There is an enormous amount of mental health content online now that begins with some version of: “5 signs you have ADHD.” “7 signs you have trauma.” “10 signs you were raised by a narcissist.” “If you do these three things, you probably have…”
A diagnosis can give language to something confusing, connect someone with appropriate treatment and accommodations, But I do think we have swung too far towards categorising every human difficulty and then explaining people back to themselves through the category. The downsides of that have been seen in my own practice for clients of mine who spend a lot of time online.
Instead of a diagnosis being one useful piece of information, it can become the organising explanation for who we are, why we struggle and what we can expect from ourselves. We become very good at recognising ourselves in lists of symptoms and less practised at asking: What happens in me? What have I learned? What is biological? What is relational? What is happening in my life? What patterns have become automatic? What capacities could I strengthen? Where do I still have influence? I am seeing it add to passivity, to not understanding that we have deep influence over how we experience life, and losing an attitude of accepting challenge as a way to grow resiliency.
I see something similar happening in the trauma world. The recognition that trauma is embodied was desperately needed. Trauma is not simply a story we tell ourselves or something that happened in the past. AvAdverse experience affects physiology, autonomic nervous system stress responses, attention, perception, memory, beliefs that influence genetics and our bodies, movement patterns, and the ways our bodies prepare for threat. Approaches that ignored the body were incomplete.
Not The Whole Story
But “the body keeps the score” has sometimes morphed online into another reductionism: trauma is stored in the body, therefore we heal trauma through the body. That is incomplete too.
In Dan Siegel’s interpersonal neurobiology framework, which I am trained in and work from, mind is not treated as something floating somewhere inside the skull. Our mental lives emerge through processes involving brain, body and relationships. Human beings develop through relationships, make meaning through relationships and continue changing through relationships. The mind is embodied, but it is also relational. It cannot be ignored when it comes to trauma, because adverse experience shapes self concept, beliefs, how I mind is organised. Often in mental health challenges we see this on a contiunuum of lots of rigidity or/and lots of chaos. And my work, and that of good clinicians is to bring those extremes into greater coherence where there is flexibility, and there is stability. This is known as integration.
So of course the body matters. But so does attention, beliefs, meaning, memory, expectations, relationships, behaviour, emotional capacities, self-talk, identity, environment, physical health and what we repeatedly practise.
You cannot meaningfully separate mental health from physical health either. Sleep changes how we think and feel. Light and circadian rhythms affect our biology. Nutrition, movement, illness, hormones, pain and inflammation can affect mood and cognition. Relationships affect physiology. Psychological stress affects bodies. Bodies affect minds. These are interacting systems, not competing explanations.
Unfortunately, social media has monetised easy explanations and “hacks” for wellbeing. I don't think wellbeing is impossibly complicated, but it does take time, self-understanding and practice. It asks us to become curious about our own particular system: our biology, history, relationships, environment, strengths, vulnerabilities, habits and the ways we have learned to meet life.
This is one of my concerns when any explanation becomes an identity rather than useful information. Whether the explanation is ADHD, perimenopause, being highly sensitive, trauma or something else, it may describe something very real about us. Hormonal changes can profoundly affect mood, sleep and cognition. ADHD can involve genuine difficulties with attention, impulsivity and executive functioning. Some people really are more sensitive to sensory and emotional information. Understanding these things can be enormously helpful.
The problem comes when the explanation becomes the end of our curiosity: “This is my ADHD.” “It's my hormones.” “I'm highly sensitive, so I can't cope with that.” We can inadvertently move from understanding why something may be harder for us to assuming there is little we can do to influence how we meet it. This is where we can slip into passivity. Then we stop exploring. What are my strengths? Where do I struggle? What makes this br environmental changes would help? What patterns are adding unnecessary stress? What capacities could I practise growing more of? What aspects of my physical health need attention?
A label should help us ask better questions, but when an explanation becomes tightly woven into identity, questioning it can begin to feel threatening, as though someone is questioning the validity of our experience rather than exploring what else might be possible. This is where good therapy needs to challenge this. But now we also have this therapy language of 'I feel unsafe' if someone challenges labels, instead of being able to identify discomfort, and, enough safety to explore that.
I want self-understanding to make all our worlds bigger, and in doing so allow empathy for others and their challenges too, because we all have them! ADHD, hormonal changes, sensitivity, trauma, temperament and biology can all influence us, sometimes substantially. Influence however is not destiny, something we really emphasise in our community learning. Understanding what has shaped us should help us work with ourselves more intelligently, while continuing to discover where we have choice, capacity and room to grow. This is what led me to train in approaches that empower integration.
Integration rather than another label
One of the ideas I find most useful in Dr Siegel’s work is integration. Integration means linking differentiated parts of a system. Different parts remain different, but they communicate and work together.
Think about what that means psychologically. I can notice a feeling without becoming entirely consumed by it. I can receive information from my body while also taking in what is actually happening around me. I can remember the past without automatically treating the present as though it is the past. I can hold my own perspective while remaining curious about yours. I can experience fear and still access reflection, choice and action.
Health is not the absence of difficult thoughts, emotions or physiological responses. A well-integrated system can move, adapt, recover and reorganise. Siegel uses the acronym FACES to describe qualities associated with an integrated flow and I love this, it really is a guiding principle for how I see my clients get better as their mind, brain, and body gets more harmonious:
Flexible: I can change my response when circumstances change rather than becoming trapped in one automatic pattern.
Adaptive: I can learn from experience and respond to what is actually happening now.
Coherent: my inner experience has enough organisation and continuity that my thoughts, emotions, memories and actions can make sense together.
Energising: there is vitality and engagement with life rather than all our energy being consumed by defence, suppression or survival.
Stable: I have enough continuity and resilience that difficulty does not repeatedly throw the whole system into chaos or rigidity.
This does not mean being calm all the time. That would be a bizarre goal for a human being living an actual life, and, as an aside, it is one of my issues with over medicating the human experience with anti anxiety meds and anti depressants. Flexibility includes anger, grief, fear, excitement, uncertainty, pleasure, disappointment and stress. Mental health is partly our capacity to experience a wide range of states without any of them becoming our permanent state of being.
There are interesting parallels between this framework and modern neuroscience. Psychiatric conditions are increasingly studied in terms of altered communication within and between large-scale brain networks, rather than one faulty “anxiety area” or “depression centre.” The precise patterns vary considerably between conditions and individuals, so it would be an overstatement to say that every psychiatric disorder is simply a disorder of integration. But difficulties in coordination between systems involved in attention, emotion, self-processing, salience and cognitive control appear across many forms of psychological distress and labels like depression, anxiety, ADHD, trauma, etc.
We also see evidence that some effective interventions alter how these networks communicate. Mindfulness research, for example, has found changes in connectivity among default-mode, salience and frontoparietal networks, systems involved in self-referential processing, detecting what matters, attention and cognitive control. A meta-analysis found increased connectivity between parts of the salience and default-mode networks following mindfulness training.
I like to teach this in the community because mindfulness is sometimes reduced to another wellness technique for “calming the nervous system.” I think that radically undersells it when it's actually about regenerating the brain, healing our mind, and increasing our capacity for aliveness and health.
Mindfulness develops awareness of our own mind. We begin noticing thoughts as thoughts, sensations as sensations, impulses as impulses and emotions as experiences that contain information without automatically dictating what happens next. Attention becomes more flexible. We can notice the body while remaining connected to the environment. We become better able to observe an old prediction without immediately organising our behaviour around it.
That creates choice!!! Everything we do in Befriend is really honing people's awareness to where they have choice, agency, to create health out of sickness, and feel and live better. It is what I am most passionate about in my life. Showing people how powerful they are to digest what is an objectively tough life for many of us, in ways that allow them to thrive and enjoy this gift of life we have.
There is robust research about how integration based interventions help us heal. A recent systematic review of brain research also found associations between mindfulness and neural systems involved in emotional reactivity, self-awareness and attention. This helps humans be healthier, regardless of what label they have.
Psychedelic research provides another interesting example. In studies of people with depression, psilocybin therapy has been associated with increased communication across previously more segregated brain networks, and those changes correlated with antidepressant response. That does not mean “integration” explains everything about psychedelics, or that psychedelics are appropriate for everyone. It does show why I think we should be interested in the capacity of the mind and brain to become less rigid and more connected rather than simply accumulating ever more labels for its difficulties.
This is also why I don't post much clickbait mental health content. I could probably get more views telling you the “5 signs your nervous system is dysregulated” or the “3 things you need to heal trauma.” But I don't think that is how human beings work. Good clinicians genuinely do not post those things. There are no five universal steps that teach a person how to navigate grief, uncertainty, relationships, illness, conflict, their own history, their physical body and the inevitable unpredictability of being alive. Good mental health is built through capacities. This is what I teach and help people practice in life. Not as a 30 day somatic path to wonderland, but as new ways to live their lives.
Can I notice what is happening inside me? Can I distinguish a thought from a fact? Can I tolerate uncertainty without immediately trying to eliminate it? Can I recognise when my history is shaping my interpretation of the present? Can I feel an emotion without either suppressing it or handing it the steering wheel? Can I listen to my body without becoming frightened of every sensation? Can I communicate, repair, set boundaries, receive feedback, change my mind and ask for help? Can I care for my sleep, movement, nutrition and physical health? Can I recognise when something genuinely is outside my influence and adapt to that reality?
They are foundations for human mental health. This is why validation alone is not enough for me therapeutically. People absolutely need their suffering understood. But if validation becomes “everything you currently think and do makes perfect sense and therefore nothing needs to change,” we have confused compassion with helplessness. Understanding why a pattern developed should give us more options.
Perhaps hypervigilance once made enormous sense. Perhaps perfectionism helped you gain approval. Perhaps disconnecting from your body protected you during something overwhelming. Perhaps avoiding conflict kept an important relationship intact when you were eight.
We can honour the intelligence of those adaptations without assuming they must organise the rest of our lives. That is where influence comes in. Influence is different from control. We cannot control our biology, other people, everything that has happened to us, whether illness occurs or what life will throw at us next. Mental health should not become another impossible project in which we are told that if we meditate correctly, breathe correctly, heal our trauma correctly and think positively enough, nothing difficult will happen.
But lack of control does not mean lack of influence. We can develop attention. We can examine beliefs. We can practise different responses. We can build emotional skills. We can become more aware of our bodies without obsessively monitoring them. We can strengthen relationships. We can change environments where change is possible. We can look after our physical health. We can become more flexible in how we interpret and respond to experience.
Over time, those capacities will shape our brain's perception of stress, our perception of ourselves, and so this will vastly change stress mediated illnesses, which I primarily work with. It is why psychological flexibility and optimism are evidence based to heal chronic pain. These are capacities!
How I Personally Work
My objective with clients is therefore much bigger than reducing a symptom or teaching someone another technique. I want people to know and like themselves. I want them to understand their brains and bodies without becoming frightened of them. I want them to recognise their patterns without turning those patterns into identities or fixed futures. I want them to develop enough mindful awareness to catch themselves in an old automatic response and realise, sometimes for the first time, “Ah. I have options here.”
I want them to become more flexible, adaptive, coherent, energised and stable. Not permanently happy. Not “healed” into somebody who never struggles again. Robust enough to live in ways that do not unnecessarily add suffering to their minds, bodies and relationships. I see this capacity grow in people over and over again, and there is genuinely very little that brings me more joy than watching someone realise how capable they are of living, loving, experiencing pain and enjoying life in new ways.
Because life is complex. Bodies are complex. Relationships are complex. Minds are complex. A genuinely good approach to mental and physical health should respect that complexity while still helping people understand where their influence lies and how to build foundations of wellbeing that last.
One of the greatest barriers I see is the belief that healing is something that happens to us: if we just find the right programme, practitioner, treatment or diagnosis, someone will finally fix the problem. Treatments and programmes can be incredibly valuable, and sometimes medical treatment is essential. But they cannot do all of the work of living for us. At some point, where we have the capacity and our basic needs are sufficiently met, we have to become active participants in our own lives. That might mean becoming willing to examine a long-held belief, noticing how we respond to uncertainty, recognising a pattern that once protected us but now causes suffering, practising a different response, asking for help, changing our environment or accepting something we cannot change.
I genuinely do not mean this harshly. Quite the opposite. None of us chose the biology we were born with, the families we arrived into, the experiences that shaped us or many of the things that have happened to our bodies and minds. Understanding that should reduce shame, not create it. But compassion does not require us to conclude that our past has written our future. I am not an over validating therapist. I have deep compassion, and, I will absolutely show someone where they cause themselves suffering, so that they can alleviate it, because I care for them.
As conscious human beings, we have a remarkable capacity for learning. We can notice ourselves differently. We can develop skills we did not previously have. We can question beliefs that once seemed unquestionably true. We can practise new ways of relating to our bodies, ourselves and other people. We can make different choices where choices are available to us. None of this guarantees anything in concrete outcomes, but it paves the way for a life well lived.
That requires learning, practice, humility, humour, relationships, embodiment, reflection and the wonderfully imperfect laboratory of daily life. We don't develop these capacities by completing a programme perfectly. We develop them by living, noticing, experimenting, getting things wrong, repairing, adapting and gradually discovering that we have more ways of meeting life than we once knew. I am still right there with you all; learning, failing, adjusting, and these days - really enjoying the gift of the challenging and beautiful life I have been gifted with.
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