Mental Illness vs. Mental Health

Humans are experts at taking what we already know and stretching it to solve a new problem or conceptualize things in a new way. Consider the water wheel. Invented by those ingenious, if hedonistic, Romans in the 3rd century B.C. the basic technology of the water wheel is the same fundamental technology that moves aircraft carriers through the water, and moves turbines that create electricity. Take something fast and relatively useless, and convert the energy into something slower and relatively useful...glorious torque. Windmills basically do the same thing. We’ve been doing it for over two thousand years. Let us take a moment to remember the Romans.

This extension of technology applies to lots of stuff. The scientific method itself is based on thousands of years of combined philosophy. We keep stretching our own simple inventions to make them, and by extension, our world, more complex. We solve more problems. We are awesome.

All of my tech friends are really excited right now because they think I’m going to stop talking about booze and drugs and brains and sadness and start talking about technology stuff. Oh how I hate to disappoint. See, we did this same technology overlay thing when we, as a society, started trying to tackle mental illness. At some point in the 19th Century we began to move away from the idea that mental illness was caused by some sort of spiritual failing or demon possession. We began to apply scientific principles to this phenomenon. And the most readily available technology we had available to do this is the same one we’re using today—Medicine. All in all, I’d say it’s a good thing we did this. It’s been way more useful than the holy water-cross brandishing-pray-burn-at-the-stake strategy we were using before.

Treatment of mental illness, a term directly related to this medical model, was still pretty god awful for another century and a half or so, but principles of medicine did allow progress. Using this medical model has some distinct benefits. It has allowed us to categorize symptoms. We have been able to use the scientific method as much as possible to understand natural variations in the human experience. Additionally, we’re beginning to understand the physical underpinnings of human behavior, which has fantastic implications for recovery from mental illness. We’re able to make some objective observations about the subjective human experience. We have data on what treatments work, and what medications may be helpful.

But looking at mental illness this way can lead to a focus on deficits. This makes sense up to a point, but recovery requires the recruitment of all of a person’s strengths. So it makes sense to focus on resources such as family, community, physical health, internal motivations, and for some spirituality among many other strengths unique to each individual. Additionally this deficit-focus fails to acknowledge the inherent strength it takes to survive any length of time with a mental illness. If you’re coping and surviving with voices that tell you to harm yourself yelling at you all day, you’re a badass. Let me say that again. If you’re coping and surviving with severe mental illness YOU ARE A BADASS. Every time you resist the urge to harm yourself in the depths of depression, or you reach out for help one more time, or you try a new antidepressant, or you reluctantly do that mindfulness exercise that your therapist said might be helpful, you are the human embodiment of a badass. But it’s hard to feel like your strong, when the prevailing paradigm tells you that you’re weak or sick or messed up or abnormal.

I also think that this disease construct can unwittingly perpetuate stigma associated with mental illness. We can divide everyone on the planet into those who have hepatitis-c and those who don’t. It’s a blood test. You either have it, or you don’t have it. But it doesn’t work the same way with mental illness. In graduate school I had to take a class called Differential Diagnosis. It is in this class that you learn how to diagnose mental illness using the Diagnostic and Statistics Manual. Students who take this class are warned at the beginning not to diagnose themselves. This warning is usually a little tongue-in-cheek, in a just kidding/not really sort of way. Because invariably you see aspects of yourself in many of the different disorders you’re studying.

For me, this was a good thing. It points directly to the fact that most of us are walking around in varying degrees of dysfunction at any given point in our lives. The mentally ill vs. mentally healthy binary is a false paradigm. Our mental health exists on a spectrum. Some of us are more resilient than others, but we’ve all got our struggles. We can’t divide ourselves into the healthy ones and the sick ones. And yet, when we encounter a person with mental illness we’re often scared of what to do or how to react. When we experience mental illness ourselves we’re ashamed of our weakness. And we’re treated by a system that tells us that we used to be healthy, now we’re sick, and we have to get healthy again. And since there is no concrete definition of what “healthy” is we’re left to strive for a nebulous goal. Interferon will get rid of hep-c. Suicidal Depression is much much trickier.

The final issue here is that we humans have been known to treat any socially unacceptable behavior as pathological. The worst example of this is homosexuality with was considered a mental illness until it was fully removed from the DSM by the American Psychiatric Association in 1986. That means that the really nice man who cut me and my brother’s hair for my mom for free because she couldn’t really afford it DIED OF AIDS about a year before the top mental health experts in the field decided that he wasn’t mentally ill. This statistic pisses me off every time I hear it. Seriously? 1986? Moving on…

Diagnosis of mental illness is subjective, varies across cultures, and can be tricky to pin down. Luckily, mental health professionals focus on symptoms in the context of function. This is really helpful because it questions whether or not your sadness, or your habits, or your anxiety are causing serious problems in your life. If whatever you are experiencing isn’t causing problems in your life, it’s not diagnosable. This is really important for all you grad students taking Differential Diagnosis to remember.

But the thing is, what if a person only has a few symptoms of a diagnosis? What if a person only has a few symptoms of PTSD, but it is causing serious problems for them. What if the grad student is really suffering? (I’ve known a lot of grad students. They’re all suffering.) This is similar to the person who is physically sedentary, a little bit overweight, and has low energy and high cholesterol (I may know something about this particular situation personally). A person with these physical symptoms may not be diagnosable with a specific illness, but it is certainly affecting their health.

Do you see where I’m going with this? If we focus on increasing mental health and increasing level of functioning the diagnosis may matter less. Also, I think it puts us all in a similar boat and decreases stigma. Mental illness is an extreme (or not so extreme) variation of universal human experience. It’s easy to see mental illness as an experience foreign to ourselves that affects a distinct set of “others” who are very very different from “us”.

However, you don’t have to be “mentally ill” to be “mentally struggling”. It’s for all of these reasons that I try to focus on mental health and mental health recovery instead of mental illness in my practice and on this blog. I understand the medical model, and I think it’s very useful. For my professional friends out there, I’m not bashing this particular practice orientation. It’s a language that I speak, but it’s not my first language. It’s not primarily, the way I work with people. My first language deals with increasing safety, functioning, and overall well-being.

The difference between the “mentally ill” and the “rest of us” isn’t a matter of who won the neurochemical lottery. The difference between the two is that there really isn’t one. When we have empathy for our own situation we’re better able to have empathy for others. Additionally, the principles that make for good mental health are useful to all of us whether we have a diagnosed mental illness or not. Everyone struggles, and everyone’s struggle is legitimate.

What do you think? We’re going to talk about the ten factors of mental health recovery soon. Stay tuned, and feel free to share this post with anyone who might find it useful.

As always if you are struggling, and you need help check out the sidebar for some links that maybe be useful. If you feel as though you’re not safe, and you thinking about harming yourself call 911 or go to your nearest emergency room.