With people often misusing mental health terms, it can become difficult to truly understand the meaning of mental health. Are people just exaggerating? What can we do if people are truly struggling? Before answering these questions, I thought it’d be best to answer what are mental health illnesses? Let me know if this has been useful.
The Frugal Frenchie
In the past, before mental health awareness, people would describe those, who showed “abnormal” behaviour as mad, crazy, or other derogatory words. This is something I’ve mentioned in a previous post about mental health stigma, so make sure to read that too.
Now, the sheer idea of “abnormal,” is controversial. What does this mean, exactly? Traditionally, it’d be defined as a behaviour or act that doesn’t conform to societal standards, expectations or norms. This is all subjective, however: whose norms are they? Who is establishing them? People’s behaviour, or judgements, are 100% subjective. Even our self-judgements are not necessarily fair representations, as our beliefs can be distorted.
As a matter of fact, in clinical psychology, “abnormal,” behaviour is not defined or measured according to how strange an act or behaviour is, how unjustified or irrational it may seem. It’s defined by the degree of interference the behaviour has on life, work and relationships. When somebody says “I love having my desk tidy, I’m so OCD about it,” that is not interfering with your life. It isn’t something that stops you working, restricts you doing activities you love and so on: that’s an incorrect and potentially offensive way of using the term OCD.
The degree to how a behaviour interferes with one’s life is an essential symptom for many mental health illnesses. Otherwise, it would be very hard to establish when somebody’s negative thoughts were just due to a bad week, or if it was associated with ill mental health.
Cultural and societal norms do not make the definition of “abnormal.”
Why did it start?
With physical illnesses, this question is never asked. When somebody breaks their leg or is bed-ridden due to illness, they ask what happened and will normally accept the answer.
If you tell somebody since you last spoke to them two years ago that you now have depression (which already is hard to say for a lot of people), they will not ask what happened, but why it started. With mental health illnesses, for some reason, there seems to be this expectation that whatever happens, shouldn’t result in ill mental health, but that you should just “get over it,” “get some fresh air,” “breathe,” or “think less.” Why is this?
So many things can cause a mental health illness, or it can just be an accumulation of things, a set of events that act as dominoes and leads to further problems or difficulties. These are just a few examples:
- Relationship problems
- Personal difficulties
- Losing a loved one
- Friendship issues
- Financial issues
- Achievement problems
- Feelings of inadequacy
- Constant comparison
- Feelings of failure
- Seeing success in others
- Physical problems
- Distressing life events
- Abuse (of all kinds)
- Victim of a crime
- Witness of a crime
Processes in psychological problems
The factors I mentioned below can often act as triggers or the cause of mental health illnesses.
These, of course, vary in intensity for the people and can fluctuate according to interference and debilitation. Other things to bare in mind, is that how somebody reacts to these depends on personality and context. For example, it may not be witnessing domestic abuse that causes psychological problems, but this may later influence your choice of partner, lead to being abused and this is then what triggers it during mid-adulthood.
The experience of negative emotions can maintain psychological problems too. Negative emotions are present in all psychological disorders, especially in depressive and anxiety disorders.
People with mental health problems, often find emotional regulation difficult to. This, for those who didn’t know, is the ability to control experience/expression of emotions; be it positive or negative. It makes dealing with them very difficult and it’s often a case of physically not being able to or not knowing how to.
On the contrary, mental health illnesses, for example, schizophrenia, can lead to a reduced emotional expression; affective flattening it is called. This is where there is a lack of empathy, remorse or guilt shown, even when it would be deemed necessary to show these. It can often be interpreted as being lazy, not caring or being rude, but it’s mostly a consequence of the numbness a mental health illness can make one feel.
Cognition is anything related to brain processes, such as thoughts, intellectual functioning and information processing.
In some mental health illnesses, one can experience delusions or bizarre thoughts. Others may have impulsive thoughts or negative schemas.
Negative schemas are essentially negatives beliefs. These can be about the world, oneself or future. Negative schemas can often fuel things like paranoid, depression or just lead us down a path of utter unreality.
Perceptions are similar to cognitive processes, which include hallucinations in psychosis or attention biases in anxiety disorders. Attention biases are where we will focus our attention on the things that make us anxious, and ignore other solutions, explanations or alternatives. It is clear how it can be easy to be stuck in these patterns of misperceptions.
Relationships with others play a big part in mental health. Not only are they key for good psychological functioning, but if there’s bad relationships, it may be detrimental to one’s mental health. Be it friendships, romantic relationships, family relations, social support networks or even colleagues – all of these are very important.
One’s relationship with oneself changes too. Our self-esteem, self-regard and self-criticism can all worsen in mood disorders, whereas in schizophrenia or psychosis, disillusion ideas of grandiose aren’t uncommon.
Classification of psychological disorders
There are two main diagnosis manuals that psychologists use to diagnose somebody. The main ones are DSM-V (the latest version) and ICD-10.
These two manuals have many functions. They give the latest description of disorders, keeping it valid and reliable and in doing so acts as a source of education as well as aids consistency and communication amongst clinicians. Indirectly to patients, it allows for the standardisation of research and basis for treatment.
ICD-10 was developed by the World Health Organisation. The main difference with DSM-V, is that they talk about physical stuff too, rather than solely mental illnesses. They cover a variety of categories, such as: mood (affective) disorders, neurotic stress-related disorders, disorders of adult personality and behaviour, mental retardation, schizophrenia and delusional disorders.
DSM-V, stands for Diagnostic and Statistical Manual of Mental Disorders. It was developed by the American Psychiatric Association (APA) and is regularly updated and extended. The recent changes are three sections:
Section I: Basics –> How to use the manual
Section 2: Disorders –> Where all mental illness diagnoses are written
Section 3: Emerging measures and models –> Including self-assessment tools and categories that require more research
How do you get a diagnosis?
To get a diagnosis there are normally some psychological tests or interviews that need to be done. The aim of the psychological tests is to provide information about one’s issues, problems or cncerns, and to help score and interprete the information. Interviews are needed to find out more about the wider picture, and try explore how and why a patient reached the stage they are currently in.
Some interviews may include the Mini International Neuropsychiatric Interview (MINI) or the Structure Clinical Interview for Diagnosis (SCID). Other tests or scales exist but these are very dependent on specific conditions.
Patients can also be diagnosed based on the observation of their mental state and functioning. You’d be suprised how much can be impacted by ill mental health:
- Affect and mood
- Thought content
Once a condition is diagnosed, psychologists will then find the relevant scale or questionnaire to find out the intensity. This can often be easier for somebody then “admitting” it face to face. In my next post, I shall talk more about treatments and therapies.
Have you ever been diagnosed with a mental health illness? How was the process for you? Did you struggle with understanding the concept at first? Let me know in the comments below.