It sounds like the opening scenes of a certain wildly popular television drama: on Labor Day 2013 I found myself on a gurney in the ER of Beth Israel in Boston, a perfectly healthy 44 year-old victim of an epic panic attack, who would have a very expensive night of tests to determine if what I was feeling was real. I was released around noon the next day with a clean bill of health, and a delicate suggestion: I might want to find myself a therapist.
There is so much about basic preventative care that's broken in our health care system, mental health is hardly even on the radar. Therapy, while no longer exactly stigmatized, as long as it's in the pop-culture context of self-help or increased productivity, is still very much an add-on. We have no real concept of ongoing mental health that's built into our bare-bones idea of preventative health. Add to this our zero-sum culture's bizarre and harmful view that any stumble in career or personal life is a FAIL worthy of censure and scorn, and it's clear we've built a public culture that fuels a need for ongoing mental health care while simultaneously discouraging those who seek it out.
I had struggled with periods of situational depression for decades, and had negotiated them clumsily by literally moving away from anything that brought them on. I had moved from the Midwest to the West Coast to the East Coast, to Europe for a long stint, back to the Midwest and then the East Coast again, but it was as they say: wherever you go, there you are. I found myself, now in my forties, now constantly on the go, exhausted, unhappy, and increasingly afraid I would not have the energy to outrun this thing forever. So, naturally, I panicked.
While I have been very active in my own preventative care, actually seeing a mental health professional had always seemed like a last resort to me. Most Americans go without mental health care just as many of us go without preventative care in general. We do this for a variety of reasons: because society says we should be able to deal with it on our own; because there's a whole lucrative cottage industry of self-help to "assist" us; or maybe because we believe faith can heal us; because we don't know what "mental health" is or what it entails; we don't know how to navigate the mental health system; we're afraid of the cost of this "secret menu" item in our insurance policy; or a thousand other reasons.
The sad thing is: These are actually all good reasons to avoid our mental health care system, such as it is. I have a very caring Primary Care Physician, with a holistic approach to health, who understands that mental health plays a huge role in our overall health and well-being. But she is not a mental health professional. Neither is your insurance provider. When I finally did decide to go ahead with counseling I received a list of about 20 mental health professionals based on two factors: their being in the provider's network and their geographic proximity to me. Proximity is obviously a factor, but it's not like choosing a bank based on location. I ignored the list, threw caution to the wind and tapped my social network for referrals.
But this was only the beginning. Mental health is a practice, it requires intention and time, and it's not one-size-fits-all. While there are best practices, there's not really a single fool-proof procedure that works for everyone in the case of depression, anxiety, a bad break-up or a death in the family. And you don't really want to be tasked with finding a therapist that's right for you when you're in the middle of a midlife meltdown. But that's where I found myself. I did the best I could negotiating the health care and insurance maze and ended up with a couple referrals for a reputable practice that was near my office and would honor my insurance. I felt lucky: my copay was $20.
My first therapist was nice enough, but rather passive. We met mid-afternoons, right after his lunch break, and I recall many a stifled yawn as, slouched in his big comfy swivel chair, he struggled valiantly to stay awake. The only thing that really pepped him up was whenever I would mention my trials and tribulations with dating apps. He would rally in the last five minutes of our session to give me a little pep-talk, usually only tenuously related to whatever had preceded it, and we would confirm our appointment for next week. This went on for four or five months, until one restless night out of nowhere he popped up on my Grindr app to say hello. Pretty sure I hadn't checked "transference" in my profile settings. I felt it best to just block him and move on.
Unfortunately my next therapist was, in many ways, worse. Openly antagonistic, he often expressed frustration with my analytical approach to my own narrative and would interrupt me often to ask, urgently: "But how did it make you FEEL?" When I attempted to answer and banged on too long, he would interrupt me again, greatly agitated: "Did it make you feel sad? Did it make you feel angry?" It turns out it was not an essay question but a multiple choice, and I got the sense when he told me I had grieved wrong after my dad's death that there was definitely a right and wrong answer for him. We parted ways, after his more and more bizarre attempts to get a rise out of me began to border on criminal malpractice.
But while therapy never clicked for me, that eight months of focusing on whole health was a big step toward discovering a community of support and a path to well-being. I discovered that just like with the gym, where I'd been a regular since high school, mental health starts with intentionality but involves practice. I began to see therapy not as a magic bullet, but as a kind of weekly workout, with the therapist as trainer. You go to a trainer for a program of exercises that will make your body healthier and stronger, and to monitor and motivate you in your progress. The therapist can't do the heavy lifting for you, but by listening and guiding and giving you some exercises, she can help you develop a regimen to maintain health and wellness in everyday life. It's an oversimplification, perhaps, but for folks without clinical or acute mental conditions, who may yet be battling everyday stress, anxiety, or coping with career issues and life-changes like I was, regular therapy can still have a profound long-term impact on overall health.
The gym isn't a bad metaphor, actually. Look at it this way: over the course of my lifetime, going to the gym and working out has gone from the margins to the mainstream. The number of gym memberships in the US has increased exponentially, from 1.5 million in 1972 to almost 60 million today. Imagine if mental health care were to make the same transition, from something you did when you were "sick" to something you did when you were healthy, to stay healthy. Imagine a whole health culture where talking about mental health wasn't always actually a discussion of the crisis of mental illness.
We're certainly not wrong to focus what meager resources we're willing to put into it on mental illness, but in America today that's more or less all we talk about in relation to mental health care. It's important to remember that mental health and wellbeing are not simply the opposite or the absence of mental illness. Sure, it's understandable in a crisis culture, but the goal of our mental health apparatus should be the fostering of a robust culture of whole health and well-being for everyone, across the spectrum, throughout all stages and phases of life. Even just starting down that path can go a long way toward averting or allaying a mental health crisis in the future like the one we're obviously in the midst of now.
Like physical health, with which Americans are seemingly obsessed, mental health and well-being requires intentionality and daily practice. An optimal people- (rather than system-) centered culture of whole health would focus on ongoing mental well-being and its impact on physical health. The whole health approach has long been embraced by advocates of community-based health care, like pioneering Fenway Health in Boston, where I live. But this option is not available to most Americans. It's time to change that, for the health and well-being of us all.