What is Mental Illness?

What is mental illness, a mental disorder, insanity, or any of the other terms often used to indicate a problem with the mind?  In college, student’s often take a class in “abnormal psychology” to learn about the disorders of the mind.  So does mental illness mean anything that is not “normal” in the mind or psyche?  It would be a simple definition, but it is a bit more complicated than that, and there has been much debate through the years over what criteria should be required to define mental illness. However, the widely accepted definition of mental illness actually does begin with a discussion of what is considered “normal” in a society or culture.

Just like our heart, lungs, kidneys, or any other part of the body can stop functioning they way it was designed to, or have a life long disorder, so can the brain.  However, when the brain doesn’t function properly (or has a disorder/illness), the signs and symptoms of the illness often manifest as thinking, feeling, or acting in a way that is often not considered normal by society.  This also partially explains why there is so much stigma associated with mental illness.

A whole chapter could be written on how a society, or culture, determines what is considered normal. If you are interested in how a society decides on it’s norms, pick up any sociology textbook, and the first chapter will usually contain in depth information on this topic. For this discussion, we will simply say that a society’s norms are defined as: what each society views as acceptable behavior.  Keep in mind that norms can vary, sometimes drastically, by each culture. Each culture has it’s own set of shared beliefs, that guide the majority of people from that culture, on everything from how to appropriately interact with others, value systems, and right versus wrong.  Anything falling outside the decided on standards of acceptable behavior is viewed as abnormal. So this ties back into our earlier statement, that said “the signs and symptoms of mental illness often manifest in ways of thinking, feeling, or acting that are considered abnormal”.  So we can see how a person suffering with mental illness can easily be stigmatized, and looked down upon by a society.

So how does our society, and the medical community, determine what is considered to be “normal behavior” vs. a mental illness.  Let me provide some examples to consider:

Cindy’s mother passed away about a month ago.  She is still very sad and finds herself crying many times during the day.  She has declined invitations from her friends to have coffee, and often ignores phone calls.  She is normally very well kept, but hasn’t showered in a couple days.  She doesn’t feel like eating and has difficulty getting to sleep at night.  Is Cindy simply grieving over the loss of her mother, as many people would, or is she becoming clinically depressed?  At what point would this person be given a diagnosis of depression, and prescribed an antidepressant medication?

John is a businessman who has recently been promoted.  His new promotion has required him to make several trips back and forth from New York to London over the past few months.  He has been starting to feel very fatigued, agitated, and has trouble sleeping.  Is John experiencing a normal case of jet lag? Or should John be diagnosed with, and require treatment for, what the medical community calls Desynchronosis?  Desynchronosis is defined as a sleep disorder arising from alterations in the body’s circadian rhythm.

Olga is an elderly Latino lady who recently lost her husband.  She believes that she can still communicate with her husband who has passed.  She is not distressed about this and is physically healthy. It is also common in her culture to believe that a person can still communicate with loved one’s who have died.  Should Olga be diagnosed with a thought disorder and be given an anti-psychotic medication?  Or should the healthcare provider understand this is a cultural belief and hold off on prescribing any medication for Olga?

A doctor is examining a child who’s family has recently immigrated to the U.S. from an Asian country.  The doctor notices that the child has several unusual bruises on his chest.  In some Asian cultures, there are a couple of folk remedies called cupping and coining.  Coining is performed by vigorously rubbing a coin on the body.  The bruising caused is believed to help the person heal.  Cupping is performed by applying a heated cup to the skin, creating a vacuum, to try and pull out the cold that is believed to be causing illness.  Should the doctor report the parents for suspected child abuse?  Or should the doctor ask more about the families culture, and try to incorporate their cultural beliefs into the treatment plan?

So to say that mental illness is only thoughts, feelings, and behaviors that violate societies norms is not enough.  This would imply that if you don’t conform to the belief system of the majority, than you are mentally ill.  This is why their must be other criteria to define mental illness, in addition to abnormalities of thought, feelings, or behavior.  Some of the other criteria used when defining mental illness include: the level of distress the person is feeling, how well the person is functioning, and even statistics.

When we say “level of distress” this involves what the individual is perceiving.  Are any of the individual’s feelings, thoughts, or actions, causing them to feel concerned, anxious, or unhappy?  This criteria can also include distress felt by others.  The person may be acting in a way that is causing distress to their loved one’s, or hurting other people. A common example of a disorder that may cause loved one’s distress, even though the individual person feels there is no problem, is substance use disorder.  The people around a person with substance use disorder, often notice the dysfunction and/or harm being caused, long before the person who is abusing the substances. So this criteria includes distress felt by the individual, and/or those around them. However, generally if a person is happy and content with their life than they do no meet this criteria.

Level of functioning refers to how well a person is able to navigate successfully through normal daily life.  Does the person interact well with others, and have healthy relationships with other people?  Are they able to successfully keep a job? In addition, level of functioning would include the ability to cope with stress, manage money, practice good hygiene, keep themselves safe, live independently, and all other general life skills that enable a person to be a productive member of society.

Statistics have a part in helping to determine how the general population averagely functions, and the prevalence of disorders.  For example, IQ scores and other tests help to determine an individuals level of intellectual functioning, or performance.  The distribution of IQ scores helps to determine what is average for the population.  For example, an average IQ score ranges from 90 to 109.  A score above 130 is considered superior intelligence.  Scores below 71 are usually considered to fall into different categories of mental retardation (Fadam, 2009), or what we now commonly refer to as intellectual disability.  The term “mental retardation” was changed to “intellectual disability” by the Supreme Court. Most of the medical community, along with the majority of our society has followed this change.  This is another example of the stigma associated with mental illness.  The word “retarded” had become to common as a negative connotation, or playground insult, in our society.  Some people can unfortunately be cruel to those who are viewed as different.

So what is mental illness? Mental illnesses are disorders that manifest as changes in personality, behavior, thoughts, and/or feelings that either cause distress and suffering, difficulties coping, problems interacting with others, difficulty functioning independently, poor daily life skills, and/or intellectual disability. There are a wide variety of mental illness that range on a continuum for minor to severe.  The symptoms may include some or all of the criteria we have discussed.

Some mental disorders are caused by obvious trauma or disease, that can be easily pinpointed, such as brain cancer or a traumatic injury to the brain. Some delusional beliefs, or thought disorders, have even been linked to brain lesions.  However, many mental illnesses do not yet have an identified specific cause.  There are theories and studies to support ideas about what may be the cause, but often still nobody knows for sure.  There are often many interrelated influences such as genetics, environment, lifestyle, and trauma, that may play a role in causing some mental disorders.

Mental illness is significant and needs to be treated.  Some illnesses have a more clear biological cause, and others are more mysterious, with only speculated causes for the changes in the mind, mood, or behaviors of the individual. It seems the more we learn about and are able to determine the cause of the illness, the less stigma is attached.  For example, disorders such as Alzheimer’s disease have a clear biological cause. People with Alzheimer’s disease, and their caregivers, receive much sympathy and support, rather than negative attention. While other disorders such as depression, anxiety, bipolar disease, substance use disorders, and the like have less clearly defined causes. It’s easy  too notice these illnesses have much more stigma attached, usually because people are just not able to understand why the person is behaving the way they are.

So the changes that occur in a person, when there is an abnormality associated with the brain, usually impairs the person’s ability to function in a way that is considered “normal” in society.  The person may perceive the world differently.  We must try to realize that when the brain has a disorder it causes changes in the person that are often times beyond their control.  In some cases the person can choose to improve these changes by seeking help, and adhering to treatment programs with medications, therapy, and other treatments, but we should keep in mind that they cannot just wish the symptoms away with shear willpower.  People who have not had a mental illness can sometimes have a difficult time understanding why the mentally ill person can’t just decide to think or act the way they “should”.  In addition, sometimes people are not able to access effective quality mental health treatment.

There is hope.  There are many medications and therapies available today that can improve the mentally ill person’s ability to function and live a better quality of life.  There are also many community programs aimed at self help, and interventions that can help the person become as independent as possible.  In addition, there are hundreds of support groups available, not just for those who have a mental illness, but also for the families and loved ones of someone who is living with a mental disorder. We have come a long way, in our society, in improving mental health treatment.  But we still have improvements to make in this area that would benefit us all.  We all deserve to experience the ability to think rationally, experience joy, interact successfully with others, and live as independently as possible. And those who are struggling with a mental illness deserve the same empathy, and access to treatment, as any other person with an illness.

You have probably heard about some of the most common mental disorders.  The National Alliance on Mental Illness estimates that at least 1 out of 5 adults in the U.S. experience mental illness in a given year (NAMI, 2017).  Maybe you have wondered if you, or someone you care about, is suffering with a mental illness, or just wanted to learn more about it.  My blog postings will provide information about the most common mental illnesses, as well as some less common illnesses that you may not have heard about, and other topics related to mental health.  I will include educational articles, and feature stories from people who are living with mental illness, some who are still struggling, and some who have returned to living happy productive lives. I would love to hear your opinions and ideas if you have any comments. Please remember as we discuss sensitive topics with each other to be nice.  We all have strong opinions at times, so it’s okay to agree to disagree, if need be. However, healthy discussions and debates are welcomed.  I would love to hear how other people feel about each topic.

Please remember any information I post is not meant to be substituted for medical advice from your health care professional.  My articles are written with the hope of shedding light on what are sometimes difficult topics to talk about, providing encouragement, and reducing stigmas.  Stigma is not productive, but rather drives people into the shadows, and often prevents them from seeking treatment.  I believe the more openly these sensitive topics are discussed, the easier it is to reduce stigma, increase empathy, and help to improve mental health treatment.

If you or someone you know is struggling with a possible mental illness, I have posted a list of Helplines . These phone numbers may be able to help you find a starting point for seeking help.  Of course if you are in immediate danger you should dial 911 instead.

 

REFERENCES

NAMI/National Alliance on Mental Illness. (2017). Mental Health by the Numbers.  Retrieved from http://www.nami.org

Fadam, B. (2009). Behavioral Science. (5th ed.). Philadelphia, PA.: Lippincott

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