Is Being Well the Same as Being 'Real'?

'Can you be real?'

In the months between the miscarriage of my first pregnancy and the successful conclusion of my second, I had regular sessions with a midwife-counsellor at the local maternity hospital, and this was a phrase she had to use more than several times. What it meant, in this context, was something like: 'Can you see that you have overestimated the risk of [e.g. fatal choking, drowning, stranger-rape which will harm the baby, my mother's car getting hijacked with my in it, me death in childbirth, contracting a disastrous infection by taking a sip from a glass of water after it has been left standing on table for a few hours etc. etc.] by an absolutely enormous margin?' She usually could get me to see—especially if she printed off the statistics and showed me.

The overestimation of risk is a cognitive distortion characteristic of OCD and their sufferers. Others—as listed by Veale and Willson in their book Overcoming Obsessive-Compulsive Disorder—include: catastrophising, assuming you predict the future (which will be bad), assuming that you can read other people's minds (they hate you), thought-action-fusion (thinking of a bad thing is the same as bringing it about) and, linked with it, an over-inflated sense of personal responsibility. Other mental illnesses, such as social anxiety, body dysmorphic disorder and depression, have their own distorted thinking patterns.

All this might seem to imply that better mental health equates to a firmer grasp on reality, but the truth is far subtler, and far more intriguing. Some studies have shown that depressed people actually have a more realistic sense of themselves, their lives and their capabilities than their non-depressed counterparts. It is not straightforward realism as such that is conducive to good mental health—more realism (but not too much of it) tinged with the right amount of positive cognitive distortion. It's like my mother always said: optimists and pessimists may come to the same end regardless of their attitude, but optimists enjoy themselves more on the way. And—as explained on a recent episode of the BBC's science programme Horizon—they are more likely to get out of bed and get on their way in the first place.

So, if you want something done, ask an optimist—but get a pessimist to do the risk assessment.