Two random notes

Why do I refer to the people who come to see me for treatment as patients and not clients? I feel that therapists come from a lineage of healers, be they doctors, shamans, folk healers, spiritual healers, or the like. The word client seems to me to refer to someone who comes for a particular service, such as a legal service, but has nothing to do with someone who needs healing. The root of the word patient comes from the Greek word for suffering, pathos.

What is Mental Health?
Freud believed that the mark of one’s humanity was to be able to love and to work: “Love and work are the cornerstones of our humanness.” In thinking about what is mental health, I think that love, as ability to form attachments — including friendship and familial bonds — not just romantic love, is one of the criteria of mental health. Work, should be meaningful work, not necessarily paid work. A child’s work could be school or play; both develop essential skills. The work of a retired person might be spiritual work, readying oneself for the end of life.

There are other important elements to mental health as well. For one, the ability to adapt, to be flexible, is a key to survival. Again, Freud said (don’t ask me where, since I can’t find the reference), “If you can’t do it, give it up!”

Knowing when to give up and when to hold fast is an ongoing process. The 12-step programs have made this a part of their essential Serenity Prayer. When people are stuck with fixed ideas about themselves or others, they are not able to adapt.

In a related way, being stuck in a fixed mental state for long periods of time, is a sign of mental “illness” or dysfunction. One is then responding more to internal stimuli than external ones; there is no balance between the two. Extreme cases of this are catatonia and dementia. The inability to respond to what is actually happening around you, instead of your thoughts about it, is typical especially of mood disorders, but is present in all mental illness. So mental health would be an ability to be in the present, in the external situation, while able to maintain one’s own internal thoughts, and to have a balance between the two.

Other important constituents of mental health include creativity, spontaneity, humor. Thee are aspects of humanity that are not a result of a fixed or frozen state. These are not mere sublimations or defenses; they are expressions of who we are as people.

A final note: to me the ability to feel gratitude is a hallmark of mental health. Gratitude comes from a sense of fullness, wholeness, of being given to. Gratitude keeps us in the present. Fear, envy, anxiety and grief keep us in the past and future, and prevent us from feeling alive. It is difficult to feel grateful when you are suffering. If we are able to feel gratitude, we are experiencing some degree of health.

Many religions repeatedly give thanks throughout the day (all those Blessed art Thou's) — this seems to me to be a tool for returning to present time. Whether we're thinking of Ram Dass saying "Be here now" or Aldous Huxley's mynah birds saying "Here and now, boys; here and now", being present is inextricably linked to being grateful.

"Gratus animus est una virtus non solum maxima, sed etiam mater virtutum onmium reliquarum." [Latin: A thankful heart is not only the greatest virtue, but the parent of all the other virtues. ] Cicero