Introduction:
I’ve talked about how the brain reacts a lot more like muscle than it does like hormonal or other physiological systems. And I’ve mentioned that I tend to think of most mood and affective problems more like injuries than illness. But I want to spend a little more time on the idea of mind-as-muscle and how it ties in to developing a more realistic model of diagnosis and treatment of ‘minor’ psychiatric problems.

I’ve often heard it said that the mind is what the brain does. And moving weight (actually, producing torque) is what muscles do. But there’s a lot more to lifting weights–especially if you’re cross-training for a sport and not just ‘getting big’–than just slinging lead. It’s much the same way for the mind. Good genes are of course important for building strength. Bone density, tendonal elasticity, muscular growth potential are all things that are in many ways limited by genetics. But a few strands of DNA are hardly the whole story. Building a body capable of moving a lot of weight at rapid acceleration for long lengths of time requires a proper training regimen. And this prescription can help people with not-so-good genes achieve some pretty stellar heights themselves.

Diagnosis And The Power Of Words:
I’ve never met a man who never trained who could bicep curl a 50lb dumbbell. And I’ve met plenty of men who, though more than strong enough, injured the hell out of themselves attempting such a feat. Could you imagine if a doctor told the first that he needed steroids? And if he told the second that it wasn’t his fault, that he suffered from a joint imbalance?

It just wouldn’t be done would it? The doctor would say to the first man that there was nothing wrong with him, he just had to learn how to develop his musculature, and to the second that he had to learn how to use his body.

But when it comes to the mind, the very first thing that many mental health professionals turn to is the DSM-IV TR, and they ask themselves “What kind of disorder does this guy have? What kind of disease? What kind of treatment should we pursue?” Loaded words, every one of them. There are fortunately still mental health professionals who after such a rummage through The Book wouldn’t immediately turn to the prescription pad, but rather to the therapist’s couch. Still, the words we associate with psychological issues–ones of illness and of defects–set the tone from that point on. Which is why I make it an issue to refer to them as issues, problems, or injuries.

Now, I’m not a very PC guy (if you hadn’t noticed), but words can be important. Particularly those that have to do with a person’s health. The labels ‘disease’, ‘incurable’, ‘chemical’, and ‘genetic’ aren’t very empowering; they make a patient feel like there is very little in his power. None of that compares very well with a skinny kid being told he needs to change his diet and put in a little time, but soon he too can be benching 300 lbs, as long as he really wants to hit that goal.

The Importance Of Proper Training:
Every fall, like clockwork, college freshmen join the gym and start lifting, wanting to get huge to compensate for their lack of confidence in themselves and who they are. And every fall, with increasing frustration, I drop my own weights to stop the idiots from killing and/or maiming themselves. I then give them the two minute lesson on exercise nutrition, and another two minute lesson on planning an effective workout to increase your strength at a decent, but safe, pace.

The mind is a lot more complex, a lot more fragile, and a lot harder to strengthen than your average shoulder joint. Yet most of these kids received a good deal more instruction in my short-tempered canned rants on the latter than they ever had on the former. So, if they became depressed, anxious, or otherwise upset, I’d think the default position would be that they were inadequately prepared and/or trained to deal with the world and the goings on inside their heads.

From the first day of orientation at university until the day I graduated, I was a regular at the gym. And you know, I never saw most of those kids for more than a few months. Which honestly, was probably a good thing. Most of the ones that did stick with it were textbook cases of the whole Male Distorted Body Image Disorder thing:

Guy: “I’m soo tiny.”
Girl: “Guy is cute, but he’s too big. Almost grotesque looking.”
Nick: “Dude, you’re more than big enough. Trust me, girls do not go for that kind of thing.”
Guy: “Yeah they do!”
Nick: “You just heard her say that they didn’t!!!”
Guy: “Well, yeah she says that. But she means I need to get bigger.”
Girl/Nick: “Moron”

Anyway, now that I’m completely off point (but have hopefully brought your attention to a VERY big problem among males), I thought I’d say that one of the reasons I think these guys failed so often was that they were after something that weights couldn’t give them. They wanted self-esteem, they wanted self-acceptance, they wanted to fulfill an image that they’d produced of their ideal selves.

And I think when a lot of people come in the door of a therapist’s office, they’re after something that a strong mind won’t necessarily give them. They want to be happy (which isn’t exactly the word I’m looking for). While there’s certainly nothing wrong with being blissful, it’s not exactly what I’d call a natural state of being. But sounding like Eeyore in the depths of your resignation isn’t exactly right either. What people should be after is a happy medium…a state of mind that I think the word ‘contentmen’ captures pretty well. To me contentment isn’t just about affect (happy), or philosophical acceptance (resignation), but about an emotional and cognitive mindset that allows you to roll with the punches. It’s about training a mind that’s strong enough to get you through the low points in life and flexible enough to keep you from breaking when you go through it.

Muscles aren’t supposed to be big. They’re supposed to be strong. They just happen to get big doing it. A mind isn’t supposed to be invariably happy, it’s supposed to help you get things done, something that only really happens if you’re content.

Strong Is Only One Step Away From Brittle:
Even though I approached lifting with a good deal more preparation and sanity than did most, I was still susceptible to adrenaline-induced lack of judgment, overtraining, and–especially in the damaged arm–sprains, strains and twists. If I did see a doctor, she wouldn’t declare that I had a cartilage defect or a musculoskeletal disease that causes my brachialis to sprain when I’m skullcrushin 165. She’d tell me I was an idiot, no one had any business using weights that large, and then she’d put it in a splint, cast, or sling as necessary. After hitting me again, for being a doofus (this is what you get for using docs you’re related to), she’d then tell me not to come back to her office if I hurt it again lifting.

Strong people break too, they’re just a lot less likely to. And when they do, chances are that they don’t have a disease, don’t have a disorder, but simply pushed themselves farther than their conditioning went. They need to be treated that way. Figure out just what pushed them there. And if it can be removed, remove it. If it can’t, make an action plan to deal with it. Maybe it’ll involve a couple weeks or months of pills, maybe it won’t. But the patient will think of it as transitory.

Conclusion:
The main point of this piece is simply that we must treat the mind in a way that reflects both its biological nature and its more abstract psychological workings. If my 7th grade swimming coach had looked upon the 5′ tall 74 lb kid and simply said ‘Well, he’s a skinny wimp, never amount to anything much’, he wouldn’t have been able to turn me into a state level swimmer within the year. He certainly wouldn’t have believed that that scrawny creature would grow almost a foot taller and nearly triple in weight (mostly muscle…mostly lol). If we don’t recognize that the vulnerable patient in front of us can become a resilient, self-willed individual whose strength of character we’d be envious of, we won’t ever learn to ‘cure’ psychological problems. And if we don’t recognize that sometimes the stronger you are, the harder you break, we seriously risk not being able to rehabilitate these individuals.

The man you see on the street is rarely as muscular or athletic as he could be. The same is just as true of his mind.