Mental Health as a Continuum

Mental Health as a Continuum

by Imei Hsu

What might happen if we changed our view of mental illness and mental health from a problem only a few have, to a health concern that each person checks in with each day? Photo by Imei Hsu.

She shuffled slowly inside of the spare hospital room, eyes alert, and a frightened expression on her contorted lips.

“You see them, don’t you? Shut up, just shut up!” she would snap at the empty space to which she pointed and gestured. Before I could answer, she harumphed, turned on her heel, and headed away from me.

I was 20 years old and working as a student nurse on a psychiatric floor of a large hospital outside of Seattle. At the time, I considered my first months working the evening shift at an in-patient psychiatric ward to be the first time I was face-to-face with people who were diagnosed with a mental illness or were suicidal. I thought that what I was seeing was the real face of mental health and mental illness.

Since then, I’ve come to see those experiences differently. While they were real manifestations of mental health crises and psychiatric disorders, they certainly weren’t the only ones.

What it required from me was to expand my understanding of mental health, moving it from a fixed point when someone expresses all the behaviors and thinking that “checks all the DSM boxes” for one disorder or another, but to see mental health and physical health along a continuum.

What Does That Mean, “Mental Health on a Continuum?” 

Rather than asking a person, “Have you ever been diagnosed as, ‘X disorder?'” we look at your mental health on a range and not a point of arrival.

What this means for the average person who does not show psychopathological behavior (a very small percentage of the population, BTW) is that most of us can recognize a little bit of everything within our capacity of expression.

For example, I can have a day, week, or month where I feel truly saddened by the news of the death of a friend. If I act sad because I feel his absence, I can look at this as pathology (medical model) if it goes beyond a certain amount of time, or my reaction to his death begins to follow a pathway of maladaptive dysfunction. Yet I can also look at this as mental health on a continuum — grief over time — and experience the highs and lows of moving on without my friend. 

I  can say, “I feel depressed and sad,” and that can signal to me that I need to take time to care for my mental health. Mental health care, as seen on a continuum, doesn’t even need a particular trigger in order to employ. One would simply tune in and rate from time to time how one was feeling and responding to the day, and adjust accordingly.

What Could That Look Like?

If we diminished our focus on the stigma and stereotypes of mental illness and replaced it with this continuum model around mental health and mental wellness:

  • maybe we wouldn’t wait so long to ask for care
  • maybe we would encourage one another to talk to someone about how we feel
  • maybe we would slow down and take time to get some of our physical and emotional needs met, big or small
  • maybe we would prioritize “being” over “doing”
  • maybe we would spend less time “chilling out” and more time “tuning in” (less Netflix, more quiet walks?)
  • maybe we would feel more confident to talk about rough times and vulnerable thoughts, instead of dressing up our stories to all be “Instagram-worthy”
  • maybe we would honor mental health hygiene, like we respect toothbrushing and handwashing. Neither of these practices guarantee we’ll never get cavities or a cold, but then we don’t berate people for going to a dentist for extracting a rotten tooth or taking an anti-viral if they get a nasty case of the flu. We applaud them. 

My opinion is not to remove the DSM as a means of recognizing and treating psychiatric disorders, but rather to expand and broaden the picture of how we look at mental health as a society.

If you have a body, you will have mental health concerns across a lifetime. There is no escape. Instead of viewing mental health as something only certain people have to deal with, we can introduce mental health early in education as a natural part of life.


My thanks to Dr. Cynthia Li (functional medicine) and author of Brave New Medicine, for sharing her journey with life-altering chronic illness and pain. Her well-written story includes her own discovery of disease and dis-ease as a double-sided arrow, resisting the idea that illness only occurs when symptoms cross the threshhold of “here.”  You can find her book online and in your local bookstore. 


We Name What Is Without Tiptoeing

Image by Capri23auto from Pixabay


I believe that the challenges that each of us face cannot be addressed unless we name what we see for what it is.

In this short post, I want to speak both personally and professionally about something that affects all of us, not as a political concept, but as a daily reality for many Americans, and as it so happens, for myself and for many of my clients.

I am naming it here, without tiptoeing. Whenever I see, experience, or see another person on the receiving end of racism and racist bullying either in front of my face or in the public sector, I will name what I see.

My promise to you is that I will believe you when you tell me your stories of being on the receiving end of racism and racist bullying. I will also believe you and help you name your own struggles with the racist concepts and bias, no matter where you have lived.

My promise to you is that I will not tiptoe around yours or the stories of other’s treatment at the hands of racist bullies by creating euphemisms, polite explanations, or lessening your emotional distress by calling the perpetrators of racism as simply “racially challenged.” While in public discourse there are opportunities for using more nuanced words to foster open dialogue rather than defensive name calling, in the therapeutic setting, racism and racial bias must to be identified clearly.

You are free to talk about race and the effects of racism on you and your family members, your workplace, your schools, and your communities. You are free to explore past and present scenarios you have traversed in your role in perpetuating generational and systemic racism in order to do something about it. 

Professionally, I do not talk about my political affiliations, yet you are free to talk about yours as they pertain to your care and sense of well being. My commitment is to support you. 

If you have a child that is experiencing racism or racial bullying, this is a crime defined as racial discrimination. You will need to know your state’s laws in order to understand what you can do as a parent to protect your child from racism in their schools and programs.

If you or your child is experiencing racism through Social Media platforms, you may wish to look at how each platform handles complaints, trolls, and bullies. You may wish to talk about how to monitor and limit what your child sees and the access that others have to your child via these platforms.

While racism and racist bullying are not new, what does feel new is the increase in tiptoeing that comes with racist exchanges in public dialogue. Many resist naming it. Much like diagnosing an illness, if you don’t name what is wrong, you can’t treat the problem. If you don’t name the racism that you see, it’s that much more difficult to face how it affects you.

You may ask, “Why wouldn’t I want to name something or someone as ‘racism’ or ‘racist’?” The answers are many.  Perhaps at its most basic truth, you may resist naming something so heinous because of the ramifications that follow. Just like naming abuse, it changes how you interact with the abuser and those who collaborate with the abuser. 

As a mental health counseling service, we do not discriminate because of gender, race or ethnicity, sexual orientation, age, or any other point of physical appearance or means of identity. If your concerns fall within the scope of our licensed practices and treatment experiences, you will be met with warmth, concern, and professional care.  If your concerns do not fall within our scopes of practice or experience, we may be able to refer you to someone else who can be of help.


Happy Fourth of July

Wishing you a Happy 4th of July!