What is mental health? What does psychological wellness feel like? Happiness? Mastering all negative emotions? It’s tricky, isn’t it.

Only very recently has there even been an interest in understanding mental wellness – mostly pioneered by the positive psychology movement.

Before, the focus was always more on mental illness and even worse: in an effort to improve the diagnosis of mental illness, there was an increasing movement towards external observable symptoms. And a movement away from internal experiences.

All that makes it really hard to put words to the question: What are our inner experience and abilities when we are psychologically well?

For a long time mental health has been understood as being free from symptoms. No anxiety, sleep problems, or distrubing impulses, sadness.

But thriving in life has to be more than just freedom from something. If we look at living a meaningful life grounded in psychological wellness, we want freedom to love, work, play.

This article and video above are inspired by and a summary of a brilliant lecture given by master clinician Nancy McWilliams (plus some of my own musings). In her lecture, she put together 16 signs of mental health that I want to share with you in this article.

You know those quotes that are attributed to famous people but you don’t know whether they really said that? Freud has a few of those and one of those is:

“Health is the ability to love and work.” – Sigmund Freud (apparently 😉)

1. Capacity to Love

Mental health involves the capacity to love. That is not just being able to engage in authentic intimate romantic relationships. It’s also the ability to have deep friendships, the ability for devotion required to raise children. This already hints at the fact that mental health is not just happiness. Relationships are hard, raising children is hard. You sometimes have to sacrifice your own comfort, you have to learn to make compromises.

2. Capacity to Work

The second measure of health Freud apparently proposed was the capacity to work. This doesn’t mean to just slave away at a job you hate, it means to feel that what you contribute has meaning and matters. It means being useful to society. Alfred Adler another thinker I wrote about would’ve called this social interest. In order to feel like we are a meaningful member of society, we need to feel useful and that what we contribute matters.

3. Capacity to Play

It’s not a coincidence that psychoanalysts, such as Winnicott, put so much emphasis on the importance of play in children. You can only play freely when you feel safe, are curious and open towards the world out there and inside of yourself. Play takes on different forms as we grow up, it becomes singing, dancing, creating, doing sports.

McWilliams elaborates on the fact that rough-and-tumble play in mammals (for example dogs) is critical for the animals to develop the capacity to concentrate. And she makes an interesting connection to ADD/ADHD diagnoses in today’s structured environment that enforces more sitting still than playing out loud.

4. Secure Attachment

The fourth sign of mental wellness is a secure attachment pattern. This is basically an elaboration on the capacity to love. Everyone talks about attachment theory these days and it’s honestly not my specialty, so look google away for other people who can explain this much better than me.

Attachment theory was put forth mostly by Bowlby, who was long shunned from the psychoanalytic community. McWilliams explains that there are two things that can change your attachment style (based on research I assume): (1) is a secure intimate relationship of at least 5 years, or 2 years of psychotherapy. The question always is: has the person internalized some sense of being safe in the world?

5. Sense of Agency

Being mentally well includes having a healthy sense of agency. We need to feel that we have self-efficacy, that we can be stewards of our own fate. Unhealthy ways of achieving this is through consuming drugs (such as cocaine that hijacks your dopamine response), restricting food in anorexia, developing obsessive-compulsive habits.

Here you can see what is called the function of disfunction. We prefer a perverted sense of agency than no sense of agency at all. Of course you can also see how society and culture play into this, it’s easier to feel like you have agency as a woman in the modern western world than at the beginning of the last century.

6. Self- and Object-Constancy

For our psychological wellbeing we need a sense of consistency in our self and in others (which are called objects in psychodynamic terms). It means that we have integrated our identity. There is a link between who we were, are and will be. We are aware of our own strengths and weaknesses. The same is true for others, we know that everyone has good and bad qualities. If we are asked to describe important people in our lives, we are able to give three-dimensional, colourful descriptions. Otto Kernberg and object relations theory have contributed a lot to understanding this.

7. Ego-Strength

Are you able to function well under stress? If yes, that is what we call ego-strength or in modern terms resilience. Functioning well means to not just go on rigid autopilot but to give an adaptive response. Most people think about external stressor, such as work, relationships. But I think one of the most interesting psychodynamic contributions to this is the idea of internal stress because of inner conflict. For Freud and the following ego psychology movement this was the tension the ego (the I) had to endure between the demands of the id and the super-ego. Modern psychodynamic thinking has extended this idea much further into the idea of an inner conflict.

8. Self-Esteem

Self-esteem is such a hot topic these days. In the psychodynamic approach self-esteem and the linked area of narcissism has been elaborated on a lot by Heinz Kohut and Otto Kernberg. The issue was and still is to develop realistic and reliable self-esteem. Back in the day Freud focused on softening up the super-ego because people tend to be too harsh on themselves.

Today that is often over-corrected for. There are prizes for everyone, the elimination of frustration or losing. This can create a feeling of fraudulence and overly relying on getting self-esteem from others externally. Both over-criticising or over-valuing creates problems with developing healthy self-esteem. We need enough love and appreciation and we need some struggle and frustration (that way, we can master with our own abilities). That way, we can build a healthy, stable sense of self-esteem that comes from within.

9. Values

Our values like our personality are pretty stable throughout our life. This includes our ethics, morals, integrity. Psychological wellness means having abiding values that you can use as guidance for your decisions and actions to drive you towards meaningful goals.

McWilliams cites a worrying Harvard business study, saying that in the past the personality style of CEOs tended towards OCD, meaning very conscientious, perfectionistic, controlling. But now the personality style of CEOs tends more towards narcissistic bordering psychopathic styles, meaning focusing on “getting over on others”, establishing self-esteem through business success, focusing on power and status.

10. Affect Tolerance and Regulation

The tenth and one of the basic building blocks of mental wellness is the ability to tolerate and regulate our own emotions and thoughts. Being a mentally healthy adult means that you can feel your emotions but you don’t need to act on them. This also includes the ability to delay gratification and control impulses – all fundamental to reach meaningful goals and build deep relationships.

11. Insight

Understanding yourself and being understood, achieving insight is one of the main goals of psychodynamic psychotherapy. That’s why this approach is often called insight-oriented therapy. Self-awareness is the basis for any sort of personal development or self-improvement. I’d encourage anyone to foster insight into their own personality, defense mechanisms, history. Because unless you understand yourself, you can blindly try to adjust habits, follow goals – but it will be harder to know whether this is really moving you in the right direction.

12. Mentalization

The 12th sign of mental health is the ability to mentalize. Mentalization is a tricky concept to understand. In philosophy it’s generally know as “Theory of Mind” and in the psychodynamic approach Peter Fonagy did a lot of work understanding what the ability to mentalize is and why it’s so important. Mentalization is not an inborn ability, it’s something we all have to learn. It’s the ability to understand our own mental states and the mental states of others.

If a young child is upset, you’ll likely see a good-enough mother comforting the child but also offering ways of understanding: “Poor you, are you sad that you had to leave the play date with your friend? I can imagine that must be sad but we have to head home to make dinner.” or “Are you angry that your sister took away the toy? That must feel frustrating because I could see how much fun you were having.”

The mother offers the child language to give words to inner states. And as we grow up and get more and more words to describe and understand what’s happening inside of us, we can talk about it, regulate, think about it – instead of doing crazy things to act it out.

13. Flexibility of Defenses

We constantly manage our own anxiety with (what in psychodynamic theory we call) defense mechanisms. They allow us to function in our everyday life. But either the lack of defenses but also the rigidity and overuse of defenses can cause problems. People in constant denial, intellectualizing every emotion, always projecting their own inner states onto others will run into trouble. It’s important to have flexible and mature defenses – and if you want to learn more about what that is, check out this article.

14. Balance

In life we are often caught in inner conflicts because we constantly have to straddle seemingly opposing demands. We need to be able to be in relationships and function well on our own, we need to take control of our own fate and surrender to it, we need to be able to take care of ourselves and learn to ask for help, etc. A sign of mental wellness is that we can find a sustainable balance between those life tasks. Of course every now and then we tip to one side or the other but none of these topics show up as rigid dysfunctional patterns in our life.

15. Vitality

Some might say that the opposite of depression is vitality. It is the capacity of feeling alive and is closely related to the capacity to play if you ask me. In his psychoanalytic theory, Freud proposed an economic quality to the main life energy he called the “libido”. It means that the amount of life energy inside of us is always the same but it can be pushed into the unconscious where it is then no longer available in our everyday experience. Regaining a sense of vitality is essential to mental health. Esther Perel, my favourite couple’s therapist remarked that in her community of Auschwitz survivors she could differentiate two groups: One were the ones who survived, the others the ones who came back to life.

16. Acceptance

Finally, no list about psychological wellness would be complete without the capacity for acceptance of what cannot be changed. Yes, we want self-efficacy, yes we want to feel that we can be the stewards of our own fate. But ultimately in life, we will come face to face with the fact that we can’t control everything.

We might experience infertility, sickness, death of a loved one, and other experiences that will show us the limits of a life we thought was limitless for us. And acceptance of what we cannot change goes hand in hand with grief. We need to surrender to and mourn the life vision that is no longer ours.

The process of grief is a healthy process. Freud himself wrote a wonderful short paper in 1917 called “Mourning and Melancholia”, I’d encourage you to read if you are interested in the difference between grief and depression.

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