This I Know: Mental Health

American asks four wonks to weigh in on a single topic

Illustra­tion by
Traci Daberko

stethascope with a heart, an eye and a flower, a plus sign, scissors cutting a noose

Kari Greenwood, SIS/BA ’05, WCL/JD ’08

Too often mental health is considered independent from physical health. Yet examples of the interplay between the two abound. Individuals with serious mental illness have higher rates of chronic medical illnesses, such as diabetes, heart disease, and obesity. A major mental health diagnosis is also associated with significantly earlier death—anywhere from 7 to 24 years—with the majority of these deaths resulting from cardiovascular disease, respiratory diseases, and infectious diseases. Of particular importance to the work that I do—individuals who experience complex trauma as children may not only suffer mental and emotional consequences; the trauma can also affect brain development, the immune and hormonal systems, and even change how their DNA is read and transcribed.

Despite this evidence, we continue to engage in siloed care, which fails to provide clients with the best or most effective treatments. All of us—mental health providers, consumers, and anyone who supports evidence based, sound public policy—must advocate for an integrated approach to health care, in which providers work together to offer both mental health and medical care.  

Greenwood is a clinical mental health social worker in Bethany, West Virginia. 

Adrienne Frank, SPA/MS ’08

It starts with a familiar churn in my stomach. The “ugly butterflies,” as one doctor called them, don’t bear messages of giddy love or excitement but rather an ominous nervousness. Sometimes I can will them to stay in my gut. Other times I’m powerless against the anxiety that begins to work its way up my body, bringing with it a rush of heat that makes me sweat. I suddenly feel claustrophobic. My chest tightens, and I take quick, gasping breaths, punctuated by heaving sobs. My body shakes as my fight-or-flight instinct kicks in.

And flee, I do—outside, where there are no walls caving in on me, only sky and earth. I take an inventory of what I see around me in order to focus my mind on what’s real—not the panic, stress, and fear that have spiraled beyond my control. Yellow flowers, silver car, wooden bench. And so it goes until my breathing slows, my tears stop, and the butterflies retreat. Yellow flowers, silver car . . . 

Almost 20 percent of American adults live with mental illness. I’m not ashamed to say I’m one of them. I have wrestled with anxiety and depression for more than six years. Medication helps, as do exercise and music. So does talking about it. 

Frank is editor of American magazine. 

Jeffrey Volkmann

For too long psychology has focused on a person’s deficits. The famous psychologist Abraham Maslow stated that the science of psychology has “been far more successful on the negative than the positive side; it has revealed to us much about man’s shortcomings, his illness, his sins, but little about his potentialities, his virtues, his achievable aspirations, or his full psychological height.” I believe that all individuals have the potential to flourish. People who do experience greater happiness and well-being and a deeper sense of purpose. In order to flourish, people must understand and cultivate their strengths. Through that process, people will be able to build and nurture their interpersonal relationships, increase the amount of pleasure they experience, and contribute to society in 
a meaningful way.

As a clinician, I have found that people often see therapy as a tool to “feel better” or “feel normal again.” While feeling better is an important aspect of treatment, I strongly believe that it is only one component of therapy. Feeling better is not enough; therapy should be used as a tool to help individuals flourish. 

Volkmann is a clinical psychologist and executive director of the AU Counseling Center. 

David Jobes, CAS/MA ’84, CAS/PhD ’88

As the 10th leading cause of death in the United States, suicide is a major public health problem. Each year 1.2 million Americans attempt suicide and another 9.8 million have suicidal thoughts. 

Only a handful of psychological treatments are proven to specifically target suicidal ideation and behaviors. Unfortunately, they are rarely used in routine clinical practice. Instead, suicidal people are typically prescribed psychotropic medications, which can treat certain mental disorders but have not been proven effective for treating suicidal risk. Moreover, too many suicidal people are unnecessarily hospitalized for brief inpatient psychiatric stays that are insufficiently focused on treating suicidal ideation and behaviors—stays that may actually increase suicidal risk. 

So why isn’t suicide routinely treated by effective interventions instead of relying on those with limited to no empirical support? This paradox has consumed my clinical research for 35 years. We can effectively treat this epidemic, but to do so we must use suicide-specific treatments proven to work through rigorous clinical science. Until we do, suicidal people earnestly seeking treatment may tragically die.  

Jobes is director of the Suicide Prevention Lab at the Catholic University of America.