Last week I wrote about physical health. I argued that your mind is the tool you use to do your work, to engage with your friends and family, to lead your team or organization, and to experience literally everything, and that you cannot get the most of your mind without maintaining your physical body.

My broader objective was to begin the new year by putting first things first, i.e., health. Any such effort would be tragically incomplete were it not to address mental health directly.

Let’s Get Right To It:

I hold a deep, personal conviction that a cultural shift in our willingness to discuss mental health openly and objectively is critical to reversing the current negative trends.

We have made progress, no doubt. Awareness of and conversations about mental health have increased markedly in my lifetime. This is good news, and worth celebrating.

Yet, mental health problems are still poorly understood and widely stigmatized. They can be a source of shame and embarrassment, and are viewed as a sign of weakness to be minimized and hidden from public view (especially by those suffering).

How Do I Know?

I know our society still has work to do because as I contemplate what I am about to share, I can feel my chest and throat tighten.

Do you know that feeling? It is as if one’s body is literally trying to choke off the words before they escape into the wild. Body and mind, inextricably linked.

I can feel the dread rising within me, and I know our work is not done, because I know my hesitance and fear of judgment is justified, at least in part.

What will people think? I can’t know, but it seems now is the time to have the courage of my convictions.

My Depression

In 2006, I was in the middle of a painful divorce. I was the unprepared, too-young CEO of a company that, in retrospect, seemed purpose-built for failure. My two business partners, both thirty years my senior, were justifiably concerned—panicked might be a better word—and were conspiring to remove me from my position, no-holds-barred style. To say it was stressful would be a significant understatement.

HIPAA, Anyone?

One day that year, newly separated and having just moved into a dreary apartment, I made a terribly uncomfortable visit to my former home to collect my share of the mail from my soon-to-be ex-wife. She sheepishly handed me an envelope from my doctor. The doctor’s office apparently didn’t want to splurge on the more expensive privacy envelopes because right there, plainly legible through the back of the envelope in large, bold font, was the word “DEPRESSION.”

That diagnosis was preceded by years of “Maybe something is wrong,” a thought inevitably followed by, “You’re making excuses for being a loser. Pull yourself up by your bootstraps.”

Is this internal dialogue familiar? If so, I encourage you to challenge it.

That not-so-private letter came after I was finally convinced to seek help, and was desperate enough to follow the good advice. Anyone in my situation might struggle, I supposed. Yet, my depression was not situational.

Diagnosis

I was officially diagnosed with Major Depressive Disorder at age thirty-three, but in retrospect it seems clear that my depression began as a teenager. It has been with me my entire adult life.

Today, I am happy to say that my depression, like my high cholesterol, is well-controlled. Certainly I have difficult days or weeks, but overall, my mental health is as good as it has ever been, and still getting better. It has, however, been a long road.

As I traveled that road, there were many days when I simply could not will myself, despite every sincere desire to the contrary, to do much more than stare at the ceiling, or perhaps my computer screen, pretending to work while secretly freaking out that I couldn’t. Although I knew even then that exercise or seeing friends could help, I could not compel myself to do it. Nothing felt good. Nothing felt like much of anything.

A New Day

In sum, years of my life were lost to a state of total apathy, a few days or a few weeks at a time.

From that place I could not have imagined how I feel today. I now regularly experience the opposite of apathy, a sometimes hard-to-contain passion to fully experience this miraculous life.

Yes, the hard days still come, but far less often, and when they do I experience something akin to annoyance, an unwelcome interruption like a guy selling vinyl replacement windows ringing the doorbell. Irritating, sometimes more persistent than others, but manageable.

How Did We Get Here?

Mental health problems are the result of complex interactions between...

• our genes,
• our brains and nervous systems (for which our genes were the blueprint), and
• our environment (which can, in turn, cause epigenetic changes—and around and around we go).

“Environment” includes everything from our life experiences, including traumatic ones, to the culture we live in, the food we eat, and the air we breathe. Genetics are a significant factor in essentially all mental health problems, but our genes result in predispositions and vulnerabilities, not destiny.

The important message here is, we didn’t choose our genes, nor did we choose most of those environmental factors. Mental health problems are not the result of weakness or personal failure. If you are suffering from a mental health problem, you did not cause it, but there are things you can do to make it better.

Taking Action

Whether it’s depression, anxiety, OCD, bi-polar disorder, PTSD, or any of the other mental health challenges, I cannot know what will work best for you, but here’s what I do know:

If You Have a Mental Health Problem...

Addressing it is your top priority, along with maintaining your physical health (because really they are two sides of the same coin).

Yes, life marches on anyway. Yes, you still have other responsibilities, and yes, there are people who depend on you. But, I can tell you from experience that you won’t be very effective at any of those things if you do not take care of yourself first.

Secure your own mask before assisting others.

If You Think You Might Have a Mental Health Problem...

Assume that you do and seek qualified help. If you are worried that tightness in your chest might be a warning sign for a heart attack, see your doctor. My comparisons to preventive care for physical health issues are very intentional. Mental health is not different.

Even If You Don’t Think You Have a Mental Health Problem...

Check in with your doctor or a therapist anyway. Treat these check-ups like you would the necessity of getting a colonoscopy after age 45. 

Patience and Persistence

Treating mental health problems can be like measuring the results of your marketing efforts: you know that 50% of your marketing initiatives work, you just don’t know which 50%.

For me, managing depression has involved many different interventions: changing my circumstances, medication, therapy, exercise, limiting social media, meditation, improving my diet, personal development work, engaging in things that I enjoy, emphasizing social connections, and more. Which one made the difference? I have no idea. There is no single fix.

Thus, it is important to explore lots of options. There are many treatments today that were not available even ten years ago, and more refined applications of those that were. There are two obvious categories: drugs, and not drugs.

Drugs

Finding the right pharmaceutical treatment for mental health problems can be enormously frustrating, but there are many treatments that are effective. Today, not only do we have new drugs, we have a better understanding of how different people are likely to respond to different drugs.

For example, genetic testing for SSRI response can reduce the trial and error. Overall, pharmaceutical options are far from perfect, but they are getting better and the landscape changes quickly. Only your doctor can help you here.

The key message is this: If you tried drug treatments in the past and did not achieve the results you hoped for, it might be worth another look.

Not Drugs (Therapy, Etc.)

Not all therapy is created equal.

There are many forms: cognitive behavioral therapy, internal family systems therapy, dialectical behavioral therapy, equine therapy, play therapy, and mindfulness-based cognitive therapy, to name just a few.

Different approaches are better suited to different challenges. Importantly, trauma requires specific interventions from clinicians trained specifically for trauma. Do some homework and try different forms with a skilled and licensed therapist.

Even if you are not suffering from a mental illness, working with a therapist can be enormously beneficial. Life is challenging, even with good mental health. Well-being is not merely the absence of disease.

Exercise

I know, I know. You’ve heard it a million times. Exercise helps. I have rolled my eyes, too. That said, my own experience is that, cliché or not, it is true. Exercise can be very helpful, but I want to be careful because I know all too well that depression can stop you from doing the very things you know might help. It is a cruel paradox.

Focus on the things you can do, and be gentle with yourself when it comes to the things you can’t.

Your mind is the tool you use to do your work, to engage with your friends and family, to lead your team or organization, and to experience literally everything. Your physical body is the vehicle through which you interact with the world. Maintaining your physical and mental health is everything.

This is your life. This is your work. Don’t miss it.

Greg