This episode of The Mindstream Podcast is the heart of a special editorial package, Mental Wellbeing 2021, which offers articles that delve into aspects covered in this episode. It was released on 20 September 2021. Below is the full transcript, complete with links of all resources and fact sources mentioned. This transcript is also available as a PDF with embedded links (16 pages in A4 format).
Advertising support of Episode 8 provided by EmbodyMe.live

Podcast Transcript

INTRO
Host Liza Horan: Welcome to The Mindstream Podcast, exploring the facts and the stories around mind-body-spirit pathways to greater health and happiness. I’m your host, Liza Horan.

Over the past few years many levels of society have been shifting the conversation of mental health from one focused on disease and dysfunction to one of holistic wellbeing. The cobwebs of ages-old stigma are being blown away, replaced by medical research, education and empathy — and it couldn’t be better timed because we’re now living in the global mental health crisis that was warned by the World Health Organisation in early 2020.

The pandemic has illuminated this most human aspect of ourselves: how our thoughts and feelings influence how we relate to the world and how we function in it.

Researcher Katherine Johnston joins us for an interview to discuss the Global Wellness Institute’s landmark report, “Defining the Mental Wellbeing Economy.”

In Episode 8 of The Mindstream Podcast we cover where mental health is today, demystify the language around our intellectual and emotional selves, discuss the mind-body-spirit connection, and report on the Global Wellness Institute‘s landmark report called, “Defining the Mental Wellness Economy.” It’s significant for many reasons, but for me it recognises the role of spirituality and altruism as part of our wellbeing, and notes that this is a grassroots movement powered by consumers, professional practitioners and businesses. And the report shows that we’re bringing back centuries-old natural and holistic modalities into the mainstream. Most health reports don’t acknowledge any of this. Katherine Johnston, who co-authored the report [with Ophelia Yeung], joins us for a special interview.
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PRELUDE
In this episode, we’re focused on mental wellbeing from three perspectives: personal, the business side and society at large.

We’re looking at the personal aspect because thoughts and feelings form an important part of the human experience. The business side because the economy around mental wellbeing is big and getting bigger: It was forecasted to grow from $121 billion in 2019 to more than $16 trillion by 2030. We’re looking at it from society-at-large because our individual experiences influence the collective one, and because we need both a top-down and bottom-up approach to improving mental health and wellbeing.

So what is mental wellbeing exactly, why is it so important and what is the mind-body-spirit connection?

This episode will clarify the big questions and provide actionable insights for us on a personal level and on a professional one, for those who work among the many facets of this intriguing industry. We’ll wrap up with what needs to happen and what’s happening so far. It’s encouraging, but is it enough? We’ll see.

Mental wellbeing is such a vast topic I couldn’t cover it all in this single episode so it’s the heart of an editorial package at MindstreamConnect.com/mentalwellbeing. Those articles dive further into some important aspects of what is being discussed in this episode.

I learned a whole lot researching this program and I’m really excited to share with you. This topic is a game-changer for health and happiness. Ready? Let’s go!

THE MENTAL HEALTH CONVERSATION COMES OF AGE
[05:00] Do you sense a shift in the conversation about our non-physical health from before the pandemic to now? I sure do. When I think back to 2019 and the years leading up to it, it seemed that the media and conversation around what was happening in our minds was either about mental illness or self-care. It was as if a person was either in one camp or the other opposite ends of a continuum. I know here in the U.K. there have been public information campaigns on dementia and loneliness, among others. There is even a loneliness minister in the UK Parliament.

And we’ve also heard advice on being kinder to ourselves, plus loads of marketing of products and services encouraging us to indulge ourselves in the name of self-care. In some ways it feels like a rather serious topic has gotten watered down in marketing to the mainstream.
Feeling anxious? Take a bubble bath.
Buy this thing to fix yourself!
As if it were that simple, right?

Then 2020 happened. Covid-19 changed the awareness and the conversation around health and made it everyone’s business. We learned that just as we had to take measures to protect yourselves and others physically, we had to do the same mentally. Finally the media headlines started talking about the negative thoughts and feelings that accompany trying to survive a global pandemic. Covid-19 normalized the conversation around our mental selves.

And now here we are in 2021, and those in the best physical health — professional athletes — are revealing publicly that their mental health is suffering. First it was world No. 2 tennis pro Naomi Osaka, who — risking ridicule and up to $20,000 in fines — withdrew from mandatory press conferences at the French Open. She wrote in an essay published by TIME Magazine that that decision was to “exercise self-care and preserve my mental health … It’s O.K. not to be O.K.” Perhaps Osaka’s lighting of the Olympic cauldron shortly after that to kick off the summer Games also lit the way for athletes to be open about mental health.

American gymnast Simone Biles took the torch, so to speak, withdrawing from four events because she wasn’t in form mentally, which affected her physically. Here’s someone who has excelled with the pressure of performance her whole life, but she had to step aside on this important occasion because of what was happening internally for her; and if you read her story, there was a lot going on off the mat. Now Simone Biles is hailed as an advocate for mental health. Whether you watched the Olympics or not, chances are you are familiar with the news story — and that making front-page news is a massive shift from years gone by. Even through the 1950s, mental health was discussed behind closed doors, if at all.

MENTAL WELLBEING 2021

So what’s the state of the world’s mental wellbeing today?

Frankly, we’re in a global crisis. The fear, anxiety and stress of the coronavirus and the isolation of lockdown caused the number of American adults reporting symptoms of anxiety and depression to nearly quadruple, and in the U.K. the number of people reporting symptoms of depression almost doubled. This is according to a February report in the journal Nature.

We should have seen this coming.

Before the pandemic, it was estimated that more than 1 billion people worldwide experience a mental disorder, and that mental illness accounts for more disability in developed countries than any other group of illnesses. In America, that’s 1 in 5 adults experiencing mental illness each year, and 1 in 20 with serious mental illness each year; that’s according to America’s largest grassroots mental health organisation, the National Alliance on Mental Illness (NAMI). The difference of these two classifications — mental illness and serious mental illness — depends on the level of debilitation they bring; schizophrenia, for example, is a serious mental illness. We’ll get more into that in a few moments when we discuss the language of mental health.

Would you be surprised to learn that many people are not seeking help, likely suffering in silence? Well, unfortunately, that is the case. A U.S. report in 2017 stated that 18% of adults had a mental illness, yet only 13% sought treatment. In England: As many as 75% of people with diagnosable mental illness receive no treatment. Is it because they feel shame or feel stigmatized, or is it because the waiting times to get seen are too long or there are no local services or no affordable services? It could be any of these reasons or others.

While the real-life impact of mental goings-on can be told through stories of those living it, the economic impact has been tallied — and it’s expensive. “Poor mental health” costs the global economy $2.5 trillion a year; $1 trillion of that $2.5 trillion is due to loss of productivity from anxiety and depression alone. That’s according to The Lancet. In the U.K., gross domestic product (GDP) could have been over £25 billion higher than what it was in 2015 if not for the economic consequences of mental health problems to both individuals and businesses. That’s according to the Mental Health Foundation.

All of this could be alleviated by scaling up treatment for common illnesses, like anxiety and depression. In fact, the World Health Organization says for every dollar invested in mental health, there is a $5 return in better health and the ability to work. Can you imagine getting a quintuple return on any investment? It’s absolutely off the charts — it’s fantastic!

So, this is an urgent situation. The global median spending on mental health stands at around 2% of total government health budgets, and that’s not enough. If governments don’t invest now in mental wellbeing, the global economic hit is going to jump from that $2.5 trillion to somewhere between $6 trillion and $16 trillion in 2030. And that’s a pretty big spread — that’s a spread of $10 trillion! That’s because I found several different reports making the forecasts, from the medical journal, The Lancet, to a joint report from Harvard School of Public Health and the World Economic Forum. Consider that these forecasts are pre-pandemic forecasts. I’m not sure who to believe or what impact the pandemic will have, but trillions of dollars is serious money.

There’s reason for hope, though.

GOOD NEWS

I’d say the most significant is the shift in language across the medical industry, the public sector and the mass media from using “mental health,” which has a bias toward disease and dysfunction or lacking, to the more positively framed term, “mental wellbeing.” The term wellbeing is an acknowledgement of the holistic nature of all aspects of our health and the mind, body and spirit being connected. It’s also humane.

We’ll get into the definitions around mental wellbeing in a moment, but first we’re going to look at two significant shifts toward wellbeing in society at large: In the health industry and in government.

The National Center for Complementary and Integrative Health, which is part of the National Institutes of Health in the U.S., is spearheading discussion of a major paradigm shift in medicine. They want to switch from focusing on disease and dysfunction to focusing on wellbeing. So the NCCIH has gathered with the Veterans Administration and a number of leading researchers, doctors and healthcare professionals this summer for the purpose of putting wellbeing on the agenda. The goal is to, “improve measurement of holistic wellbeing outcomes in research, clinical care and population” health. They believe this will provide a common language among patients, clinicians, policymakers, and others to define and assess positive outcomes. [Update: The NCCIH has announced a strategic effort around ‘whole person’ health research.]

This is major, and a lot of research is already funded. For example, the University of Connecticut is studying emotional wellbeing right now in their Spirituality, Meaning and Health Lab. “Emotional wellbeing” is an overall state of emotions, life satisfaction, sense of meaning and the ability to pursue self-defined goals.”

[15:46] The University of Connecticut is a premier public health university. I just absolutely love that there is a lab that has the words “spirituality,” “meaning” and “health” [together in its name]. So when people question if mind, body and spirit are connected, let me tell you there are scientific researchers, medical people, people working in public health that are taking a holistic approach and they believe that all our systems are connected; that they’re influencing each other, that mind, body, spirit are connected. This is significant and it’s something that sceptics need to know.

The other point of fantastic news is that governments are starting to recognise that the wellbeing of their citizens is the point.

Traditionally the success of a nation has been measured in dollars through gross domestic product (GDP). Well, the Wellbeing Economy Alliance (WEALL) is changing that. It’s a collaboration among governments, businesses, organisations, and individuals to ensure that a nation’s success is characterised equally on its citizens’ wellness as it is GDP.

Listen to the official vision of these governments: “Policy is framed in terms of human and ecological wellbeing not simply economic growth. That businesses provide dignified lives for their employees and exist to meet social needs and contribute to the regeneration of nature. And that the rules of the economy are shaped by the collaboration between government, business and civil society.”

Friends, this is morality making a comeback. This is about ethics in action. And it’s not just lip service.

Five governments signed on so far: Iceland, New Zealand, Scotland, Finland, and Wales, all of which happen to be led by women by the way. They’ve all established plans, policies and practices to achieve wellbeing economies in their countries. And on July 27th Norway announced their interest in developing a wellbeing economy, so there will be more news coming from them.

[18:20] Scotland and Wales are part of the Wellbeing Economy Alliance, but England and Northern Ireland aren’t — yet. There is a petition gathering signatures right now for the United Kingdom to focus on a wellbeing economy and if that gets enough signatures it will go before Parliament.

This is a top-down and bottom-up movement. The governments are enacting policies, and people like you and me can do our part. I’ve joined. You can join. It’s free to join. Go to WellbeingEconomy.com to sign up.

It’s absolutely fascinating and it’s great reason for hope. You can learn more about this in our package at Mindstreamconnect.com/mentalwellbeing.

LANGUAGE IS IMPORTANT

What do we mean with the term mental wellbeing?

As I researched this topic, I saw many terms bandied about: mental health, mental illness, mental disorder, mental wellness, mental wellbeing, emotional wellbeing, mental toughness, mental strength, self-care, contentment, fulfillment and happiness. I wondered, What do these mean? and Where does self care end and seeking medical care begin?

[19:51] There is no single glossary for all of this, but they all do refer to the emotional and intellectual state of one’s self, our ability to function in the world and even to thrive.

Let’s start at the beginning: The earliest notion of “wellbeing” in recorded history goes back to the Greek philosophers. Notes from Aristotle’s lecturers were captured on scrolls and they’ve since been turned into a series of books. The first book is called “Nicomachean Ethics.” Aristotle’s concept of wellbeing was called eudaimonia. Eudaimonia is “a state of good spirit,” according to Aristotle. It’s about “growth, meaning, authenticity, and excellence within one’s self.”

Eudaimonic wellbeing, especially in regard to feeling purpose in one’s life, has been shown to lengthen lifespan, protect against disease and regulate emotions that stem from your body and your brain. Some scholars say that eudaimonia has been misappropriated as happiness, and that wellbeing is what we ought to cultivate in life, rather than this notion of happiness because hedonia (or hedonism) can bring happiness, but that is very different. Hedonia is about pleasure, enjoyment, comfort, and the absence of distress.

[21:34] It really clarifies why the enjoyment of vices or lavish excesses may bring momentary pleasure, but they don’t bring sustainable fulfillment or long-lasting wellbeing.

In modern terms, the clearest explanation I found for mental wellbeing came from the Global Wellness Institute report, “Defining the Mental Wellness Economy.” It defines a mental wellness or mental wellbeing as an internal resource that helps us think, feel, connect, and function, and an active process that helps us build resilience, grow and flourish.

Did you hear that? So mental wellbeing is both a resource and a process. If it’s a resource that means it can get depleted and filled up again. And if it’s a process, that means that it is constant, it works in stages and it’s certainly something that can be improved. The report says mental wellness is an active process of moving from languishing to resilience to flourishing.

So, on one hand, mental wellness is about prevention of mental illness, coping with life’s adversity, being resilient when we face stress, loneliness, anger and sadness — because we will; this is life, it has ups and downs. And on another level, mental wellness moves us toward a deeper, richer and more meaningful human experience. This is the flourishing aspect.

What it means to flourish is very personal and it’s shaped by your values, your culture, your faith … What does flourishing mean to you?

“Mental health” has been the go-to term in our lifetime to explain our emotional and intellectual selves, but this report by the Global Wellness Institute states “mental health” is actually a scientific and objective assessment; an analysis of one’s emotional and intellectual status, whereas “mental wellness” or “mental wellbeing” (they use those terms interchangeably) is personal and subjective.

This report emphasises that focusing on mental wellness shifts the perspective from stigma to shared humanity and it can help shift our focus to a more positive and empowering approach to how we think, connect, and feel and function.

[24:37] We’ll get more into the components of mental illness and pathways to mental wellbeing as I highlight the Global Wellness Institute report right before the interview with Katherine Johnston, so stay tuned for that.

For details on these definitions around mental illness and mental wellbeing check out MindstreamConnect.com/mentalwellbeing. I’ve gathered information on these terms and evidence for the momentum around the shift to mental wellbeing from forces such as the National Institutes of Health in the U.S., the World Health Organization and not-for-profits like Wellbeing Scotland, among others. It’s a must-read!

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THE MIND-BODY-SPIRIT CONNECTION

So it’s great news: Medicine is starting to look toward our wellbeing in a more holistic way, governments are prioritising wellbeing as a matter of success, and the other, more immediate opportunity, I see for progress to improve our individual and collective mental wellbeing are the mind-body-spirit disciplines. We’re talking about complementary and alternative medicine, natural health and spiritual growth practices.

They have a great role to play. They’re helping relieve symptoms of medical distress and disorders and relieve side effects of medication for serious mental illness. Most of these modalities are safer, more accessible, more sustainable, and often more affordable than pharmaceutical treatments.

I’m going to run down a long list of mind-body-spirit practices currently being used for mental wellbeing, but first let’s consider the current go-to treatments for mental health in conventional medicine: pharmaceutical prescriptions and psychotherapy. However, neither one of these may work for any particular person and an individual may stop using them. So even the “science-backed” solutions are not a sure thing. I think that’s really important to understand about where we are with mental health and wellbeing, and where we need to go, where the opportunity is for growth and support.

So what is the position of mind-body-spirit discipline to support mental wellbeing?

[28:09] I consulted many sources. I looked to the U.S. National Institutes of Health, the National Alliance of Mental Illness (NAMI), the Cleveland Clinic, the NHS, plus the U.K. charities Mind and Rethink Mental Illness, among others. There are lots of major hospital systems in the U.S. that are successfully using holistic services for mental and physical conditions. This is very encouraging.

In the U.K., the only NHS hospital offering holistic services is the NHS Centre for Integrative Care in Glasgow. Otherwise it’s a “postcode lottery,” as they say, of holistic services sprinkled throughout the country and you may have to pay for such services yourself.

It’s important to note here that these are evidence-based modalities. There’s scientific research and there’s evidence from actual personal experience. No hospital system would be using any therapies or practices that were not evidence-based. However, the body of scientific research supporting complementary and alternative medicine is limited. The challenge is that there’s just not enough research getting funded, and when research is conducted it’s often very niche and cannot be extrapolated to the larger public. For example, meditation among depressed college students or mindfulness among those being treated for cancer.

The sheer amount of research done for pharmaceutical solutions exponentially outweighs the research done for complementary, alternative and natural solutions. Pharmaceutical companies have nothing to gain from these more natural treatments. So there’s a warrant for more research.

I’m going to run down a long list of complementary and alternative medicine, natural health and spiritual growth practices currently being used for mental wellbeing, but first I need to state some important facts:

  • Please keep in mind that any substances that are ingested — such as herbal remedies, vitamins and supplements — can have interactions with medications that you may be taking and they may have side effects themselves. So please consult a doctor or pharmacist or licensed practitioner to see if what you wish to take is advised and is compatible.
  • Always speak to a healthcare professional before undertaking any practice or treatment.

[31:03] Now here’s that long list of mind-body-spirit modalities that support mental wellbeing. It’s a long list — are you ready? Let’s dive in!
Acupuncture
Animal Therapy, especially equine (meaning horses)
Aromatherapy
Ayurvedic Medicine
Deep Breathing
Bowen Technique
Energy Healing

Exercise and movement, like walking and Tai Chi. Physical activity can actually help reduce weight gain, fatigue and other side effects that come with the conventional medicines used to treat mental disorders.
Herbal medicines and remedies. I can give you an example: St. John’s Wort and ginkgo biloba are often recommended to treat depression.
Homoeopathy
Hypnotherapy
Light Therapy
Massage
Meditation, guided imagery, mindfulness, and Mindfulness-Based Cognitive Therapy. There’s actually encouraging evidence that Mindfulness-Based Cognitive Therapy is superior to standard antidepressant drug treatment to prevent depression relapsing for people who have recurrent major depression. And there’s an emerging practice called Mindfulness-Oriented Recovery Enhancement (MORE), which unites traditional mindfulness meditation with CBT and positive psychology. It specifically aims to reduce addictive behaviour (view research abstract on alcohol and opioids, and chronic pain) and alleviate physical and emotional pain. A webinar was just presented on this new practice.

Music Therapy
Nutritional therapy, like B vitamins and Omega-3 fatty acids to help maintain your mental health and help Schizophrenia.
Another category is the psychedelic drugs like psilocybin, or magic mushrooms. They’ve had fantastic success for people living with chronic PTSD.
Reflexology 
Reiki
Spiritual Healing
Traditional Chinese Medicine
Yoga

I recommend that Art Therapy should join this list, too, because I’ve heard very positive instances of its use. And this week I met a woman on Facebook who found that photography helped her deal with the trauma of rape, and she now runs an art therapy service to help others based on her experience.

Stay tuned: The body of research for mental wellness and complementary and alternative medicine therapies is growing. And I anticipate that the personal relief that people are reporting will be borne out in further research. Unfortunately, the onus is often on the patient to research potential solutions such as these because conventional medical training does not cover complementary and alternative medicine and access to services in society has to be improved within established medical systems.

[34:47] I truly believe this is the biggest opportunity to improve mental wellbeing quickly and on a grand scale.

ABOUT THE MENTAL WELLNESS ECONOMY

So we know that mental wellbeing is a personal and societal affair, and that demand is greater than supply right now. Never before has mental wellbeing been explored, considered, defined and measured in the way that the Global Wellness Institute has done with its special report, “Defining the Mental Wellness Economy,” which you can download at GlobalWellnessInstitute.com [or order a printed copy]. It was published in November 2020, and in it we learn that the business of mental wellbeing in 2019 was $121 billion. For context, the entire global wellness industry is valued at $4.5 trillion. There are 11 sectors within the wellness industry and mental wellbeing is about the same size as the spa economy and the wellness real estate sector.

However, at $121 billion, it’s a fraction of the size of the mega-sector of Healthy Eating, Nutrition & Weight Loss; that’s $702 billion. The biggest sector, by the way, is Personal Care, Beauty and Anti-Aging — all of that comes in at more than $1 trillion. Now, these sectors surely crossover with each other, but this gives a scale of what we’re talking about. It’s important to note that pre-pandemic the global wellness industry size was more than three times the size of the pharmaceutical industry, which indicates a real shift toward wellness and wellbeing.

Now in a few minutes we’re going to hear from Katherine Johnston. She’s co-author of this report [with Ophelia Yeung] and a senior research fellow with the Global Wellness Institute. First, I’d like to share my 3 highlights of this 122-page report.

The most important newsflash that this report delivers in my mind is that for the first time there is an acknowledgement of spirituality — or meaningful beliefs — covered in the wellness industry assessment. Up until this point spirituality has been very elusive within the wellness industry. It’s only come so far as talking about mind-body connection, and it leaves the word “spirit” aside. I suppose maybe spiritual things are considered controversial?

[37:46] The word “spirit” to me is simply an acknowledgement of an active energy that is outside of the physical. It’s a belief system, and those who are religious can be spiritual, though those who are spiritual aren’t necessarily religious for a traditional wisdom faith, such as Christianity or Judaism.

Another exciting assertion in the report is that the mental wellbeing movement is very much a grassroots one being powered by consumers and by professional practitioners. “The need and the passion has sparked innovation and growth in solutions, services and products to help people improve their mental wellbeing,” the report says. “Consumers, practitioners and businesses have led the charge in seeking self-directed alternative solutions outside of the established fields of medicine, psychiatry and psychology. They are bringing centuries-old natural and holistic mental wellness modalities into the mainstream, pushing science into areas where it has not gone before to consider the efficacy of ancient practices and emerging solutions.”

This is mind-body-spirit practices, friends! I hope you can see the great opportunity ahead for this field and whether you are an enthusiast like me or you’re a professional practitioner or someone who is considering getting into holistic wellness, now is the time.

My third pick for a highlight is that this report thoughtfully and thoroughly demystifies and defines mental wellbeing in a down-to-earth way. The Global Wellness Institute has got some super clean, clear graphics that really bring this alive (at left). Starting with this definition, as I said earlier, the Global Wellness Institute defines mental wellness as both a resource and a process. It is dynamic. Mental wellness is an internal resource that helps us think, connect, feel, and function. It is an active process that helps us to build resilience, grow and flourish.”

There are four sections within mental wellness. They are Thinking (our mental dimension); Feeling (our emotional dimension); there’s Connecting, which is our social dimension; and then Functioning, which they call psychological dimension — how do we function in this world?

But they take it a step further; they say mental wellness is multidimensional, holistic and personal: “Mental wellness recognises the integrated and holistic nature of our health and wellbeing. The state of our mind affects our body, and vice versa. Sometimes when circumstances change we need to adopt new practices or strategies to handle stress and prove resilience and deal with adversity.”

There are four main pathways to mental wellness, this report says: Activity and Creativity; Growth and Nourishment; Rest and Rejuvenation; and Connection and Meaning. Isn’t it great to see all of our aspects or dimensions being acknowledged?! So often I find that everything is lumped together, so to see it really parsed out like this is so exciting.

Since this report is very much about sizing the economy of mental wellness they looked at the two of these four pathways that they can actually assess in monetary terms. So everything‘s not represented — it’s actually bigger than the $121 billion that the mental wellness economy was valued at in 2019. They looked only at Growth and Nourishment, and Rest and Rejuvenation. That covers self-help, therapy, coaching, mindfulness, meditation, diet and nutrition and supplements, sleep, mind-body practices, and sensory experiences like Aromatherapy, Sound Therapy, Light Therapy.

[42:40] Of the $121 billion, almost half of it was about Senses, Spaces and Sleep. We’re talking Aromatherapy and sleep aids, for example. The next two, at about $34 billion each were the Self-Improvement category and then the Brain-Boosting Nutraceuticals and Botanicals category. The fourth category, which is dwarfed by all of those yet it’s growing like mad, is the $3 billion Meditation and Mindfulness sector.

INTERVIEW WITH KATHERINE JOHNSTON

And now my special interview with Katherine Johnston, a special researcher to the Global Wellness Institute and the Global Wellness Summit, which is happening in Boston in November and, for the first time, will have an option to attend virtually.

[43:38] Host Liza Horan: Hi Katherine, welcome to The Mindstream Podcast!

Guest Katherine Johnston: Thanks!

Host Liza Horan:  I consider this a landmark report. Would you agree?

Guest Katherine Johnston: This is the first time we’ve covered this topic and, as far as I know, the first time anyone has covered this topic quite in this way. The term “mental wellness” swirls around out there. People talk about it in the wellness world, but it’s never been really understood what it is or clearly defined so that’s what we saw as our job is — to really take a comprehensive look at it and just try to define it for the first time, so that everyone is using the same language and kind of understanding what it is that were talking about, and what falls in the realm of mental wellness. So it was a daunting task to do that.

Host Liza Horan: It’s a real paradigm switch, I think, to be taking “mental health” and framing it as “mental wellness.” Can you just talk about how meaningful the shift is, pulling it out of the dark corner of taboo calling it mental health and switching it into a positive framing of wellness. And it also suggests, as you say in the report, that it’s a process and it’s a resource. I’d really love to hear your thoughts on the terminology.

Guest Katherine Johnston: Yeah, what’s really important about it is people talk about mental health — and, of course, it’s in the media everywhere now as it should be, especially given Covid, even before Covid; we have so many challenges. But the conversation always tends to get stuck in “mental health,” which is everything from feeling stress to how that leads to falling into depression or falling into a diagnosed or clinical mental disorder. And what we feel is really important to pull out of the work that we did, and we really want to emphasise, is that mental wellness is more than that and separate from that. It’s just as important to be talking about.

There’s a percentage of the population that has a diagnosed disorder or is at risk of having one of those, but that doesn’t mean that everyone else is feeling great. We can parallel that to the physical health field, which is we what we cover in the wellness topic in general; that we have big massive medical healthcare system that’s really broken and [has] unsustainable costs, and there are all these problems with it. But it’s really a sick care system and it’s designed to address: You have an injury you get it taken care of — you’re sick. It’s not a preventive health system, and we don’t do a good job of that. So that’s what wellness in general is all about; it’s saying there are all these things that we can do and should be doing to prevent falling into that system to begin with. So healthy eating and exercise and all that help your lifestyle habits.

Mental wellness is the same. We should not just be stuck saying, “I have depression and it needs to be treated,” but they’re all these behaviours and lifestyle factors that we can actually engage in to help out mental wellness in the same way it helps our physical wellness. So we really wanted to emphasise it’s equally important and it’s a preventive measure that can help us address the mental health crisis that we’re having.

There’s not as much scientific research in that as there is in the physical health field, but it’s there and it’s growing. It’s pretty well established that there are certain practices and lifestyle things that we can do that definitely help address stress, prevent stress and can prevent falling into deeper problems. So we feel that understanding that difference is really important from this report in legitimizing the wellness side of it as something we should be investing in, and it’s worthwhile, and even down the line can reduce costs in other things when you get into the healthcare system.

Host Liza Horan: Absolutely, thank you for explaining that. And it’s really about prevention and instead of reaction.

Guest Katherine Johnston: Yeah, be proactive.

Host Liza Horan: But there’s a lot that you covered that’s about learning about the [mental] system. Just by that statement, “It’s a resource and a process,” gives people hope that, Yes, you can draw on that resource, you can fill it up! And then, “It’s a process.” Processes can change. This is a report of hope. It’s an actionable report.

Guest Katherine Johnston: We’re known for doing numbers, but this report, in particular, is really not about the numbers, but it’s about What is this? and Why should we be focusing on this? The more people who can really dig into that and understand and help promote it the better. We encourage everyone to read it. Even if it takes you a few weeks! Read. Digest.

[48:22] Host Liza Horan: Were you surprised at any of the insights that were revealed by doing the work that led to the report?

Guest Katherine Johnston: Well, I would say, a couple of things. The first is: When we set out to figure out What is mental wellness, How do we explain that this is different from mental health, we had some hypotheses about how we wanted to talk about it but we weren’t sure how much we would find when we actually researched it, other work that people have done that would support that. So we’re actually really pleasantly surprised to find a whole body of literature from the psychology field that explained, in better terms than we could, exactly what we wanted to say. And that this is something that a certain chunk of scientific researchers have been talking about for awhile, but it’s not widely known — even in that field. We conversed [with] and ran a report by a number of people who are versed in [the topic], clinical psychologists, and most of them weren’t even deeply familiar with this particular piece of research that has come from their field just because they are dealing with a different aspect of psychology. So that was the first surprise — that we had a really good body of research to support what we wanted to say.

The second interesting thing that came out to us and really stood out: Our job was to go from the definition to understanding, Okay, if we’re going to help our mental illness, what do we need to do? What’s helpful for that? So we created what we called “pathways” (see graphic), that captures all of the practices and lifestyle habits that have shown to be helpful for mental wellness. And then from there we went into the economy piece. But that pathways graphic is interesting because when you really frame it that way, what we should be doing for our mental wellness is really not any different than for our wellness in general and our physical health.

When people think about, What do I do for mental wellness, Meditation is usually the first thing that comes to mind. There are certain practices that are associated with it, but sometimes we lose track of the fact that maybe eating a healthy diet actually has a greater impact on our stress, on our sleep, on our mental wellness than these other things that have been marketed as helping it. So just the holistic nature of it, and understanding how much all these pieces fit together, I think, was an interesting insight in the end.

[50:37] Host Liza Horan: I’m really encouraged to hear you say that because I think that we often want to put things in a box and we know where they stand then. But in this case, coming from the holistic angle — saying, “Your food can affect you more” — is important for people to understand because you can be doing all the meditation you want, not getting the results you want, and getting more stressed out by it. In fact, there are a couple of stories I’ve seen lately about how, If I’m working on my meditation and being present in the moment, why am I so stressed out?! I think this report speaks to that. Switching over to sizing the economy, what factors did you look at? Was it the sales of products? Was it this legislation? Was it the growth of the workforce? Investment in products? It’s just so vast.

Guest Katherine Johnston: It’s a tricky job to do that. We’ve been doing this work with the Global Wellness Institute for 12 years now. We’ve gotten better at it. We have a lot of research resources we draw upon and we have a lot of experience of figuring out, How can we best estimate this? We can’t go out and ask everybody how much they spend on their mental wellness, so we have to use the best inputs that we can gather and make an informed estimate of the numbers.

In the past in our GWI research, we usually put out reports that are full of lots and lots of numbers, every country gets its own number all broken down. We decided not to do that for this study, partly because it’s just too new and quickly changing of a market even for us to do that. So what we really focused on was putting out some big global numbers; really just first segmenting the economy of it: If we’re measuring spending on mental wellness, what are we spending money on? So we came up with the four sectors that we present in the report. We have Meditation and Mindfulness, Self-Improvement, Brain-Boosting Nutraceuticals and Botanicals, and then Senses, Spaces and Sleep. It took us, like, half a year just to even figure out those categories.

Host Liza Horan: I believe it!

Guest Katherine Johnston: Because a lot of the measurement depends on you define it, and defining it can be very hard. Each segment is measured a little bit differently. Just to give you an example: For meditation, a lot of people meditate, but not everybody spends money on it, so we have to recognise that to begin with. The practice of it is different than the economy of it.

[53:04] In terms of the spending: There are different parameters we can use to measure that We have access to databases of all kinds of numbers on consumer expenditures that we use. For example, one proxy benchmark for us would be how much money people spend on yoga across different countries because a lot of people come to meditation through yoga. People who have the means and the time and the interest to do one activity are going to be more likely to spend money on the other. And so that’s the type of comparison we make when we’re doing the estimates, to say, Okay, what’s a good representation of a spending pattern for a consumer, and how does that inform measuring this other thing? Each segment’s a little different.

Host Liza Horan: What you’ve done with this report is put a stake in the ground. You say, Okay, we’re going to start with our own definitions, tell you the context. It’s a new space to be defined — that’s great. So what I do with Mindstream is: I’m attempting to throw a lasso around the herd of cats that is the mind-body-spirit scene. To define that it’s complementary and alternative medicine, natural health, spiritual growth disciplines, and personal development. And, I tell you, I’ve been beating my head against a brick wall since 2017 as I’ve been trying to size the economy — even in the U.K., because I live in Edinburgh, Scotland. And looked in the U.S., and it’s remarkable that it’s so hard to get numbers.

First of all, these are largely unregulated areas — some are self-regulated areas — and so the authorities that I think I’m going to [get figures] are things like the Reiki associations; plural because there are many of them.

[54:54] And in the U.K. there are two bodies that are professional registries to carry out Parliament’s oversight basically to make sure that consumer rights are protected. I spoke to the head of the Complementary and Natural Health Council (CNHC). And I said, “I’m trying to get some numbers. For instance, how many Reiki professionals are in the U.K.? Is this number growing at all? Do we know anything about participation? Do we have anything on the economy?”

And you know what she said? She said, “We have asked those two leading associations and they refuse to give us any numbers because they’re in such tight competition.” And so, how do any of these cottage industries — as large and as fast-growing as they are — expect to get attention or money from the public, and respect from society-at-large if they cannot bring together their voices to be heard? That’s part of the fire that I’ve got under Mindstream, is to make sense of this landscape to the public, to society-at-large, and to help the professional practitioners because some of these areas are still kind of shrouded in the shade: That’s woo-woo! That’s nonsense! There’s no evidence for that!

I love pointing to the Global Wellness Institute’s work because you do go into certain areas, especially around natural health; this mental wellness is a large part of it.

I just did a search in the report for the word “spirit,” because mind-body-spirit is holistic. A lot of professionals in this realm talk about the “mind-body” connection; they’re still not really comfortable talking about “spirit” unless they’re in that niche.

As you were doing the research, as you put this report together, where does this whole secular versus spiritual aspect live? For example, is it completely based on the individual? Because I’ve seen the evidence about meditation, and anybody who does meditation improves whatever their state was; if it was anxiety or depression, whatever. But if they do spiritual meditation the effects last longer or the effects are greater. What I’m led to believe is that it’s based on what the individual feels comfortable with. My question to you is, how much of this kind of spiritual area that may not have clinical evidence behind it, how much did that figure into mental wellness?

[57:48] Guest Katherine Johnston: It actually has a huge role. That was actually one of the more surprising and interesting pieces of this research — is digging into that and figuring out how that piece fits in here. I think we put it in the Appendix in the report, but we did a big sort of history and background on a lot of these mental wellness practices, and one of the big findings that we highlighted is that there are very deep spiritual roots to every single one of these practices.

When you go back thousands of years, where does meditation come from? It’s a spiritual practice. It wasn’t secularised until the 20th century. And the same with other mental wellness practices. So when you look at herbal-based medicines, the use of mind-altering drugs, all these sensory-based healing — like sound healing and colour therapy — every single one of them has a spiritual root historically. But sometimes you go way back, sometimes it’s more recent. It’s been interesting with how these have entered the mainstream and they’ve become familiarised to modern-day consumers that, at some point, most of them did become secularised and they sort of lost that spiritual aspect to it in some way and for some people. Because, like you said, they’re all kind of subjective and personal. All these practices people do in their own way for different purposes — meditation being the best example of that.

There are a million different types of meditation — everything from the very secular mindfulness practices to very spiritually rooted Zen Buddhism. It’s just infinite. And everyone’s going to come to it with a different motivation and what they’re looking for, why they’re doing it, how they practice it.

That’s really important here. You need practices that are going to be meaningful to people and appeal to them to be effective. For some people that might have the spiritual dimension, it might have a Christian, Buddhist, whatever [leaning] … for some people it’s completely atheist and secure, and that’s fine. It’s not to put a value judgement on which one works better, it’s just to recognise that that spiritual aspect is really important for people. It’s part of this. It’s actually something — and again I think we touched on this in the report a little bit — it’s something that the wellness industry is a little bit uncomfortable with is that spiritual side of it and that overlap. But it’s there.

[1:00:01] What’s interesting is when you see things like the trajectory of meditation as it became secularised and when you get push-back from different spiritual communities about that happening in different ways. In India you have people feeling upset with yoga and meditation becoming secularised and pulled away from Hindu tradition and a lot of people don’t like that. Then on the other side, you have Muslims and Christians complaining that if you teach them yoga, it’s anti-God. Every side of the spiritual issue is coming into play here. It’s a little bit controversial, but it’s interesting just to see how that’s changed over time. But I found the history fascinating when we worked on it, and all of the religious roots of all these things. Long-winded answer!

Host Liza Horan: I’m so happy — take all the time you want because what you’re saying is so important and actually recognises the issue that I’m trying to move on. And that is that the holistic

health and wellness does include some spiritual aspect, and we are more than flesh and bone and brain. And people are very hesitant to go on the record about the whole spiritual side so I would say that this report actually legitimises a conversation around spirituality — whatever that means for you; it doesn’t have to mean religion, it doesn’t have to mean acknowledging a “god,” it doesn’t have to be any of that, but it brings it into the wellness conversation in a new significant way.

Guest Katherine Johnston: Yeah, and something else that was interesting [in] the history: The meditation that we know and have secularised has come from the Buddhist tradition, at least what was mostly practiced in the West, but every single religious tradition has a meditative tradition. And it just happens that it was the Buddhist tradition that, you know, kind of became the mainstream version. But I don’t think it needs to be controversial. Meditative traditions are there for you and your traditions and the history of your religion. The same for Judaism. There’s a huge meditative tradition in Judaism.

[1:02:16] Host Liza Horan: Do you equate meditation with prayer when you talk about those formalized religions?

Guest Katherine Johnston: People certainly do. It comes from a prayer tradition. In Judaism and in the Eastern Orthodox tradition, too, there are forms of prayer that were meditative. It’s a way of being still, talking to God, and it’s all linked with prayer in some way when you go to the spiritual roots of it. And for some people it still is, and for some people it’s not. Again, it all overlaps.

I don’t think we want to negate the value of prayer as being a wellness practice for many people. That’s a reality and that’s great if that’s what helps you and it does if you want to meditate in a secular way, that’s fine, too.

Host Liza Horan: Choose your own adventure.

Guest Katherine Johnston: Exactly.

Host Liza Horan: Right now mind-body-spirit — all this holistic stuff — is spread throughout different sectors in GWI’s reports, and I wonder if that’s the kind of thing that getting some attention on mind-body-spirit [could help]. It’s growing exponentially, but it’s a fragmented collection of cottage industries and that leaves open the chance for misunderstanding.

Guest Katherine Johnston: Yeah, it’s tricky! It’s weird because it’s a very fragmented and siloed industry in some ways, but it’s a really holistic topic. In terms of practice, it’s not fragmented — it can’t be. That’s something we grapple with in the research all of the time. And especially with mental illness to say, Okay, how do we even separate out one piece from another?

But when you get into the actual business of it you can’t because, like you said, there’s a whole set of practitioners of Reiki or people teaching meditation that is completely separate from the people over here who are selling sleep services. It’s just a whole different set of expertise and set of businesses, which is fine. I just think that’s the role that GWI and GWS try to play, that is really to be an integrator of those businesses and bring them together because it is important.

But the other phenomenon that’s happening at the same time is that as wellness has become so much more mainstream and understood by consumers that crossover is happening in so many ways, it’s so much less integrated than it used to be. I mean, now you have the gyms, who are offering not just exercise but yoga, meditation, nutrition counseling. There are bigger providers who are trying to integrate those things. Spas have been doing that for a long time in their own way. So that poses other challenges when everyone’s trying to do everything. But it is helpful in the sense that it recognises how integrated these practices are and how holistic they are. I think it’s something that’s really in flux. It’ll be interesting to see how it shakes out.

The challenge for the wellness industry is that the people who really are pure practitioners of these modalities tend to be a little bit protective of the pureness of it: I’ve studied Reiki, I’m an expert in it, and I feel threatened when this gym giant, gym down on the corner, is now offering something that I don’t see as good a version as what I’m offering.

That’s happening right now across the entire wellness industry. And some of the things that were touched on in the GWS Trends report: You have Hollywood, Netflix and big media taking up wellness and offering it through these very huge, accessible live streams and streaming channels, all these things — and that’s a threat to the industry but it’s also a boon because you’re opening it up to so many more consumers who would not have come to these practices otherwise.

So it’s a challenge as an industry grows and something becomes more popular. I think that’s just a natural evolution that’s going to happen. But it’s not easy.

Host Liza Horan: And that’s the Yin and the Yang of it, isn’t it?! 

Guest Katherine Johnston: Yeah.

Host Liza Horan: Do you feel the mind, body and spirit are connected, Katherine?

[1:06:30] Guest Katherine Johnston: Absolutely. If you’re researching wellness either as an industry or as a practice, there’s no question that you have to bring those pieces together and we can’t be well without hitting all those buttons. So definitely essential.

Host Liza Horan: This was the first report. Do you anticipate this being every couple of years or every year?

Guest Katherine Johnston: The way we do research at GWI is we tend to put out every couple of years what we call the Global Wellness Economy Monitor, which looks at all of the industries and sectors within wellness and we do updated numbers. The likelihood is that we will be coming back to this topic because we’re going to be doing a new version of the Monitor with updated numbers and so we will update the Mental Wellness [economy] number and, in a short chapter, touch on it briefly. And we’ll be covering all the sectors that we research, so that will include Physical Activity and Spas and Wellness Tourism and Wellness Real Estate, all of those areas.

Host Liza Horan: Great! Thank you so much. I really appreciate your time and this enormous, amazing report you’ve done. You’ve been working there for 12 years, so thank you for all of it.

Guest Katherine Johnston: Glad you enjoyed it! Thanks.

Host Liza Horan: So how do we move forward? The Global Wellness Institute says the effort to improve global mental wellbeing needs to happen on three levels: the individual, the community environment, and the macro system or government.

[1:08:04] We’ve heard about some great developments happening at the society level, but on a personal level improved mental wellbeing begins with us. We can all start by listening to our thoughts and feelings throughout the day, every day, and slowly learning what helps or hinders us. If we can quiet ourselves enough to better understand the signals our mind, body and spirit are sending us, we’ll then be able to respond. And that’s where my mind-body-spirit practices can help.

So where does self-care end and medical treatment begin?

To me it’s like the sea. Picture the waterline: Coping with life is swimming and keeping our head above water. Sometimes a wave might crash over our head and other times a swell will lift us higher.

This is life happening — rolling with the ups and downs.

And within a few feet of the surface we can probably maintain a healthy position for most of the time. And if you want to get higher, maybe surf or waterski, we can tap into our inner resources and learn how to do it through books or videos or take lessons. To me, this is akin to enlisting a life coach, who can help us work toward a goal or establish a new healthy habit.

But when seas are rough and the struggle to stay afloat is too much, a lifeguard’s assistance may be required. To me, that’s a certified therapist.

However, if we feel we’re sinking below the surface — being pulled down too deep or too often or both — then it becomes a job for a rescue diver …  someone like the Coast Guard or the RNLI. And, to me, that means a licensed medical professional: a psychologist, a psychiatrist, a doctor.

This is just my take. Does it strike a chord with you?

It’s been said that our mental wellness is a matter of nature and nurture; a combination of genetics, personality, environment, and circumstances.

One could say that the health threat of Covid-19 has actually been a powerful catalyst toward understanding how our bodies and minds work, and identifying our needs to cope and feel good.

And that’s a dynamic journey — not a fixed destination.

Part of being human is having a wide range of emotions. That’s only natural. And like any belief we hold or any behaviour we practice, if it starts inhibiting you, it could be time to research options for support. We have nothing to lose and everything to gain.

I truly believe the big opportunity to shift this global mental health crisis to one of improved mental wellbeing for all is about the discovery and adoption of mind-body-spirit practices.

The continuum of mental wellbeing — from disorder to thriving — affects our physical health and vice versa. The holistic approaches of complementary and alternative medicine, natural health, and spiritual growth disciplines can be gateways to greater wellbeing. Most of these modalities are safer, more accessible, more sustainable, and more affordable than pharmaceutical treatments. But don’t take my word for it: Visit MindstreamConnect.com/mentalwellbeing to see the sources of all the facts presented in this episode and to learn even more.

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The Mindstream Podcast is put on by MindstreamConnect.com. Thank you for listening.
This is Liza Horan, signing off with love and light.

[1:13:03] Music.

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