I was asked to write a piece for World Mental Health Day this year. Whew! What a task! There are so many things to talk about, it would take more than a month, let alone a day, let alone a blog!
So, here I am trying to give some perspective on my thoughts regarding World Mental Health Day. I will attempt to pare down the data being reported on mental health by the WHO (World Health Organization), and the effects of COVID, provide some information on the impact of the Roe v. Wade reversal, and highlight important suggestions for our infertility population, all pointing to the importance of a sense of control. At least that’s my plan.
The Status of Mental Health
The World Mental Health Day, October 10th, has been on the books since 1992 to raise awareness of mental health issues around the world, and to mobilize efforts in support of mental health and the treatment for mental illness. Some of the emphasis in the past has been on suicide prevention, psychological first aid, living with mental illness, mental health in the workplace, global mental health, etc. Despite the efforts of the mental health field to elevate the importance of mental health, it took a pandemic to bring the importance of mental health to center stage. Previously, it was a topic that was ‘sort of important’ but underneath the water of the iceberg – basically, don’t make it an issue until we can see it!!
Prior to the pandemic, 1 in 8 people were estimated to be living with a mental health disorder. As a result of the pandemic, the worldwide rise in depression and anxiety is estimated to be 25% more than before the pandemic. In a study between August 2020 and February 2021, the percentage of adults reporting recent symptoms of anxiety and depression increased from 36% to 42%. Huge numbers! I imagine it was because all of us felt the fear and worry of the pandemic. How could you not??? These numbers were big enough to get the government health panel, U.S. Preventative Services Task Force, to recommend anxiety and depression screening for all adults under the age of 65 by their physicians.1
In recent years, it has been recognized that the absence of mental disorders is not the same as the presence of mental health. Adam Grant, an organizational psychologist & a thoughtful guy, popularized the term “languishing” in a New York Times article identifying the feeling of those who were not depressed, but not flourishing. Languishing is defined as “a sense of stagnation and emptiness”, as opposed to, flourishing, which is “a strong sense of meaning, mastery and mattering to others”. Languishing is not anxiety, not depression, or any other mental illness, and it doesn’t suggest mental well-being either, but it is a predictor of the potential risks of being diagnosed with a mental illness in the future. In the study that brought languishing to light, inherent in several of the social well-being scales that were measured was one’s sense of control indicated in one’s purpose in life, environmental mastery and self-acceptance. Alfred Adler, the founder of the school of individual psychology, held the belief that a sense of mastery (control) over one’s fate is a key to psychological health.
Dobbs v Jackson decision
Now we move onto to the next trauma, the impact of Dobb’s v Jackson and the Supreme Court ruling to overturn Roe v Wade. For almost 50 years, women have had control over their reproductive decisions and care. The Supreme Court gave this decision to the states who in some cases say, there are no rights for abortion which may include care for miscarriages and ectopic pregnancy.
There are some who believe that having an abortion paves the wave for depression and suicide. Years of research, 50 to be exact, shows that having an abortion is not linked to mental health problems. It is mind boggling that the Supreme Court did not consider that restricting access to safe, legal abortions does cause harm. Research has shown that those denied abortions have worse physical and mental health, worse economic outcomes, more anxiety and symptoms and stress, lower self-esteem, lower life satisfaction, greater likelihood of living in poverty, and greater odds of staying with a violent partner.
Children born because of abortion denial are more likely to live in poverty, experience poor bonding with their mothers, and are at greater mental health problems that can continue into adulthood. 97% of women who made the decision to have an abortion and do not have to hurdle the barriers to care say they made the right decision.2
Reproductive Care for Family Building
Now, let’s turn to those on the other end of the reproductive spectrum – our IRMS patients and our nation-wide community struggling to conceive, and why the Dobb’s decision is also important to you. It too boils down to control of the decisions you make for your life. My recommendation here is to keep a watch on what’s going on, because it really comes down to voting. Find your favorite resource for how your reproductive rights are being impacted, and make sure you vote even if you are in what appears to be a protected state like New Jersey or New York.
On a more personal note, we have known that the uncontrollability, ambiguity, and uncertainty associated with a fertility condition are significant and explain why, for most patients, infertility can turn treatment into an unbearable stressor. Realizing that having a personal sense of control is an important coping resource, that the events and conditions in one’s life are controllable by your actions rather than being a consequence of luck, chance, or fortune. Persons with a high sense of control effectively cope with stressors by trying alternative actions if their current behavior doesn’t seem to work. If one strategy doesn’t work, try another. It’ll help lower the stress and increase the sense of mental well-being.
Now, realize I am not saying one has control of the outcome. This is control in how you cope with the stressor, and not being able to control the outcome.
Check out Resolve’s website on strategies to manage stress. It is a great resource as it lists so many things you can do to help manage how you feel about the fertility process. You can also find lots of content here on IRMS’ site, like a recent blog I wrote on mental health coping skills for infertility.
I do want to emphasize a very important fact for you to know, especially at the beginning of your journey. Infertility and fertility treatment are hard. Embarking on this journey will bring challenges to your life and impact your mental well-being in a way that is unexpected. If you begin by acknowledging that this journey is hard, and it makes sense to feel rotten because it’s hard, and not because you’re weak or not up for the fight, you’ll be ahead of it. Infertility is never something one planned for nor are prepared for, so you will find yourself in a completely new world that will test you.
My short piece of advice – try the 3 N’s:
- NOTICE – your feelings or thinking’s, or that you are feeling and thinking
- NAME IT – the feeling or thinking, or that you are feeling or thinking
- NEUTRALIZE IT – learn a strategy to bring you into the Present Moment.
Know that although a mental health provider is someone who works with those with a mental diagnosis, they are also professionals who work to help you increase your sense of mental well-being. Don’t be afraid to reach out to someone who is very well versed and trained in the many aspects of infertility care to help boost your mental well-being while you are on this path.
Claudia Pascale, PhD, LLC, had been the Director of Psychological and Support Services at IRMS for over 20 years and has recently moved to focusing on her private practice. As a psychologist and specialist in the field of mental health as it relates to reproduction and family building she helps patients and their families’ deal with the struggles of infertility. She sees individuals and couples for counseling; organizes and offers support groups for multiple themes.
Office Tel: 862.333.6230
2 UCSF Turnaway Study Shows Impact of Abortion Access on Well-Being https://www.ucsf.edu/news/2022/06/423161/ucsf-turnaway-study-shows-impact-abortion-access
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Keeton CP, Perry-Jenkins C, Sayer AG. Sense of Control Predicts Depressive and Anxious Symptoms Across the Transition to Parenthood. J Fam Psychol. 2008 Apr; 22(2): 212–221.
Keyes C L M, Dhingra S S, Simoes E J. Change in Level of Positive Mental Health as a Predictor of Future Riskof Mental Illness. American Journal of Public Health, December 2010.
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