The question “what is 'good' mental health?” is surprisingly difficult to answer.
Whilst being happy is the natural answer to the question, it is not enough. Being happy is not enough in dealing with tragedies such as bereavement, cancer, or abuse - but what does help is resilience.
Resilience is important but is often not a well articulated concept in therapy. The focus of resilience in Cognitive Behavioural Therapy (CBT) is often narrow and suggests that simply having new thoughts and behaviours is sufficient. What is missing is an approach that helps people to make sense of these changes.
Risks can sensitise us
The sociologist Michael Rutter states that resilience is "an interactive concept that is concerned with the combination of serious risk experiences and a relatively positive outcome despite those experiences".
We need to think about the lessons we learn from these risk experiences. Rutter goes on to tell us that such lessons learned fall into two categories. Risks can either “sensitise” or “steel” us.
If they sensitise us it means that we become afraid. John’s angry row with his wife Julie was made worse when he remembered witnessing the shouting between his mother and father when he was a child. He responded by going quiet or leaving the situation.
John starts to avoid the emotions he was experiencing. Despite this, he tried to cope but he could only think of solutions which were 100% perfect. The result inevitably falls short of his idea of perfectionism and he became even more sensitive. After being turned down for an internal vacancy at work having given what he felt was the perfect interview, John was plunged into a state of abject misery for the next week. He coped through drinking.
Inoculation to steel us against future experiences
The lessons we need to learn are the ones where the risk experiences steel us, allowing us to be resilient to future risks. The analogy that can be made here is with the idea of inoculation. When we are inoculated against something we experience small amounts of distress.
The discomfort we experience when we have a flu jab is the price we pay for the softer landing we get whenever we get a more severe bout of flu. Inoculation in managing a mental health condition such as depression can involve taking a different attitude towards failures. Miles Davis once said “do not fear mistakes - there are none”.
This attitude says that we learn something from everything. This is the opposite of John’s perfectionism. Rather than think about making no mistakes we need to think about what can be learned and how that can help us, informing future experiences.
- See more: The resilience narrative obscures the wider causes and solutions for children's mental health
- See more: Join us at Mental Health Today Wales 2020 to hear Michael discuss therapeutic approaches
The distinction between risks which sensitise and risks which steel is important. When supporting people who experience phobias, CBT therapists will expose them to graded amounts of risk in order to steel them against future risks. People with a phobia of spiders are better prepared to face the anxiety of real spiders if they start off by holding toy spiders. Tolerating the anxiety of this exposure then inoculates them against the stress of what they perceive to be a greater risk.
In the case of depression, risk might involve being more assertive in a relationship and disclosing feelings. In the next row with his wife, John responded by saying how he felt rather than going quiet.
After doing this, John felt that he had overcome his fear of rejection which in turn, gave him the resilience talk about his feelings more often to his wife and his work colleagues. Becoming resilient means tolerating distress because that distress will ultimately steel us against future experiences, leading to better mental health.
Michael O'Sullivan is a Cognitive Behavioural Therapist in the Derbyshire Healthcare Foundation Trust. Buy Michael's book "A Practical Guide to Working with Depression: A cognitive behavioural approach for mental health workers".