Better Mental Health Part 6: A Change of Scene-ry

 As per parts 1, 2, 3, 4 & 5. I'm not a qualified clinical psychologist. Services are available, particularly in Australia to speak to somebody qualified or at the very least trained to deal with people in crisis when it comes to Helpline, Beyond Blue or Social Work that is informed by science. Investigate, explore, but please don't unfurl your sails to catch the slightest breeze of bullshit, even with my opining. 

Today I want to introduce a framework I've found incredibly useful for navigating mental health - the biopsychosocial model. It relates to the following cliches:

“You can choose your friends but you sho' can't choose your family." ~ Harper Lee, To Kill A Mockingbird

"A man is known by the company he keeps." ~ Aesop, Aesop's Fables 

"Birds of a feather flock together." ~ English Proverb

"Opposites attract." ~ English Proverb

Sometimes better mental health is attained through better choices. Instead of doing things that make you feel bad, do things that make you feel good. Instead of spending your time with people who make you feel bad, spend time with people who make you feel good.

Of course, nothing so simple is ever actually simple. I hear, cocaine can make you feel great, and yeah you may at points in your life attract sycophants and/or yes-men who don't challenge any of your stupidest ideas, to your own detriment. 

Our attention is ultimately a scarce resource, we can ostensibly be friends with everybody but we can't have a conversation with everybody, we can't sit next to everybody on the school bus, we can give everybody a piece of cake but only one person's name features in 'Happy Birthday to You'. We all inevitably make investment decisions. We often enough, make poor investment choices.

What I suspect is at play is a very powerful human intuition of loss-aversion. Like you are managing a team, one employee competently does her job with little input from you, the other is a dingus and doofus who routinely makes the same erros. Naturally you pour your time and energy into the dingus, worried that they will make you look bad, and we tend not to worry about putting time and energy into the competent employees further growth and development at the risk of them making us look good.

So too, often enough we commit ourselves to relationships, friendships, jobs and even activist causes that make us miserable, feel shit, loath ourselves or perhaps most commonly simply feel insecure in ourselves. Then we double down, we invest more time trying to conquer or overcome.

This creates an opportunity for a counsellor to maintain a simple yet effective discipline we often enough cannot do ourselves in the form of a question that punctuates our chain of reactions to life events:

'How does that make you feel?' (Conduct)

or:

'How do they make you feel?' (Relationships)

These questions if asked often enough can produce a valuable data set, emotions are data and it is in my opinion worth factoring into our decision making, and also since emotions motivate our decisions certainly worth being aware of. Emotions drive decisions that drive consequences that drive emotions. It's a feedback loop, bringing us neatly back to -

The biopsychosocial model, short for biological, psychological and social factor model is for me a useful diagnostic tool for figuring out the stimulus of my mental emotional state. I know in my case I am prone to making attribution errors, and while it isn't perfect, stopping to question whether the traffic is particularly bad today, or whether maybe my mood has more to do with my toothache is worthwhile.

Gabor Mate is my preferred narrator of the biopsychosocial, unfortunately his most comprehensive and succinct video on the matter is no longer on you tube. But from memory he goes through the following false dichotomies and points out they are in fact co-dependent:

You can't separate the mind from the body. (bio-psycho feedback loop)

Hopefully you can confirm this with your own experience. You may notice for example you are more irritable when sick, or that when you are stressed you crave fattier, saltier, sweeter foods and when you gain weight you get more stressed. You may notice that your mind can prevent you from sleeping, just as a lack of sleep effects your mind.

I don't want to spend much time on this, apart from observing that mental health and physical health have a feedback loop. Personally, if I can enjoy good mental health, that's better than being in physical health and unable to enjoy it, indeed that is the truly terrifying thing about mental health, when young physically fit people end their own lives because they cannot face another day of anguish.

I will, before moving onwards just say, my own experience to being presented with this false dichotomy was 'my god why wasn't this obvious to me?' and the answer probably is 'God', or rather religious intuitions such as dualism, where consciousness is treated as a homunculus or soul inhabiting a body but it is separate and special from the carcass it animates. 

I've been an atheist for as long as I can remember, but this intuition persists, even when I accept that consciousness is an emergent property of electrical activity in the brain, and even when entertaining weirder notions like panpsychism.

You can't separate the individual from their environment. (psycho-social feedback loop)

For this one, the example Gabor uses is an addict recovering in rehab, and the high rates of relapse. Or recidivism of convicts (though that is harder because often prison is a debilitating process). You disrupt an addict's life with new routines, new activities, new diet, new restrictions and they get sober, they get through withdrawal etc. Then they are discharged from rehab and go straight back into the environment in which they were an addict. And so, if the stressors are reintroduced, or the social norms are reintroduced the addict becomes that much more likely to relapse.

Addiction though, and particularly the kinds of addictions that are debilitating enough to land someone in rehab - as opposed to sugar, caffeine and pornography - are pretty extreme.

For most people though it's useful to conceptualize their mental health as a function of their environment. Hence 'how does that make you feel?' and in particular with social environment 'how do they make you feel?'

(note - it's also useful to conceptualize mental health as a function of things like diet, sleep schedule and body chemistry which can be treated through changes to routines and habits, or altered through medication - I have no experience however of taking medication for my mental health, apart from self-medicating - sugar, salt, fats, Netflix - which for me and most people is not a great pathway to better mental health.)

Of course, after rejecting both of the two false dichotomies you can chain them together into the bio-psycho-social model, indeed vegans probably know well that what you eat can dictate who your friends are, and anybody who has tried organizing a dinner party in a wealthy democracy in the past two decades knows the reverse is annoyingly true also. 

So How did they make me feel?

In grade 5 I got left behind. I was abnormal. I didn't want to be older. I was running with the cool kids, and suddenly what was cool, was no longer being a kid. My inability to get over pastimes like tag, fantasy board games (Talisman) and computer games created a schism as the conversation moved towards girls, beer and smoking.

None of which, I'm fairly confident my fellow 10~11 year olds understood. They were aspirational though, seeking esteem by trying to 'pass' as their older siblings. It culminated for me in a confrontation with my best friend as to why I wasn't invited to his birthday party in grade 6. I was given a story about strict limits on numbers, but I suspected it's because I wasn't cool enough. I asked why I was cut, but a kid who'd never been to any of his past parties was invited. In a foolish move, my friend not having an answer said he'd flip a coin for it, a coin that hit the ground and he immediately stamped on with his foot and said 'heads! it was heads!' (I called tails)

Highly suspicious, I suspected a sophisticated 11 year old's conspiracy was afoot. The party came to pass and despite my then unknown tendency toward stoic resolve, I had a cry and confessed to my mum that I was on the outs of my social circle.

The solution to my distress was rather a simple one - change friends. I stopped investing in the losing battle for esteem with the cool kids, and started hanging out with the weird kids who welcomed me into their ranks.

I'd be interested to know if this is a statistic that is measured, my google-fu couldn't produce anything dependable so I shall lean on my highly unreliable availability heuristic - but I'd guess the average Australian who completes up to secondary school in Australia attends on average, slightly more than 2 schools. Like 2.2 schools (or 20% of kids change either primary or secondary schools). 

I went to 4 different schools in the one town. My folks had me and my siblings change primary, and then I did my first year at a public school, so beyond migrating within a school from cool kids to weird kids, I actually had to make new friends 5 times before graduating. The only times I was on a level playing field were starting prep and starting year 7, the rest of the time I was the new kid.

But by happenstance, I had been forced to learn through childhood that you can start over rather than keep investing in the environment presented to you.

The saying 'You can pick your friends...' isn't quite true. At best we pick among a narrow sample of possible friends chosen for us, usually by our parents. As such, our social environment is likely to be defined by a set of passive reactions rather than active choices. Our parents shipped us off to school, school influenced our career aspirations, our career aspirations influenced our post school choices (what to study > where to live) that presented us with the pool of people to date.

To me, this is one of the ways to actually contemplate a non-genetic mechanism by which mental health issues can be passed down through generations. 

Biopsychosocial gives us three avenues of variables to accomplish better mental health - changes to our biology (diet, sleep, exercise, medication), changes to our psychology (mindfulness, CBT, talk therapy, practical philosophy) or social environment (break up, join a club, relocate, change jobs, change schools).

The first two avenues generally require change to be effected through maintaining a discipline. The third avenue often requires a decision and in this way, I regard it as the 'easiest' way to effect positive change.

You may hear the amatuer diagnosis again and again throughout your life 'they fell in with the wrong crowd.' so we acknowledge a peer group as influential. 

The 'fell in' implies a degree of randomness, which the biopsychosocial model can also remove. Indeed Gabor Mate introduced it as 'who we are and aren't friends with is not an accident'.

For example, if you were looking at two potential share houses to rent - one cost $50 a week, and one cost $500 a week. Which one is likely to put you into a social environment where recreational drug use happens any day of the week, and which where recreational drug use forms weekend binges? Which household is likely to consume more weed, and which more cocaine? Which is likely to be a social environment shared with a freegan and which with someone who purchased a Mercedes on finance?

I feel it important to note, for people whose mental health suffers from a relentless pursuit of esteem, that higher rents do not translate to better mental health outcomes. Unfortunately, effecting a change in your social environment for postive mental health outcomes is not as simple as spending more money.

In recent years, my home city has seen a murder of an international student by a 20 year old vagrant, and a porsche driving mortgage broker under the influence of crystal meth taunt a dying police officer before fleeing the scene, running the full gamut of socio-economic brackets.

Personally I am persuaded that genes and environment interact, they both play a role. I reject the notion of tabla rasa, largely because there's too much evidence to the contrary and those that claim or appeal to it overtly or covertly have not made a compelling case to exclude that evidence.

I have never struggled with picking my friends, I did struggle for a good decade with picking partners. Here talk therapies were really useful to me, and particularly the heuristic of 'how do they make me feel?'

This enabled me to become conscious that very often the women I apportioned most of my attention to, made me feel shit, stressed and anxious. The core mystery I had to unravel, through talk therapy, was why I was attracted to the women in my life that made me feel shit, and not attracted to the women in my life that made me feel secure, valued, relaxed. 

There's a number of notions and hypothesis I have on that, but unpicking that knot was a lot of work, this is making changes to the 'psycho' part of biopsychosocial. I had to identify patterns, commonalities and most laborious of all, trying to experiment in approaching women who were 'off-type'.

Much much easier than this, I discovered, was to change my environment. This is rather extreme and particularly in a global pandemic not of direct value to many at the moment, but the first step I took in this direction was to go live in Genova, Italy for 3 months. 

For me, this was a living lesson in the power of biopsychosocial, because it turns out, when you go halfway around the world into a city where you don't know anyone, don't speak the language, and have nowhere to live - unlike the biopsychosocial environment I was born into, I wound up finding accomodation with the type of person who opens their home up to strangers. I made friends through groups that want to practice their English and teach people Italian, ie. volunteers, and I was introduced to people that share my interests, winding up in art classes.

3 months was too short to settle down and find a family, but by the end of my time there I was meeting women that had I more time, I'm confident I could have dated, healthily and happily. Like a woman who approached me at an exhibition opening I went to to invite me to the independent bookstore she ran, or the woman from an architecture collective that had a stall at a zine fair I attended. I was meeting the people that I meet when I apportion my time and attention to the activities I actually want to do. Unburdened by a largely inherited and accidental social environment I wasn't quite compatible with.

I would also actually meet my next major intimate partner on that trip, albeit on a side trip to Spain, but I came home with valuable skills about how to approach my time and attention better in Melbourne. Less of what I feel obliged to do, more of what I want to do basically - and the people and opportunities follow.

I met my current partner, incidently about 2 months into my year in Guadalajara, Mexico, again facilitated by me picking the kind of household in the kind of district I wanted to live in, my housemate introduced us. It took 6ish months to get together, and we are still together despite Australia's liberal travel bans proving a stalwart obstacle to our reunion.

None of this is to say 'fuck you' to my friends and family in Melbourne, it's just to illustrate that your social environment is probably filled with a bunch of legacy baggage. As a hypothetical example - say you are an actuary, in your mid 40s. You earn a good wage, but struggle with ennui, and one day you bump into a smug deadbeat artist at a party who asks you 'what 10 year old dreams of being an actuary?' 

The answer is hopefully, none. But you realize at some point in your secondary education, you stopped thinking, without noticing about what you want to do, and started thinking in terms of what you could and should do. That you didn't pick your school, because your dad sent you to the school he and his father went to. That school was affiliated with a residential college you followed your peers to, where you absorbed their social habits of going out drinking. Full time work caused you to back off how much and how often you drank, substituting quantity for quality. Which is where you wound up taking a wine-tasting course and joining a wine club that naturally led you to attend a wedding at a winery where you met your wife in your early 30s. 

'I wanted to be a truck driver when I was ten.' you tell the deadbeat artist, and yeah okay, I wanted to be a baker. It's okay for dreams to change as you become wiser to the world, but probably from a priority of mental health - not the criteria. Don't become a truck driver because your 10 year old self thought it would be fun, but by all means at 18 do something you want to do, pick from the options of things that you want that best allays your fears of being destitute, but don't switch your criteria to the qualification you can obtain with the marks you have that pays the best.

An Important Caveat

Now important caveat - much like 'fake it until you make it', Aesop's 'A man is known by the company he keeps' and it's inverse 'A man is known by the company he avoids' (Gordon Livingston M.D.'s variation) should not be seen as an invitation to participate in such contemporary cultural phenomena as ghosting, cancel culture, ostracism etc. These practices are I feel by this stage well researched and approach being certified 'objectively awful'.

To back peddle to assertive communication - people have a right to speak, a right to listen and a right to make repairs. Ostracism and its variations take away all three.

That said, attention is a limited resource, we lose touch with people frequently and think nothing of it. The big difference between losing touch (fine natural) and ostracism (also natural, violent) is that losing touch is passive where ostracism is active. Losing touch is by definition mutual, ostracism is sustained unilaterally.

If you have friends that are making you miserable, and you've never communicated to them the effect their conduct has, I believe they are best served by getting this feedback, and having an opportunity to adjust. The 'I've tried nothing and I'm all out of ideas' is not justification for ghosting out on your friends. Sure, if your husband is beating the shit out of you and you fear for your life, by all means tell him you and the kids are going to the shops to get some milk and run to a women's shelter.

Generally though, people to avoid I defer to Gordon's list in his book 'How To Love' you want to avoid the major personality disorders, you want to avoid people with substance abuse problems, you want to avoid the sub-clinical category of people colloquially known as fools. But chances are if you are entagled with an individual or embedded in a culture, the problem you have with them is shared by many and it's worth giving people an explanation before cutting them off, otherwise you are effectively rendering them unable to respond for the next relationships they form.

But avoiding is an extreme, generally it's just about who you invest your time in. If you look around and think 'I spend 10% of my time with the really nice people and 90% of my time with the really mean people' it can be the simple act of just reversing those ratios, or rebalancing them. Alternatively, it can be the choice to stop going to friday night drinks and start going to the Sunday crossword club.

WWIDIIMTT? (What Would I Do, If I Moved To Toronto?)

This is the exercise you can do, you can get ready in fact for whenever you are let out of lockdown. I just picked Toronto Canada, because I imagine it's similar enough to Melbourne and wouldn't lead to very literal interpretations of the exercise like maybe picking Cairo would 'well... first I'd have to learn Egyption, or... is it Arabic?'. 

While by moving to Genova and Guadalajara I forced myself to do this for reals, I made this exercise up to point to perhaps an unconsciously felt obligation to maintain what may or may not be working for you in lifestyle. 

In many ways, this was what I was hoping for in terms of a pandemic mental health windfall - the mass habit disruption. Prolonged social isolation is going to wear on everyone eventually, but the initial disruption I am still curious as to whether anybody capitalized on being unable to socialize in ways that were toxic for them - a basic example being people who's primary motivation for spending their paycheck on cocktails every Friday was FOMO.

Now, if by happenstance upon hearing Toronto your thought immediately goes to 'Well I better visit my Aunt, my mum will probably want me to take her some Vegemite...' PICK ANOTHER HYPOTHETICAL CITY

The underpinning assumption of the biopsychosocial modal is that doing activities you want to do will facilitate meeting people you want to meet, and in turn this will relieve the need for much consumption behavior that you might use to self-medicate for the stress your current environment induces.

Another way to look at it is to think on the metaphor of 'baggage'. Imagine just in the limited domain of wardrobe that you wear a white t-shirt and gym shorts for comfort on your long haul flight, and arrive at baggage claim to discover your luggage has simply ceased to exist, they offer you $3,000 compensation to replace your lost items - would you buy the same wardrobe? Or would you say, take the opportunity to buy a suit so you could apply for the job you actually want, or buy more outlandish clothes so as to better express who you are, rather than your existing wardrobe that consists of clothes largely gifted to you by people with more conservative tastes.

Just so this applies to almost every aspect of our lives, if you had no friends in a new city, do you join a futsal league to meet people? Now do you wind up making friends with fit active people actively doing something for their mental health, rather than the sedentary work colleagues that got you into the habit of after work drinks? 

Not to rag on after work drinks, or socializing with office workers, there are many benefits to it. It's just probably the thing you don't or shouldn't value is the drinking part of after work drinks. Now imagine the effort required to lobby your work colleagues to play futsal instead of working a bar stool. 

This is the output of WWIDIIMTT? You might identify that freed of the baggage of your habitual social life you passively go along with, you would build a social life by design by joining a futsal league instead. Then you just make that change, without moving to Toronto.

One of the first things I did upon returning from Genova, was lookup on Meetup.com an Italian-English language exchange group in Melbourne to join, so I could in effect be the other half of what I'd done while in Italy. Unfortunately Italian groups in Melbourne at the time appeared to consist entirely of groups for ethnic Italians to meet other ethnic Italians in Melbourne so they didn't have to marry non-Italians. Not having the resources at my disposal to start my own language exchange group, that particular avenue didn't pan out for me. 

But moving into an art studio, joining life drawing classes etc did. 

Even in a pandemic, you are probably still making passive habitual choices as to your social environment - who you interact with on facebook, who you chat with on messenger, how you flout the lockdown rules. There are people drinking themselves through lockdowns and watching the news, and there are people forming online communities undertaking creative endeavors.

It's all a matter of asking 'how does it make you feel?' collating that data and then experimenting.

One final thought, is that another source of data is your physical health. In fact when I was first enamored of biopsychosocial I began to make very unscientific correlations between couples who were in toxic relationships and couples who gained copious amounts of weight once they started dating. It of course ignores all the unhealthy relationships vegans are prone to get into. But I still find this heuristic a beguiling idea founded on the biopsychosocial model. I think it will generate both false positives and false negatives, but I contrast that with couples whose physical health improves dramatically after they hook up.

In the next part, I feel it's time to address practical philosophy and ideology.