THE DYNAMICS OF CHANGE

Our capacity to withstand life's slings and arrows is largely predetermined, by heredity and by childhood experience. But that needn't be the end of it. Mental well-being can also be learnt
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The Independent Culture
ONE IN 10 people will suffer some mental illness at some time in their lives. The other 90 per cent are, medically speaking, mentally healthy. Yet in practical terms, the fact that these people are not actually mentally ill tells us nothing much about how well they are. It gives no indication of how fulfilling they find their lives, or how successfully they run them. It takes no account of the fact that many are dependent on tranquillisers or alcohol to get through the day, or that they may dread going into work each morning or feel a sinking of the spirits as they come home each night. Some of these apparently mentally healthy people will never manage to make a successful adult relationship, perhaps because they cannot tolerate emotional intimacy, perhaps because they have never developed the self-reliance and independence that makes them truly adult. Others may have such a poor self-image that jealousy or insecurity makes their relationships miserable for both partners. Low self-esteem can make it difficult for someone to attract a partner or sustain a relationship; it can also make people stay in abusive relationships. There are plenty of people who tolerate chronic, low-grade unhappiness in their jobs or relationships for years. Few of these people are ever likely to come to the attention of a psychiatrist, but their mental health is well below par.

But is there an equivalent of a healthy eating and exercise regime for the body to improve our mental state? I believe there is. We now know enough about how the mind works to make any necessary changes in our lives and in our thinking to achieve a sustained state of what I call mental well-being. Mental well-being is not the same as happiness, but it encompasses the ability to be happy. It is more than a mood, more than a behavioural strategy; it is a state of being that includes a whole range of attitudes and aptitudes. It is also, in many ways, the secret of happiness.

People who are mentally healthy find their lives fundamentally satisfying, and are able to run them effectively. They have reasonable expectations, of themselves, of their lives and of other people, so that they are not doomed to disappointment at every turn. They can adapt to changing circumstances and so are less likely to be thrown off balance by unexpected events or setbacks. They may not be happy all the time, but they have the possibility of happiness.

It all sounds so simple: keep an open mind and a sense of perspective and don't let the buggers get you down. But for many of us there are forces at work, forces inside ourselves and from the outside world, that blow us off course. Sometimes bereavement, ill health, falling in and out of love, financial problems - all the life events which are part of the fabric of living - produce emotional peaks and troughs which are both more intense and more prolonged than usual. But even these black periods are nearly always self-correcting and self-limiting, provided that we learn how to manage them. It is perfectly healthy occasionally to feel sad, lonely, irritated, put upon or valueless; it isn't healthy to have these feelings constantly. Mental well-being implies a state of equilibrium. It does not depend on external circumstances, although it may seem to us as if it does. What matters is not stress, or difficulties, but the way we react to them.

Consider two middle-aged male executives unexpectedly made redundant. Both are likely to have the same initial reaction - a sense of shock and devastation at the sudden loss of status and security, a sense of emptiness and lack of purpose. For a week or two both will probably feel depressed and worthless, be unnaturally irritable with their families, lack the energy even to think about what to do next.

After a time, one man may start to work out how to deal with the situation. He may discuss it with his wife and start applying for other jobs, think about the possibility of re-training, maybe even see advantages in the situation - more time to pursue his own interests, the opportunity to change direction in his life and start an entirely new career. The other man will spend many hours feeling increasing bitterness towards the company he has left, and sliding even further into depression. He may start to drink too much. He will refuse to talk about what has happened with his partner, but instead may release his tension in frequent outbursts of anger against her. He will be quite incapable of taking positive action to salvage anything from the situation or making any changes to it. Neither man is luckier or unluckier than the other; but one has a set of attitudes that make his life easier.

How we deal with a situation depends on how we have been taught to deal with it in childhood. Rejection - by an employer, a partner, a friend - reawakens old feelings of rejection - by a strong authoritarian father, or by a family that didn't care. When our whole life has been coloured by these feelings of rejection, we have no mental capacity to cope, and we sink further and further into depression - and perhaps finally into mental illness. If, in addition, our genetic make-up is such that we are extremely sensitive to psychological stress, even the simplest conflict may be enough to tip us into depression.

The question is, what can we do about it? Many of us may resort to behaviours - drinking, drugs, gambling, eating - which, while they may temporarily lift our mood, can all too easily spiral out of control and, in any case, do nothing to solve the real problem. Yet there are other, more psychologically successful ways of dealing with such problems. To take advantage of them, we need to understand the power that we have to change ourselves; and, to do that, we need to understand what makes us the way we are in the first place.

WHAT MAKES one person more vulnerable than another? Why is one person vulnerable and easily thrown off balance, while another is so much more resilient, at ease with him- or herself and with life, better able to cope with setbacks or problems?

Vulnerability has its roots in childhood, but early experiences are insufficient to account entirely for the way people cope as adults, or how they respond to stress. Life events may act as triggers too, but mental breaking-point is primarily determined by an interaction of genetics, brain chemistry and childhood experience.

Genetic studies show that the genes which provide the blueprint for each individual's physical characteristics also determine temperament, the style of a person's inborn response to their environment. At the Maudsley Hospital in London, two temperamentally different strains of rats have been bred, the fearful rats and the fearless rats. The strains breed true, fearful rats producing fearful offspring, who behave fearfully whatever situation they are in because their genes make them shy, unadventurous and unassertive. The fearless rats produce exploratory, aggressive offspring who dominate the pack. They lead because they have been bred to be fearless.

A similar process may well take place in humans. Certainly, differences in temperament can be seen even in very young children. Studies of these differences have identified three basic types of baby. There are those who are "easy": happy, adaptable babies who react positively to new events. There are "difficult" babies, who cry more and are much less adaptable, reacting vociferously and negatively when they meet new situations or new people. The third group, "slow-to-warm-up" babies, are wary but not downright negative when faced with anything new.

Temperament is not the same as personality, but it forms the base on which personality, moulded by environment and experience, develops. Inborn temperamental traits influence a child's later adjustment and determine the way other people respond to them. Take, for example, the infant who screams almost continuously for his first three months. His behaviour may be due to his temperament and it is likely to affect the ease with which the mother bonds to the child, and mean that within the family that child is labelled as "difficult". The label may be hard to dislodge, particularly if the child's sensitivity of temperament ensures that as he grows through childhood into adulthood he continues to be easily overwhelmed by external circumstances. One study has found that children with difficult temperaments are more likely to have school problems and to show excessive aggressiveness, tantrums, or speech problems in later childhood. The "easy" child, meanwhile, will get treated differently from a more cranky sibling, no matter how much the parents try to avoid this. In other words, children are not just passive recipients of experience. Their own temperament contributes to the events and the interactions that go to make up that experience.

Then there is the contribution of brain chemistry to consider. This subject is becoming increasingly fascinating, as links are discovered between mood or behaviour and the chemistry of the brain. A study of Royal Marines found that those who were particularly aggressive had abnormally low levels of the chemical serotonin within their nervous systems. We know too that when people are depressed or under stress, the level of a brain chemical, cortisol, is raised. People who feel themselves to be low in the human pecking order have been shown to have a raised level of cortisol and become depressed. What is even more interesting is that it now seems probable that some traumatic life events can actually cause changes in the way the brain works. It has often been observed that children who have suffered serious abuse in early childhood are more likely to suffer depressive illness as adults. Recent research carried out in America indicates that very severe stress in early childhood - before the age of 11 - may alter brain chemistry in a specific way, leaving a mark of vulnerability such that minor life events produce major declines, and this effect may persist for life.

At the same time, the new field of psychoneuroimmunology is telling us that we ignore at our scientific peril the point that a human being acts as an integrated whole. Psychoneuroimmunology is the study of the relationship between the mind in its most general sense, brain function and their effects on the immune system. The evidence suggests that there is a delicate balance between what we think and feel on a daily basis and our physical and mental health. Observation certainly suggests that illness often develops against a background of unhappiness, which seems to act as a trigger. It now looks as though there may actually be scientific evidence that this does happen. Another study looked at the number of colds suffered by men on a battleship. It found that those who were more homesick had more colds than those who seemed happier and better adjusted to life on board. An experiment carried out with medical students in New Zealand asked one group to spend a week focusing on sadness, writing down sad thoughts every day. A second group was asked to write down happy thoughts each day for a week. At the end of the week they were all given a Mantoux test - a skin test to detect whether or not a person has immunity to tuberculosis. The "happy" group reacted strongly, indicating immunity; the "sad" group gave a weaker reaction, suggesting that something - negative thinking, perhaps? - had reduced the efficiency of their immune system.

BUT HOW do you make yourself "think" differently in a situation? How do you adopt healthier attitudes? One of the most rewarding areas to look at is childhood experience. Along with our genetic blueprint, our experiences as children play a crucial role in forming our personalities; and - in contrast to our genes, which we cannot change - we may well be able to change beliefs about ourselves learnt at this stage that may be contributing to our unhappiness. For example, if children are labelled as fat, clumsy, unattractive or stupid, it is destructive to the way they feel about themselves as they grow up. High expectations may be damaging too: if the child cannot live up to them he or she has to carry a restrictive burden of failure through life. The son of a cold and rejecting mother may grow up to be an adult who is unable to trust women and repeatedly breaks up relationships as they deepen. But learning why you have these feelings is the first step towards being able to change them.

The concept of "emotional abuse" was not even recognised until the early Seventies. But research is beginning to show that repeated exposure to adverse parenting, which may involve rejecting, isolating, terrorising, ignoring or corrupting the child, may have profound effects on their psychological development. Children who have never been given affection or shown warmth grow up to have low self-esteem and adapt poorly to adult life. Some have been shown to be more aggressive and less emotionally responsive.

It takes bad parenting on a heroic scale to do severe and long-term damage; but there are very many families around in which the quality of parenting does not reach the "good enough" level, a concept identified by the eminent child psychologist Dr David Winnicott. Children from such families may never develop the emotional armoury they need for optimum future well- being. For example, children who have always been told what to do may find it difficult as adults to accept responsibility and take decisions. Parents who are very authoritarian often tend to be overprotective; their children, because they have never been encouraged to take risks and test limits, may become timid, over-cautious adults, with little self-confidence and low self-esteem. As adults they may find it hard to loosen these family ties. There are, for example, people who find it natural to tell their parents good news or bad news before they tell their partner, or who turn to them first for advice about their problems. It is hard for a couple to have a truly adult relationship if one partner still regards the parental nest as their primary source of comfort and support. Conversely, the children of permissive parents tend to lack social responsibility and to be anxious, dependant and lacking in confidence, and some of these effects will persist into adult life.

Good parenting, by contrast, seems able to provide a positive, protective influence on future mental well-being, making the child more resilient and better able to withstand adverse experiences throughout his or her life. It can even reverse the brain chemistry changes produced by previous serious abuse. Children who grow up feeling loved and secure learn early in life to make secure loving relationships, and are able eventually to become good parents themselves; children whose parents make them feel good about themselves grow up with a feeling of self-worth.

Good or bad, by the time we reach adulthood, the patterns are in place. The fortunate adult, the product of lucky genes and good parenting, is in a strong position to deal with life's vicissitudes. The adult whose emotional foundations are more shaky is more vulnerable to life events, and has fewer resources to deal with them. If there were no way of redressing the balance, this would be a gloomy picture. Fortunately, human beings can learn from experience. They can devise stratagems to help them cope, and learn to steer clear of situations with which they cannot cope. People who become tense when under stress can learn to keep calm by practising breathing techniques, or to still their minds with meditation. Cognitive therapy can teach the spider phobic to touch a tarantula, the socially anxious to brave people and parties. Once we have accepted that we can change our attitudes and modify our behaviour, we are no longer so much at the mercy of external events or adverse circumstances.

In the mentally healthy, feelings respond to the prevailing emotional climate. When we are feeling low, it is almost instinctive to take the kind of simple measures that will help to brighten our mood. At the end of a difficult day, a drink and sympathetic hearing at home are often enough to make things start to look up. If a low mood persists, other strategies can be brought into play. Treats are essential. Exercise helps - physical activity releases endorphins, one of the body's natural anti- depressants. But the most vital management skill is the realisation that depression feeds on itself, changing the actual chemistry within the brain. People who are depressed think in a different, more gloomy and pessimistic way. They will tend to select only negative thoughts and memories from their memory bank, and so will become even more depressed. The ability to see silver linings in clouds is not simply Pollyannaism; it is a healthy self-protective mechanism with a good biological basis.

Anything that shifts perspective, that alters the depressive mind-set, will help restore emotional balance. Making time for yourself and the things you like to do is one way. Making time for other people, looking outwards rather than inwards, is another. Doing something, even something trivial, for someone else, can lift the mood in an amazing way. Talking to friends can help put problems into perspective even if it can't solve them. Thinking about problems one at a time may enable you to find some solution. Dwelling on an accumulation of problems at the same time can only produce a feeling of utter helplessness, an inability to take any positive action at all.

When depression deepens to such an extent that it interferes with one's ability to live and work as usual, medical help, in the form of drug treatment, is the only answer; one survey suggests that about one person in 25 will at some point in their life be in need of such help. But usually depression is self-limiting and self-correcting; and, when it persists for longer than a few days, it is often because the situation that precipitated it in the first place is slow to change. An unsatisfactory job, for example, a bad relationship, a heavy mortgage, or ill-health, can all contribute to an on-going depression. All that can be done here is to change what can be changed and to try to improve the quality of one's life in other ways.

One of the greatest sources of happiness - and paradoxically of pain, too - is other people. Good personal relationships, intimate and otherwise, are essential for our mental health. Few of us can be genuinely happy if we are emotionally isolated. Those who have a supportive partner or family, or a good network of friends, will always be able to cope with crisis better than those who do not. And yet often people seem unable to help behaving in a way which jeopardises their relationships. Next week, this series continues with an article by a leading American psychologist, Harville Hendrix, who has developed detailed strategies for breaking these damaging patterns of behaviour and improving our intimate relationships. He also explores the mystery of sexual chemistry and attraction.

Changing other people's behaviour is usually a hopeless task; a more fruitful, though still difficult, endeavour, is to change your attitude to yourself. A sense of self-worth is essential to mental well-being. A poor self-image doesn't just affect the way people feel, it affects the way they behave, and so how people behave towards them. One way to ensure a more positive self-image is to set realistic goals. Success is healthier than failure, and if your goals are unachievable, you are building failure into the system. People with low self-esteem tend to be so self- critical that they overlook or minimise their strengths.

For most people, some philosophy which helps to make sense of life is a prerequisite for mental well-being. Religious faith fulfills this need for some people. But even those who find it impossible to subscribe to any particular religious creed need some sense of purpose in their life. Studies of people who have survived conditions of great hardship - prison camps, shipwrecks etc - suggest that it is those who believe they will survive who actually do so most successfully.

Being the sort of person who sees a bottle as half-full as opposed to half-empty makes a significant difference to mental well-being. It's the optimist who seems to have a head-start in life. What you think, the "mental company" you keep, really does matter. Perhaps Coue - the French psychotherapist who made his patients repeat each morning, "Every day in every way I get better and better" - was right after all.

! Week two of the Secrets of Happiness: 'Getting the Love you Want: a Guide to Intimate Relationships'

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