I guess the answer to that question depends on whether you are asking about understanding mental disease or mental illness. Just to clarify: Disease is a diagnostic term used to classify a pathological condition. Illness is more contextual. An illness is the subjective experience that arises from living with a disease. There are many published accounts of illness narratives written by people who live with a disease, but I don’t believe I have ever heard of a disease narrative. So back to the question: How well do we understand mental illness?

Through the written word 

Tom Ellis, PsyD, ABPP, recognized how noted psychologist Marsha Linehan courageously publicly disclosed her experiences with living with mental illness and suicidality. He called our attention to others in the field who have written eloquently about their own experiences with mental illness, such as Kay Redfield Jamison (An Unquiet Mind) and Norman Endler (Holiday of Darkness).

Many others also have shared their mental illness experiences,including Pulitzer Prize-winning author William Styron (Darkness Visible: A Memoir of Madness), poet Sylvia Plath (The Bell Jar), actress Brooke Shields (Down Came the Rain), attorney Terry Wise (Waking Up: Choosing to Die, Deciding to Live) and writers Joanne Greenberg (pen name, Hannah Green) (I Never Promised You a Rose Garden) and Julie Hersh (Struck by Living), to name a few.

David Lovelace (Scattershot: My Bipolar Family), Michael Greenberg (Hurry Down Sunshine), Patrick Tracey (Stalking Irish Madness: Searching for the Roots of My Family’s Schizophrenia) and Christopher Lucas (Blue Genes: A Memoir of Loss and Survival) have given us views into families’ experiences with mental illness.

Through the arts

Self-portrait with Bandaged Ear, 1889, by Vincent van Gogh

This is merely a partial listing of mental illness narratives. There are also many other genres that are readily available to help us understand the experience of living with mental illness. Who has not gazed upon a Van Gough self-portrait and not recognized distress and known it in a slightly new way? The photographer Michael Nye (Fine Line: Mental Health: Mental Illness) has given us a photo voice exhibit that profoundly captures the lives of some of the most vulnerable, poor, desolate people with mental illness.

Learning from the arts

The question is: How do we use these media to really understand mental illness? After all, it is in understanding something that it becomes less taboo, that the stigma is reduced.

I have a couple of ideas about this. First of all, what would happen if medical, nursing, psychology and social work educational programs made understanding the illness experience a core part of the curriculum? Programs that include courses in narrative medicine are aimed at training interdisciplinary clinicians in the art of using patient and family illness narratives to provoke reflection, empathy and compassion in the service of patient-centered care.

Second, what would happen if researchers applied narrative analytic methods to the published illness narratives? Lt. Cmdr. John Fleming, a psychiatric nurse practitioner in the U.S. Navy, and his colleagues conducted such a study of Michael Nye’s exhibit. Reports from such studies have the potential to stimulate future research in understanding how to incorporate the patient and family experience into clinical practice.

Next, what would happen if narrative medicine were included as a core component of continuing education programs? Such a development could help enhance the development of the therapeutic alliance by providing an additional lens through which to interpret the patient’s perspective. 

Regardless of the approach, the call to patient-centered care is a call to understand the illness experience. I believe in doing so we will be better informed about mental illness.

In the evening on July 8 we learned that former First Lady Betty Ford had died at the age of 93. Those of us who were around in the ’70s remember well the impact Mrs. Ford had on the country. She was known for being gracious, elegant, poised and outspoken, characteristics that don’t easily go hand-in-hand. Betty Ford was able to help create a shift in the country’s thinking about a number of issues that were socially taboo at the time by using the power of her position and her unique personal characteristics to compel us to think differently about many social concerns.

Former First Lady Betty Ford

Initially, she showed us how to blend wifely and motherly roles with the feminist movement. At every possible opportunity, she encouraged women to use their voices, communicate their opinions and take a stand. This was a very courageous stance for a First Lady to take in the 1970s. But much bigger challenges lay ahead for Mrs. Ford.

Sharing her story of survival

In 1974, Betty Ford was diagnosed with breast cancer. This was a time when it was still somewhat socially taboo for women to disclose a breast cancer diagnosis, sometimes even to their own family members. For many women, it was a shameful diagnosis. Because of the social stigma around breast cancer, it was considered unbecoming to discuss “female health problems.”

So how did we know that Betty Ford, First Lady of the United States, had a radical mastectomy to treat breast cancer? Because Mrs. Ford herself made this public. Why? She said she was concerned for the health of women, and that by disclosing her own diagnosis and treatment, perhaps more women would participate in breast cancer screening – and that is exactly what happened. The walls of shame and stigma around breast cancer cracked and soon came tumbling down.

Battling addiction

Mrs. Ford also suffered with painful arthritis. She became addicted to painkillers and alcohol, and in 1978, with her family steadfastly at her side, she admitted herself to a treatment facility. In keeping with her honorable approach to life’s difficulties, Betty Ford publicly announced her addiction. This stunned the nation. Mrs. Ford had broken the silence expected of women about such things.

She put the issue of women, drugs and alcohol on the table – actually the kitchen table. Her openness was discussed in homes all over the country at dinner time and when families watched the news together. Yes, there really was a time when people did such things. The walls of shame and stigma about drug and alcohol addiction cracked – but have not come tumbling down – not yet. This wall is strong.

Paying tribute

In tribute to Betty Ford, I believe it is our duty to bring those walls down! We need to do this by developing interventions and programs that are more effective than exist today. We can start by committing to using evidence-based approaches to treatment and applying improvement science and practice-based evidence to continuous advancement and by funding a robust plan of research to break through this debilitating condition. This would be our most enduring tribute to a real American hero, Betty Ford.

Editor’s note: For a related post by another blogger, take a look at “Remembering Betty Ford.” For other blog posts by Dr. Mahoney, check out:

• Do you want to be a jailer or a healer?
• Can we afford to tolerate the idea that jails and mental illness go hand-in-hand?
• Nature and nurture: Promoting an optimal healing environment in mental healthcare
• Blending grace, honor and resilience through healing relationships

Recently, I had the opportunity to give a talk to a group of psychiatric nurses about the environment of care. This group worked in public sector acute care psychiatric hospitals where the treatment goal is stabilization. In years gone by, these same institutions might have worked to develop the nurse-patient relationship and the patients’ sense of belonging. However, with the shortened lengths of stay and other factors inherent in the healthcare system, the focus has shifted to managing behaviors, biomedical stabilization and discharge.

Defining environment

One of the concepts that continues to be a part of the vernacular of psychiatric hospitals is the “milieu,” or environment. Historically, in psychiatric hospitals and therapeutic communities, the framework for a therapeutic milieu has included containment, support, structure, involvement and validation. In today’s acute care environment, the milieu focus is often on containment alone. The result is that nurses in these settings often feel like control officers because of the urgent need to maintain safety, and the nurse-patient relationship takes a back seat.

The talk I gave that day was focused on how to re-conceptualize the milieu from management, containment and control to one of a healing environment in psychiatric inpatient care. In both ways of thinking, safety is a priority. After all, how can anyone heal if they don’t feel safe? I talked about how the issue of safety becomes a point of contention when those charged with maintaining the safety of the patient view this as “being the bad guy” and patients feel like they are “being punished.” The question was raised: Do you want to be a jailer or a healer?

I suggested that these views are the result of how we frame safety situations. Reframed, maintaining safety is a healing activity. In the early stages of engagement, nurses who view safety as a prerequisite for healing orient the patient by explaining,

“You have come to us for help with some life difficulty. We will partner with you on this journey of recovery as we discover new ways to improve your situation. One of the first things we will do is create a safe place for you to do your work. It is often very challenging for people who enter treatment to build a safe environment. When this challenge is not met, therapy is sabotaged. We have learned how to create a safe environment to support treatment. There may be times when you do not agree with the structure we have in place. At those times, we should talk about the importance of safety in your life so that you can develop mastery in creating your own safe environment after you go home.”

Healing environments

That day, we talked about a healing environment based on our relationships with patients as well as each other and our other colleagues and how all are equally important. We talked about the need for healing places and spaces, self-reflection and intentionality, personal wholeness and healthy lifestyles; all are components of an optimal healing environment and the need to create a sanctuary for healing.

At the end of the discussion, every nurse in the room enthusiastically identified concrete ways they would apply the principles of a healing environment into their practice. They said they thought this mattered because thinking like this was energizing, not energy depleting as was the “control” model of care. To quote one participant,

“I love the idea of a healing environment. This puts me in touch with the heart of nursing and the reason I started doing this work in the first place, to help my patients.”

Benefits for the spirit

In a June 26, 2011, editorial published in the Houston Chronicle, Rabbi Samuel  Karff called our attention to the time-honored principle of the doctor-patient relationship. He contended that the doctor-patient relationship is a part of the spiritual dimension of care. I believe he would extend this to include the nurse-patient relationship and the relationships that all clinicians have with their patients. He suggested that relational practice is good for the spirit – both for patients and clinicians.  It was evident to me that the nurse who spoke up about the “heart of nursing” was talking about what is good for her spirit and the spirit of those for whom she provides care.

Editor’s note: To read one of Dr. Mahoney’s more recent blog posts, check out “Honor, grace and courage: a tribute to Betty Ford.”

It is no secret that the healthcare system in this country is in dire need of repair. In an effort to provide some direction related to this concern, the Institute of Medicine (IOM) published a number of reports known as the Crossing the Quality Chasm series to address issues related to patient safety and the fragmentation of health services. One of these reports was entitled Improving the Quality of Care for Mental and Substance Abuse Conditions. In it, the authors discussed the impact of stigma on people with a mental illness.

Stereotypes and stigma

The report identified two negative stereotypes that impact a person’s ability to receive the most appropriate care. The first stereotype is the misperception about the extent to which people with a mental illness are capable of making decisions about their treatment. The second stereotype relates to the erroneous belief about the extent to which people with mental illness pose a danger to themselves or others.

In the 5 years since the IOM reported on the quality of care for persons with mental and substance abuse conditions, not much has changed. This became crystal clear most recently when the Houston Chronicle published a story last month with the headline “As state cuts services, jails brace for influx of mentally ill.”

Jails are repositories for criminals who have demonstrated a threat to society. Currently, in Harris County alone, according to the article, approximately 25% of 10,000 inmates receive services for diagnosable mental illnesses. Placing the mentally ill in jails and prisons not only perpetuates the stereotypical erroneous belief about the extent to which people with mental illness are a danger to themselves or others but also increases the financial burden to society. The Houston Chronicle article reported the cost to the county for caring for the mentally ill behind bars was $27 million dollars a year.

Value of diversion programs

Jail diversion programs are sorely needed to address the social stigma problem, the financial problem and the allocation of appropriate services for the mentally ill. In 2006, the U.S. Department of Health and Human Services published a guide for mental health planning: Jail diversion: Strategies for persons with serious mental illness. Other federal agencies have published similar reports.

The time has come to take the recommendations of these agencies seriously. The Houston Chronicle highlighted such a program in Bexar County, Texas. According to the article, the jail diversion program saved the county more than $15 million a year. The cost savings are important, but so is the fact that the program provided appropriate services to the mentally ill.

As a mental health provider, I am outraged by the thought that society supports the notion that mental healthcare and jails go hand-in-hand. No other illness is relegated to the penal system. This represents the ultimate stigmatization of mental illness.

Colin Firth as King George VI

Sometimes we can learn magnificent lessons from historical films. The stories told often parallel modern challenges. Such is the case in the story of the film The King’s Speech. In the film we come to know about the plight faced by King George VI of England.

In a remarkable portrayal of the king, Colin Firth takes us into the private world of disability, frustration, shame and embarrassment as experienced by an historical figure and world leader. However, we are also exposed to the same man’s triumph over a disabling speech impediment. All stories of triumph in the face of adversity seem to hold some universal truths that are worth contemplating. While the story of George VI is concerned with his speech, I think some of the factors that play in his success can be applied to disabilities associated with emotional problems and mental illness.

Mythic journeys

The story of King George VI can be likened to Joseph Campbell’s myth, the Hero’s Journey. George, or “Bertie,” as he is affectionately called, is summoned to a great adventure, to become king following the abdication of the throne by his brother, Edward. Because of a severe speech disability that involves stammering, Bertie refuses the call. Nevertheless, a sense of obligation prevails, and he is thrust upon the world stage just prior to World War II.

Much like the hero in Campbell’s story, Bertie enters the “belly of the whale,” the place in his life where he hits a low point of despair and intense frustration due to his challenges with stutters, stammers and long pauses during public speaking. But it is also a place where he recognizes the possibility of something new, something great.

Healing relationships

During this time, encouraged by his wife, he begins to work closely with Lionel Logue, an eccentric speech therapist. His relationships with his wife and his therapist can be thought of a “healing relationships.” He travels the “road of trials” and ultimately achieves the goal of success. This is due, in no small part, to the grace with which he and his support system face the problem with a sense of honor. It is this grace and honor that form the foundation for strengthening the resilience needed to succeed.

Much like people with other illnesses or disabilities, people with emotional problems or people with mental illness also profit from being in healing relationships. Such relationships are critical to the development and sustainment of resilience needed to achieve wellness goals. This is a universal truth.

Family and friends can create healing relationships with people who are suffering from mental illness, but there is a crucial role for knowledgeable, capable and compassionate professionals to also participate in these relationships. I believe that when people recognize the power of the healing relationship, fear of being stigmatized because of a mental illness can be diminished. This is the work of mental health professionals.

Photo by D. Sharon Pruitt via Flickr

An age-old debate continues to thrive in science and in society about the cause of mental illness. In some circles this is known as the nature-nurture debate. Nature refers to the biological makeup of an individual. Today the focus is on the genetic, cellular and molecular levels of the person. Nurture refers to the environmental and interpersonal factors that influence human biology and behavior.

Bridging the gap between nature and nurture

A recent article in the New York Times called attention to epigenetic research. Epigenetics refers to the expression of the genome that does not cause a change in the DNA. It is believed that the study of epigentics bridges the gap between nature and nurture. This area of research has much to offer the field of mental health, as those of us who are dedicated to the care of persons with mental illness strive to identify more effective interventions to improve the lives of those who suffer with mental disorders.

When we consider the role of the environment on gene expression, it seems consideration would be given not only to the family and social environment in which patients live but also to the healing capacity of the environment in which patients receive care.

Creating healing environments

Nurses at The Menninger Clinic have been promoting the idea of an optimal healing environment in which nurses and other clinicians create an atmosphere of healing places and spaces that:

• promote awareness and positive intentions;
• personal wholeness;
• collaborative medicine;
• healthy lifestyles; and
• healing relationships.

The idea of an optimal healing environment was first developed by the Samueli Institute as a framework for all of healthcare. An optimal healing environment is one in which the physical environment that promotes the biological, psychological and social experiences of calm, comfort, and support is experienced by all people within the environment. Such an environment calls for strong relationship-centered care in patient: clinician and clinician: clinician relationships that are built on respect and appreciation.

What would happen if there was an ethical mandate to promote an optimal healing environment in mental healthcare? Is it possible that such an environment would maximize biological and psychological interventions and ultimately improve the quality of care for the mentally ill?

I was having a conversation with some colleagues the other day when someone asked a very intriguing question:

If we considered ourselves as protagonists in a book – our own life story – what would be the title?

This got me to thinking … at first I thought I would title the book “Trying to Make Lemonade.” Then I decided on “Loving Lemonade.” I think it’s a catchy title. I have to admit, I may have been inspired by the nearly 100 degree daily temperatures we have had in Houston this summer. What is better than a tall, very cold glass of lemonade on a blistering hot summer day?!

Simply perfect

I found the recipe for perfect lemonade online at Simply Recipes. Sure enough, it’s real simple – just lemons, sugar and water. Of course the trick is to get the ratios of the ingredients just right. But isn’t that always the case? Nothing is really that simple.

Lemons ~ sugar

Over at The Squiggle Sense, Scott Kelso and David Engstrom use the squiggle (~) to indicate complementary pairs, opposites that occur naturally and are connected intrinsically. Sweet (sugar) and sour (lemons) are complementary pairs. In the case of lemonade, you need the complementary pairs, sweet (sugar) and sour (lemons), plus water to blend the two.

I think “lemonade makers” are possibility thinkers – “what if” kind of folks. I like to think I am “making lemonade” when I try to change something negative into something positive. For example, what would happen if I give that grumpy guy a bright smile? Would his mirror neurons kick in and cause him to send a smile back my way? I certainly would rather that happen than find myself sending back a frown.

Now, I don’t want to sound Pollyanna-ish about this because I have really grumpy days, too. It’s just that there are so many possibilities for things to be better. I became curious about the opposite of stigma. I confess I had to look up the antonyms. I found several, but the two I like the best are honor and grace. Why these? Because, in addition to other definitions, to stigmatize is to dishonor or to disgrace. So the question is this: How do we “reframe” a situation in which a person is disgraced and turn it into a situation of grace?

Something to contemplate over a cold glass of lemonade!

We have been writing for some time now trying to get out the message that it is time to say “no” to stigma. Since stigma carries personal pain and suffering, which is particularly true of persons who suffer with severe and persistent mental illness, I thought it might be useful to reflect on at least one historical fact about what stigma means.

Defining stigma

The Professor and the Madman: a Tale of Murder, Insanity and the Making of the Oxford English Dictionary by Simon Winchester begins with a scene that took place in 1872 in Lambert Marsh, a less than desirable section of London. A young worker, George Merrret, left his home where his wife and young daughter slept to work the night shift at a local brewery. On his way he was shot and killed by a man wearing a mask and yelling furiously in a fit of paranoia.

William Chester Minor was arrested for murder and taken to jail. Later it was learned that he was an American, a qualified surgeon and a former military officer. Dr. Minor was found not guilty of murder by reason of insanity under the McNaughton Rule, which stipulated that someone who commits a crime yet cannot tell right from wrong must be considered not guilty by reason of insanity. (This rule of law still governs prosecutions in the State of Texas today.) The judge sentenced Dr. Minor to the Broadmoor Criminal Lunatic Asylum.

As it turned out, Dr. Minor had served as a surgeon in the Union Army during the Civil War. As part of his duties, he was ordered to brand the cheek of deserters with a D. This particular duty caused Dr. Minor incredible distress, and ultimately, the Army discharged him because of mental instability. Following the war he was admitted to St. Elizabeth’s Hospital, a mental hospital. Later he traveled to England to quiet what he experienced as an “inflamed” mind. The next year he shot and killed George Merret.

One man’s contribution

Dr. Minor was a lover of books, and his hunger for them led him to correspond with London booksellers while he was at the Broadmoor Asylum. Through his correspondence he learned of a call for contributions to what would later be known as the Oxford English Dictionary. He contributed scores of definitions with supporting phrases, examples and historical references. It wasn’t until quite some time later that the editor of the Oxford English Dictionary became aware of Dr. Minor’s history and situation.

Dr. Minor

One of the definitions submitted by William Minor was stigma: to mark or to brand. The man who was ordered to brand other men was faced with living a stigmatized life, a life in which he was branded by society as a deviant.

The irony of the story is sobering. It raises many moral and ethical concerns related to stigma. There is a need to protect society from violence and to protect victim’s rights.

The real struggle seems to be how to accomplish this while simultaneously addressing such concerns as appropriation of mental health services, mental health social policy, social justice and the recognition of strengths, not merely weaknesses, among all people.

When Dr. Minor was placed in mental health institutions, the conditions were deplorable. There were no sound treatments for mental illness in his day. Despite this, he was able to make significant contributions to the development of the Oxford English Dictionary, an important literary work.

Today, thanks to neurobiological advancements and an understanding of therapeutic factors that lead to recovery, there is hope for people with mental illness. But hope is elusive for those who live in a world in which the pain and shame of social stigma outweighs the yearning for wellness.

You know how sometimes you have a couple of seemingly unrelated experiences and awhile later you make a connection between them? Serendipity! Well, recently, this happened to me.

Pride, prejudice and honor

Men of Honor, starring Robert DeNiro and Cuba Gooding Jr.

I was watching Men of Honor about a week ago. I have always enjoyed the hero’s story in this movie. In spite of all of the obstacles thrown before Carl, he triumphs! At the beginning of the movie Carl meets Jo, a librarian, and is really “taken” with her. Jo is an utter snob, who haughtily (pride) asks Carl about his education. He tells her he has not finished high school. She announces that she is too busy for him. She has high ambitions to go to medical school, and she can’t be bothered with someone who lacks education (prejudice). Undaunted, Carl surprises Jo with one bright flower. She smiles. Carl “melts” her pride with one simple flower, and a true-love life-long commitment is born. In that moment, her pride and prejudice dissolve—the rest is history.

Later, Carl meets up with his Master Chief who lets Carl know, in no uncertain terms, that he will never be a master diver in the U.S. Navy because no black man has ever accomplished this—and basically this isn’t going to happen on the Master Chief’s watch either (prejudice). Carl retorts, “I am making something of myself, Master Chief” (pride).

I realized as I was watching the movie that pride can come in two forms: the arrogant, disdainful, haughty form and the pride that comes from a healthy sense of self-respect. Prejudice is always the same – it just closes the door.

Pride, prejudice and a Pulitzer

A few days later I started reading To Kill a Mockingbird with my 14-year-old granddaughter. I thought this could be a great bonding moment for us, especially since this the 50^th anniversary of this Pulitzer Prize-winning novel, but I digress.

In one scene, Tom has been taken to jail accused of raping a white girl. Atticus, Tom’s lawyer, is sitting guard outside the jail anticipating there might be trouble for Tom. Sure enough, trouble comes knocking. A mob of townsfolk

Gregory Peck starred as Atticus in the film version of To Kill a Mockingbird

descend with a vengeance (prejudice). It is Atticus against the mob, and the odds are not in his favor. He tries to reason with the group, but has no luck. Scout, Atticus’ young daughter, stumbles onto the scene and suddenly realizes that she and Atticus are over their heads. Then she remembers her mother’s advice about how it helps to talk with people about what they are interested in. So, she starts cheerfully greeting one of the men, mentioning that his son is in her class at school. She continues talking about his son, how they get along, and how he’s doing in school. Basically, she talks to the man about something important to him. The man eventually loses enthusiasm for going after Tom and tells the mob, “Let’s go.”

I started thinking that this was another way to “melt” prejudice, even if only temporarily. Atticus puts his arm around Scout, and they walk home together. You can picture the pride Atticus feels about Scout in this very moment.

Pride, prejudice and the military

The next day I was driving to work listening to NPR. Army Vice Chief of Staff General Peter Chiarelli was being interviewed about a study the Army had conducted related to suicide in soldiers. The general talked about all of the stresses related to deployment, but he also talked about the stresses of being a young adult in today’s world. He mentioned the common factors of trying to make it in a world of economic uncertainty and inflation. He talked about drug use and family discord and many other real life problems that soldiers face each and every day. He also mentioned the stress many soldiers face from living in a military culture in which pride often overrides compassion for those with mental illness (prejudice). He assured the public that is changing.

The next news segment featured a report about the Tragedy Assistance Program for Survivors (TAPS). I was so taken aback when I heard a young widow interviewed about her husband, who died by suicide while the family was on vacation at Disney World. I tried to imagine the shock, trauma and grief that young family experienced. She talked about how she and her children were ostracized (prejudice). Then she found out about TAPS, which she and her children began to participate in. She spoke about being honored as a family whose deceased family member was appreciated for his service. They began to heal because someone honored their loved one. Nothing more, nothing less. I started thinking that honoring someone in this way is another method some people have used to help “melt away” the stigma surrounding suicide.

Connecting these three stories underscored for me the need for all of us to find novel ways to melt away hurtful pride and prejudice in so many areas of life. All three stories highlight some way a person changed a situation for the better through making a positive human connection. The case of the TAPS story is an example of how healing relationships can foster dignity and respect and dissolve stigma in real life, not just in books and movies.

We’re all familiar with the expression “the straw that broke the camel’s back,” which Charles Dickens coined in Dombey and Son. Humans are resilient creatures, but we all have limits to our ability to endure under pressure.

In the past, we thought resilience was a product of a strong will. However, neuroscience and other areas of research have provided us with a fresh new lens through which we are able to better understand our limits. This knowledge is freeing–it allows us to be free from the self-imposed stigma Tom Ellis, PsyD, ABPP, referred to in an earlier post.

This self-imposed stigma can be the result of our internal narrative that speaks about the need to be stoic and shoulder all adversity that comes our way. When we find that we are not able to hold true to this narrative, we often believe that we have failed. In thinking this way we relegate ourselves to the margins of society and fulfill the new narrative of “being less than.”

Allostatic overload

The scientific term for “the straw that broke the camel’s back” is “allostatic overload.” This refers to one becoming ill as a result of the chronic over activation of the body’s regulating systems–some of which are voluntary, and some of which are not.

We have often thought of the human physiological regulatory systems (the body’s components for keeping us healthy) as being somewhat independent. For example, we might have focused on the health of the heart and not realized the interplay of the cardiovascular system with the other systems in the body.

Medical scientists who study allostatic overload understand that the human body is much more complex. This new way of thinking is based on a “whole body” view about health. Our own unique genetic and biological makeup interacts with the biology and minds of other people and with the external environment in often fairly unpredictable unique ways.

Understanding stress

When our narrative speaks about the need to be stoic and “hold up” under pressure, we are basically saying that there is only one answer to handling our stress, and that if we do not rise up over adversity, we have failed. In doing so, we do not recognize that our physiology also plays a role in how we manage stress.

While some medical professionals overemphasize the biological aspects of stress, others tend to focus only on the psychological aspects of “the mind.” We have all heard people say, “It’s all in your head.” Instead, it would be more helpful to remember that the “whole body” is made up of both body and mind and that these are not separate parts of the whole.

The whole body can only take so much pressure before it gives out, regardless of how “strong” we are psychologically or physically.

Stress and mental illness

The concept of allostatic overload gives us a new approach to thinking about the complexity of stress which is often manifested as mental illness. It helps us realize that internal body mechanisms beyond our complete control are also at play in our reactions to events that cause us stress. Furthermore, this way of thinking helps us understand the importance of interacting with others in a healing environment.

When we develop this awareness, we can see the importance of reaching out to mental health professionals who have experience in helping shape new healthy narratives, ones that can influence body functions in a positive way. This can result in a shift from a self-imposed state of stigma to one that helps us interpret a situation without guilt and failing. The new narrative has the potential for placing us more fully in healing relationships with others, rather than isolated on the margins. Being in healing relationships provides a person with added support to carry the “last straw.”