The Self-Healing Mind

An Essential Five-Step Practice for Overcoming Anxiety and Depression, and Revitalizing Your Life

Gregory Scott Brown, M.D.

• Editorial: Harper
• Año: 2022
• ISBN:
  9780063094499
• Categoría: Personal Development
• Categoría: Mental Health & Wellbeing

Self-care is a powerful, evidence-based medicine for the mind.

Mental health is the driving force behind every decision we make—how we live, work, and love. Many of us suffer from depression and anxiety, which impede our choices and quality of life, and despite the proliferation of prescription drugs, the numbers are growing across the globe. But there is another, proven way to achieve mental wellness, beyond antidepressants and talk therapy. Practicing psychiatrist Gregory Scott Brown believes that mental health begins with actionable self-care.

The Self-Healing Mind is a holistic approach to emotional and psychological healing that focuses on how evidence-based self-care strategies can be used to improve and sustain mental health. Dr. Brown challenges the current state of mental health care and the messaging around it, showing us how to move past outdated notions of "broken" brains and chemical imbalances. While he agrees that prescription drugs and talk therapy in many cases are important for healing, his personal and professional experience has taught him that lifestyle interventions are also key to sustainable mental wellness.

Dr. Brown's clinical philosophy supports an integrative approach that combines conventional treatments (medication and psychotherapy) with what he calls the Five Pillars of Self-Care: breathing mindfully, sleep, spirituality, nutrition, and movement. These purposeful lifestyle practices, backed by science and proven in his clinical practice, can be adopted by everyone. Dr. Brown's advice and insight put the power of healing back in your control.

Part I

A Change in Perspective

Chapter 1

Redefining Mental Health

Start where you are. Use what you have. Do what you can.

—Arthur Ashe

Most of us avoid talking about mental health—that is, unless we’re sitting on a therapist’s couch looking for advice. Even if you’ve never been there personally, I’ll bet you know someone who has. Maybe it’s your son or daughter—or your husband, girlfriend, or dad—and you’re wondering how you can best show love and support. It’s also possible that you’re asking yourself: How does a playbook about mental health and self-care relate to me? Years before I became a psychiatrist, and spent time studying the mind, I would’ve asked that same question.

Now, I have come to realize that mental health is the driving force behind every decision we make; how we live, work, and love. But most important, achieving mental health begins with actionable self-care. Let’s start by moving beyond the idea that self-care only translates to ritzy spa dates or expensive organic foods.

In fact, self-care, approached the right way, is a powerful evidence-based medicine for the mind. You just have to learn how to tap into it. There have been times when I’ve spent years working with patients, exploring different types of therapies, and looking for the perfect prescription, when ultimately the cure is in simple techniques that we so often take for granted—self-care practices like sleep, breath work, nutrition, movement, and spirituality. The challenge is learning how to fully utilize these skills in a way that feels doable. It’s a process I’ve seen unfold in my own life, as well as with patients like John.

The first time I met him, he was in his mid-fifties, and sitting anxiously in the waiting area of my office. John was wearing a heavily starched button-down shirt and designer jeans. I could see him clutching a can of sparkling water in his hand, and he exuded a cool dad kind of vibe. Frankly, he looked like he’d rather be anywhere else than in that chair. From my office door, I could see John relentlessly scanning the perimeter, as if he were afraid that he might run into someone from work.

John drove a sports car, ran marathons, and was a total technology geek. By the time I called his name, he was a nervous wreck. To be honest, that’s not uncommon. I get it. Many people don’t know what to expect the first time they meet with a psychiatrist, and that uncertainty can lead to a lot of fear. For some people, an hour a week conversing on the therapy couch is just part of what you do as a responsible adult: Eat three meals a day, go to the gym, show up to work on time, and have a reliable shrink on call just in case. Most of us, however, don’t fall into that category.

John was afraid that an appointment with any mental health professional, which included meeting with me, would mean he had officially “lost his mind,” and from that point forward, there’d be no turning back. Because of this fear, he completely avoided the couch where my patients usually sit, and he was also careful not to make eye contact with me as he passed it—a gesture that brought a subtle but empathetic smile to my face. Instead, he took a seat at a small round table in the corner of my office. So I pulled up a chair and sat across from him.

Before I could introduce myself, John shifted back in his seat and said, in a calculating tone, “Okay, Mr. Brown. Fine. Maybe I’m drinking too much.” He was intentional about not calling me “doctor,” probably to create even more distance from becoming an official “psych patient.” It didn’t bother me, so I just went along.

“Well, nice to see you,” I said.

“Sorry,” he said, with a sweeping gesture of his hands, belying his discomfort. “I’m John. Hi,” he continued and extended a firm handshake.

“So how much drinking are we talking about?” I asked.

“I don’t know,” he replied. “A couple of beers every day. Maybe more.”

“Did you come here on your own?”

“Yeah, I did,” he said. “Well, I mean, I brought my wife with me. But she didn’t make me come,” he replied motioning toward the door.

After spending the hour speaking with John, it became clear he came to see me that day only to appease his wife, because as he put it, “I love her, but she’s the boss.”

However, her concerns aside, he didn’t really think he had a drinking problem. He did acknowledge work was increasingly stressful; he was spending more time alone, and he enjoyed winding down at the end of the day with a few beers. What was wrong with that? Eventually, John’s wife, with his permission, joined the conversation. She mostly agreed with his assessment, but she said his feelings of stress were negatively affecting their marriage, as well as John’s relationship with extended family and friends. He hadn’t told me that.

So, here was my dilemma: Was John mentally ill?

John would be the first to tell you he absolutely was not; he made good money, he had a beautiful family and loyal friends, and he was self-sufficient. The idea that he might have a mental illness was simply out of the question for him; in fact, he interpreted it as being on the verge of insulting. As for professional opinions, if you put five psychiatrists in a room, you would likely hear five different opinions about whether or not he met criteria for a particular psychiatric diagnosis, and if he did, there would surely be some colorful debates about which one. Regardless, it was obvious to me that John wasn’t well. He freely acknowledged he was not living his fullest life, because he was drained, was stressed out, and wanted to feel better than he did. He was coping with the stress of a demanding career with alcohol, and his wife was concerned by the toll it was taking on their family. It was important to them both that things changed for the better.

Over the next few months, our discussions revealed that John was not only drinking too much, but he was also struggling with some mild symptoms of depression, like having a hard time falling asleep at night, feeling tired during the day, and often losing his train of thought at the office. He was sleeping downstairs on the couch most nights with a Netflix series on auto play in the background, and sex with his wife was essentially nonexistent; he just wasn’t “in the mood” anymore.

Drinking provided quick relief by slowing down his thoughts and allowing him to feel detached. It was an easy escape from reality that in the moment made him feel better, but the effect wore off quickly and he found himself wanting to “go there” more often, even throughout the day. Despite his admissions, he still didn’t exactly fit into the defined criteria for major depressive disorder. That didn’t mean I couldn’t help him, because definitions and semantics, especially when we are talking about heavily stigmatized topics like mental illness, too often pose a barrier to treatment. Even if John didn’t fit neatly into a diagnostic box, there were still ways to improve his mental health.

Understanding the Difference Between Mental Health and Mental Illness

Have you ever thought about the difference between mental health and mental illness? Most people haven’t. Understanding the distinction between the two is an important step for activating your self-care playbook.

Mental health isn’t just another term for mental illness; instead, I’d like you to think about mental health as the state of living with purpose, balance, contentment, and hope. This way, you can also see why your lifestyle choices play a vital part in supporting your own mental health.

The American Psychiatric Association (APA) defines mental illness as “health conditions involving changes in emotion, thinking, or behavior (or a combination of these) . . . associated with distress and/or problems functioning in social, work or family activities.” While the Diagnostic and Statistical Manual of Mental Disorders (DSM), the psychiatrist’s diagnostic guidebook, lists symptoms linked to specific mental illnesses, it quickly becomes apparent that it’s missing some situations that would cause many of us serious emotional distress. For example, there is no diagnosis for loneliness, or neglect—and no diagnosis for feeling like you don’t have a purpose. Although these are not mental illnesses, per se, they can have a profound impact on your mood and your life. That’s why it is so important to think beyond common perceptions of mental illnesses when considering whether or not paying attention to your mental health is worth your while. It’s something all of us need to pay attention to. Your ultimate intention, and mine, should always be pursing mental health.

If I asked you about “mental health” on the fly, you might start reciting a list of diagnoses that fit into the APA’s definition of mental illness without even knowing it: depression, anxiety, bipolar disorder, substance abuse, or schizophrenia. You might also refer to a popular movie or book that features someone struggling with mental illness, like Silver Linings Playbook or Girl, Interrupted—or even bring up a completely fictional character like Sherlock Holmes or Batman’s nemesis, the Joker. Some people may even start talking about a friend or loved one who has been diagnosed with a mental illness. There’s good reason for this. Someone starts talking about mental health and our mind immediately goes to everything that could go wrong with it—instead of what can go right.

After spending hours in conversation with my patients, as well as learning from my own battle overcoming depression, I personally understand that mental health means that your mind is firing on all cylinders, giving you both the confidence and the ability to achieve your intentions, whatever they may be. It’s about overcoming challenges and embracing joy. Simply put, mental health is the mode of being that each and every one of us should be working to pursue, not only to prevent the potential onset of mental illness but to live richer and more fulfilling lives.

It’s not any different from the distinctions we make between physical illness and health. Most of us now understand that there’s no sense in waiting to get sick to take care of our bodies. We work toward physical health, whether by improving our diet, cutting back on alcohol, or regularly going to the gym. There’s more to our efforts than just wanting chiseled abs or toned arms—though both are definitely nice to have. It’s about doing the things we need to do to feel our best.

One glass of green juice or a couple of rides on a spin bike isn’t going to get you to that optimal state. Acquiring physical health does not happen overnight. It’s something that requires ongoing work and maintenance. No matter how in shape you may be today, if you don’t continue to pay attention to what you eat and find time for movement, you may find yourself at risk for chronic health conditions like high blood pressure, heart disease, or diabetes tomorrow. The pursuit of physical health is a lifetime journey. As you may have guessed, mental health is no different. It is also a process that requires active and continuous engagement with your mind, regardless of how fit you may believe it to be.

As you steer away from the idea that mental health is a set of diagnosable illnesses—or reduce the concept to the chemical reactions taking place in your brain—you learn that you have the ability and agency to implement the kind of positive changes to make yourself, and your life, better.

Despite the pervasive notion that it’s the doctor who can cure what ails you, unfortunately, there is still much that doctors don’t understand about the inner workings of the mind. While scientific studies are published every day offering remarkable new observations about the different molecules and processes that give rise to thoughts, feelings, and actions, such findings are not easily translated into specific mental health disorders or, by extension, effective treatments. Even without those actionable insights, there is hope. In the end, when it comes to your mind, you will soon find that there is no better expert than you—and you hold the tools you need to address and maintain your mental health.

As a psychiatrist, the work I do with my patients in session is important, but it’s just the tip of the iceberg. Because the truth is, real therapy begins the moment my patients walk out the door and back into their own lives. That’s where they can put the strategies we may have discussed into action, as well as develop new strategies on their own. That’s where they can apply what they’ve learned to break the mental or emotional habits that may have been holding them back. And that’s where they can learn to become a truly active participant in their wellness journey as they work toward mental health.

Diagnosing Mental Illness

Years after finishing medical school, there were some cases where I still had trouble distinguishing between what was likely a normal emotional response to a stressful life event and a psychiatric condition that warranted medical intervention. Most of my colleagues would admit to similar feelings. It is not always easy to determine whether someone has a mental illness. Most of the patients who walk through my office doors exhibit symptoms of depression or anxiety—or a combination of the two. That’s not necessarily a surprise; they are the two most commonly diagnosed mental illnesses, affecting millions of people in the United States and around the world. The diagnostic challenge I face is whether or not a patient’s melancholic mood after the loss of a spouse, for example, is a temporary and expected response or something that might require more aggressive treatment. How can you, or I, know for certain?

Unfortunately, there are no objective measures, like a blood test or X-ray, for mental illnesses or emotional distress. To determine whether someone may be suffering from a mental illness, psychiatrists rely on the DSM, what some in the field refer to as our “Diagnostic Bible.” The DSM is just shy of one thousand pages and includes an incredible amount of useful information about mental illnesses, including both epidemiological and diagnostic data. Page over to the section on generalized anxiety disorder and you’ll find its common symptoms as well as checklist criteria that help mental health professionals give a proper diagnosis.

Despite advances in neuroscience technology, including brain imaging studies that determine which brain regions are active in response to changes in mood, the diagnostic process really boils down to a doctor asking—and the patient honestly answering—a list of basic questions. Over the past month, have you felt depressed, isolated, or hopeless? Have you lost interest in doing the things you usually like to do? Are you feeling a lack of energy? Are you having any problems sleeping? Any changes in appetite? What about feelings of guilt or worthlessness? If the patient answers yes to any of those questions, it is important to follow up to understand the details. How long have you felt this way? Have you experienced this kind of situation before? Do you have a family history of depression or mental illness? How are these feelings affecting your day-to-day life?

The specific symptoms that a patient may be experiencing are important, of course, but so is the duration of those symptoms and the context in which they present themselves. In the case of the patient who just lost a spouse, how long has he or she felt sad and hopeless? Has it been for a month or an entire year? Is it affecting their work? What about their relationships with friends and loved ones? Is the situation leading to suicidal thoughts? The story matters—and it matters a great deal—as the psychiatrist determines a diagnosis and the appropriate course of treatment.

Let’s face it, if you are feeling worthless, unmotivated, spending most of your time alone, and have lost interest in the things you once enjoyed, you may be suffering from depression. You may also just be going through a slump. With some careful listening, a doctor should be able to determine the difference as they learn more about the severity and duration of your symptoms. But it is not always that cu...