Ouch I hate this title.  But I chose it because of what it evokes in me and I imagine others and what we might be able to learn from our response to it.  In me the title evokes an anxious sense that finally someone will tell me the answer.  Someone will tell me if I am OK after all.  This desire for paternalistic answers is neither healthy nor helpful and our tendency to do this is one reason why I approach this topic with huge trepidation: talking about emotional health leads almost reflexively to an evaluation of ourselves and others by external standards that may be unhelpful and even harsh. Here is another reason for my trepidation:  I know what emotional health looks like.  It is when I am happy or when other people do things that make me happy.  The person who gives me a nice smile when she passes me my americano is so "well-adjusted."  The person who makes a left without signaling is "passive-aggressive".  It is so easy to take this stance.  And ubiquitous.  And doesn't get us very far.  How dare I make myself into the arbiter of emotional health?  The subjectivity of our experience can be badly misused in a way that is damaging to others when we make ourselves into experts or authorities.

On the other hand, it is possible to address emotional troubles.  And having a framework of what it is like to be healthy is important because it opens us up to what is possible.  We are all pretty good at talking about problems - most people are familiar with anxiety, depression, narcissism, low self-esteem, etc etc etc.  But we sometimes lack the language to talk about what it looks like to be a healthy human being.  So I make the choice that this is important enough to talk about despite the slippery slopes of judgment and subjectivity.  But please - be kind to yourself and be kind to others as you take in these thoughts.

And one final thought before the list.  Perhaps the one closest to my heart.  I am writing on this topic because I believe that psychotherapy is not just about relief of suffering.  It is about living a good life.  I find this notion to be little understood and certainly little discussed.  Many clients leave therapy as soon as the crisis of suffering which brought them there has passed.  In so doing I believe they walk away from what is available beyond relief of suffering.  This second part is harder work - it takes longer and often doesn't feel good in the short-term.  But it is worth it.  So worth it.  See below.

The following draws heavily from"The Profile Of Mental Functioning" in the Psychodynamic Diagnostic Manual, PDM Task Force, 2006 and a talk given by Nancy McWilliams to the Toronto Institute of Contemporary Psychoanalysis on November 17, 2012.

What is emotional health?

1. The ability to regulate oneself, to pay attention, and to learn. Regulation is a crucial skill that many of us continually struggle to master, if that is possible. I think of the child who cries at their birthday party. The ability to calm ourselves down when we are excited, to soothe ourselves to sleep, to get the blood flowing when we feel sluggish - this is all about regulation. We need to regulate to be able to sustain our vitality throughout the day and then to be able to restore ourselves with sleep at night. We also need to regulate ourselves in order to have focus. The ability to focus and to learn are the result of a clear mind, unhampered by trauma and pain. That doesn't mean that trauma and pain do not exist but that they are expressed and well held so that we can also take in something new.

2. The ability to experience, identify, and express emotions. A wide range of them.  Including the ones you'd rather not feel - whichever those are for you.

3. The capacity to have close relationships. Can we allow others to get close to us? Do we care about others? Do we have empathy for others? And can we stay close even when life is difficult? Every human being struggles in intimate relationships. The ability to sustain this struggle is a sign of health. This involves the ability to recognize the humanity of another person even when they have deeply wounded us. The ability to ask for help. The ability to speak of our experience even when it feels risky. The capacity to tolerate the ways in which those close to us do not meet our needs.

4. Realistic and reliable self-esteem. When we have self confidence we have a sense of well-being. We have energy. We may experience times when our self-confidence is challenged but we bounce back and know that we will do so. Healthy self-confidence is not unrealistic - we have a realistic sense of what we can do and what we can't do.  We are able to tolerate exploring our faults knowing that we are worthy, loved, and human.

5.  The ability to self-reflect. Self-reflection is the ability to think about ourselves.  It requires a level of detachment from our feelings (from time to time).  And the ability to think about ourselves in relation to the world - including the words and actions of others.

6.  Conscience. Conscience is an inner sense of morality or values.  It is the sense of a standard that we want to live up to.  Conscience is internal rather than external.  It allows us to feel appropriate guilt and to make reparations for our mistakes.

7.  The ability to love, work, and play. Here McWilliams referenced Freud's famous words about the goal of psychoanalytic treatment.

8. Independence. This is our freedom to act in the world. We know that the perceived or real expectations and desires of others are not the final word. We have something inside of us that must be reckoned with.  This is our independence.

9. Object constancy. Object constancy is developed in early games of peek-a-boo - even when a parent is hiding we come to understand that they are still there. Object constancy is the recognition that relationships continue despite physical distance. It allows us to remain confident in our connectedness and safety even when changing environments. And it allows us to know we are connected even when a loved one is preoccupied or tired.

10. The ability to allow our thoughts to inhibit our actions. In moments of great feeling we may want to send an email, hit somebody, or cry.  Sometimes emotional expression in the moment is exactly right.  But sometimes we have to hold back.

11. Flexible coping styles. This is a bit of a complicated one.  Coping styles can also be referred to as defenses.  There are many types of defenses - from humor to psychosis.  Using multiple styles, and using less rigid styles means that your deepest feelings are closer to the surface and more directly available.  Talking about defenses is loaded - the word has shades of judgment.  Defenses are there for a reason.  They protect us.  And thus deserve our utmost respect while we work to soften their edges.  It's a paradox.

12. Meaning, passion, and vitality.

13. The capacity to mourn and surrender. We cannot control everything. Our losses over a lifetime are great. The capacity to mourn and grieve, to recognize our losses and integrate them into a continued life is an emotional achievement.

14. Recognition of vulnerability and dependency. This makes me think of the diagram from elementary school that shows how plants breathe in carbon dioxide and exhale oxygen whereas humans breathe in oxygen and exhale carbon dioxide. Simplified as this is it makes an important point that we usually forget: we are completely dependent on each other and on the planet for our very survival. There is no such thing as being alone. The recognition of this makes for a realistic and wise human being.

And, added this morning in my therapy (post-distribution of this essay):

15. The ability to be creative in the midst of suffering.

As I struggled with writing this piece, someone I love was pointed out to me that books are written about this - by which he meant to say that this is a complicated topic.  And then I relaxed.  The points above interweave and overlap.  The theoretical foundations are varied.  But it's a start.  We'll keep talking.

I am working on a second part to this article with examples of human flourishing, particularly in the digital world. I would love to hear your suggestions and examples.

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