@OccSci_USA 24th Feb, by Grant Mitchell. Pre Chat Reading


On Sunday, February 24th, at 7 pm EST, 4 pm PST, the Twitter account for the Society for the Study of Occupation: USA found at the twitter handle @OccSci_USA will be hosting a topic chat that can be found following #OccSciChat. This Chat will be on the topic of occupational therapy (OT) history and its relevancy to OT science and OT practice. The only requirement to join is that you come ready to share your perspective!

Pre-Chat Reading

Occupational Therapy History: It’s Relevant!

William Rush Dunton Jr, one of the six founders of OT in America once quoted Dr. Thomas W. Salmon who said “The old, unproductive controversy over what is ‘mental’ and what is ‘physical’ in normal or abnormal functions is ending” (Dunton, 1945). Yet a century later, the controversy remains. Beginning with Descartes who separated the idea of the mind from the body; the idea of OT originally set out to combine the relationship of mind and body with the concept of function (Serret, 1983). While science has primarily been the study of the material world, OT has emphasized a holistic approach to the study of the human.  

The idea of what occupation is, may have had closer associations with the word diversion at its beginning (Dunton, 1919). As a half a century passed, the word “occupation” became increasingly replaced with the word “activity” (Bauerschmidt & Nelson, 2011). This marked the biomechanical era, labeled by Kielhofner (1983) as the “paradigm of inner mechanism” and faulted for its reductionism. Reductionism is essentially the separation, organization, and study of the fundamental parts of the whole. Reductionism remains an essential and valuable tool of science in the study of any material phenomenon. Kielhofner (1983) explained “Since the field is a dynamic and changing medium, the history provides the best possible definition of occupational therapy – not only what it is, but what it has been in the past and where it seems to be headed.” Price (2017) argued that OT professional programs have “decoupled occupation from therapy.”  

Whether good or bad, humans change and their occupations change with them. As OT has evolved and adapted, could it be that the relationship between occupational science and OT practice has lost its connection to the original idea? Could it be that history on the surface appears less interesting or is otherwise undervalued? In the 1920’s there were debates on toy making, whether going to baseball games was occupational enough, and defining what OT is. OT history remains relevant to the study of OT as a science and a practice, yet it can also be interesting!

Discussion Questions

Q1: Do you feel occupational therapy history is an interesting subject? and what could make it more interesting and relevant?

Q2: Do you feel you gained an adequate knowledge of OT history during your study?

Q3: Are there any elements of occupational therapy history that you feel impact your day-to-day practice?

Q4: How does the history of occupational therapy impact our professional perspective of the science of occupational therapy?

Q5: How do you think the fundamental idea of occupational therapy has changed over time and how might it continue to change in the future?


Bauerschmidt, B., & Nelson, D. L. (2011). The terms occupation and activity over the history of official occupational therapy publications. American Journal of Occupational Therapy, 65, 338–345. doi: 10.5014/ajot.2011.000869

Dunton, W. R. (1919). Reconstruction therapy. WB Saunders Company.

Dunton W. R. (1945). Prescribing Occupational Therapy. (2nd ed.) C. C. Thomas

Kielhofner, G. (Ed.). (1983). Health through occupation: Theory and practice in occupational therapy. FA Davis Company.

Price, P., Hooper, B., Krishnagiri, S., Taff, S. D., & Bilics, A. (2017). A way of seeing: How occupation is portrayed to students when taught as a concept beyond its use in therapy. American Journal of Occupational Therapy, 71, 7104230010. https://doi.org/10.5014/ajot.2017.024182 Serrett, K. D. (1985). Philosophical and historical roots of occupational therapy. New York: Haworth Press.

OTalk2US 2nd Sept, by Grant Mitchell. Pre Chat Reading

I discovered #OTalk2US and #OTalk while completing an article I was writing for another informal OT peer to peer website. I collected and organized roughly 200+ OT Twitter accounts by practice area such as pediatrics, mental health, and general advocacy. Certainly, there are thousands more, however, I focused on accounts that were topic specific or subject related. Since, I have participated in collecting and organizing OT podcasts and YouTube accounts, and most recently, a general (non-academic) OT-book-authorslist using online platforms. These are examples of social media for informal professional networking and growth. 

In 2011, Giordano & Giordano found that online media was becoming a “primary source of information” for health professional students including occupational therapists. At the time, Facebook was the primary platform. Since 2011, Facebook has plateaued in second place to YouTube while Twitter and particularly Instagram are gaining users (Smith & Anderson, 2018). However, in addition to primary social media platforms include broadly, the general internet and digital based resources such as OT run websites, podcasts, and blogs. 

Though social media and internet sources may not replace peer-reviewed research, it can certainly be a peer-reviewed discussion and lead occupational therapists to evidence-based practice material. Occupational therapy is an evidence-based and science-driven profession; yet, there is far more to engaging evidence than following directions. Professional growth involves ongoing discussion, professional engagement, and informal sources while online platforms can support this professional growth positively (Ranieri, Manca, & Fini, 2012). 

The digital age that we live in today, allows us to engage with professional peers from across the nation on a casual Sunday evening (#OTALK2US), or across the globe on a Tuesday mid-day (#OTALK). Bodell & Hook (2011) described Facebook as a “Modern-day essential” for “developing diverse, low density networks free of charge and with reduced cost in terms of time effort” with occupational therapy professionals. In another study, Bodell & Hook (2014) found that educating incoming students on professional uses for social media could support “professional networks and facilitate continuing professional development (CPD).”  However, Murray & Ward (2017) found “willingness to use social media within CPD” is not dependent upon age. 

From sharing book collections and starting journal clubs to discussing AOTA mandates, social media platforms and online sources have an important role in the communication of occupational therapists. Other reported uses include; communicating with members and promotion (Hamilton et al., 2016). A qualitative mixed-methods study by Grant (2018), found that internationally, occupational therapists valued the non-profit informal online platform TheOTHub because it provided an online community and network opportunities with ithe most visited page being Resources + Services: Specialisms. The Facebook page OT4OT (occupational therapy 4 occupational therapy) includes nearly 23,000 members with 47 sub-groups of which the member page of MH4OT (mental health 4 occupational therapy) remains the largest at 9,000+ members. Social media and internet sources offer an organic peer-to-peer professional growth, that Greenhalgh, Robert, and Macfarlane (2004), define as “pure-diffusion” or in other-words, a less structured (horizontal) rather than more structured (vertical), growth. This pure-diffusion was found applicable to occupational therapy by Hamilton et al., (2016).  

Vaguely, people prefer different platforms while others feel they need to take a break from social media as the plateau in Facebook use has indicated. There is a significant discrepancy in un-used potential for occupational therapists on social media to engage peers as Wong (2018) found with influence comparison in his poster Advocacy in Digital Influencer Era for Occupational Therapy Students and Practitioners.   

This talk is not themed about how to reach a greater audience, self-promote, or use social media more; but rather how those of you who participate can use social media and internet sources practically and professionally. 

Broadly, the theme of this discussion is: how does social media and internet platforms impact your professional life practically and what resources have been most helpful? 

  • Q1: What communities of practice do you use for Professional Networking? (Examples include; National, state, local, lunch meetings informal, social media) 
  • Q2: What ways have you used social media for professional growth? 
  • Q3: In what practical ways have online digital resources informed your OT practice? 
  • Q4: What barriers do you experience with social media use or internet sources? 
  • Q5: In what ways can we be more inclusive of intergenerational, international, and interprofessional (PT, nursing, social workers) collaboration? 

Also, if you are interested in contributing to a research project of what impact participating in these twitter talks has had for you, consider completing this survey: 




  • Bodell, S., & Hook, A. (2011). Using Facebook for professional networking: a modern-day essential. British Journal of Occupational Therapy, 74(12), 588-590. 
  • Bodell, S., & Hook, A. (2014). Developing online professional networks for undergraduate occupational therapy students: an evaluation of an extracurricular facilitated blended learning package. British Journal of Occupational Therapy, 77(6), 320-323. 
  • Giordano, C., & Giordano, C. (2011). Health professions students’ use of social media. Journal of allied health, 40(2), 78-81  
  • Greenhalgh T, Robert G, Macfarlane F, et al. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004; 82(4): 581629. 
  • Grant, J. (2018). What are the benefits, limitations and potential of The OT Hub for occupational therapy? Research supporting the development of a new online platform for the profession. (Doctoral dissertation). Retrieved from www.theOTHub.com/research-portal [Accessed 2/9/18] 
  • Hamilton, A. L., Burwash, S. C., Penman, M., Jacobs, K., Hook, A., Bodell, S., … & Pattison, M. (2016). Making connections and promoting the profession: Social media use by World Federation of Occupational Therapists member organisations. Digital Health, 2, 2055207616653844. 
  • Murray, K., & Ward, K. (2017). Attitudes to social media use as a platform for Continuing Professional Development (CPD) within occupational therapy. Journal of Further and Higher Education, 1-15. 
  • Ranieri, M., Manca, S., & Fini, A. (2012). Why (and how) do teachers engage in social networks? An exploratory study of professional use of Facebook and its implications for lifelong learning. British journal of educational technology, 43(5), 754-769. 
  • Smith, A., & Anderson, M. (2018, March 1) Social Media Use in 2018. Pew Research Center. Retrieved from http://www.pewinternet.org/2018/03/01/social-media-use-in-2018/ 
  • Wong, B. (2018, April). Advocacy in Digital Influencer Era for Occupational Therapy Students and Practitioners. Poster session at the annual meeting of American Occupational Therapy Association, Salt Lake City, UT. 

What is Occupational Therapy? An OT Spiel

“What’s your OT spiel?” Is an ongoing discussion for OTs. The occupational therapy (OT) spiel is similar to what’s commonly known as an elevator speech, but for OTs. My purpose in writing this article is as a personal assignment to organize my favorite OT spiels into one place.


Defining OT was one of the first assignments I remember in my introduction to OT class. “Develop your OT spiel” was one of the first pieces of advice I remember from doing clinical work. The OT spiel continues to be an important discussion among OT circles.  I do not believe there is a one-size-fits-all OT spiel.

During my second American Occupational Therapy Association conference in 2017, I went to a presentation titled “PromOTe.” There, audience members were invited to come onto the stage and give their best “elevator speech.” Surprisingly, though the room was packed, nearly no one volunteered. Wearing the extrovert shoes I do in social situations such as that, I volunteered. 

My goal was to make people laugh and act personal. I said something along the lines of “most people think occupational therapy is all arts and crafts, but I like to inform them it can be fun and games too.” 

Maybe one or two people chuckled, mostly the joke fell flat on the audience. I continued with about one minute more of talking. As soon as I finished, the presenter asked the audience if they had any feedback.  Apparently they had been listening, because I swear, the entire audience, raised their hand. 

“it was too long.” 

“it wasn’t professional enough.” 

“it made OT sound like all arts and crafts.”  

Thankfully, the presenter boasted my self-esteem when commenting she was proud that I was one of the few who had the courage to attempt an OT spiel. Well, ignorance is bliss, because I realized after the session why I was one of the few. 

The presenter was Karen Jacobs, a recent president of the American Occupational Therapist Association (AOTA). I was only glad to have figured that out after I left the room and not on the stage. 

Since that moment, I have thought deeply about what occupational therapy is, to the point of diving into the Archives of Occupational Therapy, edited by Wm. R. Dunton, Jr., MD, Volumes I-III, 1922-1924. These documents are found at the Wilma L. West library which can be located online at the American Occupational Therapy Foundation (AOTF) website. 

An OT Spiel From the 1920’s

One of my favorite definitions of OT comes from one of the original founders of occupational therapy Adolph Meyer (1922): 

“There are many other rhythms which we must be attuned to: the larger rhythms of night and day, of sleep and waking hours, of hunger and its gratification, and finally the big four – work and play and rest and sleep, which our organism must be able to balance even under difficulty. The only way to attain balance in all this is actual doing, actual practice, a program of wholesome living as the basis of wholesome feeling and thinking and fancy interests. 

Thus, with our patients, we naturally begin with a natural simple regime of pleasurable ease…Our role consists of giving opportunities rather than prescriptions. There must be opportunities to work, opportunities to do and to plan and create, and to learn to use material.” 

While words change, definitions change, culture and rhythms change, there was an understanding that Adolph Meyer had about humans. While argument and debates about what is what, may always be. For a moment in time, Adolph Meyer understood something about us that I argue, can not be understood better. All further definitions are simply new interpretations, culturally relevant applications, and translations into modern words.  

My Personal OT Spiel 

If I were to say what occupational therapy is to me, it would be this: 

Occupational therapy is more of a philosophy than a skill set. It’s an idea, that people must be actively engaged with the world in doing things as opposed to not doing. It’s by this ‘doing’ that meaning, purpose, and value is brought to life. ‘Doing’ is anything from mundane daily routines to the pursuit of our passions, from washing dishes, dressing, brushing our teeth, to photography. So, what matters to you?” 


My Mental Health OT Spiel

In the workplace however, I typically start any discussion on what OT is with: 

“Have you ever worked with OT before? If so, what’s your experience of its purpose?” 

When I begin explaining occupational therapy in the mental health setting it goes something like this:  

“Occupational Therapy is dealing with how people ‘occupy’ time. Think ‘routine’. Wake up, shower, get dressed, eat, work, talk with friends, journal. That’s healthy living. When I’ll-health stops that, we focus on strategies to get back to a healthy routine. If in a wheelchair, being able to get into the shower is important. If dealing with depression, having a coping strategy is needed (…or insert your own examples). Being able to engage in day-to-day activities is the occupation, practicing is the therapy.” 

My Physical Health OT Spiel

I do not believe mental health is separate from our physical health, but the reality is, the public does. I believe it’s important to meet others where they are at and gain an understanding through listening first.

My typical OT spiel for the inpatient rehabilitation setting where those with physical injuries like stroke, cardiac & spinal injuries, amputations, and other disabilities go for “intensive therapy” prior to going home, goes more like this: 

“Occupational therapy may look different depending on the setting, but it’s goal is the same, to help people be as independent as possible with their day-to-day activities, with stroke that might look like dressing or using the bathroom, or simply getting around your room.”  

Depending on upon the day or conversation, I may further elaborate. 


What occupies our time may change, but the need for the human to be occupied will not.  The word occupation itself may even carry different images and opinion, yet the understanding of the human need to be engaged remains as critically important forever.

In an international discussion on “what’s your OT spiel?” Several occupational therapists reported a negative stigma associated with the word occupation and occupy more as a “meaningless” or “blasé” use of therapy. This stigma may exist in different forms in the US or around the world as well.  

I don’t believe there will ever be a final definition of what occupational therapy is. I believe occupational therapy is an idea that can only live in the minds of those who see it. Words are used to translate that idea and phenomenon, but the problem is; occupation fundamentally relates to people, and people change. However, people’s need to be engaged does not change.  

The realist OT will always stand adaptable, ready to modify and adapt that idea into the frameworks and understanding of the audience to whom they wish to share the idea.  


Meyer, A. (1922). The philosophy of occupational therapy. Archives of Occupational Therapy, 1,1–10. Retrieved from http://www.aotf.org/resourceswlwlibrary/archivesofoccupationaltherapy 

Why Goal Setting Should Be EASY

Do you set goals? If you do, do you actually ever achieve them? 

I have never really been a goal setter by its common understanding; such as: 

  • Running marathons 
  • Quitting drugs 
  • Starting businesses 
  • Ending homelessness 
  • Writing a Book 
  • Getting a promotion 

When I say I am not much of a goal setter, I mean; I rarely focus on accomplishing a goal or setting a new resolution. Every year we come to the point in which it is time to make New Year’s Resolutions. Some argue it’s a waste of time because they always fail, others continue to try for the same goals year after year.  But I have had success with changing my behavior and habits. Below is an essay video made to illistrated the point. The details and research is elaborated on in the article below.


In this article, I intend to elaborate in detail, the evidence behind the argument I make in the video above. I want to “un-pack” the myths, history, and practical reality of what works with goal setting, as it applies to day-to-day life. I am not making a case for what corporate strategic planning should do. I want to know what the common person should do, in order to live healthier.  

I will make the final point: If anything, a functional, practical, useful, personal goal should be: 

  • Everyday – (Something you can DO nearly every day) 
  • Action-oriented – (Don’t avoid things – always plan to DO something) 
  • Short-time – (make it easy to DO, such as 2-20 minutes) 
  • Your Purpose –  (it should relate to your purpose and values!) 

Is Goal Setting Itself, Part of the Problem? 

There is significant evidence we are all trying too hard. It’s possible the mere act of goal setting itself is part of the problem, or at least the way the average person approaches goal setting. As the professor and researcher Roy Baumiester points out in his book Willpower (Baumeister & Tierney, 2012), we have limited reserves of willpower that get used up throughout the day. With modern technology and media, we are often faced with attention and decision fatigue. While goal setting should hypothetically, allow us to focus on our priorities, it often distracts us from behavior change with vague ideals, overwhelming complexity, and high activation energy.  

Rather than complexity, healthy behavior should be simplistic. There is a massively common theme among true expert experts, to whom I will identify in an upcoming article. In these various areas of health, the theme is in relation to the simplicity of health. 

A Few Areas of Health Simplicity

  • Dieting: Researchers Lisa Mann and Brian Wansink, note this simplicity in nutrition and dieting, and argue that part of the problem is trying too hard (Mann, 2015; Wansink, 2007). 
  • Nutrition: Journalist Michael Pollan and Researcher Collin T. Campbell back this anti-diet movement up with evidence that healthy eating should be simple and traditional, rather than complex (Campbell & Jacobson, 2013; Pollan, 2008). 
  • Hydration: In an interesting video by Thomas Frank titled How to Stay Hydrated: Here’s Everything You Need to Know (2018), in reviewing the research behind what healthy hydration actually is, points out that the “8 glasses of water a day” is a myth. Thomas Frank cites his sources in showing that, taking time to drink water when our bodies cues us with thirst, for the average adult, is all that is needed. 
  • Sleep: Sleep studies show a similar trend in those suffering with insomnia, that a poor understanding of how good sleep is acquired is equally matched by complicated approaches. Better sleeping will often come from trying less; that we need to listen to our bodies rather than constantly be trying to manipulate them (Carney et al., 2010; Carney & Manber, 2013). 

What Else Does Health Simplicity Apply To?

Might it be a stretch if I predict these same principles could be found in other areas of health? For example, could it be, that healthy exercise may include nearly no exercise regimes? That while working out with iron weights is acceptable, it’s also not nearly as health producing as reducing the amount of time you sit during the day or a simple walk instead? 

Could it be that mental health is also the same in its simplicity? 

In addition to the over complexity we make of health and change, we drain our reserves. Goal setting, then, if effective at all, should be helpful for identifying priorities in order to simplify our lives. This however, is not the case. Certainly, there is evidence that failing to achieve goals has a negative impact on the individual (Fishbach & Ferguson, 2007; Förster, Liberman & Friedman, 2007). Often, goal setting is simply a reminder of failure and can detract from our already spread-thin ability to make focused decisions (Moberly & Watkins, 2010; Jones et al., 2013). 

The Major Mistakes People Make with Goals 

The major mistakes people make with goals include: 

  • Setting broad goals that are not clear (I.e. “be a better person”) 
  • Setting avoidance goals (I.e. “don’t smoke”) 
  • Not making an action plan to achieve the goal 

The bigger problem is this: If one’s goal was to quit smoking, in some ways, they never “achieve” that goal so long as they are still alive. Secondly, if at any point you smoke once, you’ve failed your goal.  Therefore, the goal of trying to quit smoking is notoriously failed because it’s nearly impossible to achieve in the first place. In having this discussion during an OT group discussion I was facilitating, a patient once pointed out to me: 

“I disagree, I believe quitting smoking can be achieved, because I quit a long time ago and don’t ever think about smoking now.” 

In this patient’s case, I would agree. Yet for the majority of people, this state of freedom from temptation is rarely the case for any goal from food, drugs, to weight-loss. In looking for more details as to what the failure or success rate of goal setting is, I find it difficult to find adequate information. Most literature I found, is related to corporate planning or a new years resolution.  

New Years Resolutions

Statisticbrain.com (2018) found the top three most common New Year’s resolution was:  

  1. Lose Weight/Healthier Eating at 21.%. 
  2. Life / Self Improvements at 12.3% 
  3. Better Financial Decisions at 8.5% 

Statista.com (2018) found the top three most common New Year’s resolution was:  

  1. Save money at 53% 
  2. Lose weight or get in shape at 45% 
  3. Have more sex 25% 

Notably, these goals have a high failure rate, which is likely due to the fundamental error of being vague. These results also show dramatic variation, making the likelihood of accurate results, poor. The methods used to obtain the statistics are likely influential in the results. Statisticbrain.com also reports that the highest demographic for achieving their goals by self-reported means were the 20-something year olds at 37.8%. One could likely find support that those who are better at achieving their goals are more likely to also answer questionnaires, surveys, and participate in studies in the first place.  As the researchers Epton et al., found in 2017, the majority of goal setting research was conducted on the 20-something, male, white, students.  

Where Did Goal Setting Come From? 

What I want to know is the hard truth: how can we live healthy lives? In what way is goal setting actually helpful for the average person on a day-to-day basis? The average person being, NOT high-level exceptional athletes or mega-rich CEO’s. I want to know about how goal setting positively effects the store clerk, the college student, or the stay at home parent. 

Goal setting is one of those modern catch-phrases that has been drilled into my head by TV, books, classes, and work. It’s a shocking moment to ask oneself:  

  • Where did goal setting come from? 
  • Who determined goal setting was so needed? 

The word Goal, itself is listed by Merriam-Webster as being first used in 1531 as a middle English word for boundary or limit. Merriam-Webster’s (2018) definition of

“Goal: the end toward which effort is directed : aim  

Henry David Thoreau born 1817 is credited with the quote: 

“What you get by achieving your goals is not as important as what you become by achieving your goals.” 

The above quote might lead one to think “goal setting”, as it’s used today, has been around for centuries. Quote investigator (2016) found that this Thoreau quote is not confirmed to have come from Thoreau but instead a misquote of Zig-Ziglar’s 1974 quote: 

“What you get by reaching your goals is not nearly so important as what you become by reaching them” 

Goals and Purpose  Versus Goal Setting

However, it’s primary uses have been related to sports or as a synonym for purpose. This is a very different type of goal, than say, “losing weight.” Unless your life’s purpose was to lose weight, in which case you would not live long. I was surprised to find out, goal setting has been around for less than 100 years. I am sure in some way, we can contribute the success of modern industry and technology to goal setting, if you believe those are good things.  

Almost all available sources credit Edwin Locke and Gary Latham as the primary developers of “goal setting” as it’s used today. Others have been credited such as Cecil Alec Mace, with beginning the research that led to goal setting in 1935. However, it’s Edwin Locke, who first established goal setting in a 1968 article titled Toward a Theory of Task Motivation and Incentives (1968). 

Though this goal setting theory has only been around 50 years, it is treated like an 11th commandment of the bible. The problem is, this goal setting theory is almost entirely aimed at the workplace environment for labor, production, industry, and management. I am not arguing this is wrong, I am arguing it’s misplaced in society and health for the common-person.  

Though goal setting was used for the workplace, it has been found to have influenced a variety of major movements in the social sciences as Lunenburg (2011) explains: 

  • Maslow’s (1970) Hierarchy of Needs 
  • Skinner’s (1979) Operant-based behaviorism 
  • Vroom’s (1994) VIE theory 
  • Bandura’s (1986) Social Cognitive theory 
  • Herzberg’s (2009) Motivation theory 

Edwin Locke and Gary Latham have continued to develop the theory involving goal setting.  They report “goal setting is an open theory” and” can be used effectively on any domain in which an individual or group has some control over the outcomes” and “can be applied in numerous other settings” in which they include sports and rehabilitation (Locke & Lathem, 2006). 

Are S.M.A.R.T Goals Actually Smart? 

There is a variety of goal setting acronyms, most which include the same elements. I’ve found the most common and familiar to be S.M.A.R.T goals. 

  1. Specific 
  2. Measurable  
  3. Achievable 
  4. Relevant  
  5. Time-Bound 

It appears S.M.A.R.T goals really are the gold-standard of goal setting and as explained by Epton et al., (2017) “Goal setting theory (Locke & Latham, 2002; Locke & Latham, 2006) postulates that goals are optimally effective if:  

  1. the goal is sufficiently difficult,
  2. people are committed to the goal,  
  3. the task complexity is not too high,  
  4. feedback on goal progress is provided, and  
  5. there are adequate situation resources / few situational constraints. “ 

There are several problems however. These goals are primarily for concrete, quantitative, metric oriented, and workplace long term goal setting. Yet despite the fact that S.M.A.R.T goals are for long-term, there is little evidence that goal setting changes behavior longer than 1 year (Epton et al., 2017). As researcher Traci Mann argues in regards to dieting and weight loss, there is few studies and in-fact poor support for dieting beyond 2 years (Mann, 2015).  

However, S.M.A.R.T goal setting was designed at the outset for corporate use, not personal daily use. My focus is not to attack the use of S.M.A.R.T goals. In fact, there is research evidence to support the use of S.M.A.R.T. goals, as S.M.A.R.T. goals are a direct derivative of Edwin Locke and Gary Latham work and research. The researchers Epton et al., (2017), in a recent large Meta-analysis of 141 research articles on goal setting re-evaluated the goal setting ideals explaining evidence that goal setting is effective if: 

  1. difficult,
  2. set publicly, and
  3. was a group goal.  

But Does This Apply to Mental Health?

Unfortunately, Goal setting as it relates to mental health care falls short in a variety of ways including; the lack of studies including those with low socioeconomic status, in primary care, behavior versus performance, diverse populations, or beyond a year of use (Epton et al., 2017). 

Practically everyone I work with, goal setting has not been applied effectively too. 

The most important distinction and point I would argue Epton et al., (2017) make in their meta-analysis, as it applies to the common person and to mental health use, is the difference between behavior versus performance goals. Epton et al., (2017) argues, little research addresses this difference. 

I used to utilize S.M.A.R.T goals in my mental health groups. As you may or may not expect, this was quite possibly the most boring group I had. I tried to make it interesting, adding treats, trying paint swatches and creative materials, using games, but with no avail. The reality is, practically no one kept the goal setting materials, and it’s unlikely anyone used the S.M.A.R.T method. It’s unlikely anyone used any method.  

How Do Goals Relate to Occupational Therapy? 

One of the definitions of occupational engagement in the occupational therapy practice framework cites Christiansen et al., (2005): 

Goal-directed pursuits that typically extend over time, have meaning to the performance, and involve multiple tasks” 

The word “goal” occurs 52 times in the occupational therapy practice framework (AOTA, 2014). Goal setting, certainly has a major role in the profession of occupational therapy. It’s implied that the founders of occupational therapy emphasized goals in addition to a client’s environment, values, and desires back in 1922. However, as Locke hadn’t developed goal setting until 1968, it’s likely the use of the concept “goals” initially was similar to “purpose in life.” The use of goal similar to purpose is different however, than this example of goal use as found in the occupational therapy 3rd practice framework (AOTA, 2014): 

“Financial Management: Using fiscal resources, including alternate methods of financial transaction, and planning and using finances with long-term and short-term goals” (AOTA, 2014). 

What OT’s Do in Mental Health

Occupational therapists however, have provided a variety of interventions in inpatient mental health including; Leisure, counseling, anxiety management, ADLs, creative activities, assertiveness, social skills, and work (Craik, Chacksfield, & Richards, 1998). As Lloyd et al. (2010), list, occupational therapists primarily provide services through: 

Individual assessment 

Individual treatment 

Therapeutic groups 

Discharge planning 

It appears however, there is great variation in what interventions that are used in mental health settings and how groups are conducted (Lipskaya-Velikovsky, et al., 2014). Still, in a recent meta-analysis by Ikiugu et al., (2017), occupational therapy was found to have a positive small to medium effect in long-term outcomes. While the words “small” and “medium” do not sound ground-breaking, those words reflect a valuable outcome: behavior change. 

The Need for Better Goal Setting

Goal setting however, is quite metric focused; in most-cases it relates to the care-plan. Goals then, as used in occupational therapy, tend to be performance based or else broadly related to an individual’s purpose. While occupational therapy, incorporating goal-directed behavior has supported evidence in positive outcomes for providing mental health treatment, it’s likely, S.M.A.R.T goals are ineffective for the day-to-day lives of those struggling to practice positive mental health. While I may not have sources to back up that claim, there are equally, NOT sources available to support the use of S.M.A.R.T. goals or performance goals, or goal setting in general, with the mental health population, and particularly the inpatient setting. As Sames (2010), explains in Documentation in Occupational Therapy 

 “In acute care settings where clients are seen for a short time, the occupational therapy staff may not distinguish between short- and long-term goals. There are just goals. It is not necessary to separate goals by length of time when the occupational therapy practitioner is only going to work with the client for less than a month. Some facilities or programs may not separate long- and short-term goals if the clients are seen for 90 days or less…” 

In short, goal-directed behavior is important. Goal setting as it’s commonly used is poorly supported for the mental health population. It appears, goals and goal setting whether performance based or behavior changing, has not been adequately studied. Occupational therapy provides goal-directed treatment for the mental health population. While goal setting may be valuable in other areas of occupational therapy practice, the mental health setting, could likely use more effective tools when it comes to supporting clients, patients, or participants in treatment with goal setting; that is, if goal setting is to have long-term behavior changing positive outcomes. 

My Goal Setting Epiphany

One day, an epiphany hit me: 

“how, if I didn’t practice goal setting as a healthy, educated, mental health practitioner, was I supposed to expect people going through a low point in their lives to actually set and adhere to their own goals?” 

This motivated me to re-evaluate my approach. 

Like a message from heaven, I came across two videos within days of having my previously mentioned epiphany. In the first video, Adam Alter (2017) engages in an interview-style discussion for Big Think about how goal setting is a “broken process.” Adam continues to argue that we should scrap goal setting and instead make “systems” which focus on changing daily behavior. This sounded convincing to me. Then a viral video about the value of the “daily sketch” was produced by a Youtuber by the name of Kesh (2017), this video was the perfect illustration of using a system instead of a goal.  

At this point I was won over with this new method of creating systems instead of goals.  

However, I still knew opinion was not enough to begin teaching new methods in an inpatient mental health hospital, I needed more. I needed an evidence-based, literature supported, scientific, and medical reason to redesign the goal setting process group. 

Fortunately for me, within a week from watching those videos, I read an article in my professional magazine called OT Practice. That article was titled Putting Goals Into Action for Health Behavior Change (Baily, 2017). This article could not have come at a more opportune time. 

In this article, the author describes exactly the same thing as a system, but instead calls it a “Mastery Goal” as its cited in previous research. 

A Theme Among Experts

I find a theme in these types of debates. One expert argues for this, another expert argues for something else. Yet the fundamentals are relatively the same, it seems the biggest issue is not goal setting. The issue is the process that takes place when people intend to achieve change.  

In a pragmatic approach, while different things work for different people at different rates of change; it might be that the process of change remains the same.  

Goals as they are traditionally set, when applied to the daily lives of the common person, are as Adam Alter describes as “being in a failure state” until reaching that goal, feeling good for quick unsatisfying moment and making a new hopeless goal that leaves you feeling like a donkey chasing a carrot. 

The issue again, is not the term goal or system, it’s the process. In some ways, the whole philosophy behind my profession as an occupational therapist is to use systems or mastery goals for day to day tasks. You can set a S.M.A.R.T goal if you would like, such as run a marathon, at a certain speed, on a particular day, in order to consider yourself health.  

Practical Goal setting for the Real Person 

Earlier I explained that goal setting was initially designed for the workplace environment. The research by Epton et al., (2017) argued that there was a poorly defined distinction between performance goals versus behavior goals. Behavior goals come with a variety of names also including mastery goals or systems. While the meta-analysis and study by Epton et al., (2017) found there to be little research into the use of “behavior goals”, I’d argue, that there is a massive amount of evidence, research, and support for them; just not in the realm of “goal setting.” Instead, the support is found in behavior changes in the fields of science such as dieting and nutrition as addressed by Traci Mann (2015). The main differences of types of goal setting are listed effectively by Mann, Kentaro & Ridder (2013) below: 

Performance vs. Mastery Goals 

Performance goals place emphasis on a future desired outcome like losing weight or trying to quit smoking. 

Mastery goals sets the emphasis on developing a particular skill and tends to be time based like walk or draw for 15 minutes every day. 

Approach vs. Avoidance Goals 

Approach goals describe what you are trying to do such as eat salad or go for a run 

Avoidance goals involve avoiding things like desert or cigarettes

Challenging vs. Easy Goals 

Challenging can sometimes be motivating but not if unrealistic 

Easy goals can be quite useful for momentum building

However, instead of procrastinating, the more effective goal is to make a goal that features these elements; achievable on a near daily basis, time-based, and easy to start. This is creating a habit. Habits create behavior change. That is why Brian Wansink (2007), the nutrition and diet scientist/researcher makes the claim “The best diet is the one you don’t know you’re on.” If anything, a functional, practical, useful, personal goal for the common person that will actually change habits and behaviors is likely to be: 

Everyday – (Something you can DO nearly every day) 

Action-oriented – (Don’t avoid things – always plan to DO something) 

Short-time – (make it easy to DO, such as 2-20 minutes) 

Your Purpose – (it should fit into your life and purpose!) 


Where am I going with all this? You might be wondering the same thing I’m wondering; what is the point of creating large written articles about the complexity and misconceptions about goal setting if it just adds to the heap of words written in places that few will read?  

I agree. 

I don’t think this article will change the understanding, health, or lives of many. What I hope to do in the future is, simplify this information into handouts and materials that might be useful to the common-person. With the website MillennialOT.com, my vision is to advocate that positive mental health is simple rather than complex and can be engaging rather than boring. Before I do that, I must know what I’m talking about.  

These articles are comprehensive approaches to topics of information, building an evidence-based, research supported, and grounded, epistemology of sorts.  

Similar to how I addressed the issue of the negative impact of vague and broad definitions of health and well-being; there appears to also be an issue of vague and broad definitions of the use of goals and goal setting. 

On one hand, there is the use of “goal” similar to purpose such as “it’s my goal in life to have grandkids” versus the use of goal as a concrete objective measure such as “It’s my goal to make 1,000 sales this year”. As Epton et al., (2017) point out, there is a poor differentiation from performance goals “it’s my goal to make 1,000 sales this year” and behavior change goals like “I am going to exercise every day.” 

If one theme is reoccurring, it’s the importance of specific definitions and clarity. If one’s goal is to be healthy, then one better define what a goal is and what health looks like; or they won’t accomplish either.  


American Occupational Therapy Association.(2014).Occupational therapy practice framework: Domain and process (3rd ed.).American Journal of Occupational Therapy, 68(Suppl.1), S1–S48.http://dx.doi.org/10.5014/ajot.2014.682006 

American Occupational Therapy Association. (2013a). Guidelines for documentation of occupational therapy. American Journal of Occupational Therapy, 67(Suppl.), S32–S38. http://dx.doi.org/10.5014/ajot.2013.67S32  

Alter, A [Big Think]. (2017, June 21). Goal setting is a hamster wheel. Learn to set systems instead [Video file]. Retrieved from https://youtu.be/x44zEK39GOM

Baily, R. R. (2017, July 10). Putting goals into action for health behavior change. OT Practice.  

Baumeister, R. F., & Tierney, J. (2012). Willpower: Rediscovering the greatest human strength. Penguin. 

Campbell, T. C., & Jacobson, H. (2013). Whole: rethinking the science of nutrition. BenBella Books. 

Carney, C. E., Edinger, J. D., Morin, C. M., Manber, R., Rybarczyk, B., Stepanski, E. J., Wright, H., & Lack, L. (2010). Examining maladaptive beliefs about sleep across insomnia patient groups. Journal of Psychosomatic Research, 68(1), 57–65. http://doi.org/10.1016/j.jpsychores.2009.08.007 

Christiansen, C., Baum, M. C., & Bass-Haugen, J. (Eds.). (2005). Occupational therapy: Performance, participation, and well-being. Thorofare, NJ: Slack. 

Craik, C., Chacksfield, J. D. & Richards, G. (1998). A survey of occupational therapy practitioners in mental health. British Journal of Occupational Therapy, 61(5). 227-234.

Epton, T., Currie, S., & Armitage, C. J. (2017). Unique effects of setting goals on behavior change: Systematic review and meta-analysis. Journal of consulting and clinical psychology, 85(12), 1182. 

Fishbach, A., & Ferguson, M. F. (2007). The goal construct in social psychology. In A. W. Kruglanski & E. T. Higgins (Eds.), Social psychology: Handbook of basic principles. (2nd ed., pp. 490–515). New York: Guilford Press. 

Förster, J., Liberman, N., & Friedman, R. S. (2007). Seven principles of goal activation: A systematic approach to distinguishing goal priming from priming of non-goal constructs. Personality and Social Psychology Review, 11, 211–233. Doi: 10.1177/1088868307303029 

Goal. 2018. In Merriam-Webster.com. Retrieved March 15, 2018, from https://www.merriam-webster.com/dictionary/goal

Ikiugu, M. N., Nissen, R. M., Bellar, C., Maassen, A., & Van Peursem, K. (2017). Centennial Topics – Clinical effectiveness of occupational therapy in mental health: A meta-analysis. American Journal of Occupational Therapy, 71, 7105100020. https://doi.org/10.5014/ajot.2017.024588 

Kesh [Kesh]. (2017, January 9). Man who drew everyday for 10 years [Video file]. Retrieved from https://youtu.be/Cwne8d2FZ6E

Lipskaya-Velikovsky, L., Avrech, B. M., Bart, O. (2014). Context and psychosocial intervention in mental health. Scandinavian Journal of Occupational Therapy. 21(2). 136-144.  

Locke, E. A. (1968). Toward a theory of task motivation and incentives. Organizational behavior and human performance, 3(2), 157-189. 

Locke, E. A., & Latham, G. P. (2002). Building a practically useful theory of goal setting and task motivation: A 35 year odyssey. American Psychologist, 57, 705-717. doi: 10.1037/0003-066X.57.9.705.  

Locke, E. A., & Latham, G. P. (2006). New directions in goal setting theory. Current directions in psychological science, 15(5), 265-268. 

Lloyd, C., & Lee Williams, P. (2010). Occupational therapy in the modern adult acute mental health setting: a review of current practice. International Journal of Therapy and Rehabilitation, 17(9), 483-493. 

Mann, T. (2015). Secrets from the Eating Lab. New York: HarperCollins. 

Mann, T., Kentaro. F., & Ridder, D. D., (2013). Self-Regulation of Health Behavior: Social Psychological Approaches to Goal Setting and Goal Striving. Health Psychology. 32(5). 487-498. Doi: 10.1037/a0028533 

Pollan, M. (2008). In defense of food: An eater’s manifesto. Penguin. 

Quote Investigator. (2016 December 6). What you get by reaching your goals is not nearly so important as what you become by reaching them [webpage]. Retrieved from https://quoteinvestigator.com/tag/henry-david-thoreau/ 

Sames, K. M. (2010). Documenting occupational therapy practice (2nd ed.). Pearson. 

Statisticbrain. (2018). New Years Resolution Statistics [Webpage]. Retrieved March 15, 2018 from


Statista. (2018). United States: “What are your 2018 resolutions?” [Webpage]. Retrieved March 15, 2018 from https://www.statista.com/statistics/378105/new-years-resolution/

Thomas, F. [Thomas Frank]. (2018, January 29). How to Stay Hydrated: Here’s Everything You Need to Know [Video File]. Retrieved from https://youtu.be/OEdR116n-78 

Wansink, B. (2007). Mindless eating: Why we eat more than we think. Bantam. 


The Totality of Mental Health Practice

In this article, I intend to explore my premise of influence on defining mental health. The argument I make regarding mental health practice is fundamentally related to health as its defined extensively in my previous article: Defining health, purpose, and the meaning of life.  

These articles are long, due to the process of identifying and addressing the role of philosophy and underlying assumptions throughout; which is unavoidable without giving vague, broad, meaningless, definitions. Vague definitions can be easily be found elsewhere, such as “to help you achieve your full potential.” The definition I argue is: 

The totality of mental health practice is adjusting what has our focus.

This article will address what value there is in trying to attempt a definition at all, as well as what underlying assumptions must be addressed to make any concrete definition of mental health. 

Why I Write 

These articles are not a short and easy read meant for receiving high views. I do not believe my writing of these articles shall fix cultures problems, for I have come to believe through extensive reading, that most, if not all of healthcare’s answers and solutions are right outside the front door, lining the shelves of libraries, and waiting for the Grandchildren to visit.  

To address this topic, I will attempt to be grounded in evidence; which is to use a heuristic approach throughout these articles. The idea is, rather than holing myself up and writing a book, that at best would only be read by America’s already literate elite, I will write here, and take action now. 

As for my motive, I am writing several in-depth articles for these reasons: 

  • To motivate myself to learn, and then reflect on the progress 
  • To organize what I learn coherently for family and friends 
  • To facilitate discussion among peers in order to weigh and evaluate the evidence 
  • To refine my understanding as I try to make positive health behavior appealing to others 

This article is influenced by the current state of America, though attempting to use universal concepts.  It should be noted however, that comparing healthcare problems internationally, is really in colloquial terms “comparing apples to oranges.” There are countries in great poverty with poor mental health nationally. There are also countries in poverty, by industrialized standards, with much greater reports of happiness and life satisfaction. There are countries with high average and overall socioeconomic status, with poor mental health, and also the opposite (Buettner, 2017; Helliwell et al., 2017). Some argue, such as Dr. Stephen Ilardi (TEDxEmory, 2013) that depression is a “disease of civilization”, similar to diabetes. While divisive, Ilardi takes strong to the nurture end of the nature vs. nurture debate calling depression a “disease of lifestyle.” However, this cannot necessarily be generalized to all mental health disorders. Though I think there may be some truth to this, I argue that the correlation is not the whole of the causation. As Wiking argues in his book Lykke (2017), “health and well-being should be separated.”

The challenge I see is this; there is “all talk and not enough action regarding health, particularly in America. I do not necessarily mean that metaphorically. Quite literally, depression and sedentary activity are on such a rise, that a literal lack of action is a good part of the problem. I don’t say this to condemn people, but to recognize this; bills need to be paid, kids fed, houses cleaned, groceries to be picked up, jobs to be attended, and relationships to be fulfilled.  


It seems that mental health is related to life as we experience it; which is quite subjective. Reasonably so, since the inception of psychology as a science, there is no shortage of perspectives of what we must do to achieve or maintain mental health. It is difficult then, to make any suggestion of what mental health practice is, without being incredibly vague. Presumably, in a vague way, therapy is to “help us reach our full potential” or “make us better” or “healthier” or “happier.” Truly, any attempt to narrow down or describe mental health and the practice of it, in anyway, is to come into disagreement with some theory, philosophy, psychologist, or field of thought, eventually.  

Freud argued that we had a will to pleasure. The philosopher Nietzsche, argued that humans had the will to power, which influenced Alfred Adler’s break in direction from Freud. Frankl Argued we had a will to meaning. I would argue, that Maslow’s Hierarchy of Needs could be described as a will towards self-actualization. Yet at the basic level, they each are influenced by an underlying assumption; that humans have a will at all. Somewhere, there is someone who would argue there is no will, such as the extreme behaviorist.

Then I might say, there is no doubt, at least the perceived experience of will. If not for you, than I speak for myself in truth. Yet in regards to the other will to [fill in the blank]; each of those concepts involve a will to change. From a pragmatic perspective, there is something fundamental in the human; that a percieved will exists. This may best be captured by Williams James’ 1892 written explanation: 

“The fundamental Fact. – the first and foremost concrete fact which everyone will affirm to belong to his inner experience is the fact that consciousness of some sort goes on. ‘States of mind’ succeed each other in him.” (James, 1984). 

Returning to a pragmatically influenced approach, and with the understanding of what positive mental health should be, as I have previously argued, I shall resume from that standpoint, what positive mental health practice is.  Which as I stated at the beginning of this article:

The totality of mental health practice is adjusting what has our focus.

I may be wrong, I accept that.  

But, if a truth exists at all in my statement, I can only benefit from being wrong in order to learn what is right.

Where I stand is, that there must be some objective truth out there. There must be some objective truth, as to what is “best” for us as a collective and/or for us as individuals. I believe that any psychology or mental health theory, is merely an attempt at discerning that truth, but that truth remains regardless. I am more interested in describing the theme I find most pertinent to share, that I argue, all mental health practices attempt to accomplish whether they agree or not. 

To make one final point clear, I do not believe I truly argue for a new definition of health, but rather, for using modern language to better define that truth which has always existed. Certainly, there has been examples of wide-spread health as well as understandings of health, centuries before our time. Even in many places today, as the National Geographic Fellow Dan Buettner (2017) has described in his book Thrive, great health often exists with traditional understandings.  

I would argue there to be an objective truth underlying what health is, in relation to the human condition, that has always remained the same. If I use any words, it’s only in an effort to translate, using modern day language, a reality that existed before my time.  

The 3-point thesis statement defining health that I argued in my last article, is listed below: 

  1. The meaning of life may be unique for everyone, but finding it is the same.
  2. Meaning in life is found through purpose, which is defined by the act of a person to focus on priority.  
  3. The practice of focusing on priority, also defines purpose, which is where we will find our meaning. 

To review a few key points from my previous article: 

  • I also believe, mental health is directly and fully related to purpose. Positive mental health is the ability to pursue purpose. Negative mental health, is any barrier that prevents that pursuit; and that pursuit being comprised of the ability to focus on one’s priorities. 
  • Rather, mental health is the ability to focus on priority, which is in many other terms, to “live and pursue”, “goal-oriented”, “self-directed”, “purpose-driven”, “meaningful lives.” Mental health, is to know purpose, not happiness.
  • I shall argue, our mental health is mutually related to life as we experience it, and is determined by where our focus is placed. Changing where our focus is directed, is the act of prioritization. Therefore, positive mental health behavior, is taking any action to focus on positive priorities.

Existentialism: Hasn’t This Already Been Done? 

One could argue, my statements reflect a therapeutic approach similar to Existentialism. I did make several references to Viktor Frankl and his form of existential therapy known as Logotherapy. Another modern-day derivative is Meaning Therapy; which emphasizes meaning in well-being while including many contemporary mental health practices such as positive psychology and cognitive-behavioral therapy (Wong, 2014). I have disagreements with keystone existential philosophers, though my disagreements divulge into opinion more than worth noting here. The primary issue remains, that much to be debated is “all talk and not enough action”; as for the validity of there being a problem at all, I will later address that in this article. 

While what I argue may be related to forms of Existentialism in value of meaning and purpose; I would also argue, that while meaning and purpose may be the primary determinants of health, they are not necessarily the primary determinants of health-in-practice 

Put another way, Existentialism may be the ends, but is itself not enough of the means.  

Put yet another way, knowing meaning (existentialism) may help you find motivation to wash the dishes or pay the bills, but often these tasks need to take place before one could ever come to closure and fulfillment in discovering meaning in their life. 

That is what occupational therapy also contributes beautifully as a profession, to health-in-practice. I am biased to include my own profession. Occupational therapy recognizes, it is also through the engagement in everyday tasks that we will find our meaning, and not necessarily through guided talk therapy and activity alone (AOTA, 2014). While other forms of therapy may have their purpose in certain instances, I argue a two-fold truth exists. A top-down understanding and recognition of meaning and purpose motivates us to complete our every-day tasks; but also, a bottom-up engagement in every-day tasks, also helps us find meaning and purpose. 

A Purposeful Digression: What is The Problem? 

It could be said, that I ought to be careful in making any conclusions here. That to define health, purpose, the meaning of life, and therefore the role of any health practitioner, is too large a subject for a young novice like myself to address. That by publishing such descriptions and conjectures, I could mislead people, especially if I promote my material. 

My credentials are not the most extensive. However, I do have a high enough education (Masters of Occupational Therapy, Bachelors in General Studies, Minor in Psychology), to have an educated opinion from a scientific stand point that: A variety of influential experts disagree on key aspects of healthcare.  

To top that, prominent and primary resources such as certain government websites, list outright, wrong healthcare information as it is presented by primary works of scientific-evidence (which I would love to tell you about in person). I most certainly, am not the most qualified, and most certainly, have a great lot to learn. This is to say, you should not take my word as 100% accurate, as I do not either, nor anyone elses. What you should do, is question, as I have. It is no conspiracy that American “common sense” is not working. Why do I believe things are not working in America as is? 

  • Epidemically increasing rates of mental illness (SAMHSA, 2017) 
  • Epidemically increasing rates of chronic conditions (CDC, 2017) 
  • The world’s highest healthcare cost per person, and still increasing (Keehan, 2016) 
  • Current decreasing rates of life expectancy (Tinker, 2017) 
  • And decreasing rates of life satisfaction? (Helliwell, Layard, & Sachs, 2017) 

You may come to your own conclusions.  

I will not list directly, sources of wrong information; for that is one possible way to get sued (defamation). I will throughout the upcoming series of articles address topics with specifics. I will form my opinion, but will list sources, and direct information, to make easy, the follow-up of references to my sources.  

Why That Digression Was Needed 

I must first ask: 

  • What then is the purpose of writing and producing opinion?  
  • Is there not enough medical models and theories currently in existence?  
  • Is not, my argument for health being defined by purpose only simply “another way” to look at things? 

Simply; the answers to health are simple, and the ‘mainstream’ says it’s complicated. I must make my effort. 

When I first begin writing on this website, I wanted to systematically address mental health topics like mindfulness, coping skills, goal setting, and the like. In the process, I found myself questioning my own beliefs and returning to the literature and evidence. What I found, was continuously diverting opinions and arguments, though seemingly similar conclusions. I found it difficult to promote these practices without knowing how it fits in mental health as a whole. I then sought to address the fundamental paradigms (perspectives), guiding what health is. This led me to writing my previous article.  

In addition to my earlier stated thesis statement, there is an underlying philosophical belief guiding this writing. At some point, one has to ask themselves which they believe; Does an objective or relative truth exist? In fact, I’d argue, regardless of whether you think you know an answer, your actions are already influenced by your perspective of that question.  

This relates to mental health practice because as I will argue, mental health practices can only attempt to use fundamental truths of humans, to address their needs. Truths such as, the idea we are conscious beings. I will take a stance to stay, that psychology is the primary and most closely related practice, to addressing our mental health. Defining psychology is then worth-while, as well as its primary field of thought. Because ultimately, I’d argue that any mental health practice that works, fits into agreement with some type of universal truth. 


Psychology Defined 

Definition of Psychology: scientific discipline that studies mental states and processes and behaviour in humans and other animals. 

While there are most likely fans of some scientist, philosopher, or thinker, who might argue that undue credit is given to their name of choice, one of the most prominent names given to the “outset” of defining psychology as an independent and specific field of study in America, was William James. For William James, along with Wilhelm Wundt of England, are listed in the Britannica as being the primary influences. 

William James created a consolidated manual, a manifesto of sorts, that was pivotal in establishing the “what is psychology.” James’ book Psychology: a Briefer Course (1984) first published in 1892, remains an incredibly relevant book to read in modern times. While maybe certain topics, modern science has come to disagree with, more can be said about the fundamental accuracies in his book. These accuracies deserve an article of their own; such as his discussion of habit as it relates to willpower; which current leading opinions and scientific evidence, appears to be completing a 180-degree return back to James’ description, reflected in modern times by the works of those like Baumiester in his book Willpower (Baumeister & Tierney, 2011). However, I attempt to hold value in William James approach to writing known as Pragmatism. If I were to put pragmatism into my own words it would be: Some type of truth exists in the things that work 

In mental health, I would argue; some type of truth exists in the mental health practices that work. For example, most modern-day evidence as described by influential researchers, scientists, doctors, and journalists, agree that; Diets don’t work (Cambell & Jacobson, 2013; Mann, 2015, Pollan, 2008; Spector, 2015; Wansink, 2007).  I used dieting as an example due to the link (not causation necessarily) between nutrition and eating habits, with our mental health. 

However, many people do find that a diet did work for them. A pragmatic conclusion would be: “something worked, so some truth exists about what worked.” Maybe that truth is, for some people in some situations, they are motivated to change their habits because of attempting a diet. The point being, rather than focusing on dieting being wrong or right, a pragmatic approach is interested in what worked. 

The effectiveness of a mental health practice then, has more to do with its relation to “some type of truth” in the human condition, than to modern medicine and science. Modern medicine and science is for the purpose of discovering those truths for literature and practice, despite that those truths may have been practiced and known for centuries. William James would argue, psychology as a science was meant to find these truths. In his book, he defined psychology using another academics description stated below as: 

The definition of psychology may be best given in the words of Professor Ladd, as the description and explanation of states of consciousness as such. By states of consciousness are meant such things as sensations, desires, emotions, cognitions, reasonings, decisions, volitions, and the like (James, 1984). 

How this relates to pragmatism and defining mental health, is the attempt at objective pursuit of truth and understanding. It’s a style of writing that I will attempt to represent. This is why I take time to digress, as I did above. That in my search for truth, in my effort to share my believed understandings, I too, want you to both question for yourself and consider the fundamental truths that may exist.  

To return to what mental health practice is, I must make a few basic observations: 

  • Some mental health practices seem to work,  
  • some don’t,  
  • some, work better than others for different people. 
  • There is a wide variety of mental health practices. 
  • Still, there must be some universal truths regarding what will work better. 


It is here I return to my 3-point thesis statement regarding the meaning of life being related to health, which is defined by the ability to pursue purpose by focusing on priority. I do not argue this is a new way of looking at things, but the beginning attempts by a well-read novice (myself), to seek out the universal truths in mental health. That in relation to mental health practices, these truths converge on the human’s ability to focus.  Which is why I argue:

The totality of mental health practice adjusting what has our focus.

It is this focus, which I will address and explore in my next article, as well as provide specific examples. This focus I will argue, is fundamental to all mental health practices. 


American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy. 68(Suppl. 1), S1-S48: http://dx.doi.org//10.5014/ajot2014.682006 

Baumeister, R. F., & Tierney, J. (2012). Willpower: Rediscovering the greatest human strength. Penguin. 

Buettner, D. (2010). Thrive: Finding happiness the blue zones way. National Geographic Books. 

Center for Disease Control and Prevention. (2017, 28 June). Chronic disease overview [webpage]. Retrieved from https://www.cdc.gov/chronicdisease/overview/index.htm  

Campbell, T. C., & Jacobson, H. (2013). Whole: rethinking the science of nutrition. BenBella Books. 

Helliwell, J., Layard, R., & Sachs, J. (2017.) World happiness report. Retrieved from http://worldhapiness.report/ed/2017/ 

James, W. (1984). Psychology, briefer course (Vol. 14). Harvard University Press. 

Keehan, S. P., Poisal, J. A., Cuckler, G. A., Sisko, A. M., Smith, S. D., Madison, A. J., … & Lizonitz, J. M. (2016). National health expenditure projections, 2015–25: economy, prices, and aging expected to shape spending and enrollment. Health Affairs, 35(8), 1522-1531. 

Mann, T. (2015). Secrets from the Eating Lab. New York: HarperCollins. 

Pollan, M. (2008). In defense of food: An eater’s manifesto. Penguin. 

Psychology. 2018. In Britannica.com. Retrieved February 13, 2018, from https://www.britannica.com/science/psychology  

SAMHSA (2017, Sept 9). Key substance use and mental health indicators in the united states: Results from the 2016 national survey on drug use and health. Retrieved from https://store.samhsa.gov/product/Key-Substance-Use-and-Mental-Health-Indicators-in-the-United-States-/SMA17-5044  

Spector, T. (2015). The Diet Myth: The real science behind what we eat. Hachette UK. 

TEDxEmory. (2013). Stephen Ilardi: Depression is a disease of civilization [Video file]. Retrieved from https://youtu.be/drv3BP0Fdi8 

Tinker, B. (2017, 21 December). US life expectancy drops for a second year in a row. Retrieved from https://www.cnn.com/2017/12/21/health/us-life-expectancy-study/index.html 

Wansink, B. (2007). Mindless eating: Why we eat more than we think. Bantam. 

Wiking, M. (2017). The Little Book of Lykke: The Secrets of the World’s Happiest People. HarperCollins.

William James. 2018. In Britannica.com. Retrieved February 13, 2018, from https://www.britannica.com/biography/William-James 

Wong, P. T. P. (2014). Meaning in life. In A. C. Michalos (Ed.), Encyclopedia of quality of life and well-being research (pp. 3894-3898). New York, NY: Springer. 


Defining Mental Health, Purpose, and the Meaning of Life

(WARNING: This is not a short easy read article, though there will be short ones to come, this one is a part of a lengthy series)

The purpose of this article is, to delve in-depth and distinguish a clear path and strong connection from the definition of health and mental health, translated to action, in order to establish its value and meaning. I must point out, that while I explore international definitions of happiness, I emphasize its impact on the US. Most importantly however, I address the practical uses of defining health and its implications for day-to-day life. In this article, I will list several organizations that influence the US national, and also international perspectives of health, as it relates to mental health, as well as my own professional organization. These organizations are listed below in the same order they are discussed in this article, and include: 

An Introduction to Defining Health

Have you ever been diagnosed with a mental illness? Have you ever met anyone diagnosed with a mental illness? In America, it would be quite difficult to not know someone diagnosed with a mental illness. The highest rate of mental illness occurs in nearly 1 in 4 (in the past year) of those ages 18-24 (SAMHSA, 2017). Trailing closely behind the young adults, are the rates of those ages 25-49. It’s not an age or generational thing. The percentage of those with a mental illness, or multiple, is increasing across all generations with no sign of stopping. 

But have you ever wondered if anything about the whole mental health situation is strange? Have you ever wondered about questions such as: 

  • Does everyone really have a mental illness? 
  • At what point do you consider something a mental illness? 
  • Are more medications really the answer? 
  • Was I actually born this way? 
  • Can it be cured, or do I have to live with this the rest of my life? 
  • Why, with all our medical advances and healthcare costs, are rates increasing? 

It seems the public culture in the United Kingdom (UK) is picking up on this healthcare epidemic faster than the United States (US) demonstrated by the organization now holding events called A Disorder For Everyone! There is growing momentum towards changing the definition of diagnosis altogether, of which several examples, I will list in this article.  

Unfortunately, I believe most of these changes are just trading in one set of carrots, for another set of carrots to chase. I do not believe the solution is complex, in fact, I believe it is quite simple. 

A Conjecture For Everyone


Definition of conjecture:

1a : inference formed without proof or sufficient evidence

  • b : a conclusion deduced by surmise or guesswork   

It seems difficult to make a useful conjecture in today’s opinion infatuated age, but then maybe it has always been difficult to make conjectures. Maybe the difficulty with conjectures is defining at what point “sufficient evidence” evolves a conjecture to something more.  

I have not been an effective consistent producer of writing because I have a desire to escape conjecture for grounded, evidence-based, quality writing. Yet, I find myself extensively deep with books and journal articles into topics such as mindfulness, focus, self-esteem, motivation, goal setting, mental health, and change, with more questions than when I began.  

Today, I shall break this cage of conjecture-fear for a 3-point thesis statement: 

  1. The meaning of life may be unique for everyone, but finding it is the same. 
  2. Meaning in life is found through purpose, which is defined by the act of a person to focus on priority.  
  3. The practice of focusing on priority, also defines purpose, which is where we will find our meaning.  

I also believe, mental health is directly, and fully related to purpose. Positive mental health is the ability to pursue purpose. Negative mental health, is any barrier that prevents that pursuit; and that pursuit being comprised of the ability to focus on one’s priorities. This is to say, without digressing further; a drug dealer may have great mental health, while someone with no diagnosis may have poor mental health, even worse than those deemed “mentally ill” by medical standards. Specifically, purpose and mental health, is not the pursuit of “happiness.” One could define happiness as their purpose, but their mental health would still be related to the ability to pursue it, not the happiness itself. The difference being; purpose and positive mental health can exist without happiness, or even well-being, as I shall argue. 

This perspective was echoed long before my time, by Viktor Frankl in his book Man’s Search for Meaning (1946). Frankl states “Man’s search for meaning is the primary motivation in his life and not a “secondary rationalization” of instinctual drives.” (pg.105) and continues to say “This meaning is unique and specific in that it must and can be fulfilled by him alone; only then does it achieve a significance which will satisfy his own will to meaning.” (pg.105) 

Viktor Frankl was a psychiatrist who survived the Holocaust, including Auschwitz.  Afterwords, he developed a Psychotherapy termed Logotherapy. Frankl describes the emphasis on meaning in relation to mental health in Logotherapy when he stated: 

“According to Logotherapy, this striving to find a meaning in one’s life is the primary motivational force in man.”  

I believe as a culture both national and international, we have forgotten the value of meaning and purpose as primary determinates of health. Instead we have come to as Merriam-Webster reflects in the first definition of each word below, an unrealistic, hopeless, and demoralizing standard:  

Definition of well-being : the state of being happy, healthy, or prosperous : welfare

Definition of health : 1 a : the condition of being sound in body, mind, or spirit; especially : freedom from physical disease or pain

Definition of welfare : 1 a : the state of doing well especially in respect to good fortune, happiness, well-being, or prosperity

As for an argument that this so called state of “health” is not achievable; I argue, has it truly ever been achieved? When you boil down the definition to it’s roots, I argue “the state” of welfare is superficial way to describe a happiness-filled immortality. If not, then how much longer must we wait? Secondly, particularly in America, the standard of living has increased to amazing proportions. Yet, despite this, in the US there is: 

  • Epidemically increasing rates of mental illness (SAMHSA, 2017) 
  • Epidemically increasing rates of chronic conditions (CDC, 2017) 
  • The world’s highest healthcare cost per person, and still increasing (Keehan, 2016)
  • Current decreasing rates of life expectancy (Tinker, 2017) 
  • And decreasing rates of life satisfaction? (Helliwell, Layard, & Sachs, 2017) 

To provide the foundations for one other cornerstone assumption guiding my perspective in writing this article, is evidence supporting the idea that meaningful life can be lived by those with mental illness. I must first ask; do you think those with mental illness can live meaningful lives? If so, why? I am not arguing we should forget the suffering of those with mental illness and stop treatment. I am arguing that treatment itself may either be in most cases, not effective, worsening the problem, or engraining in society the idea that those with mental illness are broken until “fixed and free of suffering.” Lastly, what sufficient proof do we have that there is scientific and grounded evidence for deeming all those mentally ill as, mentally ill? I shall use one example, though I could use many, for this point.  

Recovering from Schizophrenia 

I chose schizophrenia for this point, because as Jobe and Harrow (2005) explain it, “schizophrenia patients as a group show poorer outcome than patients with other types of psychiatric disorders; in this sense, schizophrenia is a poor-outcome disorder.” Yet even with this poor-outcome disorder and a strict sense, and as I argue, terrible sense, of how recovery has historically been defined, Jobe and Harrow (2005) state “only 16.3% of subjects with schizophrenia and 35.8% of subjects with other psychoses in the incidence groups qualified as recovered. Even using the strictest criteria for recovery, there remained some level of symptoms and disability among some recovered patients.” 

By modern definitions of health then, while recovery may have been possible for a select few of those with schizophrenia in these studies, there would be a near 0% chance of achieving health and well-being, so long as health and well-being included having no level of symptoms and disability. 

However, Two counter-cultural and hard to understand themes emerged throughout the conclusions of several of these systematic and longitudinal studies: 

  • Those with schizophrenia have higher rates of positive outcomes in less developed countries (Jobe & Harrow, 2005; Jääskeläinen et al., 2013). 
  • There is a large population of those with Schizophrenia who gave up on medication and treatment and recovered better than those that didn’t stop receiving “help” (Davidson et al., 2007; Harrow & Jobe, 2007). 

This is not sufficient evidence to declare all medication and mental health treatment is fraudulent and worth stopping, which is not what I believe. For those with Schizophrenia, there were other factors influencing the success rate of those that “gave up” on treatment. Then again, of the influencing factors supporting recovery, was the lack of time on medications and in treatment. This implies the correlation (not causation); the longer a person received treatment, the more dependent upon it they become (Davidson et al., 2007; Harrow & Jobe, 2007). These are however, among a great multitude of studies that demonstrate that there is a sense of “learned helplessness” and poor definitions of what recovery is, or at least what recovery is needed to live meaningful and purposeful lives. My point is summarized by Davidson et al., (2008) when stating people with a poor-outcome disorder such as schizophrenia are by many means, still able “to live meaningful and gratifying lives in the face of an enduring mental illness.” 


The Influential Organizations That Define Health


The World Health Organization (WHO) 

 The World Health Organization (WHO) is arguably, the primary influence on national and international healthcare, as well as cultural perspectives, on the definitions of health, mental-health, and general well-being. Why WHO is arguably the primary influence, is that the following organizations use or derive their definitions from WHO. 

 My own professional organization, the American Occupational Therapy Association (AOTA), also derives its definitions of health from WHO (AOTA, 2014). Again, there are aspects I can greatly appreciate in the definitions provided by WHO, yet I argue there are fundamental errors that negate the whole understanding of mental health as we know it today.

Interestingly enough, the constitution of the WHO was adopted in the same year Viktor Frankl published his book Man’s Search for Meaning, which was 1946 (Frankl’s quotes used in this article come from a later version printed in English in 1959). Considering WHOs constitution was written the same year immediately after World War II, it’s quite an advancement for international human rights, given the atrocity and devastation of World War II.

Unfortunately, it seems Frankl’s value of “meaning” did not influence WHO’s constitution at its inception, enough, though the constitution would have benefited from it. While the principles were possibly effective at the start, it is time we either change the definitions of “well-being” and “health” or change the constitution itself. WHO lists an entire 9 principles in their guiding constitution, of which I list the first two below: 

Constitution of WHO: Principles 

  1. “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” 

“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” 

I do greatly appreciate this idea that health is “not merely the absence of disease or infirmity.” Unfortunately, as its used; it seems that anyone with disease or infirmity can only enjoy the “highest attainable standard of health” at some lower level than those without disease or infirmity. Yet who can live a life without disease or infirmity? Let health be measured in dedication to purpose.  

Without digressing into the negative impacts of the highlight reel phenomenon that occurs with the current use of social media; comparisons matter. Meik Wiking, the CEO of The Happiness Institute and author, points out in his TED talk The Dark Side of Happiness, that despite having arguably the world’s highest standard of living in Denmark, suicide rates rank Denmark at average globally (TEDxCopenhagen, 2016). His point: comparisons matter. When everyone else is supposedly happy and working, then not having that experience can be incredibly demoralizing. Yet, if the definition of health is expected to be at the extreme end of constant happiness and well-being, we compare ourselves to unrealistic, unachievable, fictional expectations. 

I do not believe health as a state of “complete physical, mental and social well-being” will ever be achievable. In fact, the belief that this is a noble cause is, in my opinion, a major contributor to poor mental health and mental illness. Again, while the words and terminology may differ, this idea of “free from suffering” is blatantly, a guiding vision of what health is supposed to be as directed by science and the medical community, which will be a remerging point of contention throughout this article. 



Center for Disease Control and Prevention (CDC) 

 In the United States, the Center for Disease Control and Prevention (CDC), directly cites their definitions by WHO.  Maybe the words don’t matter to some, and it’s all opinion. Yet, I believe there is a great and notable problem with these definitions. They all imply that those with mental illness, which are those labeled and diagnosed, cannot achieve “health” until medically shedding the label or diagnosis. If one is unable to medically shed the label or diagnosis, then your life, as WHO or simply stated, “the world”, is merely measured in your ability to achieve the “highest attainable standard of health” at some second best, second rate level. No wonder people are so afraid of being diagnosed, and so desperate for a cure! In many ways, the world defines health as not being diagnosed 

 An often-cited book of great value, written by scientist and researcher, Carol Dweck, titled Mindsets (2006), address this cultural battle of perspectives. Dweck argues we need to practice the growth mindset rather than the fixed mindset. 

Pg.6 Believing that your qualities are carved in stone – the fixed mindsetcreates an urgency to prove yourself over and over. If you have only a certain amount of intelligence, a certain personality, and a certain moral character – well, then you’d better prove that you have a healthy dose of them. It simply wouldn’t do to look or feel deficient in these most basic characteristics. 

Pg.7 This growth mindset is based on the belief that your basic qualities are things you can cultivate through your efforts. Although people may differ in every which way – in their initial talents and aptitudes, interests, or temperaments – everyone can change and grow through application and experience.

Dweck does NOT argue those with the growth mindset will not experience mental illness or depression. However, her research did find that “…students with the fixed mindset had higher levels of depression” (Dweck, 2006). Of value is her earlier point that, with fixed mindset behaviors, we believe we have certain qualities that cannot be changed, so we try to “prove” what we have and don’t have. Thus, in a world defining your health and standard of living as having or not having mental illness, we try to prove or disprove what we have or do not have, rather than addressing our actual needs regardless. This is simply, a classic division of the haves and have-nots. The world, says you are either born healthy, or born destined to be not healthy. That is, unless, “SCIENCE CAN FIND A CURE” and as T. Collin Campbell argues in his book Whole (Campbell & Jacobson, 2013), “BANISH UNPREDICTABILITY.” This of course, comes at the price of an endless supply of increasing research funds, medical bills, medications, and of course, your hope.   

I am not arguing that the practice of science and research is bad, nor the use of medications. These can be wonderful things. What they are not, is an answer to life, purpose, meaning, or health. We should not place our hope in science, research, or medicine. We should not allow lives to be defined be these things.  

To reinforce the influence of one organizational definition on another, I have listed below, what Mental Health is, as found on the CDC website, as well as the CDC mental health indicators as based on their own research. 

What is mental illness? 

Mental illnesses are conditions that affect a person’s thinking, feeling, mood or behavior, such as depression, anxiety, bipolar disorder, or schizophrenia. Such conditions may be occasional or long-lasting (chronic) and affect someone’s ability to relate to others and function each day. 

What is mental health? 

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood. 

Although the terms are often used interchangeably, poor mental health and mental illness are not the same things. A person can experience poor mental health and not be diagnosed with a mental illness. Likewise, a person diagnosed with a mental illness can experience periods of physical, mental, and social well-being (CDC, 2016). 

Mental Health Indicators 

Researchers suggest that there are indicators of mental health, representing three domains. (citations 6-8). These include the following:  

  • 1. Emotional Well-being: Such as perceived life satisfaction, happiness, cheerfulness, peacefulness. 
  • 2. Psychological well-being: Such as self-acceptance, personal growth including openness to new experiences, optimism, hopefulness, purpose in life, control of one’s environment, spirituality, self-direction, and positive relationships. 

3. Social well-being: Social acceptance, beliefs in the potential including openness to new experiences, optimism, hopefulness, purpose in life, control of one’s environment, spirituality, self-direction, and positive relationships.  

These may be indicators in sum. But as I made the statement earlier, I believe mental health can exist outside of the majority of these definitions. The most useful of the terms listed include “purpose in life”, “hopefulness” and possibly “positive relationships.” This is to say, I am not arguing against all means of defining mental health or the indicators of it. I am arguing against the idea of mental illness being so fully defined by “happiness” or “the absence of mental illness.”


Substance Abuse and Mental Health Service Administration (SAMHSA) 

 I must appreciate, in a positive light, a more fruitful definition of mental health. Or, as the Substance Abuse and Mental Health Service Administration (SAMHSA) advocates for; Recovery. SAMHSA’s sense of mental health defined as Recovery is listed below: 

 “Working definition of recovery from mental disorders and/or substance use disorders: A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” 

SAMHSA, in their 10 Guiding Principles, explains hope “That people can and do overcome the internal and external challenges, barriers, and obstacles that confront them”   (SAMHSA, 2012), which is similar to Carol Dweck’s Growth Mindset. Again, as terms change, ideas and meaning can be similar. As I argue for valuing purpose, many of these ideals are described by SAMHSA’s person-driven point as stated “define their own life goals and design their unique path(s) towards those goals” (SAMHSA, 2012). The use of goals in this sense, is similar and related to how I use prioritization in my initial thesis conjecture at the beginning of this article. 

 Previously, I just listed SAMHSA’s principles of recovery to reflect their guiding beliefs behind health. Below are what SAMHSA has identified through its research sources, as the ingredients for recovery called the Four Major Dimensions: 

  • Health—overcoming or managing one’s disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem—and, for everyone in recovery, making informed, healthy choices that support physical and emotional well-being 

    Home—having a stable and safe place to live 

    Purpose—conducting meaningful daily activities, such as a job, school volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society 

    Community—having relationships and social networks that provide support, friendship, love, and hope 

 I list all these, not to the ease of any readers of this article. Rather, I have determined it necessary for my own sanity, to begin a more comprehensive approach to addressing topics related to mental health. It’s difficult to write articles on topics such as mindfulness, goal setting, horticulture, coping skills, and other positive mental health practices, without first clarifying where they all fit into the greater picture of health and life itself. The effort of this article, is to provide several lists and sources of the major influences on what defines our national and international perspectives of health. While I certainly give my own opinion and perspective on the value of these definitions, I have found it necessary personally, to be able to see several in order to weigh and evaluate. I hope in the same way, regardless of my opinion, you too, can find a wholistic and comprehensive expression of health, possibly informed by the resources listed. 




The National Alliance on Mental Illness (NAMI)  

The National Alliance on Mental Illness (NAMI) is an insightful resource and valuable organization to the US public, in understanding and moving forward. I will not discuss NAMI in depth, as it’s definitions, though not directly stated, are derived near verbatim, from WHO and SAMHSA (NAMI, 2018). However, despite my argument against WHO’s definitions, I still value NAMI as a patient empowering and resource providing approach, and I highly recommend visiting their website to browse. I agree with NAMI’s interpretation:  

Recovery, including meaningful roles in social life, school and work, is possible, especially when you start treatment early and play a strong role in your own recovery process.” 



The National Institute of Mental Health (NIMH) 

The National Institute of Mental Health (NIMH) is another leading organization, though it’s role is primarily involved in research, and reflects and cites SAMHSA and the CDC for their definitions and statistics.

 In a recent article by NIMH titled Different Approaches to Understanding and Classifying Mental Disorders (NIMH, 2017), the entire concept of diagnosis itself is challenged by leading US researchers and scientists themselves (Clark et al., 2017). NIMH points out “three existing approaches” to how individuals are diagnosed with mental illness listed below.  

 The three existing approaches— 

  • the International Classification of Diseases (ICD),  
  • the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the  
  • National Institute of Mental Health (NIMH)’s Research Domain Criteria (RDoC) 

 “…these systems often result in comorbid diagnoses (i.e., when people are diagnosed with multiple disorders at one time), and are sometimes criticized for the seemingly arbitrary boundaries they set between disorders and nondisorders. 

According to Dr. Cuthbert , “we now understand that the categories are not specific diseases (like Lyme’s Disease or influenza) but rather are broad syndromes – loose collections of symptoms that tend to occur together to some extent, and involve dysregulation in multiple domains.”  (NIMH, 2017).

 The first two current approaches called the ICD and DSM are summarized as “outdated.” The new approach that NIMH calls Research Domain Criteria (RDoC), will be a “different way to conceptualize mental disorders” that will not be “bound by specific categories or classifications of disorders or by thresholds of diagnosis”  (NIMH, 2017). While this sounds like a step in the right direction, is it not disheartening to recognize that our entire cultural conception of mental illness, as I have argued throughout this article, is going to be changed simply because of “what we now understand”?

I return to my point regarding reductionist science, and the ever-eluding hope of a cure. Science and research are, maybe helpful things; but it’s chasing a carrot. Time and time again, we will return to a point of “what we now understand.” Is it worth experimenting with the increasing suicide rates and futures of the next generation? Is it all worth our hope, meaning, and purpose? All for scientific advancement and medicine? I argue simply, we will never be “free from suffering” and we will never “banish unpredictability. Therefore, no “better classification” of mental illness, will fix our suffering. This is NOT to say, that classifications, medicine, science, or research, are themselves the problem. Instead, this is to reiterate the problem of defining health, purpose, and the value of life, on the “lack of illness” or Merriam-Webster’s definitions of health, well-being, and welfare. 



The British Psychological Society 

 In addition to the US based organization NIMH, which is soon proposing the new  Research Domain Criteria (RDoC) approach to mental illness instead of the historical DSM diagnosis, there is also a UK based proposition. This UK based proposition is called the ‘Power Threat Meaning Framework’ described in a 2018 publication by the British Psychological Society (Johnstone et al., 2018). In their article, the authors explain: 

 Power Threat Meaning Framework 

 “The Framework invites psychologists to understand distress and troubling behavior as the product of life experiences as they impact upon embodied people” 

He reports “the main aspects of the Framework are summarized by a set of questions which can be applied to individuals, families or social groups:

1. ‘What has happened to you?’ (How is power operating in your life?)

2. ‘How did it affect you?’ (What kind of threats does this pose?)

3. ‘What sense did you make of it?’ (What is the meaning of these situations and experiences?)

4. ‘What did you have to do to survive?’ (What kinds of threats response are you using?)

This work, was in fact influenced by Viktor Frankl’s Logotherapy, which I described at the beginning of this article, among several others. I appreciate most the “what sense did you make of it?” Component of the framework. What has happened to you, does possibly over emphasize the component we in America perseverate on known as “trauma.” However, as Carol Dweck (2006) points out in Mindset, there is strong evidence that implies having even 1 positive relationship is more influential than trauma, on the outcome of a person. While reflection may be necessary in the process of finding purpose, I worry that placing too much focus on that component will not over-turn the “learned helpless” that I have argued against with the implications of current standards of Health. Instead, I argue for greater inclusion of the growing concept; it’s not “what’s the matter with you?” But rather “what matters to you?” This appears to have come first from Barry & Edgman-Levitan (2012) in their article Shared decision making—the pinnacle of patient-centered care and advocated for by UK based Institute for Healthcare Improvement.  



The International Self-Care Foundation (ISF) 

 “The International Self-Care Foundation (ISF) is a registered UK Charity with a global focus.” 

“ISF’s Vision: is of a world in which people live long healthy lives, taking personal responsibility for their own wellness by adopting healthy lifestyle and self-care behaviours.” 

 I argue, ISF’s definition exemplifies a few of the primary misconceptions about mental health. Though much in the debate of mental health is related to definitions and words that carry different meaning across cultures, I believe the fundamental elements of error remain the same. Words such as “long healthy” and “wellness” are broad and vague, but also eventually, despite more noble sounding words, relate primarily to a medically defined form of “happiness.” This then, being the idea of always being “free from suffering”, which is evident despite any variance in the terminology or meaning.  

One author of several, to which I shall return to many times in the next few comprehensive articles I have already written like this one, is the scientist and researcher T. Collin Campbell who wrote the book Whole. In his book, Campell argues against the current state of science, being a practice of trying to solve all the variables to achieve some type of enlightenment, somewhere in a fantasy future. He argues instead, science can look at the big picture of what already works in a Wholistic approach. Instead, many cultures have lived long healthy lives before modern medicine. Longer lives than we live in American today. Instead, Campbell argues, we should emulate and study them, instead of studying what is wrong with us. I believe he captures the essence of my argument against “happiness and health” being the idea of “free from suffering” when he states: 

“What we really want from science is an end to randomness. We want to know why diseases strike some people and not others. We want to know how to protect ourselves against the scourges that have our names on them. We want, in short, to banish unpredictability.” – T. Collin Campbell 

Put simply; we want to be God. 

 As I move forward in this article, I still want to share a few comprehensive lists provided by leading and influential organizations, as they define mental health. Again, terms vary such as  

  • wellness,  
  • well-being,  
  • health,  
  • mental health,  
  • self-care 
  • happiness, etc.  

 Yet I believe the picture and idea that many of these organizations, and most people influenced by culture, have on what this “health” is supposed to look like, is the same. Regardless, I still appreciate an attempt to begin to break down valuable components of health. I do not believe engaging in these practices to achieve health will allow any individual to achieve health. What I do believe is, the ability to focus on priority, which is purpose, is health. In which case, having these lists, can certainly help someone make informed prioritizations. The “7 Pillars” as the ISF lists them are: 

  1. 1. Health literacy – includes: the capacity of individuals to obtain, process and understand basic health information and services needed to make appropriate health decisions 

2. Self-awareness of physical and mental condition – includes: knowing your body mass index (BMI), cholesterol level, blood pressure; engaging in health screening. 

3. Physical activity includes– practicing moderate intensity physical activity such as walking, cycling, or participating in sports at a desirable frequency. 

4. Healthy eating – includes: having a nutritious, balanced diet with appropriate levels of calorie intake. 

5. Risk avoidance or mitigation – includes: quitting tobacco, limiting alcohol use, getting vaccinated, practicing safe sex, using sunscreens. 

6. Good hygiene – includes: washing hands regularly, brushing teeth, washing food. 

7. Rational and responsible use of products, services, diagnostics and medicines – includes: being aware of dangers, using responsibly when necessary. 

 In defining self-care, the ISF does clarify its own purpose as not for “practical uses” but instead for “policy and spending in order to change behaviour at a population level.” However, I believe this step away from “practical” is what makes health care extremely costly, while also failing to meet the needs of the human condition at the basic level of finding meaning and purpose (Webber, Zhenyi, & Mann, 2013). However, the self-care pillar 7, provides an often missed component of healthcare; using medical-care appropriately. Though, what is deemed appropriate then becomes quite debatable. 



The Happiness Research Institute  

I was Inspired to review this resource, after the organizations CEO, Meik Wiking, gave his TED talk The Dark Side of Happiness  (TEDxCopenhagen, 2016). While not affiliated with a government agency, this literature produced by the Happiness Research Institute is non-the-less, valuable. In fact, its place in this article may be more valuable, because of its independent status. Of its publications, is the World Happiness Report (Helliwell, Layard, &  Sachs, 2017). They explain their purpose; “(pg.9) Its central purpose was to survey the science of measuring and understanding subjective well-being.” Technically, the definitions for the purposes of this article, are stated in the report, to be from The Organization for Economic Co-operation and Development (OECD). The OECD Guidelines on Measuring Subjective Well-being (2013, p.10) is listed below:  

“Good mental states, including all of the various evaluations, positive and negative, that people make of their lives and the affective reactions of people to their experiences…. This definition of subjective well-being hence encompasses three elements: 

Life evaluation—a reflective assessment on a person’s life or some specific aspect of it. 

Affect—a person’s feelings or emotional states, typically measured with reference to a particular point in time. 

Eudaimonia—a sense of meaning and purpose in life, or good psychological functioning.” 

The report describes the paradox I stated at the beginning of this article; that while the American standard of living is increasing, health and happiness are decreasing, and mental illness has a specific role in this (Easterlin 1964; Easterlin, 2016; Helliwell, Layard, & Sachs, 2017). As Sachs states it at the end of the report “America’s crisis is, in short, a social crisis, not an economic crisis”, he goes on to say “In sum, the United States offers a vivid portrait of a country that is looking for happiness “in all the wrong places” Helliwell, Layard, &  Sachs, 2017). My argument is, that those “wrong places” is looking for happiness in happiness itself.  However, this report is useful in light of the OECD’s definitions of life evaluation, affect, and eudaimonia. If anything, eudaimonia reflects the epitome of what I would consider health. Life evaluation, then would be the belief that one had health. I believe the US culture, on top of already over emphasizing the value of happiness itself, especially confuses affect with happiness. Affect being the experience of emotions from Joy to Sadness. Truthfully, a healthy life should include or not limit sadness.  

 Yet one might argue against my point that “it’s not sadness that’s the problem, it’s chronic, lasting, long-term sadness that’s the sign of mental illness.” Also then, the current state of medicine implies, that this chronic, lasting, long-term sadness, is the result of ” a variety of factors” but mostly “genetic and biological factors”, “trauma”, “social pressure”, “poverty” and “chemical imbalances”, which is ultimately mental illness. Which is again to imply, those born into mental illness are broken, unfixed, and unhealthy, until all those other barriers are removed; which will likely not be removed in any near lifetime.

 I contend here, that in fact, chronic, lasting, long-term sadness, is rather, in large (but not entirely), a result of the misdirection of cultural values and understanding of what health is. That is to say simply, a good part of the problem is the problem itself. The engrained belief system of mental illness and what it determines. That ultimately, the broad and large scale answer, is to revert our belief back to; a purpose-driven health. 



American Occupational Therapy Association (AOTA)

Within my own profession, health, well-being, participation, and engagement in occupation, are defined as the World Health Organization (WHO) presents them. To which I have previously given my opinion. Yet, I am thankful to work for the profession I do, as an occupational therapist. One of the primary defining documents by the American Occupational Therapy Assocation known currently as the 3rd Practice framework, states:  

 “Achieving health, well-being, and participation in life through engagement in occupation is the overarching statement that describes the domain and process of occupational therapy in its fullest sense.”

 While I have thus disagreed with the current definitions of health and well-being, I appreciate the value that occupational therapy gives to “participation in life through engagement in occupation.” This idea does revert back to the emphasis on meaning and purpose. Occupation as occupational therapy uses it, I believe, are best explained by these two (of several) definitions listed in the 3rd Practice Framework. 

“In occupational therapy, occupations refer to the everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to and are expected to do” (World Federation of Occupational Therapists, 2012). 

 “Goal-directed pursuits that typically extend over time, have meaning to the performance, and involve multiple tasks” (Christiansen et al., 2005, p. 548). 

 In the two definitions listed above, are the words and phrases “meaning and purpose to life” and “pursuits…have meaning to the performance.” This is where I begin to value the work I do. In my own efforts to seek purpose and find meaning, I find it equally important to do the work that also supports this perspective. It is my job to support others in, as my professional organization states, “achieving health, well-being, and participation in life through engagement in occupation.” To do this, I find it all the more important, to know what health, well-being, and life itself is.  



What Then is, Positive Mental Health? 

Positive mental health is “not merely the absence of disease or infirmity” but arguably also, neither is mental illness the addition of “disease or infirmity.” Rather, mental health is the ability to focus on priority, which is in many other terms, to “live and pursue”, “goal-oriented”, “self-directed”, “purpose-driven”, “meaningful lives.” Mental health, is to know purpose, not happiness. Quality of life should not be measured by the absence or even reduction of suffering for comfort, but rather for the addition of purpose and meaning.  

I shall argue, our mental health is mutually related to life as we experience it, and is determined by where our focus is placed. Changing where our focus directs, is the act of prioritization. Therefore, positive mental health behavior, is taking any action to focus on positive priorities. The way I argue, this impacts day to day life is: You must first identify your purpose or else identify what you’re willing to prioritize. Neither of these elements have to be fully framed, but are likely to be an organic growing process. What you focus on and prioritize, informs purpose, and that purpose, should also inform what you prioritize.  

Someone might argue,  

“Well how do I know what my purpose is? That is too complicated, too large a task to figure out, and even anxiety producing itself.”  

Here then, I respond, it may not be fully realized upon first attempt, but the human must move. That is to; move in body and thought. Certainly, while not scientifically backed or evidence based, I make the conjecture; that at least beginning to contemplate your purpose cannot be more overwhelming than attempting to organize what health behaviors you should begin with, given the enormous variety of often contradicting ideas provided by modern medicine.

If some, even the faintest amount, of purpose is identified first, then those positive health behaviors fall into place. Ideally one at a time, with a downstream effect on the others. That is to say, if your greatest purpose was to “spend time with my grandkids”, then exercising so that you can have the energy to do so becomes only a part of your health, but not the sole determinant of your health. If purpose was to “pursue God”, then a good sleep schedule to begin the day in prayer may be necessary.  

How this influences day-to-day health behavior change is, as explained by Stephen Covey (1989) to “Put first things first.” 

That leaves the health factors such as those listed below, valuable informers of what behaviors could contribute to your purpose. To conclude the primary heath factor lists covered in this article are: 

  • 7 Pillars of Self-Care by ISF 
  • Mental Health Indicators by CDC 
  • The 4 Major Dimensions by SAMHSA  

 One thing I have learned through the development of this article, is recognizing just how far a thread can be pulled. For example, one might see a popular magazine site publish a trending article on mental health. This article in turn, cites another popular website article such as Psychologytoday.com, as its source of information. If you go to that next article for that source of information, it may cite the CDC as its source. If you then continue clicking the links, and go to the CDC website, you might find that the CDC cites NIMH as its source. NIMH then cites the WHO as its source, and WHO then cites a series of articles as it source. Even yet, if you click the peer-reviewed research articles and take the effort to find them on a database and read them as I have, they might be a meta-analysis of a series of other articles to which the primary information was produced. To which you would then, need to pull up the original article, which is often decades or more, old.  

That is the problem with waiting for science and medicine alone, to fix our problems. It takes decades for information to catch up with us. By the time science and medicine does “catch-up”, it’s often outdated and irrelevant to current needs. Which is why, I believe, the true answers, as I will discuss in future articles, are always – simple. These simple answers, I believe, go unchanged through the course of human history. Things that go unchanged; are truths.  



Conclusion: The Next Step

I postulate, the deep wounds, hurt, and fear, that exist in society today regarding addressing mental illness thus relates to the emphasis we place on responsibility, change, willpower, and fault. 

It is no wonder an epidemic of depression exists; if we are all told our meaning in life is to be free of suffering.  What disappointment often comes to those that try; for what they expect as a product and outcome of their vulnerable effort to change at all. It is thought that happiness is the product of positive mental health. Though I believe the reality is for many, happiness is an experience often far and in-between.  

We as humans share a common experience. To be awoken in the midst of a wreckage we call life. We see our ancestors floating away as if taken by the ocean tide. They are all gone before we can ask enough questions, but, if we could ask all the questions in the world, they wouldn’t have them all.  We don’t know who or what to blame, and guilt can so easily overcome us, as though we were brought here by the fault of each of our own individual decisions to become suddenly awoken to consciousness and birthed. So how then do we make use of our situation? 

I return to my thesis statement:

  1. The meaning of life may be unique for everyone, but finding it is the same. 
  2. Meaning in life is found through purpose, which is defined by the act of a person to focus on priority.  
  3. The practice of focusing on priority, also defines purpose, which is where we will find our meaning.  

To live a meaningful life, is to focus with blistering intensity on the right priorities for the right purpose. Of what is right, is for debate, but our responsibility to take action for change, if we are to find purpose and meaning, is not. This will be done through effective delegating of automatic behaviors to habit and intentional efforts to willpower. We have limited reserves of time, attention, and willpower. How we harness these three elements determines where our focus goes. Intentional use of habit and willpower determines what we focus on, which determines our priorities, which ultimately, determines our purpose and meaning.  

Let’s not blame each other for the past misuse of time, attention, and willpower that we have each been allotted. Let’s not give up on purpose yet. Let’s keeping trying, together, today.  

“Woe to him who saw no more sense in his life, no aim, no purpose, and therefore no point in carrying on. He was soon lost.” (pg.85) by Viktor Frankl in his book Man’s Search for Meaning (1946) 



American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy. 68(Suppl. 1), S1-S48: http://dx.doi.org//10.5014/ajot2014.682006 

Barry, M. J., & Edgman-Levitan, S. (2012). Shared decision making—the pinnacle of patient-centered care. New England Journal of Medicine, 366(9), 780-781. 

Campbell, T. C., & Jacobson, H. (2013). Whole: rethinking the science of nutrition.  Dallas, TX; Bella Books.  

Center for Disease Control and Prevention. (2016, May 31). Well-Being Concepts [webpage]. Retrieved January 4, 2018, from https://www.cdc.gov/hrqol/wellbeing.htm 

Center for Disease Control and Prevention. (2017, June 28). Chronic disease overview [webpage]. Retrieved January 4, 2018, from https://www.cdc.gov/chronicdisease/overview/index.htm  

Center for Disease Control and Prevention. (2018, January 26). Learn About Mental Health [webpage]. Retrieved January 4, 2018, from https://www.cdc.gov/mentalhealth/learn/index.htm 

Christiansen, C., Baum, M. C., & Bass-Haugen, J. (Eds.). (2005). Occupational therapy: Performance, participation, and well-being. Thorofare, NJ: Slack.  

Clark, L. A., Cuthbert, B., Lewis-Fernandez, R., Narrow, W., Reed, G. (2017). Three approaches to understanding and classifying mental disorder: ICD-11, DSM-5, and the national institute of mental health’s research domain criteria (RDoC). Psychological Science in the Public Interest, 18(2), 72-145. doi: 10.1177/1529100617727266 

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Covey, S. (1989). The seven habits of highly successful people. Fireside/Simon & Schuster.

Cromby, J. (2013, January 30). An alternative to psychiatric diagnosis? Retrieved from https://www.psychologytoday.com/blog/the-bodies-we-re-in/201801/alternative-psychiatric-diagnosis 

Davidson, L., Schmutte, T., Dinzeo, T., & Andres-Hyman, R. (2007). Remission and recovery in schizophrenia: practitioner and patient perspectives. Schizophrenia Bulletin, 34(1), 5-8. 

Davidson, L., Schmutte, T., Dinzeo, T., Andres-Hyman, R. (2008) Remission and recovery in schizophrenia: Practitioner and patient perspectives, Schizophrenia Bulletin, (34)1, 5–8, https://doi.org/10.1093/schbul/sbm122 

Dweck, C. (2006). Mindset: The New Psychology of Success. New York, NY: Ballantine Books. 

Easterlin, R. (1964). Does economic growth improve the human lot? Some empirical evidence. P. A. David & W. R. Melvin (Eds.), Nations and households in economic growth: Essays in honor of moses abramovitz, (pp. 89-125). New York, NY: Academic Press 

Easterlin, R. (2016). Paradox lost? USC dornsife institute for new economic thinking, working paper No. 16-02 

Frankl, V. E. (1959). Man’s Search for Meaning. Boston, MA: Beacon Press 

Harrow, M., & Jobe, T. H. (2007). Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study. The Journal of nervous and mental disease, 195(5), 406-414. 

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Helliwell, J., Layard, R., & Sachs, J. (2017.) World happiness report. Retrieved from http://worldhapiness.report/ed/2017/ 

International Health Conference. (2002). Constitution of the World Health Organization. 1946. Bulletin of the World Health Organization, 80(12), 983–984. 

International Self-Care Foundation. (2018). ABOUT ISF [Webpage]. Retrieved January 4, 2018, from http://isfglobal.org/about-isf/ 

Jääskeläinen, E., Juola, P., Hirvonen, N., McGrath, J. J., Saha, S., Isohanni, M., Veijola, J., & Miettunen, J. (2013) A systematic review and meta-analysis of recovery in schizophrenia, Schizophrenia Bulletin, 39(6),1296–1306, https://doi.org/10.1093/schbul/sbs130  

Jobe, T. H., & Harrow, M. (2005). Long-term outcome of patients with schizophrenia: a review. The Canadian Journal of Psychiatry, 50(14), 892-900.  

Johnstone, L. & Boyle, M. with Cromby, J., Dillon, J., Harper, D., Kinderman, P., Longden, E., Pilgrim, D. & Read, J. (2018). The Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis. Leicester: British Psychological Society.  

Keehan, S. P., Poisal, J. A., Cuckler, G. A., Sisko, A. M., Smith, S. D., Madison, A. J., … & Lizonitz, J. M. (2016). National health expenditure projections, 2015–25: economy, prices, and aging expected to shape spending and enrollment. Health Affairs, 35(8), 1522-1531. 

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National Institute of Mental Health. (2017, December 27) Different approaches to understanding and classifying mental disorders. [Webpage] Retrieved January 4, 2018, from https://www.nimh.nih.gov/news/science-news/2017/different-approaches-to-understanding-and-classifying-mental-disorders.shtml 

Substance Abuse and Mental Health Service Administration. (2012). SAMHSA’s working definition of recovery: 10 guiding principles of recovery. Retrieved from https://store.samhsa.gov 

Substance Abuse and Mental Health Service Administration. (2017). Key substance use and mental health indicators in the united states: Results from the 2016 national survey on drug use and health. Retrieved from https://store.samhsa.gov/product/Key-Substance-Use-and-Mental-Health-Indicators-in-the-United-States-/SMA17-5044  

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Webber, D., Zhenyi, G., & Mann, Stephen. (2013). Self-care in health: We can define it, but should we also measure it? SelfCare 4(5): 101-106 

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What To Do After Being Diagnosed With Chronic Pain

Guest Post by Ms. Waters from  Hyper-Tidy.com [Bio Found at Bottom]

When you received your diagnosis of chronic pain, you probably wondered how your life would change. That’s entirely normal, as this diagnosis can be serious. Thankfully, there are ways you can reduce your pain and increase your tolerance so you can maintain your quality of life.

But you have to be careful about prescription painkillers, as they have a dark side.

Problems With Painkillers

Many people who are diagnosed with a chronic pain condition, such as caused by rheumatoid arthritis (RA), are prescribed painkillers. However, there are problems with these drugs. As DrugRehab.org shows, more people are abusing(1) prescription drugs and becoming addicted. Some signs of painkiller addiction include losing interest in things they once loved, having erratic behavior or mood swings, an unexplained need for more money, and missing work or school.

Then what can you do if you are prescribed medication to help manage your pain? Harvard Medical School lists several tips for reducing your risk of abusing painkillers(2). First, always take any medicine as prescribed and never take more to get through tough days. Keep communicating with your doctor about how this medicine is working for you. Lastly, pay attention to yourself. If you see any signs of addiction, contact your physician immediately.

Changes To Make At Home

Even though painkillers can help you manage your chronic pain, there are other ways to improve your quality of life. One of those is to make some changes to your home and, if possible, your work.

Health.com lists several products(3) for the work and home that can help. If moving from sitting to standing causes a pain flare-up, you could use devices that raise your chair’s seat so it’s easier to use. You can even add a raiser to toilet seats to reduce pain when sitting there. Grip bars can be installed in your bathtub to make getting in and out easier and safer.

Specially designed kitchen tools like knives and jar openers can make it less painful to hold and use, while tools that extend your reach can help you get items on high shelves without stretching and triggering your pain.

A Healthier Lifestyle For Chronic Pain

Your home is not the only thing you can change to help manage your pain. There are some changes you can make to your lifestyle to help live better.

First, eating better is always a good idea, but a specific anti-inflammatory diet can help reduce the impact of your chronic pain. The Cleveland Clinic explains that you should limit your consumption(4) of simple carbohydrates, sugar, red meat, and dairy. Instead, focus on fish, turkey, and colorful vegetables like broccoli, cabbage, and bell peppers.

Secondly, exercise and meditation can also reduce your need for painkillers and improve your lifestyle. Stretching(5), weight training, and low-impact cardio exercises like an elliptical trainer can both improve your overall well-being and lessen your chronic pain. Be sure to check with your physician before starting an exercise program. And while meditation(6) will not eliminate pain, it can help you cope with your condition while making it easier for you to live with the pain you have.

Don’t Let Pain Ruin Your Days

Although living with chronic pain is not always easy, you can still enjoy your life with some adjustments. Be careful about prescription painkillers, make a few modifications at home and work, and maintain your physical health through diet, exercise, and meditation. All of this can help you live the life you deserve.



Ms. Waters is a mother of four boys, and lives on a farm in Oregon. She is passionate about providing a healthy and happy home for her family, and aims to provide advice for others on how to do the same with her site Hyper-Tidy.com.



1 DrugRehab.org, The 45 Warning Signs of Abuse

2  Armand, Dr. Wynne; Harvard Health Publishing, The problem with prescription painkillers, Oct. 2015

3 Harding, Ann; Lee, Min-Ja; Health.com, 14 Household Tools for People in Pain; April 2011

4 Cleveland Clinic; How an Anti-Inflammatory Diet Can Relieve Pain as You Age; Nov. 2015

5 ExerciseRight.com.au; Chronic Pain and Exercise

6 Penman, Dr. Danny, Psychology Today; Can Mindfulness Meditation Really Reduce Pain and Suffering?; Jan. 2015

Therapeutic Horticulture for Mental Health

Therapeutic Horticulture for Mental Health

It has long been recognized, that positive mental health is associated with gardening and plants. This has been termed therapeutic horticulture. Cultures worldwide have made this connection for centuries, yet today, less and less time is being spent outdoors and yet more and more time is becoming sedentary. In the video above, I explore this topic, focusing on the evidence-based and research informed use of horticulture.

While therapeutic horticulture is a great coping skill to add to your tool box; it may not be that simply more green equals better mental health. Along with the mindfulness required to care for plants, the research regarding the benefit of therapeutic horticulture sheds light on a depth beyond the color of green alone.

Don’t forget to watch the video above. It’s the most work I’ve put into a video yet, and I think you will like it! Below is a summary of the information provided, you can download a pdf of this summary here: TherapeuticHorticulture Printout

What is Horticulture? 

“Horticulture is the science and art of producing, improving, marketing, and using fruits, vegetables, flowers, and ornamental plants. It differs from botany and other plant sciences in that horticulture incorporates both science and aesthetics.” (American Society for Horticulture Science, N.D.) 

Therapeutic Horticulture: The general use of plants to promote health  Horticulture therapy: The specialized, structured, goal-oriented use of plants by a therapist 

More green can equal better mental health, if used intentionally

How Plants Promote Mental Health 

However you use therapeutic horticulture, the benefit largely stems to purpose. For this reason, its not so much what is wrong with fake plants, but that the greater benefit comes from all the care that real plants require. From an occupational therapy perspective, its the “doing” that’s of value.  Below is a list of example ways you could use horticulture therapeutically. 

Direct Use: Weeding, watering, inspecting plants, harvesting  Indirect Use: Socializing, eating, tea, soup, reading, learning, writing diaries & meditative journaling, and going to a flower show 
Active Use: Sowing, germinating, potting, planting, composing beds, cultivating vegetables, and rooting various cuttings of flowers and herbs.  Passive Use: Walking, sitting near, picking flower/bouquets, watching/listening to birds, insects, butterflies, or weather 

An escape from winter, try an observatory or greenhouse

 Where to Begin 

Consider a change of scenery and get some paperwork done at an observatory or Zoo. Take a stop at your local greenhouse and wander the isles and bring a notebook or Camera.  

Easy Plants: Air Plants, Succulents, Cactus, Aloe Vera, Snake Plant, & Common Ivy   Great Places: Urban greenhouses, community allotments, water bodies, forest/woodland, countryside/farmland, wilderness 


If you want to grow plants, below is a couple great resources to get started!  

www.apartmenttherapy.com9 stylish houseplants (and how to not immediately kill them)


www.youtube.com/GardenAnswerSucculent Tips for Beginners // Garden Answer

For more information on the mental health topics I promote as an occupational therapist, read What I Teach for Mental Health



American Society for Horticultural Science. (N.D). What is horticulture? Retrieved from http://www.ashs.org/?page=horticulture 

Bazyk, S. (March, 2012). From the editor. Developmental Disabilities Special Interest Section Quarterly, 35(1), 4. 

Bratman, G. N., Hamilton, J. P., & Daily, G. C. (2012). The impacts of nature experience on human cognitive function and mental health. Ann N Y Acad Sci, 1249, 118-136. doi: 10.1111/j.1749-6632.2011.06400.x. 

Clatworthy, J., Hinds, J., & Camic, P. M. (2013). Gardening as a mental health intervention: A review. Mental Health Review Journal, 18(4), 214-225. doi:10.1108/MHRJ-02-2013-0007 

Cosden M, Ellens J, Schnell J, Yamini-Diouf Y. (2005). Efficacy of a mental health treatment court with assertive community treatment. Behavioral Sciences & the Law, 23(2), 199-214.  

Diamant, E., & Waterhouse, A. (2010). Gardening and belonging: reflections on how social and therapeutic horticulture may facilitate health, wellbeing and inclusion. British Journal Of Occupational Therapy, 73(2), 84-88. doi:10.4276/030802210X12658062793924 

Eriksson, T., Westerberg, Y., & Jonsson, H. (2011). Experiences of women with stress-related ill health in a therapeutic gardening program. Canadian Journal Of Occupational Therapy, 78(5), 273-281. doi:10.2182/cjot.2011.78.5.2 

Gonzalez, M. T., Hartig, T., Patil, G. G., Martinsen, E. W., & Kirkevold, M. (2011). A prospective study of group cohesiveness in therapeutic horticulture for clinical depression. International Journal Of Mental Health Nursing, 20(2), 119-129. doi:10.1111/j.1447-0349.2010.00689.x 

Gonzalez, M. T., Hartig, T., Patil, G. G., Martinsen, E. W., & Kirkevold, M. (2011). A prospective study of group cohesiveness in therapeutic horticulture for clinical depression. International Journal Of Mental Health Nursing, 20(2), 119-129. doi:10.1111/j.1447-0349.2010.00689.x 

Parkinson, S., Lowe, C., & Vecsey, T. (2011). The therapeutic benefits of horticulture in a mental health service. The British Journal Of Occupational Therapy, 74(11), 525-534. doi:10.4276/030802211X13204135680901 

Sempik J, Rickhuss C, Beeston A (2014) The effects of social and therapeutic horticulture on aspects of social behaviour. British Journal of Occupational Therapy, 77(6), 313–319. 

Sempik, J. (2010). Green care and mental health: gardening and farming as health and social care. Mental Health & Social Inclusion, 14(3), 15-22. doi:10.5042/mhsi.2010.0440 

Wagenfeld, A. (2012, June). Health through HOrTiculture: A natural innovation. Home & Community Health Special Interest Section Quarterly, 19(2), 1–4. 

Wagenfeld, A. (2013). Nature: An Environment for Health. OT Practice 18(15), 15–19. http://dx.doi.org/10.7138/otp.2013.1815f2 

Whitham, J., & Hunt, Y. (2010). The green shoots of good health. Mental Health Practice, 14(1), 24-25. 

How Being A Parent Has Helped Me As A Therapist

My work as an Occupational Therapist has it’s benefits. I work specifically in mental health with young adults ages 18-24. However, many often associate occupational therapy with pediatric work. In which case, I often hear people describe the idea that my profession gives me the skills to provide my daughter with above and beyond challenges that will give her an advantage in life.  

In some ways it does, but not how most would expect.  

Her Exceptional Fine Motor Skills

It was this Halloween a friend noted how well developed my daughters fine motor skills were for her age. My daughter can open jars, lids, and more things than I’d prefer. In fact, her well developed fine motor skills are slightly bothersome because we have to be so careful with what she can access. Halloween was not the first time others have made note of my daughters healthy development and made comments such as “I bet it’s great to have an occupational therapist as a dad.” However, being an occupational therapist has only helped me recognize the value of “day-to-day” activities. 

I mean, being an effective parent has as much to do with what I don’t do as what I do. 

A cute picture here
“The Itsy-Bitsy-Spider…”

The Gold Standard of Occupational Therapy

The gold standard of occupational therapy is “occupation.” That is to engage in the everyday tasks people do. This could include but is not limited to; showering, dressing, eating, playing, taking pets out for walks, going to the grocery store, and playing cards with friends. The mistake people often make about therapy when they imagine colorful cones, bins of odd shaped toys, and fancy gym equipment when doing those “therapy” like tasks, is that they are better than doing the everyday tasks I just listed. In truth, it is far better to be practicing showering, dressing, eating, playing, and so forth, than moving cones.  

In my opinion, the two things fancy therapy techniques and tools are used for is: 

  1. To support eventually practicing the occupation (showering, dressing, eating, playing etc.) 
  2. To avoid the miserable boredom of repeating the attempt at occupation if it’s not working. 

What I mean by number two is, if therapy is working on self-feeding, a patient can’t just practice eating for an hour or they would vomit. The use of therapy tools by occupational therapist is always only to support the eventual and hopefully current engagement in occupation or day-to-day tasks. That last sentence is not my opinion. 

Engaging in Everyday Tasks is the Best Therapy

It is not likely I could make my daughter a super human with therapy techniques. My daughter has well developed fine motor skills because I allowed her to help me hammer nails, wash dishes, prepare food, play with my special Star Wars Legos, and put many book shelves together. I was never providing therapy, but I was also not pushing her away from participating in every-day tasks. Kids are natural at engaging in occupation, the danger is when we stop them.  

Lots of Legos Here
Sharing the Lego Tradition

Even kids with developmental disabilities, the thing that is most beneficial, is for them to simply to be allowed to engage in day-to-day tasks even if specialized tools are needed.  

What parenting has taught me about my job as an occupational therapist, is the most effective therapy I can provide is often NOT me teaching and educating, but rather simply doing pumpkin carving. That is, simply to support and experience occupation with others. 

The day before Halloween I facilitated one of the best mental health groups yet. I measure this by my personal objective observation of joy and laughter. Group members said “I can’t believe I’m pumpkin carving in a locked inpatient unit” and “my girlfriend is going to be so surprised when I tell her what we did for group while I was here.” I even had one patient discharge and take her pumpkin home with her to show her kids. 

Happy Halloween! I hope you enjoyed it and remained safe!

I don’t have lots of research for the post, just sharing a little something I’ve learned that I hope can be of value to you.

For more info on what Occupational Therapy is, click here.

For more about what I do, read: What I Teach for Mental Health

Coping Skills, Strategies, Methods, Resources, Techniques, or Tools?

The above video is a few of the coping tools I keep with me and use. As a mental health occupational therapist, I find it important to practice what I preach. I will go into the purpose and types of coping skills further in this blog post. 

The Need for Coping Skills 

There is an ever-greater need for mental health services for college students specifically (Watkins et al., 2012). Nearly 1 in 4 experience mental illness in college today (SAMHSA, 2017). Coping skills are in part, an answer to this situation. I explain in the video above, that coping skills are not simply for “dealing with mental illness”, rather they are what should be present in positive mental health.  

Unfortunately, effective strategies to cope with stress among college students today, may not only be lacking, but many of which may actually further contribute to the poor ability to deal with stress (Bland et al., 2012). 

What Coping Skills Are 

Coping Skills is a familiar term, for some it’s a word that means “run away”, yet others may actually want to learn coping skills. Whether the idea of coping skills needs to be rebranded or just approached differently is debatable. What is not debatable, is that we need to use them.  

There are a variety of ways to define and organize coping skills in medical literature (Carver & Conner-Smith, 2010). I believe coping tools are best described in simple terms as actions you can take to deal with negative situations. These actions could simply be in your head like practicing mindfulness or physical items such as writing in a notebook. 

Should have seen these books
My favorite tools come in the form of books

Types of Coping Skills 

Vivek Murphy, a former US Surgeon General, stated in an interview “The second thing we have to do is cultivate emotional well-being. There are tools, and they’re relatively simple. They include sleep, physical activity, contemplative practices like gratitude and meditation, and social connection as well” (“3 Questions”, 2017). Murphy’s list of tools is a great start. 

  • Sleep 
  • Physical Activity 
  • Gratitude 
  • Meditation 
  • Social Connection 

Feeling supported was the number one most positive factor students who deal well with stress report (Bland et al., 2012). The other factors found to be used by students who handle stress well include: 

  • Relaxed 
  • Extra-Curricular Activity 
  • Extra-Curricular Sport 
  • Exercise 
  • Listened to Music 

As an occupational therapist, I often use the senses (sight, smell, etc.) as an approach to coping tools. Mental illness can negatively impact how adults experience the senses (Bailliar & Whigham, 2017). A variety of tools can be used to use are sense to impact our emotions and experience. Examples include: 

  • Fidgets 
  • Stressballs 
  • Ear plugs 
  • Aromatherapy 
  • Weighted blankets 
  • Holding warm/cold items 


I hope these few lists give a good start to coming up with ideas. Each of these topics could have additional lectures of their own, I’m sure you can easily find more information online. I believe there is great room to go into greater detail on types of coping skills. This article is a first step overview. I would be grateful to learn what coping skills you feel should be addressed, what works for you, and what you would do to make it more appealing? 

 For more information, checkout the article: What I Teach for Mental Health



3 Questions. (2017, September). Official Journal of the National Geographic Society, 232(3).  

Bailliar, A. L., & Whigham, S. C. (2017). Centennial Topics – Linking neuroscience, function, and intervention: A scoping review of sensory processing and mental illness. American Journal of Occupational Therapy, 71(5), 7105100040. https://doi.org/10.5014/ajot.2017.024497 

Bland, H. W., Melton, B. F., Welle, P., & Bigham, L. (2012). Stress tolerance: New challenges for millennial college students. College Student Journal, 46(2), 362-376. 

Carver, C. S., Connor-Smith, J. (2010). Personality and coping. Annual Review of Psychology. 61: 679–704. PMID 19572784. doi:10.1146/annurev.psych.093008.100352

Farb, N. A., Anderson, A. K., & Segal, Z. V. (2012). The mindful brain and emotion regulation in mood disorders. The Canadian Journal of Psychiatry, 57(2), 70-77. 

SAMHSA (2017, Sept 9). Key substance use and mental health indicators in the united states: Results from the 2016 national survey on drug use and health. Retrieved from https://store.samhsa.gov/product/Key-Substance-Use-and-Mental-Health-Indicators-in-the-United-States-/SMA17-5044 

Watkins, D. C., Hunt, J. B., & Eisenberg, D. (2012). Increased demand for mental health services on college campuses: Perspectives from administrators.  Qualitative Social Work,  11(3), 319-337.