May is Mental Health Month and at the beginning of it the State of Iowa launched their Make It Ok campaign as an effort to reduce the stigma of mental illness. Thanks in part to an op-ed I wrote for the Des Moines Register a year ago, I was contacted to see if I would take part in the campaign as one of several Iowans telling their personal story. After I was asked, I hesitated. I did so for numerous reasons and at numerous times. Paramount for me was the uncertainty I felt in saying something that would leave someone else feeling marginalized.

I also wondered if I fit. I was hung up on the term “mental illness.” It is not a term I or the therapist I still frequent use.  It’s not talked about in this way at the conferences I attend. I have never been prescribed anything. The difficulty I experienced was mostly confined to a certain period of my life.

We all waste so much time wondering what something is supposed to look like.  It probably equates the same amount of time we wait to be comfortable before we do something.

I also hesitated because I have my own thoughts on stigmas and mental health. My op-ed was in response to a beautiful piece columnist Daniel P Finney wrote detailing his own struggle with depression. I knew people would read it, think that his life isn’t what theirs looked like, and conclude that mental health wasn’t something for them.

So I wrote my own story about a series of life changes and the acute depression and anxiety that came with them. What I wanted to argue was that mental health is for everybody. After it ran, the op-ed brought up even more conversations, so I wrote a follow up blog post. I tried to state the same thing, and suggest the even bigger stigma was how we talk about mental health.

I forwarded the follow up to the state group launching the campaign. I wasn’t sure they had seen it. Perhaps I hoped they would conclude I was no longer a good fit.  They didn’t that way.

I would go on to do a phone interview, from the cab of an excavator, about how I dug into mental health.  The interview became a story, my story.  This month it was included with others from my fellow Iowans.

In the material for the Make It OK campaign, they say 1 in 5 Iowans will experience some form of mental illness. Honestly, if mental illness simply means that our emotional state is severely impairing our ability to function and think clearly at a given time, 1 out of 5 is much too low. Our emotional state impairs our ability to function most days in some way.

What I will always argue is that 5 out of 5 Iowans would benefit from learning about and working on their mental health.

I mentioned above that I don’t typically think in terms of mental illness when it comes to mental health. The terms I more often hear discussed are “symptoms,” and being “symptomatic.”  For some these terms are event oriented and associated with periods of their life.  Perhaps only a period.

For others, it’s a daily part of life.  I suppose they are more neutral terms. Perhaps more neutrality is at the heart of dispelling stigmas.

There was an army physician in World War II named Murray Bowen. During his service, he came to observe differences in how soldiers handled trauma and stress. These observations led him into psychiatry after the war was over.

In his study of psychiatry, his observations led him a different direction than his contemporaries. This direction would come to be known as Bowen Family Systems Theory. I discovered it by wondering where the hell my own therapist was taking me.

Were they going to turn a hot tempered Irish cattleman into a pacifist vegan?

In my own layman terms, where Bowen began to differentiate himself from the work of Freud relates to how many might view mental illness today.  Freud saw problems residing in individuals. To fix them, one needed to treat the individual.

In Bowen’s work, particularly aided by his work with schizophrenia patients and their families at the National Institute of Mental Health, he began to be pulled by the idea that many of our human difficulties went beyond the individual and were part of a product of our family systems.  You could help individuals by helping them achieve more rewarding relationships.

In a old blog post, I once relayed a story about a common way that this might look.  I’ll relay it again here:

Think of a family that has three people in it.  A mother, a father, and their 20 year old son.  The son is making a spring trip home.  He’s rarely been home because be around his parents always raises his anxiety.  Knowing that is coming, he’s anxious.

His mother has been excited for some time to see a son she’d like to see more of.  She wants him to enjoy himself.  She has some realization that he doesn’t seem to have been on previous trips.  She’s going to pay particular attention to him this time, to make sure that doesn’t happen.

The father is anxious that this visit will follow the past, with everyone leaving in disappointment. His already anticipating what might happen, and planning out a course to fix things in case it does.

When they pick their son up from the airport, the mother greets him and says, “Why you don’t have a coat on? You must be cold.”  It is her way of expressing care for her son, and is exactly the type of thing her mother would have said.

The son immediately bristles at the comment. “I’m twenty years old, Mom.”

The father, recognizing anxiety on the rise, decides to show support for both sides. “It’s good to see you, son. Your mother is right. It’s cold out there.”

The son feels as though he is being tag-teamed, and begins to withdraw.  The more he withdraws, the more his parents pursue him in conversation on the way home. The more they do, the farther he goes.

Finally his mother asks, “Are you sure you are all right?  You don’t seem like yourself.”

The father, still trying to fix the problem, proclaims, “He’s just tired. He’ll be fine.”

“There you go again, minimizing my worries,” says his wife.

All I have to do is make it through the next couple of days, thinks the son.

The above is a benign example anyone could relate to. But you get to see it here from the cat bird seat.  From this seat, where does the problem lie?  From this seat, what could any of our three characters do to change the narrative?  Now for the million dollar question:  How do you get to that seat in your own life?

If any of the three were to be less reactive the situation would improve for them.  If any were to dial back the focus on what they perceived the problem to be, the situation would improve for them.  In either case, it wouldn’t improve just for them.  It would improve for everyone else.

In his work with the schizophrenia patients and their families, Bowen found that just making observations about what he was seeing, asking for the observations of those he was talking to, and trying to remain neutral about it all seemed to help get a family thinking again.  Some of the ways he did it were quite subtle.  His contemporaries would ask someone, “How do you feel?”  Bowen came to ask people, “What do you think?”

It isn’t a cure all.  The mother in this case is till going to tend to focus on her concern for her son. The son will still feel a tug to withdraw in certain anxious situations. The father will still want to get in between two people and fix things. I’m still a hot tempered Irish cattleman.  Yet knowing the cards you hold will help you do a better job of playing your hand. It will also likely help those around you holding more or less difficult hands of their own.

Hopefully also, in this benign example, one can also see the complexities that would arise if any of the two decided the third person was the problem and proceeded to heighten their focus on it.  It isn’t a stretch to say it create a situation where the entire family gets stuck. No one in the family is trying to better manage themselves.

Were it another health issue, we might think of it differently.  I think of a parent who has a child with down syndrome. In that case, thousands of families, through a stance of inclusion, are finding a system that benefits themselves. Mental health is health.

Anxiety, depression, and a whole multitude of symptoms are all real. People’s ability to cope with these symptoms vary from person to person and event to event in our lives. Sometimes people are symptomatic.

Stigma about it all is real. Some of it we use to afflict others. Some of it we use to afflict ourselves.

Treatments vary.  They look a lot of different ways.  Working on becoming a more responsible self benefits ourselves. It benefits those in our relationships, whether they are symptomatic or not. It benefits our families now and in the family’s future after us.

May we talk about it in a way that leaves no one feeling marginalized.