The Flourishing Woman E-Book

Cate Howell

• Herausgeber: Exisle Publishing
• Kategorie: Ratgeber
• Sprache: Englisch

Seitenzahl: 413

Veröffentlichungsjahr: 2023

Beschreibung

The Flourishing Woman is a guide to help women achieve optimum mental health and wellbeing. Dr Cate Howell provides advice and support for women on topics such as getting in touch with their authentic selves, feeling connected, growing as a person (even at times of challenge), and finding a sense of purpose and meaning. In other words, flourishing!

Leseprobe

Dr Cate Howell is a GP, therapist, researcher, educator and author. She has over 40 years of training and experience in the health sphere, and is passionate about the areas of mental health, wellbeing and counselling. Currently Cate is mostly involved in education and writing related to these areas.

Cate holds a Bachelor’s in Applied Science (Occupational Therapy), a Bachelor of Medicine, a Bachelor of Surgery, a Masters in Health Service Management and a Doctor of Philosophy (Medicine). She also has a Diploma in Clinical Hypnosis and has trained in a range of therapies.

She has travelled internationally to present research findings and has been published in a number of academic journals. The author of five books, Cate was awarded a year 2000 Churchill Fellowship related to the study of anxiety and depression, and the Order of Australia Medal in 2012 for services to medicine, particularly mental health, and to professional organizations.

To my mother, Marguerite,and all the amazing women in my life.

Contents

Introduction

Let’s open the door to flourishing

1. Understanding women’s mental health and wellbeing

2. The foundations of mental wellbeing and flourishing

Overcoming challenges and growing mental health and wellbeing

3. Silencing self-criticism and enhancing self-belief

4. Taming stress and anxiety

5. Adapting to change and challenge

6. Overcoming depression and distressing emotions

7. Dealing with other emotions and self-harm

Dealing with issues across the lifespan

8. Managing menopause, hormonal and reproductive issues

9. Dealing with relationships and parenting

10. The impact of abuse and trauma

11. Managing other issues

12. Navigating later life

Final words on flourishing

Resources

Endnotes

Index

Introduction

The Flourishing Woman is all about thriving in life. Flourishing is strongly influenced by our mental health and wellbeing, as well as having a sense of belonging and fulfilment in life. But we are all aware that, at times, it is very hard to have a sense of ‘flourishing’, especially when life throws challenges in our path.

Our mental health and wellbeing have been especially challenged during the COVID-19 pandemic, and there is a need for information and support right now. This need is evident in therapy practices across the world, in conversations between women, and in the media. The Flourishing Woman has been, in part, written in response to this need.

It was also written for another important reason. As women we are probably more used to supporting family members, friends or colleagues, rather than looking after ourselves. Take a moment to reflect on plane travel. At the start, a flight attendant will instruct us to put on our own oxygen mask before we help others. There is a reason for this — if we become low in oxygen, we will not be able to help!

The same can be said in life generally. If we don’t care for ourselves, we cannot care for others. This approach is not selfish. We need to prioritize our mental health and wellbeing, including self-care, and take the much-needed time and steps to do this. We will then see the benefits for ourselves and for our loved ones.

My hope is that The Flourishing Woman provides some of the information, support and practical ‘keys’ that might assist you to do just this. No matter where you are starting in terms of your mental health and wellbeing, the aim is to move towards flourishing in life.

The why!

Working for many years as a general practitioner, therapist and educator, I have learnt a great deal by working with many women in my practice and by teaching. Women come to therapy or to educational events seeking information and wanting to achieve change. They may be at a crossroads in some aspect of their lives, or want to experience less anxiety, improved mood, a greater sense of purpose or more satisfying relationships.

Having written a book on men’s mental health called The Changing Man, I started to wonder whether there might be a need to write a book specifically for women. When I spoke at a Country Women’s Meeting in 2021 and asked the group about whether they saw a need for a book focusing on women’s mental health and wellbeing, there was a resounding ‘yes’ from the whole group.

The next realization came when I looked to see what was already out there on the subject. I was surprised to find a few textbooks for professionals but very little for women in general. There was a gaping hole out there, and this needed to be addressed! So here we are, with a book specifically on mental health and wellbeing for women, and also for those who care about them, including family, partners or professionals.

There are many other reasons for The Flourishing Woman. Recent research has provided new information that is important to our understanding of mental health and wellbeing. This year I had the opportunity to attend a course at the South Australian Health and Medical Research Institute and learnt about their research on mental wellbeing. They have identified that mental illness and mental wellbeing are not two ends of a single spectrum, with health at one end and illness at the other. Mental illness and mental wellbeing are, in fact, two separate but inter-related continua, and the aim is to have a high level of mental wellbeing and a low level of illness.1 We can do this by focusing on ways to improve or maintain our mental health and wellbeing, and also by recovering from or preventing mental illness. This research has also inspired my focus on wellbeing in this book.

Research has also highlighted the importance of understanding the influence of our neurobiology. We all have billions of brain cells, and as neuroscientist Dr Sarah McKay points out, the connections between these cells are continually ‘flourishing’, to meet our needs and to enable us to respond to our environment. This means that our brains are plastic and have the potential to change, no matter what our stage in life. We can make use of this potential to recover from issues and to thrive.2

Being a woman can be both wonderful and challenging. We have unique capabilities and strengths, and fulfil a range of roles in life, contributing to family, community and workplaces. We also experience a range of challenges, including health-related issues, both mental and physical. For example, we may experience reproductive health issues over our lifespans, and women have higher rates of some health conditions.3

There are other challenges. Gender inequality in relation to representation and pay levels persists, and women continue to undertake most household and childcare responsibilities including the related and often hidden mental work.4 This potentially includes being the main organizer in the home, and remembering a whole array of information related to a partner or family, including special occasions and children’s activities.

Women’s safety, in and out of the home, continues to be a major and unacceptable issue, with many impacts on women’s lives. It is time for society to tackle this. On an individual level, we are seeing women stand up, speak out and be heard and generate the necessary response in the community.

It is also time for us to focus on our own mental health and wellbeing, to place ourselves higher up our priority list, and to have the support and strategies to achieve positive change and personal growth. It is time to flourish.

Who, how and what?

When contemplating writing this book, I asked Facebook followers to post about topics they wanted to see included. Again, there was a resounding response. Suggestions included writing about common mental health issues such as anxiety and depression, and many wanted information about hormonal influences and mental health across the lifespan, especially around menopause. There were other suggestions to include dealing with resentment and managing the workload and stress related to ‘being all things to all people’. All of these topics, and more, have been included in the various chapters of the book.

The Flourishing Woman is written for adults of all ages and looks at a range of issues affecting women across their lives, in a comprehensive and accessible way. It aims to fill the gap by providing not only information about mental health, but also many practical strategies and ideas about how to achieve a greater sense of wellbeing. For ease of reading, the pronouns she and her will be used in the book.

At the same time my hope is that it provides a compassionate voice and support as we reflect on the different topics. The writing process is quite involved, and despite much experience professionally and personally in life, I found I made discoveries and developed insights as I wrote. We really are travelling on a journey together throughout the book.

The book can be read from start to finish or dipped in and out of as needed. The twelve chapters can work together, but they can also be read as stand-alone chapters. Questions related to vital issues are answered, such as why women so often put themselves last, how to deal with distressing emotions, how to manage change in life, and eating issues, as well as how to silence any internalized critical voice (the ‘inner critic’) and grow self-compassion.

We will look at challenges faced during the different stages of life that may compromise mental health and wellbeing, and consider strategies to deal with these, and at the same time strengthen our wellbeing. Topics such as reproduction, menopause and mental health, relationship issues, the impact of abuse and trauma on mental health, and a whole range of other issues will be addressed.

Recently I changed my practice logo to a door. Seeing a therapist or undertaking education is all about opening a door to knowledge, understanding, support, change or realizing potential. We are all very familiar with doors, to our homes or workplaces, our favourite coffee shop or a friend’s house. Similarly, I think we can all relate to having a door open or close to us in life, as that is life! The Flourishing Woman has also adopted this symbol, and hopefully the book will open a door to a conversation about women and mental health and wellbeing. The information provided may well open the door to understanding, validation and a greater sense of empowerment. It may open the door to identifying a range of options for the future. Equally, a door may represent something blocking us, like fear, or be about setting boundaries or closing a chapter in life.5Above all, a door may offer hope, a beginning or a gateway to possibilities and change. Within each chapter, there are brief information boxes with doors, signifying an important piece of information to consider.

There are also keys in the book, which represent practical strategies to open a door or help manage a particular issue. This book is about connecting with ourselves, in terms of awareness and understanding, and using our own valuable resources. It is also about connecting with others, and is a practical guide, focusing on how to enhance mental health and wellbeing, and deal with any mental health issues.

When reading the various chapters, it may be useful to have a notebook or a journal to write down thoughts or feelings along the way. And various questions will be posed and ideas provided to contemplate. Again, thoughts about these could be written in the journal. Let’s call it ‘the flourishing journal’ or ‘the journal’ for short!

Maintaining health and wellbeing involves addressing our physical, emotional and social wellbeing. We need to feel safe and secure in life and have a sense of belonging and connection. A holistic or ‘whole person’ approach also takes into account cultural and gender identity, occupations and spiritual life. In therapy, what is called ‘an integrative approach’ works well. This involves considering all the different aspects of a person and their distress, and combining various therapies to assist. This approach is useful as ‘one size does not fit all’ and it allows us to tailor therapy to each unique individual.

The Flourishing Woman is written using an integrative approach. It draws on recent studies that have discerned which psychological interventions are most effective in improving women’s mental health and wellbeing. For example, there is evidence that mindfulness-based and positive psychological interventions are very effective in improving mental health, and other approaches (such as Cognitive Behavioural Therapy or Acceptance and Commitment Therapy) can also have positive effects.6 More about these approaches later!

When?

Our mental health and wellbeing are vital to a satisfying and meaningful life. This book is all about working with your thoughts, feelings and actions to increase your sense of health and wellbeing so you can deal with the unexpected occurrences that life throws at us at times. Sometimes we experience distressing but normal reactions to stressful situations, and understanding these reactions can be helpful.

We all develop knowledge and many resources during our lifetimes that can support our mental health and wellbeing. Despite terrible adversity during World War II, Anne Frank held onto hope, and her words have continued to inspire the world. In her diary, Anne wrote, ‘everyone has inside of her a piece of good news. The good news is that you don’t know how great you can be, how much you can love, what you can accomplish, and what your potential is.’7The Flourishing Woman is about using all of our resources to reach our potential.

Together, we will tap into our own expertise, stories and resources, and review useful information and practical strategies along with the odd piece of wisdom! Let’s be inspired to find the keys and to open the doors together to greater awareness and connection with ourselves and with others, to change and possibilities, and to continuing to develop our skills to improve our mental health and wellbeing. Thank you for being here as we explore and grow together. It’s time to flourish!

LET’S OPEN THE DOOR TO FLOURISHING

Understanding women’s mental health and wellbeing

“

Be there for others, but never leave yourself behind.

—Doldinsky

The aim of this chapter is to open the door to greater understanding about the mind and women’s mental health and wellbeing issues in general. We will start with some definitions, current ideas about mental health and wellbeing, and some facts and figures. We will also explore ways to protect our mental health, and answer some of the potential questions about common mental health problems and what causes them.

First let’s consider the story of Mary, who was the ‘rock’ in her family and struggled to care for herself.

Mary’s husband and adult children relied heavily on her, and she spent most of her time looking after everyone else. Over time she found herself feeling more and more tired and ‘worn down’. She said that she felt irritable and was teary at times. Mary loved to garden and to walk the family’s dog, Blackie, on the beach. She also liked to visit her friend, Lena, who lived a few hours away. But these things weren’t happening very much at all and Mary’s mental health was suffering.

We will come back to Mary’s story a bit later.

This chapter covers not only important information to be aware of at the outset but it also addresses the question: Why, as women, do we so often put ourselves last? This question will get you thinking about your priorities and your own life. We also consider a few practical strategies for prioritizing ourselves more. Plus, the chapter contains a whole range of ideas to consider and provides the first of many keys to wellbeing and flourishing.

To start, a few definitions

Let’s look at some definitions so that we can understand the language used in our community around mental health and wellbeing. We’ll then take a look at the words we’ll use throughout the book.

Both physical and mental health are vital to our sense of overall wellbeing. The term mental health is often misunderstood. Sometimes it is equated with illness, but it is about feeling healthy and having a sense of wellbeing. Mental health reflects our psychological and social wellbeing and has been defined as a state in which you realize your potential, can cope with various stresses in life, can work productively, and contribute to the community.1

Recent research has suggested that mental health and wellbeing means we can better manage our mood, stress and anxiety levels. It also includes life satisfaction (or whether we like the life we lead),2 ‘positive’ emotions, meaning and purpose in life, resilience, character strengths, and interpersonal relationships.3 This is why we will take a broad look at mental health and wellbeing and incorporate all of these aspects into our approach.

Resilience refers to our ability to adapt during challenging times.4 It has been particularly important in recent years with the pandemic and natural disasters. We all need resilience to manage change, setbacks and our emotions. This is why many of the approaches and strategies in the book foster resilience.

And, as indicated by the title of the book, we are very much focusing on flourishing. This has been defined as thriving, and has been adapted by the field of positive psychology to living a ‘good life’ or, in other words, finding fulfillment, meaning and connection.5

Flourishing refers to thriving in life, or finding fulfilment, meaning and connection.

The terms mental illness or mental disorder are commonly used to refer to a diagnosable illness that ‘affects a person’s thinking, emotions and behaviours, and disrupts the person’s ability to work or carry out daily activities and engage in satisfying personal relationships’.6 On the other hand, mental health problem is a broader term related to having symptoms not severe enough to be diagnosed as an illness, possibly following a life crisis, and causing significant distress.7

Let’s consider physical health for a moment. We can be a physically healthy person generally, but unwell when we catch a virus. Let’s apply this to mental health. As mentioned earlier, recent research has provided new insights into mental health. There is evidence that mental illness and mental health are not two ends of the same continuum (a line with a range low to high) as once thought. In other words, we can have mental health and wellbeing and experience mental illness at the same time.8 And importantly, these continua are inter-related, which means we can work on our wellbeing even if there is mental illness; and that improving our mental health and wellbeing can assist in recovery from mental illness, help with prevention, and also help us to grow and flourish in life.

Improving our mental health and wellbeing helps us to flourish.

Facts and figures about women’s mental health

Part of focusing on wellbeing is understanding some of the potential mental health problems that can influence wellbeing, and learning how to prevent or manage them. The following facts and figures set the scene on potential problems and we will address some of these later in the book.

» Depression is common worldwide, with approximately 280 million people experiencing it.9 Rates of depression vary between countries, but it is reported that it occurs twice as commonly in women as men.10

» In 2019, over 300 million people were living with an anxiety disorder.11 Women are said to be two to three times as likely as men to be impacted by anxiety disorders, including generalized anxiety disorder and panic disorder.12

» Some women experience disorders at times of hormone change, for example, around the birth of a baby, premenstrually or around menopause (addressed in Chapter 8).

» Women who have experienced childhood trauma are several times more likely to develop depression as adults (see Chapter 10).13

» Mental health issues are commonly reported by lesbian, gay and queer women.14

» The prevalence of severe mental illness is reported to be higher in women, and the co-occurrence of more than one mental health problem (comorbidity) is also observed more frequently among women.15

» 80 per cent of people with eating disorders are women, and 26 per cent of young women have self-harmed (twice the rate of young men).16 (See Chapter 7.)

A recent study showed that the COVID-19 pandemic has increased rates of anxiety and depression in the community generally. This was found to be related to the pandemic’s effects on work, finances and our social lives. These were strongly associated with increased mental health symptoms and decreased psychological wellbeing.17

A women’s health survey in 2022 also indicated a decline in mental health, especially in young women. The survey reported that 17 per cent of women with a pre-existing mental health issue said their mental health had worsened.18 We will talk more about the effects of the pandemic on mental wellbeing in Chapter 5.

Some mental health problems are reported to occur more often in women. The COVID-19 pandemic has had a significant impact.

Why are the rates higher in women than men?

There are many potential reasons for the reported higher rates, but we must not ignore the evidence that women are often placed in a more vulnerable position in society, whether being seen as inferior, suffering more stress, or being subjected to abuse or violence.19 These factors will have a significant impact on mental health.

It is also suggested that even though we tend to talk about our issues, we may still internalize some emotions (such as anger). We also tend to go to the doctor fairly regularly in the Western world in relation to reproductive issues or with children, so we may be more likely than men to speak with a doctor about our mental health at the time.

Women are also more likely to be diagnosed with a mental health disorder even in situations where men have the same scores on mental health assessments and are not diagnosed. Plus, we are also more likely to be prescribed medication.20 This raises questions and concerns about potential biases in terms of diagnosis and treatment based on gender.

What are the causes of mental health problems?

Our mental health and wellbeing is influenced by many and varied things, from genetic tendencies to an illness, to what we eat and what we do in life. Both mental wellbeing and mental illness result from interactions between the mind, body and environment. In practice we talk about a ‘multidimensional’ or ‘bio-psycho-social’ basis to maintaining mental health and wellbeing and understanding problems which might arise.21 Cultural and spiritual or other factors may also be relevant.

Let’s consider a few examples of ‘bio-psycho-social’ influences on mental health and wellbeing. Biology includes our genetics, physical illnesses, nutrition, hormonal influences or drugs/medications. Some illnesses may be inherited genetically from our parents; vitamin deficiencies or thyroid conditions may cause mental health issues, or alcohol or substance use may be related.

Psychological influences include stress (such as stress caused by a heavy workload), personality factors (e.g. tending to have a more obsessional or perfectionistic nature), our sense of safety and security, early styles of ‘attachment’ to caregivers (see p. 240) or experiences of neglect, abuse or trauma. Social factors include financial stress or poverty, lack of social supports, housing issues, violence and migration.22 Stigma and discrimination in relation to gender and sexuality may contribute.

It is also important to look at causes of mental health issues through different lenses, which can help us to find focus. For example, a gender lens highlights the importance of psychological distress caused by hardship, abuse or exploitation, which have been shown to impact women’s mental health. These may be compounded by inequalities related to culture, age or sexuality.23

Risk and protective factors for our mental health

We talk about factors that protect our mental health and those that put us more at risk. This is useful because as individuals and as communities, we want to reduce risk factors and enhance the protective factors. Many strategies to enhance our mental health and wellbeing are based on this.

We need to focus on reducing risk factors for mental health problems, and growing our protective factors for mental health and wellbeing.

In 2019, a large study on risk and protective factors for mental wellbeing was carried out, and the factors were found to include the following:24

Risk factors

Social isolation and loneliness

Homelessness

Being in a sexual minority

Migration

Cyberbullying

Insecure employment and unemployment

Unsupportive work conditions

Economic inequality

Caregiving

Physical health conditions

Stressful life events (including violence or natural disasters)

Protective factors

Strong social relationships

Physical activity

Employment

Nutrition

Alcohol reduction

Access to nature (green space)

In addition, the study found that for women around the time of giving birth, risk factors to mental wellbeing include childhood and lifetime abuse, chronic medical conditions, stress and unsupportive relationships, disturbed sleep and multiple births. Social support and physical activity are protective.

Note that strong social relationships or social connectedness, or lack of it in terms of isolation or loneliness, are listed under protective and risk factors. Social connections are vital to our wellbeing. American trauma expert Dr Bruce Perry writes that ‘We are social species; we are meant to be in community — emotionally, socially and physically interconnected with others’.25 Writer and journalist Johann Hari has suggested that a significant cause of depression is ‘Lost Connections’.26

There will of course be variation in how much social connection we each need, depending on our personalities.

Connection is a vital key: Connection to others is vital to our mental health and wellbeing. We need to find a level of connection that works for us as individuals.

It is important to recognize any warning signs for mental health problems. These include:

» persistent sadness or feelings of hopelessness

» excessive fear or worry

» changes in eating or sleeping habits, appetite or weight

» low energy and fatigue

» extremely high and low moods

» increased irritability

» social withdrawal

» misuse of alcohol or drugs

» suicidal thoughts.27

Please be alert for these and seek assistance if they are evident (this is essential if there are suicidal thoughts; see Chapter 7).

The value of different ‘lenses’

As alluded to earlier, it is useful to view mental health, mental illness and related psychological approaches through different ‘lenses’. A lens can help us focus or see different perspectives. We have already mentioned a gender lens; let’s now consider a few other lenses.

Mental illness is often viewed through a ‘disease’ lens. This can be helpful in identifying the problem and providing assistance, but there can be risks of labelling too early or in error. A more recent lens involves a ‘process-based’ framework, in which the problem a person is experiencing is seen as potentially being made up of a ‘network’ of issues. For example, if the person is depressed, there may be a range of issues related to loss or loneliness.28 A more process-based approach also incorporates the idea that there are common processes maintaining different problems, and we need to deal with them. An example would be catastrophic thinking, which may be shared between different types of anxiety or depression29 (addressed in Chapters 4 and 6).

A helpful lens is the humanistic lens, which emphasizes individuality, and the person’s own perspective. An early psychological approach called Gestalt sees the person as having much expertise, as does narrative therapy. The existential lens focuses on the value of meaning and purpose in life. The cognitive-behavioural lens considers the impact of our thoughts and behaviours on how we feel.

Trauma is very common in our community. Psychiatrist Dr Bruce Perry uses a lens of ‘What happened to you? or ‘What didn’t happen for you?’ rather than ‘What is wrong with you?’30 This is an example of adopting a trauma-informed lens, as trauma so often contributes to the development of mental health problems. Perry suggests that sometimes trauma and its effects are missed and, as a result, an incorrect diagnosis can be made.31

In this book we’ll tap into a number of lenses, but the main lens will be the holistic view already mentioned. This recognizes that there are many facets to ourselves and our lives. It sees the importance of addressing illness when present, and also focuses on developing our mental health and wellbeing so that we can flourish in life. Additionally, an individualized and compassionate approach to mental health and wellbeing is seen as vital.

It is important that we are heard and respected, and seen as having many resources within us.

Why do we put ourselves last?

To flourish, we need to ensure that we prioritize our mental health and wellbeing, but it is a common experience for women to struggle with this. An Australian National Health Survey of Women found that ‘women are trying to do too much or they think they’re expected to do so much’.32

Women learn to nurture their children and family, and often their needs come first. This is often necessary, but putting others first and ignoring our own needs may cause harm. Family and the society in which women live both influence women’s lives. Society is viewed broadly as being made up of family, friends, school, government, media, culture, religion and more! We have all been influenced in positive and negative ways, and women are often trained to look after everyone else first. This can result in a sense of wanting to please others most of the time.

People-pleasing can also arise from the multiple demands on us, or experiences of trauma and the stress response that results. This is why we often struggle to say ‘no’ to demands. However, frustration or resentment can result when we are exhausting ourselves trying to meet all these demands. Difficulty saying ‘no’ may be involved. What can then result is taking on too many tasks and not including enough rest or time-out in the week.

Women are often raised to put themselves last and look after everyone else first. This can result in wanting to please others, which can come at a cost.

In addition, as humans, we naturally compare ourselves to others. Comparison is one of our innate survival mechanisms to keep us safe. In the modern world, comparison and a sense of lack (we are somehow lacking in beauty, body or something else in life) is fostered by media and advertising, principally to sell products to us. Social media excels in this as it commonly focuses on ‘the perfect woman’. This mystical creature leads to unrealistic ideals and contributes to a lot of harm in our society for women. A good way to remember to drop comparison is to recognize that to compare means to despair!’

At the centre of women not prioritizing themselves can be a sense of being less important than, or being ‘less than’, others. As we grow up, we naturally create stories in our minds about ourselves. Some are on track but others are not. Unfortunately, a ‘not enough’ story about ourselves can develop. We will talk more about this story in Chapter 3, but right now it’s important to recognize that we are valued and ‘enough’, and our wellbeing matters.

You are enough: Work on changing the ‘not enough’ story into ‘I value myself, and I am enough’.

Prioritizing mental health and wellbeing

Remember the example of plane travel and oxygen masks on p. 1? This highlighted the need to prioritize our mental health and wellbeing, including self-care. This approach will benefit ourselves and those for whom we care.

In this section, we will consider one of the major barriers to self-care for women, and that is time! And we will look into related issues such as self-belief, setting boundaries and assertiveness (which can assist us to say ‘no’) in Chapters 3 and 7. It can be challenging to give ourselves time, and some women are in situations where it is incredibly hard to do this.

For some women, making the decision to focus on what they value can help. We only have so much time and energy in life and need to focus these in areas that are most important to us. Let’s hear more about Mary for a few moments:

Mary recognized that something needed to change. She spoke with her good friend, Lena, who suggested that she see a counsellor regularly.

Mary started making a few changes. She let her family know that she needed some time to herself and would be spending regular quiet time in the garden or walking the dog. Mary also made the commitment in her mind to visit Lena more often. With these changes, she found her mental wellbeing started to improve.

Sometimes, finding time can come through cancelling some activities in the diary or reducing tasks at work. Learning to have more boundaries and to be more assertive may be related to the time issue. For others it is recognizing that we can’t solve everyone else’s problems and that they actually need to learn to do this for themselves. Teaching others that we practise self-care and won’t always be available to care for their needs may play a role.

To flourish, prioritize mental health and wellbeing: This may mean allocating more time for yourself by checking in on what is most important to you in life and letting others solve their own issues wherever possible!

Another interesting idea is ‘work–life integration’. This is about finding ways to blend different areas of life to improve wellbeing. For example, if you travel by train to work, walking to and from the station each day can provide some regular exercise. Having boundaries about not checking any emails after the end of the formal workday enables more relaxation or time to spend time with your partner or family. However, finding time might not be so straightforward, particularly if you have significant social or financial constraints. We achieve change by taking small or ‘baby’ steps, starting with just one. It may be that the first step is accessing some support from a therapist or community organization for help in making some changes.

Take steps to prioritize self-care: Small changes in what you do, think or say can bring big rewards. And having support in making these changes can help.

Let’s summarize

Mental health and wellbeing refer to a state in which everyone realizes their own potential, can manage various stresses, contributes and has a sense of belonging. It is all about flourishing!

We can work directly on improving our wellbeing, and sometimes we need to address any mental health problems impacting our wellbeing. The Flourishing Woman addresses both.

We may experience a range of mental health issues and are more vulnerable at times of hormonal change. There can be many related factors, such as biological, psychological or social factors. Women are often placed in more vulnerable positions in life and violence remains a significant issue. Homelessness is a growing issue in our communities. In addition, COVID-19 has had a large impact on women’s mental health and wellbeing (see Chapter 5).

A holistic, individualized approach to working with mental health and wellbeing is vital. Recognizing the strengths and resources already within us can assist, along with focusing on a healthy lifestyle, self-care and connection with others.

Discussion about an important question was included in this chapter, namely why women so often put themselves last. There are complex reasons for this, but we can begin to prioritize ourselves more by taking small steps towards self-care.

Let’s summarize the keys from this chapter. Remember, too, that by prioritizing our wellbeing, and maybe seeking some support to do so, we can work towards flourishing.

» Connection is a vital key.

» We are enough.

» To flourish, prioritize mental health and wellbeing.

» Take steps to prioritize self-care.

The foundations of mental wellbeing and flourishing

“

It isn’t where you came from; it’s where you’re going that counts.

— Ella Fitzgerald

This chapter focuses on general ways to support and improve our mental health and wellbeing. It has been a challenge to write about ways to both grow wellbeing and manage mental health issues. Both are vital, and this chapter provides a foundation to addressing both.

You are the expert on yourself and once you are aware of the various steps to support and grow your mental health and wellbeing, you can make choices that fit best for you. My clients often run with these, as shown in Rani’s story:

Rani was a relatively new mother and was feeling very anxious. When we talked about all the changes that had happened in Rani’s life during the last eighteen months (including a move interstate) and identified that the anxiety was the result of these changes, she understood that her reaction was pretty ‘normal’ given the circumstances.

Rani was also expecting a lot from herself, so we looked at some ways to manage those expectations along with the anxious feelings, including meditation, and Rani ran with all of this. She also organized childcare once a week so that she could return to a yoga class and catch up with a friend.

This chapter continues to increase our awareness, not only about mental health and dealing with life issues, but also about how our mind actually functions. Our brain cells have the potential to grow and form new connections and nerve pathways to meet our needs (known as neuroplasticity). An example is learning a new language — we focus and practise, and over time our mind creates new pathways so that we can understand and speak the language.

The brain is amazingly ‘plastic!’ Our brain cells have the potential to form new connections throughout life, so that we can learn and flourish.

The Flourishing Woman is based on our capacity to learn, change and adapt to life’s challenges. This chapter, which outlines ten potential foundational steps to improve mental health and wellbeing, is based on neuroplasticity and learning new skills.

First, a few words about prevention

A good level of mental health and wellbeing can help us feel good and enjoy life, and can also assist in preventing mental health problems. Prevention strategies may focus on reducing risk factors such as poor nutrition, substance use, stress, trauma or social isolation, and improving some of the protective factors such as healthy lifestyle, connecting with others and doing meaningful activities in life.

Positive Psychology, which was originally developed by Martin Seligman, has a lot to offer in relation to prevention. This field of psychology moved away from focusing on illness and instead focused on character strengths and behaviours, with the aim of helping people thrive. Seligman has a wellbeing theory that highlights the roles of experiencing ‘positive’ emotions (such as joy or love), engagement in life and activities, relationships, meaning in life, and accomplishment. This approach focuses on developing skills for healthy relationships, utilizing mindfulness, self-care and a range of coping skills. Mindfulness is a process of awareness, and involves paying attention on purpose, to experience the present moment as opposed to being caught up in thoughts or feelings.1

It is in a mindful state that the nerve cells in the brain are activated and growth is stimulated.2 That is, being mindful enables neuroplasticity and is now considered particularly beneficial to many aspects of our mental health and wellbeing. This is why we will incorporate mindfulness in various places throughout this book.

Mindfulness involves paying attention with our senses, on purpose and without judgment. It provides a powerful way to grow new nerve cell connections in the brain, and to strengthen our resilience and wellbeing.

Positive Psychology also considers the role of values and being authentic in life, and fostering a sense of purpose, meaning and hope.3 Authenticity is about being genuine in relation to who you are and how you live. Living more authentically means having self-awareness and skills to live authentically (e.g. to not be overly influenced by others). Note that a specific therapy, positive therapy, has arisen from this approach.

The aim of Positive Psychology is not for us to have ‘happy’ thoughts and feelings all the time, as this is not possible — in fact we naturally have a ‘negative bias’, or tendency towards negative thinking, to help us survive. However, we do know that our wellbeing can benefit from increasing our positive emotional experiences, such as interest, gratitude, inspiration, love or amusement.4

The work of researcher Carol Dweck in relation to education has also influenced our thinking on mental health and wellbeing and prevention. She coined the terms ‘fixed or growth mindsets’ to describe the beliefs that students had about their intelligence and ability to learn. A growth mindset involves beliefs, goal setting and effort to learn and achieve. When you have a growth mindset, you believe you are capable of change, of adapting, and of learning new things. On the other hand, if you have a fixed mindset you believe the opposite — that you cannot learn anything new, and you cannot change your thinking or your attitudes. Improving mental health and wellbeing and prevention involves adopting a growth mindset.5

Strategies from Positive Psychology and positive therapy will be woven throughout the book. Getting to know and use them can help us to flourish.

Ten steps towards mental health and wellbeing

These ten foundational steps are drawn from current thinking and evidence related to achieving optimal brain function and from psychological approaches that strengthen our mental health and wellbeing, and help to address mental health issues.

1. Raise self-awareness and identify what to focus on.

2. Be mindful of your emotions.

3. Choose some intentions or goals.

4. Attend to your physical health, lifestyle and self-care.

5. Connect with others.

6. Tap into talking therapies (to manage thoughts, feelings and behaviours).

7. Know and use your strengths.

8. Explore self-compassion, meaning and purpose.

9. Enjoy meaningful activities and practise gratitude.

10. Consider complementary therapies or medication (if needed to address a mental health issue).

These steps are not in a particular order, and you won’t need to necessarily do them all. For some, seeking help might come first, while for others, improving physical health will be the priority. Let’s consider one step at a time; you might like to write down any useful ideas in your journal as you go.

1.Raise self-awareness and identify what to focus on

Much of the work we do on our mental health and wellbeing relates to being more self-aware. This includes how physically and mentally healthy we feel, our personality styles, our internal strengths and resources, and how we deal with any challenges or changes in life.

It may be that we are not actually aware of what we think and feel. You might also want to reflect on how connected you feel with yourself and others, and what issues are impacting you at this time. Some concerns might be troubling you more than others or negatively impacting your mental health and wellbeing. These issues may be obvious, but sometimes there are a number of things involved, or they may be hidden (such as the effects of abusive behaviours within relationships). Equally, there may be a network of inter-related experiences, feelings or challenges you are trying to identify and sort out.

Perhaps start by looking at the range of factors that can influence mental health and wellbeing. Physical factors include being tired, not having enough nutritious food, not drinking enough water or being unable to find time to exercise or relax. Equally, using substances or having chronic illness can affect our health.

Emotional factors may be affecting wellbeing, such as feeling stressed, anxious or low in mood. Loss, grief, trauma or anger may be impacting. There may be social issues related to housing, employment, relationship problems or lack of social support or connection. Perhaps there are spiritual concerns, such as questions about what life is about; cultural factors; or sexuality or gender-related issues.

We can open the door to change by reflecting on issues that might be impacting our mental health and wellbeing.

Reflecting on your values in life, or what is important to you, can assist in identifying areas to focus on. We can have values in different areas of life such as family and friends, intimate or partner relationships, work and finances, education or personal growth, health and fitness, leisure, the community or environment, and spirituality. Becoming aware of and focusing on what is important to you in these areas can reduce stress and help you find a greater sense of meaning and purpose.

It can be helpful to first identify what is important to you in each of these areas, and then to ask yourself if there is a gap between what you feel is important and what is actually happening. For example, if being physically fit is important to you, and there is no time to exercise, then there is a gap to address. A review of your values in relation to each of the areas of your life and any current gaps could be recorded in your journal.

Sometimes looking at values can lead to surprising outcomes:

Betty came to therapy as she had been feeling depressed. The values exercise led to discussion about her main aim during retirement, which had been to travel. However, at retirement her husband took up an interest that required him to attend to it every day. There were no trips away and she had a large sense of loss. Once this issue came to light, it was possible to look at options for dealing with it, and a session with Betty and her husband led to a good outcome. They would travel some of the time, and their son would look after his father’s interest when they were away.

Reflect on your values: We have a more fulfilling life when our actions are aligned with our values. Consider reviewing your values in your journal.

Often, writing enables you to express what is troubling you and leads to new insights. Consider using the journal to write freely about what is happening, or not happening, and any related feelings. Or write a list of the main issues that have come to light and add to it as other issues become apparent. You might also try talking with a trusted family member or friend, or a doctor or therapist to help identify any troubling issues. The ones needing attention more urgently can then be prioritized.

2.Be mindful of your emotions

Emotions or feelings are fundamental in life and reflect our inner state. We can experience a whole range of them each day, and they can vary in intensity and pleasantness. Our individual experience of them can also vary. Emotions can be described in a word, such as ecstatic, sad, despairing, jealous or ashamed, as different from thoughts, which relate to our head-talk and are usually a string of words.

Emotions don’t come from just one part of the brain. They come from throughout our brain and body (including the gut). The nervous system is constantly collecting information about our internal and external worlds and making sense of it. A ‘core affect’ (or emotional state) results, referring to how ‘good or bad’ we feel in a particular situation.6

Emotions are often categorized as ‘positive’ or ‘negative’, for example happiness or sadness. This categorization has limitations, but in terms of evolution the more negatively perceived emotions have helped us survive. Author Leonard Mlodinow says that it is useful to start with the idea that the more negative emotions, while unpleasant or distressing, are there to help us recognize conditions that are suboptimal or unsafe, and alert us to make the necessary changes. Without them, we would have little desire to change anything.7

Understanding emotions is about being more connected to yourself, and getting to know what is happening in your mind and body.

In terms of our wellbeing, there is a tendency to think that the more ‘positive’ emotions we have, the better. They are vital as they help us feel good and function well, and they can trigger creativity. However, the whole range of emotions helps us to assess our experiences, and many of life’s meaningful experiences include some emotional challenge. These experiences, although not always pleasant, can help us grow as individuals. This is why more recent theories about wellbeing recognize the importance of meaning and personal growth. And one reason why the term ‘negative’ emotions doesn’t always fit. As a result, we are going to refer to them as ‘distressing’ or ‘uncomfortable’ emotions.

Much has been written about core or basic emotions, with various models aiming to group all of the many emotions under five to eight headings. Psychologist Paul Eckman proposed a series of universal emotions in humans, based on associated facial expressions. He grouped them into the basic emotions of surprise, sadness, happiness, disgust, anger and fear.8 It has also been proposed that the basic emotions relate to primitive states of stress (fear, anger), punishment (sadness) or reward (joy).9

Recent research by social worker and author Brené Brown found that hundreds of emotions and related experiences were reported. Brown concluded that in order to recognize and make sense of our feelings we need to:

» understand how they show up in our bodies and why

» get curious about how our families and communities shape our beliefs about the connections between our feelings, thoughts and behaviour

» examine our go-to behaviours

» recognize the context of what we are feeling or thinking by asking ourselves, ‘What brought this on?’

Brown groups emotions under a range of headings. There isn’t space