May was Mental Health Awareness Month, but the disturbing events of this past year remind us that we should attend to our mental health every day. Since January, we have witnessed mass shootings, the suicides of celebrities and influencers and other acts of violence, including an Oscar slap on live television, that people may link to psychic turmoil.
While many people might ascribe these events to “snapping” triggered by anger or depression, Timothy Fong, MD, clinical professor of psychiatry at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, is not a fan of that description. He offers, instead, a deeper context for how people reach their mental limit: “Ever since the dawn of humankind, people have acted out. They’ve fought, they’ve killed, they’ve cried, they’ve done things that have made no sense,” he said. “They’ve done all sorts of risk-taking behaviors. This has always been a part of our human condition.”
Dr. Fong eschews such terms as “breaking point” or “snapped,” which he said imply “100% loss of functioning or completely going to the point where there’s no willful choice.” Instead, “I think of it as the opposite,” he said, with “choice” at the core of a person’s action. “It’s more like the person has reached a point to where they are more likely to act out or act on the impulses of their emotional state.”
What triggers rage and violent acts of impulse?
“We know a lot more now about how the brain functions than we did 20 years ago,” Dr. Fong said. When someone commits an act of violence or rage, it may originate from regions of the brain that are responsible to reacting quickly to threats which include the amygdala, the hypothalamus and the periaqueductal gray.
The neurons within this region are designed to detect threats and respond to protect ourselves, our family and friends, and, sometimes, even strangers around us. They are, for example, what drives a firefighter to run into a burning building to save a child, or what inspires a parishioner in a church to rush a shooter, giving his fellow worshippers time to react and overcome the attacker.
However, when these regions are triggered excessively or when their structure or function breaks down — perhaps as a consequence of being under acute or chronic stress, sleep-deprived, under the influence of a substance or experiencing physical or mental health conditions, the otherwise beneficial protective response may instead turn from protective to harmful.
“The common thread is a mix of impulsive, spur-of-the-moment actions set inside a perfect storm of stress and intense emotional responses,” Dr. Fong said. Will Smith slapping comedian Chris Rock at the Oscars “is a perfect example. He didn’t plan it. But when you listen to his testimony about things going on in his life and about his wife and things of that nature, you perhaps can see there might have been other things at work that were building up to that moment.”
Other examples of impulsive rage with which many of us may be familiar are cursing someone who has cut us off in traffic or lashing out at colleagues, friends or family because we have had a bad day.
What role does depression play?
Just as anger or rage can lead to calamitous outcomes, so, too, can depression, Dr. Fong said. But in the case of depression, those outcomes may be directed inward rather than at other people.
When this condition goes untreated, a person may harm, or even kill themself; depression is the leading trait associated with suicide.
How do we recognize signs of declining mental health?
Identifying, and treating, a mental health issue can save lives, be it that of the person with the problem or of others whom they might harm. But recognizing that there is an issue can be challenging. Below are some early signs and symptoms of poor mental health. While these might not always be indications of a mental health problem, they should not be ignored.
- Sadness/tearfulness
- Frequently feeling overwhelmed
- Lethargy
- Mood swings/difficulty controlling emotions
- Easily distracted
- Use of narcotics
- Excessive alcohol consumption
- Lack of emotion/disinterest
Understanding the mental health 'thermometer'
Dr. Fong explained that there are three aspects of our lives that work together to determine the overall condition of our mental health: thoughts, feelings, and behaviors.
“If we had a mental health thermometer, it would help us better understand what is happening,” he said. “If your mental health thermometer is too high, running hot like a fever, this is a sign that something unhealthy is going on. If you don’t take the necessary steps to bring that fever down, your condition will get worse, and you eventually will act out.”
Gauging your mental health thermometer means recognizing if your thoughts are positive or if they are negative. It also means being able to accurately assess your feelings and articulate those feelings to a professional or someone who can help.
“If you have negative thoughts, they are going to lead to negative feelings. Those negative feelings could lead to acting out in harmful ways,” Dr. Fong said.
Seeking help for mental health concerns
While they play an important role in intervention, it is not enough to simply refer someone to a mental health hotline and hope for the best, Dr. Fong said. Though it may be difficult for someone struggling with a mental health issue to open up about their problem, psychological or psychiatric treatment is essential to long-term care.
The sooner a problem is recognized and addressed, the better, Dr. Fong said. This may be particularly true for young people, who are in the midst of a national mental health crisis.
“We have to acknowledge what young people are going through and acknowledge how hard it is for them right now,” he said. “That’s the first step. The second step is making the resources we know will help available to them.”
And, he added, it is important for family and friends to be supportive. “What helped me when I was growing up and facing stressful situations were friends, mentors, family and members in the community and neighborhood who gave me a sense of safety and consistency.”
If you want to learn more about coping with mental health issues or want to find a mental health provider, visit our UCLA Health psychiatry.
