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This blog continues the conversation I had Mike Veny, a leading mental health lecturer who is working to reduce the stigma associated with mental health issues. The last blog covered the basics in terms of understanding college student mental health and mental health in general. This blog continues the conversation, focusing more on ideas and strategies for maintaining mental health.
Mike: So now that I am getting a clearer picture on mental health, what are your recommendations for students maintaining their mental health?
Gregg: As I mentioned previously, the first big key is awareness about mental health in general and one’s own mental health in particular. Let’s start with the basics. Freud said there was “love and work”. These are two super important domains that you want to be reflective about. I would add a third, “play”. So, one of the basic ways to reflect on how one is doing is to ask: “How am I doing in the domains of love (relationships), work (school and career), and play (leisure, hobbies, entertainment, and pleasurable activities)?” Consider what you value in each of these domains and reflect on how fulfilled you are.
Mike: Love, work, and play. That is pretty straight forward.
Gregg: It provides a nice, easy starting point to think the important life domains related to psychological well-being. Then perhaps one can go deeper and ask questions such as: "How am I really doing, emotionally and socially? Am I satisfied with my life and its direction? Does my life have a purpose and am I growing? Do I feel known and valued by the important people in my life, including myself? Am I having problems with anxiety, depression, or stress?" To have good mental health, one must reflect on these questions. If someone is unsure, I recommend the take a screen on well-being. Here is a link to one such assessment. I would also suggest folks take a screen on depressive symptoms or anxiety if they were dealing with lots of negative emotions.
Mike: A free assessment would be very helpful it seems. What other pieces of advice do you have?
Gregg: Well, let’s break mental health up another way, this time into habits and lifestyles, academic readiness and performance, and socio-emotional health. Let’s start with habits and lifestyles. One of the most basic things to be aware of is how central your daily pattern of living is to your mental health. Your body is a system of energy flow, and the pattern, rhythm, predictability of that energy flow is key. This translates into all the basic pieces of advice about healthy habits, which I will briefly review here.
1. Sleep hygiene. Sleep is one of the most basic functions of the body and it is absolutely essential to get the sleep your system needs to keep the energy flowing smoothly. As a group, we are chronically overstimulated and under-rested. We know that poor sleep is associated with a huge number of problems. (If you are curious about sleep hygiene, see here).
2. Physical fitness. It is crucial that we have strong, flexible bodies that can exert a reasonable amount of energy, either in the form of a burst of intense energy or longer more enduring expenditures. Our environment is now set up to enable us to exert virtually no physical activity, which means our bodies atrophy, we get stiff, weak and feel fatigued easily.
3. Healthy eating. The old adage you are what you eat has much truth to it. We now know the dangers associated with high caloric, high carbohydrate diets, especially when paired with low physical activity. It is a recipe for poor metabolism and obesity, which makes one feel weak and fatigued, and not feel attractive or strong in one's body.
4. Responsible substance use. Mood altering substances are a key part of many people’s lives. Abuse or misuse of substances or chronic use and dependence set up a host of problems. Use substances like alcohol periodically for social emotional enjoyment, but not to escape from chronic anxiety or distress or to provide you with energy. If you need substances to manage your mood and emotions, that is a vulnerability that should be noted.
5. Healthy sex. Our sexuality is a basic feature of our lives. Unhealthy or unfulfilling sexual lives are a source of great distress. It is crucial that one understands one’s sexual identity and needs and has ways of managing these needs in a healthy manner. I see an enormous amount of casual sexual behavior in colleges. While pleasurable and entertaining for many, they also create lots of potential for problems, in terms of sexual abuse or assault or an emotional toll. Many people, especially women, are emotionally oriented to “see” sex as sacred and if “given” cheaply, that can result in deep seated emotional pain—yet many college campus cultures support easy casual sex.
6. Take note of your relationship with your surroundings. Our “minds” are all about the relationship we have with our environment. Many people live in environments that are over-crowded, artificial and lacking in the natural elements that we evolved to live. Take note of how your feel in your environment and take opportunities to explore how you feel in other environments, such as spending time in nature.
7. Balance your daily or weekly activities between work, love, and play based on conscious reflection of your life’s values and meaning.
Mike: That is quite a list. I would imagine some kids at college have a hard time managing all of that.
Gregg: You are exactly right. Although it is “doable”, lifestyles in college campuses are often arranged in a way that pulls against these healthy patterns of daily living. Students are chronically sleep deprived. Many sit and stare at screens all day, rather than engage physically in nature. In our culture, we are almost all surrounded by high caloric, high carb foods. In many colleges, the normative drinking culture supports alcohol abuse; that is, regularly getting drunk to the point where one loses control of one’s capacities or one blacks out or has a massive hangover. There is also a culture that endorses casual sex. Now consider that we have 18 year-olds who are, for the first time, living alone and having all of this freedom to explore all of these kinds of activities. Many of them were sheltered or overprotected or neglected or over-controlled or were not educated about how to live a healthy life nor taught how to manage their habits. All of these things can combine for a recipe for trouble.
Mike: And we have not even gotten to the thing that most college students stress most about, their academics.
Gregg: You are exactly right. In addition to learning how to manage their lives on their own for the first time in an environment that is set up to pull many toward unhealthy habits, they are also given the task of managing academics that for many are at a fundamentally different level of difficulty than they are used to. Many kids—especially kids who are first generation college kids or who come from weak educational systems or who have learning or attentional problems or are kids who have been given much assistance by hovering parents or kids who simply don’t have lots of intellectual horsepower—can find the academics to be completely overwhelming. Many have not been given information on how humans learn and remember things, nor on the best ways of studying. Many also do not have a good sense of what their intellectual strengths and weakness are, and thus they don’t really know how to set appropriate expectations for their performance. Just because someone got almost all As in high school does not mean they should expect to get almost all As in college. It all depends how well they were prepared, it depends on with their attitude, grit and motivation, it depends on their basic academic/intellectual talents, all combined with how they adjust to college life. Because kids are often clueless about where they really fall on these domains, many set completely unrealistic expectations or approach studying all wrong or sign up for classes or majors that they are not well-suited for. Many others get caught in problematic lifestyle choices listed above and then don’t even attend their classes. Assuming the student actually cares about their grades, once they begin to struggle, then all sorts of adjustment problems can ensue.
Mike: So, do you have advice here?
Gregg: My basic advice is to systematically assess your college readiness. There needs to be some assessment of an individual’s knowledge about how to tackle a college level course, how to study, how to regulate one’s behavior, along with a basic knowledge about intellectual and academic skill sets and an academic path (i.e., major and course selection) that reflects an individual’s skills, attitudes and interests (i.e., something they are genuinely passionate about).
Mike: Okay, so there is clearly a lot to think about from a lifestyle and academic achievement perspective. It is interesting that when people think of mental health, they often don’t really think of these things.
Gregg: That is absolutely right, Mike. And a key point. Mental health fundamentally is about adaptive living. Adaptive living is when you maximize your valued states of being, given your capacities and your situation. Put differently, it is about how you live your life in the broadest sense of the term. So, all of these elements are part of your mental health and well-being. I think we can now start to get into the domain of mental health that a lot of people think about when they use the term, but it is key that we understand how broadly encompassing mental health truly is.
Mike: I think most people think about mental health in terms of being depressed or anxious so that it is hard to function. And then there are serious mental illness problems, when people really have trouble, like they start acting really disruptive or experiencing really unusual things like hearing voices.
Gregg: Right again. For the remainder of this conversation, let’s discuss what many folks in my business call “neurotic” problems. These are problems of heightened stress and distress, interpersonal loneliness and low self-esteem, and high levels of anxiety and/or depression. It is these problems that we have seen dramatically increase. There are other classes of mental health problems, broadly labeled “psychotic” or "severe mental illness". These terms reference folks that lose much of their capacity to function and begin to lose touch with reality; that is, they start hearing voices or developing delusions about who they are or the world around them. I will not be addressing those problems here, although they are important for folks to understand.
Mike: Ok, so help me understand how you see what you call “neurotic” problems.
Gregg: Right, so recall the discussion earlier about what mental health is. Fundamentally, it is about having the core need for relational value met and having harmony between your experiential self, your private narrator and your public self.
Mike: That’s right, I recall.
Gregg: And also recall the story of Amber. Although Amber was loved by her parents, she nevertheless had strong negative feelings that she did not know what to do with. So she tried to hide these feelings and she ended up blaming herself for them, all while she acted as though everything was fine so that she could maintain her relationships and social influence. Amber’s story highlights what I believe are the key features that make someone vulnerable to mental health problems.
Mike: What are those elements?
Gregg: First, Amber was neurotic by temperament. That means that she emotionally was very sensitive to negative feelings like anxiety, stress, irritability and sadness. Second, although she was valued by her parents, she did not feel well-known by them, which set the stage for filtering and disharmony. Third, the way Amber coped with her inner turmoil is that she developed an inner critic that tried to control her feelings and her self-presentation. That is, the narrator “turned against her emotional self” and blamed herself for being a basket case and for not getting good grades and for letting everyone down.
Mike: I can follow those elements.
Gregg: It is the development of the last piece of the puzzle, that inner critic, that I want us to focus on. One of the most central elements of socio-emotional health and stability is the structure, organization and attitude of that inner audience. If that inner audience is an internalized critic that tries to control, cajole, censor and criticize, then you have a recipe for neurotic breakdowns (i.e., the emergence of depression and anxiety disorders).
Mike: That makes good sense to me. So what should people do?
Gregg: Well, we have been talking a lot about the first key step to mental health in college. That is awareness. It is hard for me to emphasize this enough, but first and foremost, one needs awareness, both about humans in general (i.e., healthy habits, the core need for relational value, the three domains of consciousness, etc.) and themselves in particular (they need to understand their own needs, drives, role in their family, key events in their lives, their levels of anxiety and depression etc.).
Mike: I got it and I think you have provided me with a large map of that that makes sense. So, what should someone do if they realize they have an inner critic that is causing them mental problems?
Gregg: They need to transform that inner critic into a CALM MO.
Mike: That sounds interesting. What do you mean by a CALM MO?
Gregg: The position of an inner critic is the position of a “meta-cognitive observer”. That is, it adopts the position of thinking and feeling about one’s thoughts and feelings. Thus, Amber’s inner critic looked at her thoughts, feelings, and actions, and had the thought: “Why am I such a basket case?” That is a reflective thought about herself and who she is. “M. O.” stands for Meta-cognitive Observer. Does that make sense? (For more on this and mindfulness, see here).
Mike: Yes, I think so. It is the portion of my mind that is evaluating and thinking about what I am thinking, feeling and doing.
Gregg: Yes, exactly. ‘M. O.’ has another meaning here. It also stands for your modus operandi, which is a common term that means your general mode of being. So the “MO” part really stands for the modus operandi of your meta-cognitive observer.
Mike: Got it.
Gregg: Now the question I have folks ask themselves is: What is the modus operandi of your meta-cognitive observer, critic or CALM? CALM is an acronym that characterizes the attitude I encourage folks to cultivate in the MO. The ‘C’ stands for curiosity; the ‘A’ for acceptance; the ‘L’ loving compassion; and the ‘M’ for motivated to learn more and grow from a position of security.
Mike: Can you say a bit more about what this means?
Gregg: Yes, let’s go through each word in the acronym. Instead of an inner audience or voice that tries to control what it “sees”, I encourage folks first to be curious. That is, rather than an inner audience that insist one acts or feels a particular way, instead the inner audience starts by asking, “Am I aware of how I am feeling and thinking and why I am doing what I am doing?”; “Am I truly aware of others and my surroundings?”; “Given who I am, do I understand why I am feeling what I am feeling?” In other words, the stance shifts significantly from closed-minded, critical and controlling to one of open curiosity.
Mike: That follows.
Gregg: Acceptance is the next term. I think about this in two broad ways. First, it is the capacity to accept life as it is and all that it is, the good and bad. In this context, I often instruct or remind folks that one of the most basic principles of Buddhism is “Life is suffering”, meaning that it will inevitably at times involve pain, injury and will always ultimately end in death. This is our lot in life and to try to deny or control or reject this often sets the stage for more suffering. The second meaning of the term is to foster in folks a nonjudgmental attitude toward self and other (note we can make judgments without being judgmental, see here). This involves helping people loosen the grip of “shoulds” and “must” (i.e., I should be x or I must be Y to value myself, see here).
Mike: Ok, curiosity and acceptance. What is the ‘L”?
Gregg: The ‘L’ stands for loving compassion. By this I mean a fundamentally positive valuing of human beings as creatures that have dignity and worth. With very few exceptions, I generally see people as creatures doing the best they can and I encourage folks to cultivate a general sense of foundational value for self and others. In the context of working with someone like Amber, I might help her see that she was always trying to do the right thing, even though it might have turned out differently than she wished, that did not mean the essence of who she was deserved to be rejected or was worthless.
Mike: And finally, the ‘M’?
Gregg: Motivated to learn more and grow from a position of security means that there are valued states of being that we are striving for. We do want fulfilling relationships, to find our passions, to live meaningful and productive lives. That is the long term goal and we want to guide our lives in that direction. This orients the individual to consider making changes that would foster more adaptive living.
Mike: Cool. Curious, accepting, loving, and motivated to learn and grow. I like that. Did you come up with that on your own?
Gregg: Sort of. I got the idea originally from Dan Siegel, who is an excellent psychiatrist who teaches about mindfulness. His acronym was COAL (curious, open, accepting and loving). I altered it so the acronym spelled a more appropriate word and added the MO. And I also anchor all this in my new unified system for psychology, which makes the approach pretty unique.
Mike: So let me see if I can summarize what you have told me during this conversation. First, it is clear that there is an emerging college student mental health crisis. The figure that stuck in my head was that three decades ago maybe 1 in 10 college students suffered from significant mental health problems, now that figure is 1 in 3, which is a huge increase that we need folks to be more aware of.
Gregg: Absolutely.
Mike: There is a lot that might be causing this increase. It seems to be happening in society in general and you think it is associated with society being much more fast-paced with information overload, the lack of social systems that provided people meaning, academic pressures to succeed, uncertain economic times, and maybe also an openness to negative feelings that was not present in the past.
Gregg: Yep.
Mike: And you think that we have not received good education about what mental health really is.
Gregg: Exactly.
Mike: We need to have awareness of three key things: 1) a basic map of human consciousness; 2) the core need for relational value; and 3) the developmental and social context, so we can understand why someone is experiencing mental difficulty.
Gregg: Right.
Mike: In addition, we need a broader understanding of mental health. For college students, they need to understand what are healthy habits and lifestyles and what are not and why they may be vulnerable to unhealthy living. They also need to understand their levels of college preparedness to tackle the academic life.
Gregg: Definitely.
Mike: And when people do get stressed, either by relationships or bad habits or poor performance, this creates mental disharmony and it is how they handle that disharmony that is what causes problems to become “clinically significant”.
Gregg: There are a few other things, but this is pretty much on target.
Mike: A major reason for this is because their inner voice gets critical and controlling and this adds to their mental disharmony and distress. This can then result in a vicious cycle that causes them to breakdown emotionally.
Gregg: That is it.
Mike: A key thing they need to do is realize that this voice may be working against them, even though it wants what is best. So, what they need to do is begin to shift their inner voice from an attitude of a controlling critic to one that is C.A.L.M.
Gregg: Bingo.
Mike: That is pretty cool. I really have benefited from this conversation and your model. It has really put lots of pieces together for me. You have got to get this model out there. Folks need to understand this.
Gregg: Thanks for you kind words. I am just now moving toward “marketing” this and making connections and learning from people like you how to do so.
Mike: Well, good luck. It is important work.
Gregg: Thanks. Let’s stay in touch.
