Words By Leigh Anderson
The absence of mental illness such as depression or anxiety does not mean that a person is mentally well and flourishing in life. One thing that has stood out for me as I progress through my career and improve as a paramedic is that mental health and mental illness exist as separate continuums. Becoming aware that to be a good paramedic I must first have good mental wellbeing is paramount.
Mental illness is more concerned with disease; it is a general term that refers to a group of illnesses that significantly affects how a person behaves, thinks, and interacts with the world. It is diagnosed by professionals according to a standardised criterion (1). Types of mental illness include clinical depression, PTSD and anxiety; something as paramedics we are very familiar with. Positive mental health on the other hand is something we do not focus much time on. Mental health is a broader term that incorporates functioning beyond the threshold of clinical syndromes like anxiety and depression (2). Criteria that support good mental health include positive self-esteem, warm and trusting relationships, motivation, and openness to learn from challenges and improve as a person.
Thus, mental health could be considered as a state of successful performance of psychological functions, resulting in productive activities, fulfilling relationships with people, and the ability to adapt to change and cope with stress (2).
When I was a student, I was constantly advised by the ‘good’ mentors to avoid the cynical or pessimistic paramedic as they will inevitably drag you down and you will get caught in their collective rumination. I have come to define these paramedics as languishing. From my observation, the languishing paramedic has become more common than we are comfortable to admit.
Languishing may be conceived of as emptiness and stagnation, describing those who are languishing as not mentally ill, but having little signs of health and positivity (3). Languishing paramedics are the ones who are there in body but not in mind. They can function and complete their tasks, but not with a high level of effectiveness or with high satisfaction. They turn up to work on time, however usually a minute before the start of their shift, and they can function well enough to get by, but that’s it. Languishing is not mental illness, but rather, a state where you feel aimless (3).
Elaborating on this, a paramedic who lacks motivation to do their job, is impatient, is poorly engaged, dispassionate about their work, and will lean towards the negative rather than the positive.
Obviously, we are interested in developing paramedics who instead of exhibiting the negative aspects of languishing; flourish with a sense of direction and meaning towards their work. The positive that we can take from the languishing paramedic is that the majority of people languishing don't need therapy because they don’t have a mental illness; they need support to develop their resourcefulness – to get unstuck. The strategy then should be to have flourishing as our goal and to understand that there is a continuum that extends from suffering, to languishing through to flourishing (4).
A flourishing paramedic is one that is self-accepting. They can form and maintain supportive, warm, and trusting relationships with their patients. They see themselves as becoming a better person. They have a sense of direction or meaning towards the work they are doing. They are able to shape and influence the world around them. They believe that they are in control of what happens, rather than relying on luck or fate.
1. Doll DK. Building Psychological Fitness. Karen DeCasare Doll; 2021.
2. Magyar JL, Keyes CLM. Defining, measuring, and applying subjective well-being. In: Positive psychological assessment: A handbook of models and measures (2nd ed). Washington: American Psychological Association; 2019. p. 389–415.
3. Keyes CLM. The mental health continuum: from languishing to flourishing in life. J Health Soc Behav [Internet]. 2002;43(2):207–22. Available from: http://dx.doi.org/10.2307/3090197
4. Keyes CLM, Grzywacz JG. Health as a complete state: the added value in work performance and healthcare costs. J Occup Environ Med [Internet]. 2005;47(5):523–32. Available from: http://dx.doi.org/10.1097/01.jom.0000161737.21198.3a