From the 'The Future of Mental Health' Interview Series published by Psychology Today. This article was published on 25 February 2016
The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence.
Eric Maisel, Ph.D.
Interview with Nessie Shaw
EM: You have significant experience working in mental health clinics. What’s been your experience working with clients in a mental health clinic setting?
NS: My experience in working in mental health clinics is that many people do not receive effective help and in many cases they end up with more health problems than they started out with. There are a number of well-researched reasons that cause this situation including:
Anti-depressant medications are overwhelmingly the dominant treatment modality and in many cases are ineffective. People are switched from one brand of antidepressant to another in an attempt to find a drug that works... When the medications don’t work people are labeled treatment resistant.
The research literature on antidepressant medications demonstrates clearly that efficacy has not by any means been established and is clouded by the fact that when people do report an improvement in mood no consideration is given to other variables that may be impacting the person positively. For example there are many intervening variables that are not controlled for in clinical trials, including: increased support, changed circumstances, taking on new meaningful activities and so on.
Many people experience serious side effects from high-powered medications including obesity, diabetes, anxiety and disinhibition and the sequelae that flow from these complications, including ironically, feelings of chronic depression. A diagnosis of depression so often results in that person developing an identity of permanent patient. A sense of powerless over circumstances and behavior becomes entrenched.
Psychological interventions largely do not address social factors that are well known to play a huge role in mental health. When people who are experiencing unhappiness, grief or anxiety related to a temporary change in life circumstances are diagnosed with depression that label often implies long term treatment. It is not uncommon to see people under the care of a psychiatrist for a decade or more with worsening symptoms, weight gain, diabetes and other health problems related to high doses of drugs.
EM: You’ve concluded that life purpose and meaning are “missing links” when it comes to emotional and mental health. Can you share some of your thoughts on that?
NS: Yes, from the literature and my own experience, one of the major symptoms reported by people diagnosed with depression is an inability to experience meaning and purpose. It has always seemed pretty obvious to me that helping people regain a sense of purpose and meaning would be the first place to start. The status-quo approach though is to wait for medications to kick in and the person’s mood to return to normal. I have never seen any structured emphasis in status quo therapy programs that include strategies for regaining meaning and purpose. And yet it is well-known that a sense of hopelessness and meaninglessness are the hallmarks of depression.
EM: What are some of your offerings in support of your interest in life purpose and meaning?
NS: I offer the Life Purpose Boot Camp course in face-to-face mode and also by email. I also offer ongoing email and phone coaching. In these programs I teach people how to discover what is personally meaningful and how to devise and implement coherent and effective strategies for living with purpose. People make major changes surprisingly fast when they have the insights, the tools and the support they need.
I teach people how to access a range of interventions to regain meaning, purpose and happiness with a focus on managing circumstances strategically as well as using interventions from mindfulness-integrated-cognitive-behavior-therapy. There are so many effective alternatives to the biomedical treatment approach to mental health disorders. (Read problems of living: sadness, grief, disappointment, chronic disease and so on).
EM: What are your thoughts on the current, dominant paradigm of diagnosing and treating mental disorders and the use of psychiatric medication to treat mental disorders in children, teens and adults?
NS: I have many concerns about the current paradigm in psychiatry. As I mentioned earlier I have grave concerns about the efficacy and safety of drugs used to treat so-called mental disorders, not to mention the psychological impact of reframing normal human suffering and unhappiness as a medical illness with long term implications for drug treatment. There is also the issue of the addictive nature of anti-depressant medications.
It is a shocking state of affairs when there is so much evidence that meaning and purpose can be regained and mental distress minimized or even alleviated with a range of evidenced-based social and psychological interventions. Social support, problem solving, brief solution-focused interventions, mindfulness-based-cognitive-behavior-therapy, and even regular physical exercise have been shown to be at least as effective (if not more effective) than anti-depressant medication.
EM: What has been your biggest learning experience regarding mental health?
NS: Much mental distress is a result of the impact of social structures and circumstances and not a result of human weakness. And we are affected more than we fully realize. Professor of Sociology Zygmunt Bauman sums it up when he says, “When trying to make sense of our lives, we tend to blame our own failings and weaknesses for our discomforts and defeats. And in doing so, we make things worse rather than better.” The current medical paradigm of framing the distress of difficult life circumstances as mental disorders reinforces and encourages this self-blame model and the worsening of our distress. Furthermore, the causes of our distress are left unexplored.
One of the reasons I enjoy teaching in a group format is that people get to recognize the universality of their problems as a great starting point for change. Being part of a supportive community is a major factor in mental health. Within this framework and environment a person can learn to access personal strengths, take on new meaningful activities, challenge the status quo and relinquish debilitating self-doubt.
Nessie Shaw has worked for over a decade in mental health clinics and hospitals devising and facilitating programs to help people regain meaning and purpose in the aftermath of a crisis in life circumstances. She now works in private practice.
Nessie works from the premise that while it is the impact of adverse circumstances that are the major factor in mental health and not a lack of personal resiliency, meaning, purpose and happiness can be regained with strategic and psychological-based skills (skills that can be learnt).
Nessie’s qualifications include: B.SocSc (Hons) Grad Dip Occupational Health, Grad Dip Mental Health, Diploma of Clinical Hypnotherapy.
Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, Rethinking Depression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues.
Learn more about the future of mental health movement at http://www.thefutureofmentalhealth.com.
To learn more about and/or to purchase 'The Future of Mental Health' click here.
To see the complete roster of 100 interview guests, click here.
Happiness can be an elusive concept. Sometimes it seems that happiness dissipates all too quickly. It is not uncommon for people to experience happiness in short bursts interspersed with longer episodes of dissatisfaction. There is also the idea that happiness will arrive when circumstances are just right: when we get our dream job or when we get fit, lose weight or when we are in a relationship and so on.
There has been a huge amount of research into happiness and it has been found consistently that there is a quality of happiness that goes deeper than personality traits, circumstances, and the ups and downs of life.
There is a lot of information and numerous self-help programs that claim to possess the secret to happiness. However, the truth is, many approaches to happiness are too simplistic, too unrealistic and simply don’t address the underlying causes of unhappiness. The real secret is this: there is no secret and there is no single magic key that unlocks the door of happiness.
What is clear is that happiness is not necessarily an esoteric, metaphysical process, but rather a structure made up of a set of skills and strategies that hold together coherently. The structure of skills and strategies that are strongly correlated with happiness are:
The exciting news is this: all the skills and strategies that make up the structure of happiness can be learnt. Even the process of learning happiness creates happiness. So that is a win-win situation.
I have worked in mental health clinics for over a decade, developing and facilitating programs to help people overcome the debilitating effects of depression or anxiety. As a therapist I have been in search of answers and interventions, to help people out of chronic unhappiness and into a life of meaning and happiness. This search has led me through paths of study, both traditional and alternate.
The exciting news is this: all the skills and strategies that make up the structure of happiness can be learnt. Even the process of learning happiness creates happiness. So that is a win-win situation.
Being happy is closely related to experiencing meaning. A lack of meaning can cause chronic unhappiness. There is a solution.
Philosopher and psychologist, Dr Eric Maisel puts a different twist on our efforts to seek meaning. He proposes that we humans have evolved to not just seek meaning, but to actually create meaning. We make our own meaning by choosing experiences that align with what we hold most valuable.
The difference between seeking meaning and making meaning may at first glance appear subtle, but the differences are immense and exciting. We are no longer at the mercy of external circumstances or the opinions of others or social norms. Rather we think deeply about what we hold valuable and align our thoughts and actions with those values. We are the sole performer of our own show, we are also the director and the audience. It is a challenging thought, but an incredibly empowering one.
Life can be disappointing and often is. Although there is a lot of hype that says you can achieve anything if you believe hard enough, honestly that just isn’t true. If you decide at age 35 that you want to be a world famous ballet dancer and if you haven’t been suffering through two or three decades of toe-distorting practice, seriously it just isn’t going to happen. No quality of belief and fervent desire, practice and study will make you a world-class ballet dancer if you are a 35 year old psychologist, chef, or accountant. Likewise you are highly unlikely to achieve a dream of being a neurosurgeon, a quantum physicist or an elite gymnast if you haven’t started, decades earlier, on a course of study, practice and strategy to make that happen. Seriously, not everything is possible and to experience life as meaningful, purposeful and happy, some dreams have to be let go, tweaked or re-examined in the light of reality.
The skill is to endow our dreams with just enough reality: and like the goldilocks story, not too much, not too little, but just the right amount to keep us motivated, believing and taking action. But aren’t our dreams outside of our control you may be thinking. Not really. No-one knows for sure what dreams are or how they happen. Our knowledge of the workings of the human mind is so limited.
What I can say with some certainty (from my experience as a hypnotherapist) is that we have access to our unconscious and deeper desires, wants and needs. We can ponder what makes us happy, we can decide what it is that gives life purpose and meaning for us. Even more importantly we can make choices and change directions, keeping in mind a little reality won’t go astray.
Dr Eric Maisel has coined the phrase: from seeking meaning to making meaning and it captures this notion that meaning and purpose is not an esoteric, external phenomenon that can be found if we seek hard enough or, I would add, if we believe hard enough. Rather, as Dr Maisel explains, we decide, we choose, we actively create our own purposes and meaning. In this perspective on life humans have evolved with the capacity to deem certain experiences, feelings, attitudes, values, actions, thoughts and all manner of stimuli - meaningful.
We can push past disappointments by creating new meanings, new purposes that appeal to us right now. We can let go of disappointments. I didn’t say it was easy. Some things obviously are painful, but history is studded with examples of individuals who have turned a difficulty, a limitation or an obstacle into a glorious future and made a significant contribution to our world.
A common theme that keeps cropping up with clients is the idea that something is missing in their life. The dialogue goes something like this: “I feel as though life should be more fun, more meaningful, and just more than it is. What am I missing?” Often this expression of dissatisfaction with life is accompanied by a subtle thought pattern that expresses the idea: “I am not good enough.” or simply “I am not enough.” There are many variations on this theme and they may include feelings of not being:
Brene Brown has exposed the extent to which many people feel less; feel vulnerable, feel a sense of not being good enough. Brene goes as far as to use the taboo word shame. Her TED talk, 'The Power of Vunerability', is one of the top TED talks of all time with over 15 million views. Brene has hit a nerve and her solution to vulnerability is to embrace it as part of our human experience.
Another perspective on this feeling of not being enough is that it is not we ourselves that are missing something, are faulty, or are simply not enough, but rather that we have been led to believe that we are not enough by savvy marketers, religious authorities, medicos and (dare I say it) family and ‘friends’. Harsh but true!
The feeling of not being enough often lies at the heart of many addictions. In our unconscious need to feel more we often reach for more substances, experiences, relationships or products. Many of us can relate to overeating, drinking too much alcohol, buying too much stuff, spending too much time on social media, but we may not consciously link our behaviour with our need to feel good enough.
Here is my idea. Why not reject these cultural, religious and capitalist notions of not being enough and embrace the concept that you are enough? This strategy doesn't deny the reality of living in a consumerist culture but does allow us to take a detached stance: to not buy into the message of not enough.
Let's change the message from not enough to: “I am enough and NO I am not missing anything.”.
“... in general, the default setting of the brain is to overestimate threats, underestimate opportunities, and underestimate resources both for coping with threats and for fulfilling opportunities ...” Dr. Rick Hansen, author of Hardwiring Happiness.
News that humans have inherited a brain that is programmed for negativity, stress and anxiety might seem, at first glance, pretty depressing. However, the good news is that, as individuals, we are not inadequate, broken or faulty. It is the way we have been wired. Humans have evolved with a bias towards anxiety and fear as a protective mechanism. In early human history it was crucial to be vigilant and prepared to respond immediately to environmental dangers. Wild animals and rival tribes posed a constant threat. Not only have we inherited a brain with a tendency to hold onto fear and anxiety but our brains have also evolved to quickly let go of positive and optimistic thoughts and feelings.
Unfortunately this bias towards hyper-vigilance and avoiding danger does not serve us well in our modern urban life. Calmess, confidence and optimism are much more useful states of mind and certainly more pleasant.
It might not be much compensation to know that a tendency to pessimistic thoughts and fear is part of our evolutionary make up. However, it is good news that we can re-wire the neural pathways of our brains for positive change and for more calmness and confidence.
One of the reasons mindfulness meditation has become a hot topic and a most useful import from the ancient practice of Buddhism, is because it is an effective way to reduce stress responses and dampen down the flighty nervous system.
Mindfulness meditation has become a much researched topic. Practices have been modified and linked with other cognitive techniques for even more effectiveness. Dr Rick Hansen’s book, Hardwiring Happiness, is a handbook of mindfulness techniques. One of Dr Hansen’s very effective strategies is to “take in the good.” This is a deceptively simple practice that only requires a person to linger over positive experiences throughout a normal day. Dr Hansen explains that by absorbing each positive thought or feeling for an extra 20 seconds, over time the brain structure changes and feelings of calmness and confidence become the new default position.
Of course, becoming skilful and achieving an outcome in any field requires consistent practice and that is especially true in changing the brain. But how easy is this strategy – lingering for twenty seconds over the many pleasant, micro-experiences of a usual day: a kind word given or received; a glance at a vividly coloured flower; the warmth of the sun on the face; a smile from a child or simply completing a task. So many opportunities to re-wire the brain for greater happiness and only 20 seconds at a time.
Self-compassion and its close relative self-appreciation can significantly reduce the toxic effects of self criticism. Such effects can range from dissatisfaction with life and low level unhappiness to full scale anxiety and depression.
We live in an individualistic, competitive and materialistic culture which impacts individual personality with powerful expectations of achievement, success and being above average. In this culture there is the constant threat of not being good enough, not attractive enough, not wealthy enough or just not being “enough” period.
Rejecting these cultural messages and learning to be our own best friend is a wonderful antidote to the negative effects of self-criticism. In her highly researched book on self-compassion, Dr Kristen Neff explains that although it may seem as though being self-compassionate would lead to laziness, de-motivation and passivity, actually the reverse is true: self-compassion decreases the pain of self-criticism and increases optimism, calmness and happiness (Kristen Neff, 2011).
Other research has found that being self-compassionate can reduce procrastination and lead to quickly getting back on track with activities and creating a meaningful life (Linda Graham, 2014).
Being self-compassionate is not about being narcissistic either. On the contrary, self-compassion helps us better understand vulnerability and self-criticism as part of the human condition: we are able to be more empathetic and compassionate in connecting with others. Choosing a mantra that expresses the essence of self-compassion is a great strategy. The following verse is Dr Neff’s personal mantra:
This is a moment of suffering.
Suffering is part of life.
May I be kind to myself in this moment.
May I give myself the compassion I need.
There is great power in self-compassion and self-appreciation and it’s only a thought or two away.
A note of caution: The process of self-compassion involves acknowledging and noticing our suffering. If that suffering is intense and overwhelming it may not be wise to confront the reality of the suffering alone and without support. The most self-compassionate strategy in these circumstances may be to seek professional support and counselling.
Happiness grows less from the passive experience of desirable circumstances than from involvement in valued activities and progress towards one’s goals.
David Myers and Ed Diener
One of the most valuable insights to emerge from the field of Positive Psychology is that appreciating and using our strengths deliberately, more often and in new ways can greatly increase happiness and reduce depression and anxiety.
In one of the early studies on happiness participants were instructed to identify five of their key personal strengths and to choose one as a focus for the experiment. Participants were then given the task of using that one strength more often and in new ways over the course of 7 days.
The results of the study were surprising; not only did participants become much happier during that week, but the happiness effect continued for up to six months with a corresponding decrease in the incidence of depression and anxiety within the group. Of course, this is really not rocket science, most of us can relate to the idea of doing something different, learning a new skill or taking on a new job or joining a new social group and feeling a boost of happiness. The only difference is the participants did something quite deliberately and extended the opportunities to use a specific strength that they enjoyed using. They also focused their activities on that one strength.
As I reflect on the insights from this study it occurs to me that this is what being authentic means. This is what ”being me” is really about: expressing myself through activities that are based on what I value about myself: strengths that I value in myself.
It is also true that strengths are diverse and individualistic. Strengths can also be subtle. Not all strengths are about being an elite athlete, a highly successful business person, a celebrity or a supermodel or some other high profile achiever. Messages from the media and marketing world would have us believe that these are the only strengths that have any value. Of course the reverse is true.
Some of the more subtle strengths that can be linked to happiness include: kindness, caring, courage, wisdom, perseverance, being encouraging, being witty, creativity, artistic expression, appreciating beauty in its many forms. The list is endless.
As 21st century humans we are in the unique position of being able to reflect on what we love, what we think, who we are, what we value and what strengths we have.
The opportunity to be happier by expressing more of who we are is available. If you could do with a boost of happiness, perhaps this is the time to experiment again with using your strengths and using them in new, positive ways. The results could be happily surprising.