stable, productive state in which you (or the person you support) manage your mental performance well. It does not mean you’re “depression free” or have zero anxiety issues, but rather you don’t feel overly disempowered as you manage daily any symptoms you’re be experiencing.

But let’s be honest, there are as many definitions of health as there are agencies and organizations trying to address it. What’s most important is that you recognize your own sense of well-being and that you feel empowered to course-correct or get help when your condition deteriorates.

Assessing mental health begins by asking these fundamental questions:

1. Am I comfortable with where I am today?
2. If not, where do I want to be?
3. What do I need to know and do to get there?

This series will help you answer these questions for yourself and for others.

Mental illness = on-going impaired mental performance

For the purposes of this series, we will use “mental illness” to refer to an impaired or disease-like state of mental health which is on-going or persistent. Just as physical illness has varying degrees of severity, the symptoms of mental illness vary widely such as occasional depression and high-functioning anxiety, to dementia and bi-polar disorder. However, in this series we do not limit the use of the term to describe only those who have been clinically diagnosed as being “mentally ill.”

We also acknowledge that there are semantic differences between the terms “illness”, “disease”, and “disorder”, but describing these differences is beyond the scope of this series.²

“Awareness Anchors”

Our series will be grounded in the following “anchors” or guiding principles to create greater awareness of mental health issues. We’ll post them here without commentary but will revisit them throughout the series.

Awareness Anchors ⚓

The prevalence and invisibility of mental illness

“I feel like I’m dying inside. It hurts. Nothing helps so I will just keep it to myself. It seems better for everyone that way.” These are the words of a young friend of ours who suffers from severe, paralyzing anxiety. He’s learned to bury the pain and muscles through it as if everything is OK. Everybody who knows him loves him, yet they have no idea he’s dying inside.

Michael Phelps, the most decorated Olympian in history and one of the most performant athletes in the world, also suffered silently for years. In 2018 he began opening up about his mental health struggles and the stigma of getting help. At one point he seriously contemplated suicide. Now grateful he didn’t take his own life, Michael is reaching out to help others as an advisory board member for Talkspace, an online counseling service, and by talking openly about his struggles.

Having been through the darkest of dark, Michael has learned to manage his depression and maintain peak mental performance. The message he wants everybody to understand is it’s OK to not be OK.

The prevalence of mental illness has been increasing at significant rates in recent years either because the number of reported cases (like Michael Phelps) is increasing, or our ability to diagnose mental illness is improving, or both. Some attribute the increase to social media, others attribute it to world events, while others attribute it to complexities in a country’s healthcare system, and so on.

In this series, we won’t delve into precisely what’s causing the increase in mental illness. However, consider just a few data points that demonstrate how much mental illness is impacting the world:

• About 1 in 10 people globally live with mental illness. Experts believe the rate may be even higher due to underreporting.³
• About 1 in 5 of the world’s children and adolescents suffer from mental illness.⁴
• About 1 in 7 moms and 1 in 10 dads suffer from postpartum depression.⁵
• The World Health Organization estimates that “depression and anxiety disorders cost the global economy US $1 trillion each year in lost productivity.”⁶ In the U.S. nearly one quarter of the workforce experiences a mental health or substance abuse issue each year.⁷
• Globally nearly 800,000 people die from suicide every year. “That’s one person every 40 seconds. Due to the stigma associated with suicide—and the fact that it is illegal in some countries—this figure is also likely to be an underestimate, with some suicides being classified as unintentional injuries.”⁸
• High school students who identify as lesbian, gay, or bisexual are almost five times as likely to attempt suicide compared to their heterosexual peers.⁹
• American adults suffering from serious mental illness “die 25 years earlier than other Americans on average, because they simply don’t seek or receive treatment that could prolong life.”¹⁰

Chances are you, a loved one, or a colleague is suffering from mental illness. And you might not even know it.

Physiology 101 of mental performance

True story: while the brain may not be the root cause of all mental performance issues (more about that in a moment) it plays a pivotal role in your overall well-being, both mentally and physically.

Imagine you work in Hong Kong but live in New York. To leave for work you have to get on the freeway, pay a few tolls, get instructions at the ticket counter, go through security, navigate to the terminal, and fly to Hong Kong via several layovers where you have more instructions and connections. And you do the entire process in about one second.

Nothing could possibly go wrong, right?

Sometimes our brain, for different reasons, misses a connection in the figurative process of getting something from point A to point B. Neurotransmitters, or chemical messages in the brain, play an important role in this process. When a connection is “missed” a neurotransmitter might not be used to its full potential and our brain does not produce the intended response. Or the neurotransmitter may be overused and incite an inappropriate response.

When a person is unable to function properly or return to a healthy state, it’s often due to the malfunction of neurotransmitters. This is why many mental illness treatment methods and medications are designed to improve or repair brain function via neurotransmitters.

Types of neurotransmitters include:

• Glutamate: the most common neurotransmitter with a wide variety of roles in brain function. Glutamate is believed to be linked to many forms of mental illness when the brain cannot produce or utilize it properly.
• Serotonin: sometimes referred to as the “happy chemical” because it is believed to help control mood, appetite, and sleep. Research shows those suffering depression, among other mental illnesses, have lower levels of serotonin.
• Dopamine: helps control movement and emotional responses. Research shows lower levels of dopamine in those suffering depression, and it also believed to be related to Parkinson’s disease, attention deficit hyperactivity disorder (ADHD), psychosis, schizophrenia, and other types of mental illness.
• Other neurotransmitters which you can read about here and here.

Neurotransmitters rely on neurons to transmit messages through electrical impulses. Neurons are the fundamental unit of the brain and nervous system. Synapses are tiny gaps (or conduits) between neurons where a neurotransmitter moves from one neuron to another. Brain function between neurons, synapses, and neurotransmitters (and other components we haven’t even mentioned) is incredibly complex and happens at lightning speeds. Is it any wonder, then, that things may go awry in this process? If they do, it may contribute to or result in mental illness.

Now, about the brain being the root cause of mental performance issues…

Aren’t mental disorders really brain disorders?

Not necessarily, but they may be.

In Mental Health Disorders Sourcebook, Sixth Edition (2016)—one of the guiding resources used for this series—the editors make the case that “through research, we know that mental disorders are brain disorders.”

As it turns out, this statement isn’t regarded as universal truth. Psychiatrists and doctors disagree on the link between mental disorders and brain disorders. Here’s the gist of what contributes to the disagreement:

• Because mental illness is currently diagnosed by symptoms primarily, we can’t pinpoint the brain as the root cause of mental illness with 100% accuracy. We can only infer it in most cases. “Unlike some disease diagnoses, doctors can’t do a blood test or culture some microorganisms to determine whether a person has a mental illness. Maybe scientists will develop discrete physiological tests for mental illnesses in the future; until then, however, mental health professionals will have to diagnose mental illnesses based on the symptoms that a person has.”¹¹ Said another way, “not all mental disorders have an underlying detectable neuropathology”¹² and we lack “objective biomarkers that adequately define most psychiatric/mental disorders.”¹³
• The most reliable analysis for assessing something is ‘wrong’ is often the person themself, not science. “The manifestation of [mental] illness occurs at the level of observable behaviour and felt experience,” writes Dr. Natalie F Banner of the Centre for the Humanities and Health, King’s College London. “Indeed, in no other medical discipline is the subjective experience of the patient quite so crucial to diagnosis and the aims of treatment.” Dr. Banner suggests that “in focusing the attribution of disorder on the goings on in the brain, we are missing the essence of what is going ‘wrong’ for the individual attempting to get on with his or her life” and we may discredit other factors in their lives that may not be directly correlated with brain function such as one’s environment.¹⁴
• Where medical and psychiatric professionals do agree is that mental illness is typically a result of a combination of factors that are biological, psychological, and environmental.¹⁵ Some examples:
  • Biological – genetics, prenatal damage, substance abuse, poor nutrition, etc.
  • Psychological –trauma, neglect, low self-esteem, etc.
  • Environmental – death of a loved one, changing schools, societal expectations, etc.

Regardless of any disagreement, surely we can all appreciate that mind and body are holistically intertwined. “The mind and body are inseparable,” writes Christina G. Hibbert, PsyD, in her book 8 Keys to Mental Health Through Exercise (great book, we’ll reference it later in the series). “The mind and body greatly influence and are influenced by one another and should be treated as such.”

If you’re curious how mental health professionals evaluate symptoms and diagnose mental illness, many rely on criteria published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Published by the American Psychiatric Association, the DSM-5 is essentially a handbook of symptoms and correlated diagnoses. Globally it’s considered to be the foremost source for classifying mental illness.¹⁶

A canvas of mental illnesses

You might be surprised by what constitutes a complete canvas of mental health issues. Depression, for sure, but also binge-eating, gambling, psychosis, ADHD, and much more.

We’ll focus primarily on the two most common forms of mental illness globally—depression and anxiety—but we’re confident the resources we provide in this series will be applicable to many of the illnesses listed below. We credit Mental Health Disorders Sourcebook, Sixth Edition for informing our summaries that follow.

• Addictions: alcoholism, substance abuse, etc. Addictions often accompany, amplify, or are triggered by other illnesses in the list below.
• Anxiety: this category is difficult to summarize as the complexities of anxiety disorders are very diverse and every human being naturally experiences anxiety. However, common disorders include (a) severe anxiety in which an individual experiences excessive, irrational fear for an extended period of time, (b) panic disorder i.e. “panic attacks” that are sudden and/or repeated attacks of catastrophizing¹⁷ current or future situations, (c) obsessive-compulsive disorder (OCD) wherein someone is overly obsessed with “double-checking things”, rituals, and even hoarding, and (d) social anxiety disorder marked by extreme difficulty navigating social situations.
• Attention deficit hyperactivity disorder (ADHD): elevated levels of difficulty focusing or paying attention, more common in childhood but may continue into adulthood.
• Autism spectrum disorder: a category of development disorders marked by persistent challenges with social communication and interaction, repetitive behaviors, lack of responsiveness, and even sensory sensitivity.
• Bi-polar disorder: dramatic shifts in mood, energy, and activity levels that are marked by intense “mood episodes” in which a person is extremely joyful or extremely sad or depressed.
• Dementia: a category of cognitive symptoms that affect mental performance especially memory, with Alzheimer’s disease being the most common cause of these symptoms.
• Depression: persistent feelings such as sadness, hopelessness, irritability, loss of interest, decreased energy that interfere with daily life and normal functioning. Includes illnesses such as postpartum depression after child birth (both parents) and seasonal affective disorder (SAD) during winter months when there is less sunlight.
• Eating and body image disorders: diagnoses include anorexia (under-eating), bulimia (over-eating), binge-eating, body dysmorphic disorder (BDD) which is marked by obsessive thoughts about bodily imperfections perceived or real, and emotional eating.
• Impulse control disorders: examples include trichotillomania (pulling out one’s hair), self-harm (such as cutting), gambling addictions, and other behavioral disorders.
• Post-traumatic stress disorder (PTSD): a wide range of symptoms that impair one’s well-being immediately after, and even years after, a traumatic event.
• Psychotic disorders: generally these include psychosis (a loss of contact with reality), schizophrenia (an extended loss of contact with reality), and schizoaffective disorder (similar to schizophrenia and sometimes described as dreaming while awake).
• And many more. Here’s a pretty exhaustive list.

Please note that we’ve avoided using the word “problem” in the list above. These illnesses are real, legitimate challenges for the individuals experiencing their symptoms. In many cases it is beyond their ability to control or eliminate these symptoms. Further, there are many positive symptoms that result from these illnesses, such as above-average intelligence common to autism.

The stigmas of mental illness

Oh how the current societal stigmas of mental illness break our heart! Here are just a few examples:

• Mental illness is just all in the head. “This phrase captures one of the key problems with the notion that … because [someone’s symptoms] are ‘mental’, they either do not really exist, or they should be able to be controlled or ameliorated by the person if they only tried hard enough.”¹⁸
• Mentally ill people are dangerous. In reality, “very few people who have a mental illness are dangerous to society. Most can hold jobs, attend school, and live independently.”¹⁹
• You can get over mental illness if you just get on with life. You know like just get out of bed or do something to cheer you up. Wow. A lot to unpack here. Suffice it to say mental illness is often accompanied by serious physical side effects, making it difficult to simply “get on with life.”

Later in this series we will address in greater detail these stigmas and others—and help each of us not perpetuate them.

There is hope for you 💛

No one is immune to mental illness. The strongest athletes, the smartest scholars, the most productive employees, you, us.

Because of this we contend that mental illness deserves the same exposure and attention as any other physical illness be it cancer, diabetes, high blood pressure, etc. Sadly, today there’s very little in the way of “mental illness survivor” ribbons or walkathons or other recognition in comparison to other illnesses. But we anticipate this will change in the near future.

Whatever the trigger or source of mental illness, and whether or not it’s a temporary episode or a lifelong battle, we know intimately that it can wreak havoc in your life. We know that sometimes it can be absolutely terrible, no bones about it. Yet if there’s a silver lining to the rise in mental illness, it is the correlated rise in awareness, treatment, and even compassion in the workplace.

There is hope. There is help. You can indeed go from surviving to thriving! We don’t brush aside the fact that some days you’ll do everything you can just to put one foot in front of the other or simply to get out of bed. But we attest that thriving performance can be within arms reach as you equip yourself, loved ones, and colleagues with the help you and they need. This is the aim of our series.

Lastly, a note about suicide

We don’t take lightly the fact that mental illness may lead to suicide. If you’re experiencing suicidal thoughts and especially if you feel a desire to act on these thoughts, we strongly encourage you to call a crisis hotline or go to your nearest emergency room. Or at the very least start by opening up to a trusted friend or advisor.

Yet, we also want to acknowledge that—much like the stigmas we mentioned earlier—society often falls short in understanding the factors that lead to suicide, in expressing greater compassion for those with suicidal thoughts, and in fostering an inclusive environment for discussing suicide more openly (and without fear of legal intervention). We encourage you to read this Facebook post from Cameron where he shares a few things lacking in the discussion about suicide prevention. You can also contact us if you feel you have no other resource or support network to turn to.

We’re so glad you’re here.

Part 2 →

We also offer virtual training for your team on understanding mental health and improving mental performance at work. Please contact us to schedule.

About the Authors