The Sad Fish

If you’ve read along with my blogs over the last year you will already be familiar with the “fish in the dirty river” analogy* – a narrative my clients and I use to reframe their struggles and plan change.

In the fish-in-river analogy there is a sick fish. The fish has diseased and slimy scales and sores, rotten fins, and its insides feel bad. There aren’t really any other fish to hang out with because all the fish-friends are hiding in corners where the water doesn’t move so fast (and sting their scales with pollution). There’s also no shelter – what with all the river weeds being dead – so it’s hard to feel safe.

If we scoop up this unhappy fish and pop it into a huge tank full of clean water with a great filter and lots of healthy weeds and fish medicine and fresh food and room to swim and other fish to learn fishy skills from, our friend will eventually get better and start feeling shiny and sprightly and hungry and sociable again.

But if we put our fish back in the dirty river… what happens? You don’t need me to tell you that the fish will eventually get sick again, but I will, because the point is worth emphasing.

The fish-in-river analogy points to the ways in which our personal struggles can sometimes get mis-identified as our fault. If you’re trying to fix a relationship that isn’t a good fit with personal medicine like yoga and therapy, you might be trying in the wrong direction. I think we can all agree that trying is still important. The trouble is that we can get stuck in a whirlwind of fixing and scheming and planning that gets us even more stuck. Perhaps it’s worth putting down the struggle for a minute to get some perspective. Perhaps trying in a different way might be helpful?

What might ‘trying in a different way’ mean, though?

For us humans there’s a limit to how much we can benefit from self-care if the structures in our life are unhealthy: Saunas, good sleep, practices like yoga or meditation, sweaty exercise, herbs, and appropriate medications are great – but if you’re underpaid, overworked and in a shitty relationship all the forest bathing in the world isn’t likely to meaningfully improve your mental health. If we go back to our analogy – not only does our healthy fish returned to its toxic river get sick again, but it will also never be able to get so well that it can stay healthy in a sick environment. Like the sick fish, if the structures in our life aren’t supportive of us being well, then ‘more yoga’ isn’t the answer. Without structural change it’s going to be difficult for anyone’s mental health to really improve.

But structural change is HARD!! Changing jobs, leaving established relationships, joining a union to work for equitable pay and conditions? HARD! And trying to make these changes happen from a place where you’re already feeling like your fishy scales are slimy and you’ve been swimming through murk for too long is even harder.

So, let’s look to a couple of helpful and cool alternative perspectives from the mental health field:

  • The Circle of Control, and
  • The Bio-Psycho-Social Model

The Circle of Control

Our mental health really is impacted by our resources and skills. People enduring social and economic inequality experience poorer mental health outcomes that those with more resources. Adults with lived experience of being badly parented or poverty are dealt a vastly different quality of ‘river’ than someone who grew up with safe parents and material comforts. In fact, one of the biggest ever studies about human wellbeing is about exactly this (it’s called the ACE study, and you can read about it here). This unfairness can be genuinely difficult to come to terms with – perhaps because it makes us feel powerless and a lack of personal agency naturally makes us more vulnerable to being insecure and angry. And, let’s face it, there’s a lot to feel powerless about in our world (hello, climate change).

There is a limit to the impact we can have on some of the things that make our river water sick. We can vote, we can protest, we can volunteer, but no one can single-handedly fix The Environment. In order not to become defeated before we start the first thing we need is a realistic understanding of the limits of our influence: A fish can’t pull an old car battery out of the river – but it might be able to swim upstream a little away from the battery acid.

In the “circle of control” model, there’s an acknowledgement that there are things we don’t really have any agency over: What other people think, how much money I have this week, natural disasters. But there are other things we DO have the ability to change: The effort I put into trying to be kinder to myself, whether I start looking for a new job, or if I make some calls to make sure the money I do have to spend and save isn’t supporting fossil fuel projects.

If we can identify ways that we can make an impact rather than only raging against what we can’t, then we can use our energy in ways that let us keep to turning up for ourselves and those we care about. In fact, this was the original meaning of ‘self-care’: Activists in the American civil rights movement got together to open free medical clinics in disenfranchised communities so that people could stay well enough to continue the fight to make social change. This is as true for personal change as it is for the big stuff. You probably can’t single-handedly change a horrible corporate environment, but you can definitely update your resume, set up a job vacancies alert, (and read a book about conflict management).

For each of us there is a balance: There are some things that we genuinely can’t change. Some things will remain unfair. These need our compassion and patience (and sometimes our fierce compassion). But there are things we can change with genuine courage, effort, and time. The funny thing is that some of the things that we can change can also impact the things we can’t. Things we CAN change that might eventually shift the things we can’t include:

  • Learning to set boundaries – for example with a family member when the unconscious ‘agreements’ in your relationship impact your ability to be well.
  • Putting practical steps in place to give you options in a too-complicated relationship (like learning self-compassion skills or exploring your values) even though it’s too painful to think about breaking up right now.
  • Learning some sensory modulation tactics to help quit things that we don’t like doing but are finding hard to stop (because they serve a deeper need – like stress or symptom reduction).
  • Troubleshooting what’s getting in the way of the ‘small’ hard stuff like eating more veggies, applying for new jobs, or making a choice to re-train for a new role.

When a client and I talk through the fish-in-river analogy, it’s a starting point for unpacking their experience, but it’s also an acknowledgement that real-world issues impact the quality of the inner-life we lead. But so does perspective and a sense of control. If your river is looking toxic, then what parts of it can we clean up? How much effort and support will each of those changes need? What skills, resources or help will be important? What don’t we know, but think we can find out?

Some parts of our experience probably can’t be changed – no matter how hard we work at it we can’t make a different past – but we are likely to be able to find a new skill or approach that can help us mourn, release, reframe or deal differently with those parts of the toxic river that we can’t shift. We can almost always find ways to go forward better skilled and better supported. With less energy lost to raging alone about a part of the landscape we just can’t alter.

Once we’ve identified the things we can and can’t control, it’s time to plan a way to take the energy we’ve now released from hopeless fretting and figure out what to do with it. This is where our second model comes in handy:

The Biopsychosocial Model

Head to for more of this lovely visual content – not an affiliate, just a plug for a cool website.

In 1977 George Engel described something he called the bio-psycho-social model of wellbeing. This is exactly what it seems to be – a model for understanding health that embraces physical (bio), psychological (psycho) and social or cultural (social) health. Like the Circle of Control model, it acknowledges that the structures that form our everyday life meaningfully impact our wellbeing. It’s an idea so simple it seems obvious, but it’s something that our culture seems to be re-discovering over and over.

In the Bio-Psycho-Social model:

  • Your biological health includes your basic physical wellness, as well as all the stuff that we don’t think about a lot: Is your gut okay? What are you allergic to? Do you take meds? What kind, and what are the side effects? When did you last have them reviewed? What’s your natural, inborn temperament? Do you have a neurodifference? Issues with your hormones or reproductive health? This also includes things like genetic vulnerabilities and whether you live with physical disability.
  • Your psychological health includes obvious stuff like “big” diagnoses (like bipolar disorder or schizophrenia), as well as whether you’ve grown up in an environment where you got taught to regulate your emotions or how to self soothe, or if you will need to deliberately learn those things. Psychological health embraces the psychological impacts of developmental family relationships, as well as overwhelming experience of all kinds including trauma, loss, and grief (including for things we lost slowly, or may need to mourn in an ongoing way).
  • Your social health includes your current family/ loved one circumstances, your ‘loose ties’ to your community such as whether you belong to a club, know your neighbours, have casual chats at a local café, or participate in regular community events – people to chat to but not necessarily share intimate things with. Social health includes your involvement in work, study, or other social activity, as well as what limits interactions. It includes peer groups, friendships, and neighbourhoods. Cultural needs and expectations fit into this category. Do you attend a mosque? Or perhaps as an atheist you feel kind of lonely during celebrations the religious parts of your community participate in.
  • Personally, I think of these three overlapping domains as being encircled by the huge structural things we all live within, although not equally: Can you access mental health care in a timely manner? What’s your local school system like? Do you experience racist microaggressions as a part of everyday life?

And then, of course, they all cross over: The medication you take may impact both your mental and social health – for example if side effects make you drowsy – as well as your physical health – if your meds lead to changes in your body. Your social health is likely to impact your mental health if you’re feeling isolated in a new place, while your physical health or disability may influence how you connect with meaningful social activities. Your experience of gender (a bio/social/cultural tangle) will intersect with your social and psychological life in complex ways.

A Small Experiment:

Try getting a piece of paper and diagramming your own experience. This can be a helpful way to get a sense of what your river looks like. Draw three overlapping circles (like in the picture above) and write down anything you notice about yourself that fits into each of the domains of “bio”, “psycho” and “social”. This might be listing the meds you have to take in “biological”, or “emotions feel out of control” in “psychological”. Notice where these cross over and write impacts there. This might be that your meds make you shaky and this makes you embarrassed in the crossover between all three circles because your psychological medication has physical side effects that affect your social confidence. There’s really no way to do this wrong (it’s just a thinking experiment).

Now get a highlighter and pick out what’s fouling up your river the most. Where are you stuck? What might you like to change? Can you do it alone? What’s the smallest step you could take in the direction of change? Will you need support? Where might you find the backup or advice you need? Would calling a relevant helpline or finding a service to give you information help?

Now notice what you really can’t change (at least for now). The places you’re so jammed stuck you’d need an earthquake to shift things. These are currently outside your ‘circle of control’. If you genuinely can’t change it, can you focus your energy somewhere else for a while? Just let this thing percolate and gather new information? What if you sat with not being able to change it just got brave enough to let yourself feel how shitty that feels, without trying to problem solve? What if you offered your feelings some friendly attention about the thing that you can’t change? Just acknowledge that you don’t know what to do and it makes you feel bad. Like Psychologist Carl Rogers said – “The curious paradox is that when I accept myself just as I am, then I can change.” Accepting what’s in your control (and what is not) can be powerful. It can certainly free up energy and soften brittle places.

Now do one thing you can do. Just one. Tomorrow do another – especially if that thing is to do a self-compassion practice about one of the things you can’t change.

Think of this doodling, brainstorming exercise as like making a map of your river – a map that includes your body, your mind, and the circumstances of your life – because when it comes to mental health all of them matter.  And while a map isn’t the solution, it’s a useful way to identify what parts of the river are clogged, and where your precious and important energy will have the most impact.

What changes, and most importantly what abandonment of fruitless effort, will help your river to run clear?

*Note: this fish-in-river analogy is definitely not my original idea – it’s borrowed from somewhere – but as I can’t remember where I’ll hope that someone has read the same books as me and can write in and tell me!