What is mental illness? This difficult question is commonly asked by parents who notice their children behaving strangely, by anyone who sees a homeless person talking to themselves, and by medical professionals across the country whenever a new edition of the Diagnostic and Statistical Manual of Mental Disorders is published (the fifth edition, DSM-5, came out in 2013).
Sometimes, the question is asked as a cry for help. Pete Earley, a journalist for the Washington Post, found he was unable to get treatment for his bipolar son because his son didn’t believe he was sick. Who is qualified to determine if someone is mentally ill? In the United States, patients have the right to refuse treatment if they believe there’s nothing wrong with them.
People diagnosed with illnesses like depression or anxiety disorder often report a lack of sympathy for their condition. They are told to “just try harder” or “get over it”; they complain that no one ever says such things to someone with cancer or a broken leg.
What is the difference between a mental illness and a physical illness? The human body is complicated, but we feel like we can understand problems like cancer, bacterial infections, or broken bones. We know where they come from and what to do about them. But mental illnesses are harder to pin down: they seem to involve our cultural, emotional and spiritual assumptions as well as the operation of our physical brains.
Some people don’t believe in mental illness. Anti-psychiatrist Thomas Szasz argues that the “medical model” of diseases and cures is inappropriate for talking about what he calls “problems in living.” In other words, depression, anxiety and even schizophrenia are not at all comparable to cancer or a broken leg.
Nonetheless, many people find that clinical treatment and medication are the best available solutions to their “problems in living.” Many people find that severe illnesses like schizophrenia and bipolar disorder are totally unmanageable without medication.
Al Frances, lead editor of DSM-4 and a critic of DSM-5, once told a reporter that “There is no definition of a mental disorder. I mean, you just can’t define it….These concepts are virtually impossible to define precisely with bright lines at the boundaries.” The DSM is the legal definition of mental illness in the United States, published by the American Psychiatric Association: it catalogues every recognized variety of mental disorder and describes how to recognize them.
Frances was concerned that so many young children were being medicated for the normal problems of childhood, spurred by anxious parents, a greedy pharmacology industry and a permissive mental health establishment. He worried that his own work on DSM-4, published in 1994, had made it easier to diagnose any common problem as a mental illness, and he was afraid the new edition would have even looser definitions.
Indeed, in recent decades there has been a huge increase in the number of diagnoses of mental illness, particularly among children, prompting fears of a mental illness epidemic. Are people really that much “crazier” now than they were in the past? Or have we simply gotten better at recognizing and treating mental illness—or have we made the definition of mental illness too broad?
Dictionaries—along with the DSM and other professional sources—define mental illness as a “dysfunction” of the mind, or an impairment in functioning. What does that mean? Merriam Webster defines a “function” as “the special purpose or activity for which a thing exists or is used.” Your definition of mental illness, in that sense, depends on what you think the human mind is supposed to do.
The brain is a bodily organ, and like any other organ it sometimes breaks down. Physical changes to the brain can have a dramatic influence on a person’s conscious mind. On the other hand, conscious decisions can also lead to dramatic physical changes in the brain. A person can take good care of his/her brain in the same way he/she takes care of the rest of his/her body. The brain needs exercise, rest and good nutrition.
People have a great deal of control over their physical health, and similarly they have some control over their mental health. However, there are some ailments in both body and mind that require professional attention, and medication is often the most effective treatment.
But the brain is far more complicated than other organs. A broken limb or an infection is easy to understand, but it’s hard to comprehend how illnesses like schizophrenia or bipolar disorder work.
Questions for Reflection and Discussion
How would you define mental illness? Can you come up with anything more specific than a “dysfunction” of the mind?
In what ways are mental illnesses different from physical illnesses?
How much control do you think a person has over their mental health?
How does your own experience and religious perspective influence your understanding of this topic?
Mental illness is hard to define, because it’s hard to define what the mind is trying to do.
There is an acknowledged mental health crisis in the U.S. (and elsewhere) being noted in prisons, universities…and down to grade schools. The “deinstitutionalization” of mental illness facilities has also left many who are mentally ill onto the streets to join the homeless.
As to the general treatment of mental illness or emotional troubles, there seems to be need for a balance between over-medication on the one hand, and refused medication on the other. Some people are concerned that, because of the amazing effectiveness of modern medicine, people are looking for medical-style cures to their personal problems. However, many people say that medicine deserves this trust, and it’s very helpful to look at one’s “problems in living” in medical terms.
Because of the difficulties in defining mental illness, some people who need treatment can’t get it, while others are overmedicated. If a person’s mental illness leads them to distrust medicine then they have a right to refuse treatment. At the other end of the spectrum, many people are worried that parents are overusing medication to respond to their children’s problems, especially as many drugs approved for children may have harmful side effects on a young brain’s development.