“You’re so motivated!” The researcher’s next question is one I’m asked frequently. Why? Last month I had the unique opportunity to speak with a team of researchers unraveling the question of depression at UT Southwestern. This woman voiced a frustration echoed by psychologists, physicians, doctors and nurses. We already know much about what protects mental health; we just can’t get people to do it.
Her question rattled in my brain over the past few weeks. The odds of a person like me relapsing are about 80%(American Psychiatric Association, 2000; Kupfer, Frank, & Wamhoff, 1996; Post, 1992). I’ve experienced three major depressive episodes in my lifetime: my freshman year at the University of Notre Dame (1979), in my forties when I attempted suicide and had electroconvulsive therapy ECT (2001), and after going off medication and relapsed (2007), but put back on course again with ECT. These three events put me in a high-risk category that has an average of five (Kessler & Walters, 1998) to nine (Kessler, Zhao, Blazer, & Swartz, 1997) episodes in a lifetime. Knowing the chance of relapse is so high makes me more vigilant about staying well.
My strategy for wellness is embarrassingly simple, and protects me from a long list of other diseases like Alzheimer’s and heart disease. I simply chip away at health on a daily basis paying attention to sleep, exercise, nutrition, medication, stress management and social support. When I start to spiral, I take action early, often correcting myself before problems require professional intervention. More detail on my wellness list is on the Struck by Living website. When I fall off the wagon, which happens, I forgive myself and hop back on. Why is it so easy for me to be motivated and so difficult for so many others?
The answer is I’m not magically motivated, but I’ve taken the time to make my own wellness list. My guess is most people never do this. Plus I relapsed when I went off my list, which reinforced its value. Friends and family know my list, so they keep me honest about sticking to it. I created this plan assisted by the input of my psychologist, my psychiatrist and mounds of things I’ve read. But the key is, the plan is mine. No professional dictated my list, and no professional can insure I abide by the list on a daily basis. That part is up to me.
How do we motivate people to do what’s good for them? Explain the practical elements of brain health and lead by example. Ask about progression of those habits on a regular basis. Imagine a world where every therapy session started with three questions: How’s your sleep been? Are you exercising? Can you tell me a little about what you’ve been eating? In all my years of therapy, I’ve never had a therapist ask those questions. Patients won’t assume these things are critical to brain health if no one ever asks about them or tracks them. As long as we treat the brain as disconnected from the body, mental health will remain an unsolved mystery.
I connected the dots between my habits and my brain health to learn that I could change how I felt. For someone with depression, that’s empowering. Why not try it? My list isn’t prescriptive, but feel free to use it as a starting point. Make your list of what you need to do to stay well, write it down and protect it. Try it for yourself first, then with patients or a family member who is struggling. Don't expect a patient or family member to do anything you wouldn't do yourself.
Perhaps the reason people aren’t motivated to stick to a plan is lack of ownership. The nagging mother image of wellness always inspires rebellion in me, probably in other people as well. Maybe we should all start the new year writing down the answer to this question: what do I need to stay well? An imposed plan of wellness never has roots like one created and internalized.
For more information on Julie K Hersh or her speaking events go to the Struck by Living website.