Mental health and mental illness are on a continuum but are also different.
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Who is mentally ill? Who is not? Why draw a distinction?
In recent decades, there has been a movement away from conceptualising mental health and mental illness as dichotomous, and a movement toward seeing them as points on a continuum. We are all somewhere on this spectrum.
In parallel with this, the idea of ”diagnosis” has been maintained, drawing a distinction between people at one end of the spectrum and those at the other, between people who have good mental health at the moment and those who have mental illness.
In other words, we are all on a continuum of mental health and illness, but there is a point of diagnosis somewhere along the spectrum. Diagnosis is a complex.
It is important that diagnostic systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) are used with care, humility, and flexibility, if at all. The person always comes first. The individual’s story is far more important than any diagnostic category.
Medicalising Unhappiness With the Language of Psychiatry
Today, there is an undeniable tendency to medicalise unhappiness, as people reach for the language of psychiatry to describe everyday sadness and upset. This is a pity. Psychiatric treatments are at their most effective toward the mental illness end of the spectrum.
For people who are distressed but closer to the mental health end, different interventions are more appropriate: changes in diet, more or different exercise, various lifestyle measures, and social supports. There is no benefit in diagnosing such people as “mentally ill.”
What Does This Mean in Practice?
Drawing a distinction between mental illness and mental wellness has many implications in day-to-day life.
First, public discussions about mental health and illness are more useful when they recognise a distinction between the psychological distresses of everyday life (such as feeling upset after a relationship ends) and serious mental illness (such as schizophrenia). Although debilitating, the former are unlikely to be helped by applying a psychiatric framework and might even be worsened.
Excessive psychiatric diagnoses medicalise unhappiness, disempower people who might otherwise develop better solutions to their problems, and detract from the issues faced by people with serious mental illness. Nobody wins. We need to distinguish better between problems of living and mental illness.
Second, we need to rethink the language used in psychiatric services to better reflect what we actually do. The distinction between “mental health” and “mental illness” is important. Changing your diet, taking more exercise, and improving your lifestyle can help to resolve many psychological issues, but more is usually needed for serious mental illness.
As a psychiatrist, I find that people who come to see me often feel that they have failed. They have the impression that they simply have not tried hard enough to solve their own problems. Maybe if they had eaten more broccoli, done more jogging, or signed up for more mindfulness courses they could have made themselves better? If they had just tried harder, perhaps they would not need to see a psychiatrist, attend psychological therapy, or take medication?
Broccoli, jogging, and mindfulness are all good things. They help us through many difficulties in our lives and help prevent many others, but they are not the solution to everything. Serious mental illness generally requires more.
This might mean seeing a mental health professional. It might mean taking part in psychotherapy or social therapies. It might mean taking medication. It might mean all of these things, in various combinations at different times.
The Stigma Wrongly Associated With Mental Illness
This brings us to the third and final point about the distinction between mental health and mental illness: stigma.
Most societies are in deep cultural denial about much serious mental illness. While recent decades have seen a welcome increase in public discussion of depression, anxiety, and certain other conditions, there is still minimal acknowledgment of schizophrenia, bipolar disorder, and severe depression (among other disorders).
This silence perpetuates the stigma that is wrongly associated with mental illness. Stigma can be fatal.
A stigma is a mark of shame or discredit. The stigma wrongly associated with mental illness is generally related to a poor understanding or limited experience of the issues involved.
There is strong evidence that stigma has negative effects on the physical and mental health of people with mental illness. It deters help-seeking behaviour.
This is a preventable tragedy. There are treatments and services that help greatly, but people with mental illness have been the victims of discrimination, exclusion, and neglect for centuries.
These problems persist today. They will continue unless stigma is addressed through honest public dialogue about suffering, treatment, and recovery in serious mental illnesses such as schizophrenia. This needs to happen now.
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