How to Feel Better: The Basics

Patients seek out mental health services with the hopes of feeling better.  I see it as the job of the clinician to help patients understand better why they are feeling as they do; to help patients organize what must feel chaotic and distressing.  Most importantly, mental health clinicians try to give hope, and we do this by identifying areas in the patient's circumstances that can change, where the patient has control. In some ways, psychiatrists and other mental health clinicians are the Marie Kondo of mental health: organizing the clutter that is mental health symptoms while trying to spark joy. 

One of the greatest barriers to recovery is when the patient has unrealistic expectations of what it means to get well.  Patients often think a medication or the therapist will "fix" them or the problem.  Unfortunately, this is not the case.  If patients are not ready to change themselves, or do not take ownership for the areas in their lives that are causing the disorganization and suffering, no matter what the clinician does will be futile.  Recovery takes hard work, but then again so does any other worthwhile endeavor.

But society is increasingly being medicated, perpetuating the fantasy that happiness and fulfillment is in a drug, or something outside ourselves.  This is why it is so important to emphasize the interventions that more strongly support mental health recovery, that have the fewest side effects, and result in the most sustainable improvements.  These interventions tend to be nonpharmacological ones.  These interventions tend to rely on patients taking control where they have it and bringing about the change themselves.

Here are the 4 basic components to mental health recovery:

1. Behavioral changes: what is the patient willing to change in their behavior to improve their situation?  This could include regular exercise, sleep hygiene and a self-care routine.  This could be stepping back from toxic relationships and cutting back on unhealthy habits like alcohol use.
2. Psychological changes: How is the patient perceiving their situation that may be exacerbating their suffering?  This includes certain ways of thinking that exaggerate symptoms.  For example, all or nothing thinking, catastrophizing and over-personalization are ways people can interpret events that act against their mental health by increasing anxiety and helplessness. Another key psychological trait that significantly changes outcome is the degree of insight a person has and what they tell themselves about who is responsible.  People who acknowledge and appreciate their own role in any given situation fare far better than those who do not.
3. Life circumstances: These may be less within a patient's control, but seeking outside support is not.  Getting help with financial aid, housing or respite if the person is caring for an ailing loved one are options and is a sign the person is acknowledging their limits.  Ignoring limits makes mental health worse.
4. +/- Medications: This is in the domain of a psychiatrist or family doctor.  However, at the end of the day, it is up to the patient to take the medication as prescribed and to follow-up.  I put medications last on this list because most of the time, if the above changes happen, medications are not needed.  Exceptions, where medications are prioritized, include mental illness that has reached a severe nature, psychotic and bipolar disorders.

I will conclude with a very common presentation to illustrate these points:  Patient presents with low mood and social isolation.

We know having a sense of community and connection to be necessary for our wellbeing.  Those who deal with hardship alone are at greater risk of developing a mental illness.  So the maladaptive behavior is to withdraw and isolate.  Psychologically this patient believes he is sparing others his burden. He may not want to be vulnerable with others out of pride or fear.  A life circumstance that exacerbated this was the COVID pandemic, from which we as a society  are still recovering. 

So the recommendations would be the following: there is a good chance that if the patient increases social engagement, either through recreation, or a support group, his mood will improve.  Therapy would help target the long-held psychological beliefs that prevent the patient from meaningfully engaging with others.  Fortunately COVID is no longer preventing social interaction but if this was still a concern, virtual or outdoor meetings could be considered.  I would consider medications based on severity of symptoms or if the above behavioral and psychological changes are ineffective.  Medications can not cure loneliness.