I have to admit something embarrassing. I am a registered psychologist working in private practice and I don't know what the term mental illness means. Well, on a general level I know that it refers to psychological problems, but I don't know exactly what is meant by the "illness" part.
As far as a I can tell, there are two possibilities. First, illness could be a metaphor. If a writer used a phrase like "terrorism is an illness of society," we would know that the author is using a metaphor because a society cannot literally be sick. It cannot get the flu or have a bacterial infection.
The second potential meaning of illness is literal -- there is actually a disease or sickness that affects the mental functioning of the person.
When we use the term mental illness, what do we mean? Are we using a metaphor, like the mind is not working properly, as if it was ill. Or, do we mean it literally that the brain is in some way sick?
This is not simply an issue of semantics and splitting hairs. There are consequences and implications to the language we use to describe problems, including how we conceptualize or think about the cause of the problem, and how we treat it.
When people speak of mental illness, it is common to speak of problems with the mind. But according to modern medicine and science, there is no "mind" per se. We have a brain and the neurons of that brain are responsible for our thinking, emotions, behaviour, and so forth. So, whenever we use the term mental illness or speak of the mind being unhealthy, we are really referring to the brain.
We are saying the brain is sick.
Given that the brain is an organ of the body, there are two significant implications of using the term illness to describe psychological problems.
First, there is an implication that the tissue and chemicals that make up the brain are either diseased (ex: virus or bacterial infections) or dysfunctional (the neurons are not firing properly).
Second, and following from the first implication, there is an assumption that medicine can be used to fix the ill brain. We use medicine to fix the other organs in the body, so why not the brain as well?
Hence, the term mental illness seems to lend itself more to the use of medication as an ideal and first line of treatment. And given that psychotropic medications (ex: antidepressants like Prozac) are among the most popular drugs in the world, it is fair to assume that medicine is indeed most people's first line of treatment.
But is the brain sick, and does the medicine fix this sickness?
The Biological Model of Mental Disorders
The treatment of mental illness has a long history of physical approaches, including lobotomy, electroconvulsive therapy, medication, and a variety of other such methods. Success has been variable.
As mentioned, the most popular approach is medication. The idea that medication might work rests on the chemical imbalance theory of mental illness, which proposes that chemicals in the brain are not functioning properly, causing problems like depression and anxiety.
The idea that mental illness, most notably depression, is caused by chemical imbalances is arguably the most widely disseminated theory of mental illness in existence. The theory is described on respectable internet sites, the mainstream media, professional organizations (ex: National Institute of Mental Health), and is used by innumerable health professionals.
The problem is that the research evidence for this theory is simply too weak. The problems with this theory have only really started to hit the mainstream media and the general population in the past five to 10 years. For example, multiple experts, including psychiatrists, have come forward to say that the chemical imbalance theory for depression is simply wrong. There is poor and inconsistent evidence that low serotonin causes depression.
Neuroscience has done a great job of finding correlations between mental disorders and various brain dysfunctions, but to date, no one has found a definitive biological cause for any one mental illness.
What Else Could There Be?
If biology doesn't explain mental health problems, what does (or could)? If thoughts and emotions occur because of neurons firing, then problems with neurons must underlie mental disorders right?
Not at all. Problems can arise when the brain is perfectly intact and operating with all chemicals in balance (whatever that might mean).
Imagine you touch a hot stove top. The pain will immediately force your hand to pull away quickly, which is an example of healthy reflexes.
Following this painful lesson, imagine that the stove has been turned off and you are asked to touch the stove top again. It is not hard to imagine being a little hesitant to touch it, even though you know it is no longer hot.
What is happening here? The brain has learned that the stove can cause pain and damage, and has produced a feeling of anxiety when around stoves as a precaution. This is the mark of a healthy, adaptive brain - one designed through evolution.
Now imagine that a child is bullied repeatedly at school. To prevent further bullying, they stay away from people and become mistrustful. Is this any less adaptive than pulling your hand away from the stove? Both serve to stop pain.
Now imagine that the child grows up and is very wary of other people and feels anxious in social situations. Like the stove example, they are generalizing from one period of time to another, in order to protect themselves.
In this latter example, does the person need to have chemical imbalances in their brain, or any other biological dysfunction to be anxious of other people? You might find that certain areas of the brain "light up" on an MRI when this person is in social situations, but this doesn't mean that dysfunction in these brain regions are causing the anxiety.
In fact, this person could meet criteria for depression and social anxiety disorder, and yet their brain is in no way dysfunctional or sick. If anything, their brain is operating the way we would expect it given the environmental circumstances, and the priority that evolution puts on self-protection.
Here we have a healthy brain (medically speaking) that is causing problems in the person's interpersonal life.
This person might need therapy to deal with the problem, but the root cause of the problem (bullying, mistrust, and avoidance) could never be solved by medication.
Should we say this person is mentally ill? Is their brain diseased in some measureable way?
Give it some thought. When you use the term mental illness, what do you mean?
Is it just a metaphor?ALSO ON HUFFPOST:
Do you have persistent feelings of sadness or hopelessness that have lingered for at least two weeks and occur throughout the day, every day or nearly every day? Are these feelings interfering with school or work, or your relationships? This is a key symptom of clinical depression. We all have negative thoughts from time to time, and it’s natural to be sad when there is a serious event in our lives, like a death. The difference with clinical depression is that the feelings stick around and interfere with your ability to live your life day to day.
Many people with depression find it difficult to get out of bed — and we're not just talking about hitting the snooze button. For some, getting up seems nearly impossible. They may also find themselves spending unusual amounts of time in bed throughout the day, or having trouble with normal activities because of fatigue.
As tired as you may be, if you’re depressed you might also have trouble sleeping. Marked changes in sleeping patterns, like insomnia or increased time spent sleeping, is another symptom of clinical depression.
Some people either gain or lose weight when they have clinical depression because of their change in appetite. For some, this means an increase in appetite and possibly weight gain as a result. Others lose their appetite and struggle to eat much at all. In either case, a significant change is worth investigating.
We all have times when we feel a bit more introverted than usual, but when people have clinical depression, they can lose the sense of pleasure they used to get from their favourite activities or from engaging with others. This isolation can make it harder for friends and loved ones to see the other symptoms of depression a person may be exhibiting, which makes it more difficult to know when a person needs help.
It’s more often thought of as a symptom of ADHD, but an inability to concentrate or hold focus on one’s activities can be a sign of clinical depression. Of course, if someone with clinical depression is also having trouble sleeping, not eating well or has lost interest in regular activities, this symptom can be amplified.
This is the most serious symptom of depression, says Dr. Joe Taravella, a psychologist and the supervisor of Rusk’s Pediatric Psychology Service at NYU-Langone Medical Center in New York. “When you’re severely depressed, suicidal thoughts can become so prominent, you begin to make a plan for ending your life, as you feel there are no other options.” If you are experiencing suicidal thoughts, seek help or tell a trusted person in your life and ask for help — call your doctor, call 911, or go to an emergency room. And never assume that a person who talks about suicide won’t do it. If someone tells you they are feeling suicidal or discusses plans to end their life, always take it seriously and get help.
“Many people don’t realize that low levels of chronic irritability and anger can mask an underlying depression,” Taravella says, “which can be undiagnosed and untreated for years.” A study released last year found that more than half of men and women who were experiencing a major depressive episode reported irritability as a symptom. Constant irritability is also a symptom of depression seen in teenagers and children, one that could be written off as normal growing pains or teenage behaviour.
Yes, depression can literally hurt. There is increasing recognition of the physical symptoms of depression, which include headaches, stomach pain, and back pain. One study found half of patients with depression from around the world reported unexplained physical symptoms. But because these physical symptoms are often vague or have no logical explanation, they can be missed as as symptom of depression.
For people with severe depression, basic tasks of self care can seem too overwhelming to undertake, Taravella says. As well, personal hygiene may seem unimportant if you are feeling hopeless or worthless. If someone in your life is showing a marked decrease in personal hygiene, don’t assume they are simply lazy.
Going along with trouble with concentration, people with clinical depression often have memory issues that can add to their difficulties in maintaining day-to-day activities. “As a result of these symptoms, they are more likely to become inattentive to their environment and prone to falls and injuries,” he adds. A 2013 study found that this could be because clinical depression impairs the process of “pattern separation,” which is the ability to distinguish between things and experiences that are similar.
Some people who show signs of depression engage in what Taravella refers to as “externalizing behaviours,” which include substance abuse and risk-taking activities. Men are more likely to do it, he says. These behaviours can be a sign of an underlying mental-health problem, particularly if they’re out of the ordinary for the individual.
“If you recognize symptoms of depression, take action and immediately seek professional help,” Taravella advises. There are valuable resources out there, he says, including psychotherapy and antidepressants. Many people also find some relief with meditation and exercise, often in conjunction with other treatments. It can be difficult to navigate the process of finding the right help, especially if you are having trouble just getting out of bed. Try talking to a trusted friend or family member who can help you research options and even call a therapist for you.
It can take time for depression treatments to start making a difference, which is frustrating when you've taken the difficult step of admitting you need help. But while you work on medication and/or therapy, there are things you can do. Be as active as you can, Taravella says, and try to see friends. “Create small goals for yourself each week but don’t put a lot of pressure on yourself,” he suggests. While it can take time for depression symptoms to begin to lift, it may be worth seeking different treatment options if you are not seeing any improvement after two months.
“The best way to help someone who is depressed is to be a constant source of support for them,” Taravella says. This can sometimes be difficult, however, because people with depression tend to isolate themselves despite your efforts to stay in touch and/or get involved. You may also be able to help someone by making a doctor’s appointment for them. It’s a simple task to request an appointment, but for someone who is severely depressed it can seem incredibly daunting.