Mental health is a tenuous thing. We all want it. And yet many of us struggle with it every day. Think of the people you know who suffer from anxiety or depression. The numbers are staggering. Officially one in five of us will experience a mental illness at some time in our lives. The other 4 of us will be impacted by someone who is mentally ill.
So what is it? First of all, mental illness isn’t one thing. It’s a continuum of health. For mental health, it would look like this:
The presence of good mental health doesn’t preclude the presence of a mild mental illness. That’s a spot on the conundrum that’s hard to get my head around, but I think of it this way: maybe I have an anxiety disorder and maybe I’m on medication for that illness but I’m coping with it well. That would suggest I have decent mental health (on the upright axis) along with the presence of a managed mental illness (the middle of the horizontal axis).
There’s been an interesting shift in medicine as researchers try to focus on promoting mental health, rather than treating mental illness.
We all think we know what mental illness is. (By the way, the new proposed name is mental disorder.) After all, we see it in people walking on the streets, dirty and unkempt and talking to themselves. But it’s much more than that.
Officially, mental illnesses are characterized by alterations in thinking, mood or behaviour associated with significant distress and impaired functioning. http://www.phac-aspc.gc.ca/cd-mc/mi-mm/index-eng.php and Health Canada, Report on Mental Illness, 2002.
DSM 5 defines it this way: A Mental Disorder is a health condition characterized by significant dysfunction in an individual’s cognitions, emotions, or behaviors that reflects a disturbance in the psychological, biological, or developmental processes underlying mental functioning. Some disorders may not be diagnosable until they have caused clinically significant distress or impairment of performance.
What a lot of words. Here’s my simple definition: A Mental Illness or Disorder is a disruption of the chemistry or biology of the brain that shows up or manifests in behaviour. Simply put, because of a change in our brains, our behaviour changes and may no longer be acceptable to those around us.
Mental illness is a huge problem in our society. And it’s made worse by our fears and misunderstandings about these disorders. We have a tendency to blame the person for their behaviours. After all, we are responsible for what we do, right?
We think (or say) get over it. If you’re feeling bad, get out of bed and do something. Before you know it, you’ll be back to normal. But what if a slight change in the levels of the neurotransmitters in your brain made facing the day impossible? What if those same chemicals that make thinking and feeling possible didn’t work quite right and the result was paranoia (great fear) or anxiety (lesser but still big fear).
We wouldn’t dream of telling someone who just had radiation or chemotherapy to get up and walk it off – they’ll feel better sooner. And yet, this is often what happens to those with depression.
When someone has a heart problem, we don’t blame them. But when someone hears voices or puts tinfoil on their windows, we often do. Yet the cause of both is physical. And the latter one does not have blood tests or urinalysis to determine what it is
I don’t want you to think I’m giving a ‘bye’ for bad behaviour to everyone who claims a mental illness. I’m not. But please consider that mental illness can be caused by biology, genetics, family stress and environmental stress. Specifically, medicine thinks that the causes of mental disorders include:
- Genetics: Occurrence in a relative or family history
- Certain serious infections
- Brain injuries, including those occurring pre-natal
- Substance abuse (both a disorder and a cause)
- Environmental trauma
- Psychological trauma
- Age (almost half of all mental illnesses start by age 14)
- Sex (each gender has particular susceptibilities),
- substance abuse,
- chronic diseases,
- family, workplace, life event stresses
In a previous career, I was a therapist providing support to families with an adult with mental illness. They came to my group for knowledge, understanding and hope. I was able to provide lots of the first two and a reasonable dose of the third.
One of the most heart-warming stories that was shared with us was a woman who was a tenured university professor, as was her husband. Their oldest son was completing a Ph.D at Harvard and the youngest was a double major in Honors Math and Music in his third year of his Bachelor’s Degree. Altogether a very accomplished family.
She came to group because she was frustrated with the medical system. She felt they were encouraging her youngest son, who had been diagnosed with Schizophrenia, to throw his life away. Give up school and chill out. She did NOT agree.
But after five weeks with us, fighting and resisting the implication of his diagnosis, she came to us in tears. She and her son had gone walking on the weekend. She commented that she was so glad the year was almost over (it was early December) since it had been the worst year of her life.
He totally disagreed saying it was the best year ever. When she questioned him about his sentiment, given that he’s spent four weeks in a psychiatric unit, he said this; “Mom, I’ve been hearing voices for at least eight years. I thought I was going crazy. Instead I’ve found out a have a disease – a terrible one, but just a disease. I can get treatment and medication and come much closer to living a normal life.
<deep breath here>
He understood. With treatment there’s hope. With stigma, there’s nothing but shame.
I don’t claim any particular expertise in Abnormal Psychology and I will do my best to keep it simple, but I hope you will join me as we explore the realms of the mind and how it affects our behavior.
This is awesome. I’ve changed my mind. You don’t need a ‘like’ button – you need an ‘awesome’ button!!!
I wish more people thought of it this way. How would they feel if they woke up without the ability to be emotionally stable and everyone was saying it was their own fault. Pretty sure they’d feel crazy too. Or if they saw things others did not and couldn’t make it go away.
People can learn to live with delusions. One thing no one should have to learn to live with is the unwarranted criticism and negativity given to them by those who claim understanding but in reality are ignorant.
aren’t you nice, Daphne. Thanks. the shame and the stigma are the real problems for all of us…we lose so much when we deal in fear and silence.
Louise– “promoting mental health, rather than treating mental illness” I’d love to hear more about what that means. Could you add that to post topics? This was a really interesting piece. I’ve missed so much while on my blogcation and then finding that my subscription was dropped by WordPress. It will take a bit to get up to speed. Thanks for being here. You add a dimension I don’t find elsewhere…
it’s nice to see you again Heidi. sorry about the WP mess. that’s sad for us who read your blog and enjoyed. I’ll definitely add tthe topic to my list.
be well
I’m going to jump in a little late here and give a different take on the perception of mental illness. I have suffered through both anxiety and depression all the way to hospitalization (in the unit where they confiscated my shoelaces and nail clipper).
Mental illness diagnoses are often less visible and more subjective than other medical problems. While I dont advocate that they should be stimatized, I simply am stating that I can understand how and why this comes about.
In addition, many of us volountarily (whether knowingly or unknowingly) make choices in our lives that contribute to our mental illnesses. For me, I learned that many of my thinking patterns were choices, most that I unknowing learned and continued to choose and practice.
For me, Cognitive Behaviour Therapy (CBT) helped me make great strides over my anxiety and depression by learning and practicing to the level of habit, new and more effective thinking patterns. Whereas medication had not been very helpful.
The next depressed/anxious person may be completely different. I’m just saying what worked for my brand of anxiety/depression and also suggesting that in my experience, it is wise…. in addition to whatever medical treatment one needs, to do our best to improve our health and thinking patterns so they are not adding to the medical problem.
ciao.
Chaz
Chaz, I totally agree with you on some points. Particularly with regards to depression and anxiety, our thoughts can create the problems. CBT has been studied ad infinitum and constantly shows solid rates of recovery from these disorders, and a few more. But there are other mental illnesses which arise in the structure and physiological functioning of the brain which are not noticeably responsive to talk therapy of any kind.
I used CBT for my own depression and thoroughly agree with its effectiveness for me. And I use a variant of it in my practice. But it’s usefulness is limited. If a person is in full-blown psychosis, it won’t be used. Congratulations on finding your solutions and knowing how important our thoughts can be to our own mental health. well done!
What a wonderful and courageous post. I married into a family with a long history of anxiety and depression — also a long history of brilliance, love and accomplishment. Two sides of the same coin. I love the story about the woman and her schizophrenic son.
Holding the door open on this subject is probably the healthiest thing anyone can do. I’m convinced that as we understand more and more about neuropsychology, it might change everything, from how we treat criminal offenders and homelessness, to how we see marriage and family, and how we look at our political and economic systems. It’s all part of the picture. Thanks Louise.
thanks so much for stopping by. I totally agree with you – when we shine the light on all these topics, then the world will change.
I like how you put it Louise–that mental health is a continuum of health. Makes so much sense and as always you offer so much insight.
Thanks for stopping by Coleen. glad this post made sense.
Very insightful. Thank you, Louise. It’s so sad when people dealing in these areas of mental health are unjustly labeled. I’m so grateful that healthcare has come as far as it has.
Medical treatment has come a long way, Debra. It’s torturous to read some of the research and ugly stuff that was called treatment in the 50’s.
Thanks for illustrating and explaining the continuum of mental health. And for providing that touching anecdote. It really is perspective too–from a scary unknown to a diagnosed and treatable issue.
Kourtney, mental health is a continuum like our health is…we just need to remember that and hang on to that certainty. Treatment is still difficult and not always ‘successful’ but understanding and acceptance will pave the way.
As one who has been challenged by severe depression since childhood, I agree about the story of the son with the knowledge that he has an illness. The day I realized that I had an illness, I was at least able to rid myself of the guilt that I had been living with. I still struggle every day, but have made a life that is rewarding and most of the time I can say I am happy. I work with people with severe mental health issues now and feel fortunate that I am not worse off than I am. Thank you for writing this.
Becca I am so happy that you discovered that you have an illness. it’s not a moral issue nor a personal thing – it’s an illness. and good for you for working with others. You’re right – none of us should take our health for granted ever.
I think most of us experience breakdowns at one point in our lives, but I can’t imagine having something go one and one with no hope of help. Thank goodness mental disorders are being recognized and treated now. Thanks for the excellent info, Louise.
there is much to do in the realm of treatment – meds make it better but not perfect. but when you think about it – chronic mental illness is the physical equivalent of parapalegia. Or MS. or any other lifetime chronic condition. And many of us have these problems. It is hard to imagine that something in our brain can go wrong and while we continue to function, that may be in a way that’s so different from everyone around us.
Wonderful, insightful post, Louise. You always handle these difficult topics with grace and dignity. I look forward to the day when those with mental health issues aren’t stigmatized or ostracized, but treated with compassion. At least treatment is much better now than ever before.
Tameri, I totally agree with you. Once we get to the point that there is no stigma, successful treatment will follow quickly.
What’s normal? And who gets to define it? But definitely an interesting exploration. Also happy about the transition to focus on mental health instead of pathology.
I totally agree Lara – normal is ephemeral. We can easily see and define what’s not working on the far ends of the continuum. but that big gray area in the middle is much harder. Working around people who have serious chronic mental illness, it is easier to see what’s not working. it’s not wrong but it does limit a person’s ability to follow their dreams and live their lives in a way they’d prefer.
As a mother and then grandmother I had adopted children with mental health issues, then while on a trip I was electrocuted and while laid up for 7 yrs had to fight my way back from physical and mental health issues. Pain, depression, panic attacks, agoraphobia, etc then when I was having counseling trying to learn who I was, memories from my childhood long suppressed were brought to mind. To look and talk to me now you would not be able to see the challenges that have tested and refined me. Thank you Louise for helping to shine a light and giving us a place to share.
thanks for sharing Shirley. We all have to take a turn shining a light on the issues, don’t we?
Very interesting (again). I like the definition including the word “change.” And it can be very subtle. Surprisingly high statistics, too.
So, am I crazy? I think I definitely am, but in a good way.
Patricia Rickrode
w/a Jansen Schmidt
I seriously debated about using that word in the title, Pat. it’s an ugly word with lots of bad stuff attached to it but decided if the post was affirmative and factual, I could get away with it. I think everyone is on the continuum and for most of us, the place changes regularly.
Thank you Louise for putting these mental health issues out in the open where they should be. I totally understand where Mr. Holton’s coming from. My younger brother started having siezures as a young child in the mid-sixies. And it was a source of embarassment for my parents, especially my mother and other family members. My brother also had ADHD, but at that time who knew what that was. It was a nightmare for him in which I don’t think he ever recovered from. Because of this imperfection, he wasn’t accepted. It left a huge scar. Then it was discovered schizophrenia ran on my husband’s side of the family. It wasn’t until his cousin was diagnosed that the family came clean with the information. Over the many years there was such a horrible stigma that went along with these disorders. If you didn’t talk about it, then no one would know. Ah, thankfully things have changed. 🙂
I think things are changing Karen, but there’s still lots of stigma and shame. but it’s coming…thank heavens.
For years, I had known that my parents were separated, but I was four when they split and seven when they got back together, and we never discussed it after that. It was almost thirty years before I learned that my father was bipolar and he was spending time away from us while he got well, because my mother was too embarrassed to talk about it. I didn’t find out until Mom told me that my brother was having similar problems, and even then I had to drag it out of her. And there was no reason for all the hush-hush: through medication and counseling, he learned to cope with his illness and we had a wonderful few years together (he died when I was almost eleven). But, that’s the way that mental illness was handled in the Fifties and Sixties, as something to be ashamed of. And it isn’t; it’s more like needing glasses. Excellent post!
John, thanks for your honesty. I’m glad you understand. it is simply an illness and not a matter for shame or hiding. but in the 50s we hid pregnant girls because they were so ‘shameful’. that changed and it’s time for mental health issues to come out of the closet. I will be writing on bipolar and look forward to your comments then.
“With treatment there’s hope. With stigma, there’s nothing but shame.”
This is so true. My best friend struggled for years with severe depression. She would cut herself and she even considered suicide. For the longest time, people told her to “just snap out of it” and that she could choose to be happy if she wanted to. But she couldn’t. Once she managed to go to a doctor and get medication to help her, her whole life changed. She’s now happily married with three children and is one of the most positive people you’ll ever meet.
Amen, Marcy. That’s exactly the lesson we need to learn – mental illness is an illness – it’s not a behavior or values problem.
Thank god for drugs and therapy. The world would be so much unhappier without them. I look forward to more posts, Louise.
good to see you Joan. The world is better for both of these.
That story is so touching and I couldn’t agree more with what you say about the stigma. I still worry about what people will think of me when they find out that I’m an alcoholic and have suffered from depression but I won’t let it keep me from seeking help and living a full life. I love your new site, by the way!
Karen, I respect your dedication to recovery so very much. And I am always grateful for your willingness to talk about the process of healing. Both addiction and depression are products of the brain. Keenp on keeping on girlfriend.
As insightful as ever, Louise. And such an important topic. I love examining behaviors and the mind. It’s so fascinating and extremely helpful in creating our characters as well. Thank you!
We are always fascinating, aren’t we? anyone who pays attention to the bigger picture of human behavior never fails to be amazed.
What a beautiful, helpful and heartfelt post. I hope over time the stigma associated with mental illness/poor mental health will be eradicated. Posts like this will no doubt help!
I hope you’re right Julie. When we erase the shame, tratment and recovery will improve.
Wonderful post! I so hear you on the shake it off attitude. My husband and I know people with depression, and he has a hard time grasping that it doesn’t work that way.
I’ve been called crazy before. 😉 Goes with the territory for us fiction writers.
WE are living proof that hearing voices in our heads may be a sign of creativity rather than something else.
I had to do the same thing, Stacy – I went into a depression due to long term stress. But I went and got meds and got treated. I’m not on them now, but I pay close attention to my mood and mental health to keep me well. Once I’ve gone down that path, it is very easy for the brain to slide into those pathways again.
Elena, Amen and Amen. and once we start talking about mental health and mental illness openly and without shame, the treatments will improve exponentially.
Thanks August. It is defiitely time for the shades to be pulled open and people to start talking about what is a medical condition.
Very good post, Louise. I deal with mild depression/anxiety, and it was something I ignored for years because of the stigma I’d attached to it. Even after my mother had hers treated, and I saw a marked difference in her, I still refused to admit I had similar problems. As I said, mine was mild compared to most – just general blahs and a lot of worrying – but it nosedived after I was in a car accident three years ago. I finally asked for help, and all it took was a low dose of meds to level me out. I think many more people suffer from depression than they want to admit, especially when it’s mild, and I hope posts like yours can continue to combat the stigma. It’s okay to ask for help. Definitely changed my life:)
Great post, Louise. Mental illness is so tough because it’s often the ‘invisible disease’. You’re right that the expectation is to tell people to shake it off and get over it. And that’s so hard.
Thankfully there are so many more good treatment options out there now that people no longer need to ‘suffer’ and can receive the treatment they need to be functioning, contributing members of society.
Thank you for this post, Louise. Mental illnesses affect numerous loves ones, and have affected me. I feel blessed to have been raised by parents who treated my mother’s depression as a disease—what it is—and not lunacy. And for the past 6 years I’ve taught nutrition therapy to incredible individuals on a weekly basis, all of whom have serious psychiatric illnesses. They aren’t crazy either. People who judge others due to have a different ‘normal’ are crazier than the people with schizophrenia I’ve worked with. Can’t wait for more in this series!
I do not know how much to say here since in our family and with myself we have experienced a wide range of mental health issues and continue to do so. but a short story. My mother in law complained for many years about her upbringing and the issues with her own mother, leaving home to marry as soon as she could. Many years later and after she had worked in health care herself, she admitted her mother into an elderly care facility where testing was done. Finally in her 80’s this bitter angry woman with medication to balance things in her mind became the mother always desired by her daughter, my own mother in law. For a few short years they enjoyed communication, understanding and love. I know all too well that issues can be there right under the surface covered with smiles or a good acting job. Reaching out and finding those answers, helping others or yourself can bring great joy.
so true, Shirley. so true.