We can think of "health" as the opposite of "illness." Do I have a high or low blood pressure, high or low blood sugars, high or "normal" cholesterol,…you get the idea. I might or might not have symptoms, but if I were to be examined by a doctor, and the measurements (blood pressure reading, lab results) suggest that I am not "healthy," I would want to manage my illness to become "healthy" again. I might be counseled on what to eat and what not to eat, encouraged to exercise, and I might even be placed on some medications.

While everyone can see themselves in such a situation, no one wants to admit that they might not be "mentally" healthy. There is still so much stigma attached to mental illness, that some people get offended if one suggests that they or someone in their family might suffer from a psychiatric condition. This could be because many people equate being "mentally" unhealthy with being "crazy" or feel that it is completely in their control not to have any psychiatric symptoms. This could not be further from the truth.

Even though there was a (sad) time when people with psychiatric illnesses were placed in "asylums," a lot has changed since then. It is well accepted in the medical community that psychiatric illnesses are brain illnesses, much like diabetes is an illness of the pancreas and hypertension is an illness of the cardiovascular system. The 90's was called "The Decade of the Brain." Through technological advances (EEG, MRI, fMRI, PET scan, TMS, etc.), we have been able to map the brain, view its structures, understand how its different neuronal circuits interact, and how differences exist in different psychiatric conditions. We can measure neurotransmitter levels in the cerebrospinal fluid (CSF), the fluid that bathes our brains, and even look at our DNA to individualize our treatment. We also know that psychiatric (brain) illnesses are deteriorating illnesses, damaging the brain if left untreated. By no means, do I suggest that we have learned everything there is to know about the brain, but we know enough to help people today more than ever.

One might ask why we do not have any type of measurement or marker that suggests a brain illness, like we have with measuring blood sugars in diabetes. That is a fair question. But before I talk about this, let me just briefly talk about the common flu and its symptoms. Most of us have had the flu at one time or another. People with the flu may feel miserable, tired, having headaches and body aches, and not feeling like doing anything. The doctor will examine you by asking you about those symptoms, rule out other more serious conditions and even differentiate a flu  (viral) from a bacterial infection (that needs antibiotics) without getting any lab tests.

Brain (psychiatric) illnesses also present with symptoms. The brain affects how we think, feel, behave, and perceive the world. The brain is also the "command center" of our whole body. When certain brain circuits do not function properly, they can produce different symptoms, affecting cognition (being distracted), emotions (feeling anxious, depressed), perceptions (thinking that people do not like me, people are watching me), and behaviors (sleeping or eating too much or too little). Looking at the symptom patterns, we can usually arrive into a diagnosis. We might order tests to "rule out" other conditions, but we do not necessarily need to order a "diagnostic" test to know that someone suffers from depression, for example. Even if tests are available, we have to look at the risk/benefit ratio of getting those tests done. Checking the serotonin level (a brain neurotransmitter) at the CSF to support the diagnosis of depression will not change our treatment and it actually puts the patient at unnecessary risk by having to do a lumbar puncture (LP) or spinal tap, to access the CSF. Likewise, ordering a functional MRI (fMRI) on everyone with depression will add an unnecessary cost burden to the patient.

Large epidemiological studies suggest that about 20% of US adults have a diagnosable psychiatric (brain) condition at any given year. For the majority of these individuals, their symptoms might be acute and not very severe. Only 12% of those adults (or 2.5% of the total population) have a more severe and chronic psychiatric condition, and for 20% of those individuals (or 0.5% of the population) the illness is so debilitating that it usually leads to disability. These are the individuals with Schizophrenia, but also Bipolar illness, and severe forms of Depression, Panic, and Obsessive-Compulsive disorder.

We know that there is a large genetic component with many psychiatric conditions running in families, just like hypertension and diabetes. Not everyone with a genetic predisposition will develop a psychiatric illness  and not everyone will have a predisposition. Expression of the predisposition usually happens under times of stress (mental duress). Persons with psychiatric (brain) conditions are no more responsible for their illness than persons with pancreatic conditions (diabetes).

We treat psychiatric (brain) conditions with counseling about "diet and exercise," education about their illness (like you would educate someone about diabetes), psychotherapy (because brain conditions affect how we feel, think, perceive, etc.), medications as well as stimulation therapies like transcranial magnetic stimulation (TMS Therapy), vagus nerve stimulation (VNS), and electro-convulsive therapy (ECT) when warranted.

We can think of our "mental health" as how well we cope with stress, how satisfied we are with our relationships, with our jobs, and with our life. When we start having  persistent problems with our relationships, our job performance, or neglecting our societal roles, that suggest that our brain circuits do not function as well, and we thus may have a psychiatric (brain) illness that needs to be evaluated and managed. Getting timely help not only avoids unnecessary suffering from delayed treatment, but it also helps protect the brain and its circuits from further deterioration and damage.

So, the next time you think about your health, think about both your "mental and physical" health.

Well, we had the disaster spill in the Gulf a couple of months ago…and we are now faced with the start of the hurricane season with hurricane Alex about to make landfall close to us. All of these can impact us, both physically and mentally. People might  feel that they are not in control, and that is true, as one cannot stop the oil spill or wish the hurricanes away.

In our everyday life, we all want our lives to have some normalcy, without any changes or surprises. When a change does happens, good or bad, it is automatically a stress that some can cope better than others. Getting married, getting divorced, having a child, seeing a child graduating high school and moving out to college, getting a new job or losing a job are events that are stressful.

Some people become more anxious, some more irritable or depressed, some might even go to a "denial" mode because they cannot accept ("handle") the change. Some of these responses are normal and necessary as they provide the drive to adapt to the new reality. But, for some people the intensity of these responses can be paralyzing and lead people to helplessness and withdrawal. One can minimize that impact by trying to prepare or "anticipate" what might come.

Like preparing for hurricanes, one can prepare for "life disasters." We need to stay in control of whatever we can get within our control. We can stay "informed" from credible sources about what are some of the challenges in different stages of our lives. When children are anxious about going to a new school or an approaching hurricane, we can acknowledge their fears and reassure them. We should not forget that we also need to acknowledge the same feelings in us. Instead of isolating, trying to talk to friends and family who experience similar life events can help ease some of the anxieties that changes bring.

We are for the most part resilient to life stressors. But sometimes, the effects of the life changes, like some of the hurricanes, can be so large that they overpower our coping abilities. When our feelings of depression and anxiety can become overwhelming, that's when it is time to seek help.  Help can be in the form of mental health services in the field after a natural disaster or a professional counselor after a "life disaster." In the event when someone is contemplating suicide, then one should seek professional help immediately!

Instead of denying that hurricanes will not "hit" us this year or "life disasters" will not happen to us, it is best to take control and prepare. And if the preparation are not enough to handle the disaster, then we need to know that there is help available and that like previous disasters, we will get through this one eventually.

Stay prepared, stay alert, stay safe.

Resources: The National Suicide Prevention Lifeline: 800-273-TALK (8255)

Did you know that "May is Mental Health Month?" Life is full of challenges and some people are able to handle challenges or stressors better than others.

There are a lot of misconceptions about what mental health is. How many of you can honestly say that you are "mentally healthy?" How many people live with unrealistic expectations from their spouses, their children, their co-workers, or their job? How many people feel "stressed out" or "there is not enough time," yet, instead of taking time for themselves and reevaluate their priorities, they just keep doing what keeps them stressed out in the first place? How many people tend to "escape" with drinking alcohol or procrastinate, instead of eating healthier, exercising and coming up with a plan to address stressors?

As you can see, one can be mentally unhealthy, without necessarily also having a psychiatric-medical illness. This is analogous to being somewhat overweight and having occasional pain and aches, but without also having a medical illness, like heart disease or arthritis. Without taking some time to rest and reevaluate diet choices and exercise, some people might end up developing a medical illness. So, unless one takes time to reevaluate relationships and priorities in life, one might develop a psychiatric illness, like clinical depression or clinical anxiety.

In the same way that not everyone with a poor diet will develop diabetes, not everyone with poor coping skills will develop clinical depression. People who develop diabetes or clinical depression are usually genetically predisposed, as we know that both of these illnesses tend to run in families.

Because of  misconceptions about mental health and psychiatric illness, there is still stigma that needs to be eliminated. Just like our car dashboard, our body sends us warning signals when our body hurts or feels stressed. Ignore the signals, and you can still drive for a while; but, unless you take the time to assess the signals and take care of any problems, you will end up with a more serious problem that will be more costly…

So, take the time to assess your mental health. You will feel better and live a happier, more fulfilling life.

For most people, it is a time of joy and celebration, spending time with family, and getting gifts. But, for more and more people, this time of year brings up overwhelming stress, anxiety and depression.

Why is that?

Having to buy gifts, having to put up the Christmas tree and lights, having to mail cards and gifts on time, and a lot of other “haves to” can make one to feel “trapped.” Spending money, especially when a family already struggles financially, can generate a lot more debt and stress in a family. Consider that about a third of the gifts bought during Christmas will be thrown away within a couple of months.

Being around and eating more “sugary” treats, consuming more alcohol, and being less active can all lead to making you feel tired and physically fatigued. Alcohol can disrupt your quality of sleep which can make you more irritable. And seeing that your clothes feel tighter due to extra weight gain can be frustrated and depressing.

Trying to fulfill social obligations or trying to have the “perfect” family reunion can bring resentment and disappointment. Having to face uncomfortable situations or family conflicts can drain anyone emotionally. Unrealistic expectations are just that…unrealistic.

Being alone or feeling alone after the loss of a loved one can be very painful. Memories of the deceased keep “popping up” bringing nostalgia, sadness, and emotional numbness. People might feel guilty to get in the spirit of the holidays and might become withdrawn.

So, are you one of the persons who wishes for the holidays to be over with as soon as possible, and if so, what can you do to cope with the holiday stress?

These are some suggestions that you might find helpful:

1. Take a deep breath…learning how to breathe using the diaphragm can help with relaxation.
2. Get plenty of rest and sleep
3. Eat and drink alcohol in moderation
4. Drink plenty of fluids
5. Continue (or begin) to be physically active
6. Create a budget and stick with it
7. Be realistic when making lists about commitments and expectations
8. Set achievable goals for this holiday season and delegate some tasks
9. Spend more time with people who have a positive effect on you
10. Spend less time with “negative” people
11. Know that your time and energy are “priceless” gifts
12. Consider volunteering your time at a non-profit organization or visit a nursing home to (re-) discover the spirit of giving for the holidays
13. Be thankful and focus on the things you DO have (vs. the things you don’t have)
14. Live for the present
15. Acknowledge your feelings if you have lost loved ones
16. Get professional help if you stay depressed, with loss of interest in activities that you used to enjoy, lasting for more than 2 weeks, as that could be due to clinical depression. During this time, other symptoms might also include changes in your sleep and appetite, feeling tired, having difficulty focusing on things or thinking clearly, feeling agitated or anxious, having inappropriate feelings of guilt, having excessive crying spells, and even thoughts of harming yourself. If you do have thoughts of suicide, please ask for help immediately.

I’m sure you probably have your own way of coping with holiday stress. If so, and you would like to share it, please add a comment below.

Merry Christmas and Happy Holidays to all of you!