What Is Mental Illness?

BACKGROUND

I recently received the following question from Disparity, on Twitter.

“I’m interested in all your posts, but they’re always telling us what mental illness ‘isn’t.’  Do you have many on what it ‘is’?

I referred him/her to the post There are No Mental Illnesses and received the following reply:

“I have read it a few times.  I largely agree with it.  But ‘something’ happens to people.  Whatever the label.”

Questions of this sort arise fairly frequently, and I thought it might be helpful to write a post.

WHAT HAPPENS TO PEOPLE?

I suspect that underlying Disparity’s question is the notion that “mentally ill” means “crazy,” and that there really are people who seem to be “crazy.”  This is, I think, a widely accepted notion.  But in the present context, it leads naturally to another question:  if they’re not ill, if they haven’t actually contracted an illness, then what has happened to them?

SOME FACTS

For several years now, it has been confidently stated by government agencies and by psychiatrists that approximately 50% of the population will experience a “mental illness” in their lifetime.  That’s half the population!  So if we are to believe this, then clearly the individuals embraced by the term “mental illness” are actually very ordinary and unremarkable.  It’s you, me, the man next door, the milkman, Auntie Betty, etc., etc.

What has happened to all these people is life.  Bad things happen to all of us.  Sometimes we don’t cope too well with these challenges, and if we are brought to the attention of the mental health system, we get a “diagnosis” and enter the ranks of the “mentally ill.”

Psychiatry – especially in recent months – claims that they only assign “diagnoses” when the individual’s actions or feelings are extreme.  In practice, I suggest that this is not the case.  If you go to a psychiatrist and tell him/her that you’ve been feeling very down, that your mother used to feel this way, that she has been doing very well since she started taking an antidepressant, there’s a very good chance that you will be assigned a “diagnosis” and given a prescription – especially if you throw in that you don’t feel like getting up in the morning and that your appetite is poor.  And you are now a “mentally ill” person.  So what happened?  You got to feeling down.

“What happened,” of course, varies from person to person, and from situation to situation.  A person who has experienced a truly horrendous situation and has persistent distressing memories may be assigned a “diagnosis” of posttraumatic stress disorder.  A misbehaved child may get a “diagnosis” of oppositional defiant disorder.  A juvenile delinquent might get a “diagnosis” of conduct disorder.  And so on.

Even very young children are fair game for the “diagnostic” net.  Children as young as 3 or 4 are being “diagnosed” with bipolar disorder if they display frequent temper tantrums!

THERE ARE NO MENTAL ILLNESSES

When I say that there are no mental illnesses, what I mean is that behavioral and emotional problems are not illnesses.  It is frequently suggested that by saying this I am minimizing the significance of these problems.  Nothing could be further from the truth.  Human problems can be mild, moderate, severe, devastating, and every level of significance in between.  But they’re not illnesses.

Psychiatry has promoted the falsehood that they are illnesses (“just like diabetes”) to justify their promotion of pharmaceutical products.

The matter is complicated by the fact that sometimes behavioral and emotional problems do indeed stem from real illnesses.  For instance, hypothyroidism can occasionally cause delusions and hallucinations.  However, these cases are dealt with by treating the hypothyroidism.

But behavioral and emotional problems can – and I suggest, usually do – arise in the absence of any underlying physical illnesses.

I discuss these general ideas in more detail in the posts on the individual “diagnoses.”

  • AE

    after waffling querulously for a bit, you finally got round to your opinion, which is that mental illnesses aren’t physical illnesses. well done.

    unfortunately, no reasonable psychiatrist would tell you that.

    denying that a recurrent, stereotypical form (content aside) of suffering is an illness is pedantic and rather inhuman.

  • Magnus Johansson

    Why is it pedantic and inhuman, if the change of perspective could yield use of better treatment methods? And “stereotypical” is perhaps not quite right, if you see how badly the DSM diagnoses overlap.

  • Phil_Hickey

    Magnus,

    Thanks for coming in. I appreciate the support.

  • Sweet63

    It’s as if a Dx is a litte “prize” someone gets, that Phil wants to take away.

    Oh wait, I guess it is…

  • Phil_Hickey

    Sweet63,

    Good point. Some people do seem to get attached to their psychiatric “diagnosis.” It becomes a kind of identity – “I’m bipolar”; “I’m adult ADHD” etc… This is in marked contrast to real medicine. Nobody wants a diagnosis of cancer or cystic fibrosis!

    Best wishes.

  • Disparity

    Thanks for this brilliant post.

    I think, if I was to have any issue with what you are saying, it would be that the old ‘he just needs to snap out of it’ advice seems to be in amongst your text. I am well aware that this is not the position you purport to hold but I feel that it could be misconstrued as such. This is only my own (largely uneducated about ‘mental issues’) point of view but it seems that the larger medical community don’t exactly know what is going on in the brain (in terms of anatomy and physiology) when a persons enters an ‘abnormal’ state. This ‘abnormal’ state being as defined by the society at large. From my own perspective, I was ‘diagnosed’ with social anxiety/generalised anxiety by a mental health professional (I’m in the UK if it helps). I have to admit though that she was very good and the CBT I had was only ever about recognising that I had poorly developed skills in dealing with certain situations and working on my patterns of thought and how I could resolve it through deliberate practice. Which made total sense to me and helped enormously (I greatly resisted the offer of medication). Would I be right in saying that the ‘meat’ of a lot of your arguments is that ANY human of normal brain function can enter an abnormal thinking state (for whatever reason – childhood trauma, substance abuse etc) that would be perpetuated to the point where the persons behaviour was altered in such a way as to affect their daily functioning? I don’t know if I’m making sense here but thanks for reading..!

    Paul (Disparity)

  • Phil_Hickey

    Paul,

    Thanks for coming in and for the encouraging words.

    With regards to the “snap out of it” issue, my general position is that human problems range in seriousness from mild to devastating, with every possible shade in between. Under the present medicalization of virtually all human problems, even the people at the mild end of the continuum get a “diagnosis” and usually drugs. These individuals probably could just “snap out of it” with a minimum amount of encouragement and support. Obviously as one progresses towards the devastating end of the spectrum, the amount of help a person will likely need increases. But – in my view – none of these problems is an illness unless there is some fairly clear indication that the troubling behavior or feelings are the direct result of a malfunction of some sort in the organism.

    For decades, psychiatry has been routinely deceiving its clients by telling them that these various organic malfunctions have been found and that their problems therefore are real illnesses – “just like diabetes.” This particular scandal has been outed lately, but instead of apologizing and hanging their heads in shame, psychiatry is saying: we never said that – well, not really; or if we did, we didn’t meant it; etc…

    With regards to the anxiety problems that you mentioned, I’m glad that you got help and that you were able to resist the pressure to take drugs, which can, I know, be very strong and persistent.

    I suggest, however, that the help you got was not enhanced by the “diagnosis.” In other words, if the problem had been called: “feels tense and anxious in social situations” (or whatever), I suspect the help you received would have been just as effective.

    In fact, it probably would have been better, in the sense that there would not have been the pressure to take the drug (no diagnosis, no drug). As I’m sure you’re aware, most people yield to this pressure, often with deleterious effects.

    With regards to your final question, the answer is yes, and you’ve put the matter quite well. But it’s not just significantly adverse events (trauma, substance abuse, etc.) that can have unfortunate effects. A mother who is frightened of spiders (to take a fairly trivial example) will very often teach her children to fear them also. Not that she’s teaching this fear deliberately – but children who have acquired the skill of modeling are as likely to model undesirable behaviors as desirable ones. Another example: a parent who gives a child a piece of candy when the child throws a tantrum in a store is actively teaching the child to throw tantrums. And so on.

    And there’s an interesting subtlety here that’s pertinent to your phrase “…of normal brain function…” If the tantrum-throwing child mentioned above didn’t show an increase in tantrums under such circumstances, there might be some reason to suspect that there was something wrong with his learning “machinery,” i.e. his brain. In real life, of course, things are more complicated, and we’re teaching children multiple responses at the same time. Also, there are multiple teachers. So it’s difficult (impossible?) to predict the outcome precisely in a particular case.

    So. Thanks for the stimulus to write the post, and for coming back.

    Best wishes.

  • Jeff Kelly

    “Reasonable Psychiatrist” is an OXYMORON.