Mental Hygiene

This post has been inspired by the absurd number of no-shows and last-minute cancellations I have had over the past few weeks, which have afforded me both the time and the subject matter to write this blog post. Yes, it’s the holiday season, and we’re all busy and stressed. You’ve got final exams and Christmas concerts and your cousins from Iowa visiting; presents to wrap and dinners to cook and trees to trim. But mental illness does not take a vacation. If anything, people with mental illnesses struggle even more than usual around the holidays. Putting mental health treatment on the back burner for the holidays – or for any reason – is a huge mistake.

There is a pattern I have observed in a few of my patients – they disappear from treatment for several weeks or months at a time, and then call me in crisis needing an appointment ASAP. They get stabilized, start feeling better, disappear from treatment again, neglect their mental health, and show up in crisis weeks later. This is not good mental hygiene.

What is mental hygiene? I view mental hygiene as preventative medicine for your brain, just as biannual dental checkups are preventative care for your teeth and annual physical exams are preventative care for your body. Many medical crises can be averted by getting regular check-ups and aggressive treatment for medical problems as soon as they are identified, along with good nutrition and regular physical activity.

While most people take their sanity for granted, those who have been diagnosed with a mental illness cannot afford to do so. Achieving and maintaining good mental health requires a daily practice of mental hygiene which includes the following 10 components:

1.) Regular therapy sessions. Seeing a therapist regularly helps keep you accountable and on-track with your wellbeing. It is helpful to discuss your problems with someone who has a thorough knowledge of your history and can help you identify areas for continued growth. Sessions should be held at least weekly during the acute phase of illness, but may be spaced out to once or twice a month after stabilization.

2.) Adequate sleep. While individual sleep needs may vary, most adults require 8 hours of sleep per night for optimal functioning. Adolescents require at least 9 hours. It is best to sleep a full 8-10 hours at night rather than napping during the day, which can actually increase fatigue. Before you say “well, I get 7 hours and that’s close enough,” consider this: a cumulative sleep deficit of even 30 minutes a night increases the risk of depression, impairs concentration, and contributes to daytime fatigue.

3.) Regular exercise. Getting at least 30 minutes of physical activity 4-6 days per week helps to boost mood, relieve anxiety, and increase energy. New exercise trends come out every week, but it really doesn’t matter what type of exercise you do. Just move.

4.) Good nutrition. Proper nutrition involves eating, at a minimum, three balanced meals per day, with snacks in between as needed. A balanced diet incorporates a wide variety of foods including carbohydrates, fats, proteins, fruits, and vegetables. I also recommend supplementing with a daily multivitamin and Omega-3 essential fatty acids. The brain requires sufficient calories in order to function properly – 20% of the calories we take in are used for brain activities – so a reduced calorie diet is harmful to your mental health. The brain is made of fat and runs on glucose, so it is not surprising that both low-fat and low-carb diets have been linked to depression.

5.) Avoidance of harmful substances. Don’t use illegal drugs. Don’t use prescription drugs unless they were prescribed for you. Don’t use over-the-counter drugs unless you really need them. I recommend avoiding alcohol if you fall into any of the following categories: you have a personal or family history of alcoholism or addiction; you take psychotropic medication; you have a chronic health condition; or you are under 21. If you do not fall into any of the aforementioned categories and you decide to drink alcohol, drink responsibly and moderately. Many people who suffer from depression find that alcohol exacerbates their depression (it is, after all, a depressant). If you drink caffeine, do so in moderation – excessive caffeine use can exacerbate anxiety and insomnia. If you need 7 cups of coffee just to get through the day, you are either sleeping too little or doing too much.

6.) A reasonable schedule. Being over-scheduled contributes to excess stress and anxiety, while being under-scheduled can lead to boredom, isolation, and depression. Many of your waking hours will be spent in structured, mandatory activities such as school or a job. Each person’s ideal balance of school/work hours will be different based upon their individual needs. That being said, no one does well working 100 hours a week or sitting at home all day for an extended period of time. Taking too many classes or working too many hours is exhausting and draining, and leaves little time for important self-care activities.

7.) Adequate “down time.” A reasonable schedule (see above) will allow for adequate sleep as well as unstructured “down time” to be by yourself, decompress, and regroup. Individual needs for down time may vary, but as a general rule I recommend 15-30 minutes per day. Down time may be spent taking a bath, reading for pleasure, watching TV, or something similar.

8.) Stress reduction activities. I recommend adopting a regular pattern of relaxation / stress-reduction activities which may include one or more of the following: yoga, meditation, deep breathing, progressive muscle relaxation, or massage.

9.) Social support. Robust mental health requires steady, reliable social support. It is important to have at least one person who is close to you whom you talk to on a regular basis. This may be
a spouse or significant other, a best friend, a parent, a sibling, or relative. It is also important to be a part of a larger community, such as a club, a church, a team, an extended family, or a close-knit workplace.

10.) Pleasurable activities. A good life involves a balance of things you “have to do” and things you “want to do.” It is the “want to do” activities that make life worth living. Spend some time each week pursuing a hobby or doing something that you really enjoy. I recommend scheduling pleasurable activities at least once per week.

Does this sound daunting? Perhaps it does if you have been neglecting your mental hygiene. But these basic principles can have a dramatic impact on your mental well being. If you want to feel good, you must treat yourself well. If you want to prevent a mental health crisis, you must practice good mental hygiene. Trust me – it is much easier and far less disruptive to prevent a mental health crisis than it is to pick up the pieces afterwards.