Social Health is Health!
On healing while carrying the whole human project on our backs.
In a desperate attempt not to miss an entire month of posting to my Substack community, I’m writing and publishing this on the last day of October, in the couple of hours before yet another road trip. I feel like my routine lately is to have no routine. I am traveling around, making memories with friends and family as if my survival depends on it. Which, according to a new book by Kasey Killam, MPH, it quite literally does.
Killam argues that social health is more than just a derivative or component of mental health; it’s a third pillar of health in its own right. If physical health concerns the body, and mental health concerns our thoughts and feelings, then social health is all about our relationships. Specifically, social health is how we subjectively rate the quality of our relationships. Not just the one-on-one relationships with the important people in our lives, but also our sense of belonging in our neighborhood and communities.
Something clicked into place while reading Killam’s book. Remember when I wrote previously about a definition of recovery from chronic illness or disability that hinged on habilitation, or regaining the ability to function in society?
I have had to construct a new social self through facing a seizure disorder and then sudden cardiac arrest and heart failure. My epilepsy diagnosis in 2018 undercut and eventually destroyed my role in society up to that point. In many ways, I was at the pinnacle of my social health at the age of 34. I ran a successful business, the ultimate badge of honor in our meritocracy. I’d built a community of hundreds of clients whose lives I followed closely through our regularly-scheduled appointments. I watched children grow up and parents die, and my clients and I supported each other through it all. I also had deep professional relationships, having spent 10 years in an industry where I felt seen and heard—where I stood for something. My identity was intertwined with that brand and professional persona in ways that would take years to disentangle and sort through after it ended. I also had a budding and happy new romantic relationship, having done therapy and lots of deep work to leave some unhealthier romances in the past. It took years to understand that I lost something just as vital as my physical health, when the seizures started: my social health. In having to remake my entire career and many relationships around accommodating a permanent, mysterious disorder, all three pillars of health started crumbling at the same time.
If there is to be a recovery not from, but amidst, chronic illness and disability, it depends on building back all three pillars. I knew that I had to attend to my physical and mental health, and I consulted doctors and therapists from my first unexplained seizure. I did not, until recently, understand how distinct social health is, and that it requires its own dedicated treatment plan.
After finishing Killam’s book and thinking about what optimal social health would look like for me, I realized that I’ve already made great progress. Here are some starter questions she suggests in a Psychology Today article to help analyze your social health:
Have I been feeling more connected or lonely recently?
Is there someone I can reach out to for support when I need it?
Which relationships do I value the most?
What kinds of interactions energize me and what kinds drain me?
What communities are important to me?
As early as six months after surviving sudden cardiac arrest (SCA), my heart made astounding progress. I still suffer from mild and occasional PTSD, but symptoms had become much less disruptive about a year after my near-death (temporary death?) experience. Yet despite all this progress, I felt terrible. I took a break from my career after making it through the first six months post-SCA working full-time because…well, I wasn’t sure why, at first. I figured I needed a break for my mental health, but therapy wasn’t as helpful as it had been with other issues in the past. And besides complex PTSD, I didn't have any disabling mental health diagnosis to treat.
Some part of me knew the problem, though. It’s telling how I spent my time in the past year, while hitting pause at work. I have been nearly 100% focused on building new connections and/or lavishing attention on the closest connections I already have. My biggest source of pain since my cardiac arrest has been a lack of perceived community, and I tried venturing outside my comfort zone (going on large hiking group meetups, attending local religious groups, and stepping up my volunteering) in an effort to fill what was beginning to seem like a gaping hole in my life. After a lifetime of putting career first, it took peeling that component away for a few months to reveal the heartbreak of losing my built community and social self. I had run away to the valley during a pandemic, made few friends, and settled for fully virtual coworkers. There was one major social gain—a supportive and wonderful husband—but in every other way, I’d taken a major step down.
This step down came at a particularly bad time, too, just as I was making meaning of my “first life” and writing my memoir. The entire thesis of that work is that I am more than an individual, inextricably connected to my community and to the entirety of existence—something I felt so keenly and cosmically after my brush with death.
In a recent episode of Pulling the Thread, James Hollis, PhD said it this way:
I am carrying the whole of the human project; I am not exempt from this and therefore have to look at my anger, my issues of power, my issues of jealousy. To the degree I can address those things, I’m doing a great contribution to our society, because I’m lifting them off of my children, off of my partner, and off of my neighbor.
I feel this heavy load since my cardiac arrest. I carry it every day. The weight of my connectedness means having to build up whole new social muscles to thrive. It’s been self-evident to me that this new shot at life I was given—given by other human beings who fought for me, many of them strangers—is about giving back in some way. The trick has been to figure out how. Ploughing along as a federal change consultant wasn’t doing it, not completely. So I took a break. I put relationship (be it praying together, hiking together, or volunteering together) ahead of profit or status and I took on some unpaid and very low-paid mental health side gigs to lend my support to the whole human project. Meanwhile, I continue to tend to my physical and mental health in an effort to be a bright light and not a drain on our society.
[Side note: I am mind-blowingly privileged to be able to do this with the support of my husband. Truthfully, we talk about the past year as something we did to give back, because everything we accomplish these days truly is a team effort. He works, at least in part, so I can do meaningful work that helps our community but won’t pay our bills. Most do not have this financial opportunity—indeed, at no other point in my life did I have the ability to set income potential aside as a factor! It’s a credit to Chris that he was happy to contribute in this way as opposed to living the blissful Dual Income No Kids life we so enjoyed previously.]
It took a while, but I’m learning to habilitate. It’s been the hardest part of the project of recovery but the most meaningful. I still have moments of intense grief and abhorrence for what’s happened to me, the unfairness of my past. What holds me here through those moments is and will always be my relationships. As a fellow cardiac survivor said a couple weeks ago: “I’m willing to live a lot of shitty feelings to be there for [those I love].” (Credit to the wise Joe Fisher!)
I can finally say, one year and eight months after that fateful day in my home office that upended all my plans, that I’m ready to make new plans. I used to be a person who was decisive to a fault. I told fellow students in my last grad school cohort that I learn by jumping off cliffs. Lately, I’ve dealt with a lot of analysis paralysis about what to commit to next. What if the hand of God smites me again just for trying to tackle a new project?! What if I stress myself out and my body straight up rebels? What if I have another health crisis but don’t recover as easily, leaving an even bigger mess for Chris to deal with?
These fears probably will not go away anytime soon. And meanwhile, I’m standing here like a ticking time bomb, helping carry the human project and desperately wanting to move it forward an inch. A millimeter. Something.
So I don’t jump off a cliff, exactly. But I do tip toe into a new future.
Instead of waiting for myself to resolutely decide, something I realize might never happen again, I’m opening doors…and then letting the universe take the wheel. I applied to grad schools in counseling with the hope of becoming a therapist. As of yesterday, I accepted WVU’s M.S. in Clinical Mental Health Counseling program. Meanwhile, I apply to the occasional full-time job that looks like it would support my continued emphasis on a full life spent prioritizing my personal relationships, involvement in community, and lots and lots of physical activity. I finish my yoga teacher certificate, with a mind to build a new community some day around one of my favorite pastimes. I tip toe like this, not sure how any of it will go or what new information will rise to the surface a month or a year from now. I keep hiking and journaling. I trust that when the time is right, I’ll be able to recognize the commitments that are worth making. Come what may.
When I’m really feeling the weight of recovery or PTSD or the human condition, and I want to hole up at home and bake three cakes in a row instead of facing another person—I go play pickelball anyway. I call into a support group anyway. I drive the six hours to my extended family’s farm anyway. I facilitate my domestic violence groups anyway. And I show up.
I have next to no control over my outcomes. I know you don’t like to hear that, but I’m sorry, as someone whose heart stopped one day out of the blue and has received no meaningful diagnosis to explain why my body sometimes shakes and loses consciousness—I live in the full knowledge every moment of every day how little is up to me. That is the true essence of the human condition that I carry. My job is just to show up for it. So that’s what I intend, and strive, to do.