Over the next three chapters, we’ll give you a crash course in mental illness. It will only cover the very basics but will be enough to make sense of the rest of this book as well as what mental health providers are telling you.
In the past, people knew little about mental illness. It was rarely discussed and a source of shame. People with mental illness were locked away in asylums, separated from society. Thankfully, the situation is better now. Most people today have some understanding of mental health and mental illness. They know that mental illness is not about character flaws or moral failures. It’s a medical problem affecting people from all walks of life.
When it comes to getting more specific, it’s challenging. Mental illness is vague in a way that a heart attack or diabetes isn’t. As well, there are still some pretty big misconceptions out there. Let’s fix that.
Let’s start with what mental illness means. Here’s one definition:1
Mental illness refers to a wide range of mental health conditions—disorders that affect your mood, thinking, and behaviour… Many people have mental health concerns from time to time. But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function.
Mental illness refers to a wide range of mental health conditions—disorders that affect your mood, thinking, and behaviour…
Many people have mental health concerns from time to time. But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function.
People use the term physical illness to cover a myriad of conditions such as appendicitis, a fractured hip, or breast cancer. In the same way, mental illness refers to a collection of more specific conditions such as obsessive-compulsive disorder or bulimia nervosa.
Everyone has times when they are sad, worried, or overwhelmed. Having ups and downs is normal. It’s the frequency, duration and severity of symptoms that separate mental illness from everyday experience. Let’s say you’re diagnosed with clinical depression. A friend might try to help, telling you that they were depressed once. They had a good cry, went for a run, and all was good again. What they’re describing is everyday life, not mental illness.
Just as there are many physical illnesses, there are many mental illnesses too. In fact, there are around 200, depending on exactly how you count them. Table 1 lists the main categories of mental illness, and, in parentheses, the number of illnesses in each category. Most of these are then classified by subtype, specifier, features, or severity. Additionally, more than 40% of people who have a mental illness have two or more diagnoses at the same time. The illnesses are then said to be comorbid.2
While the exact mechanisms are the subject of active research, most aren’t well understood. The majority of experts think that many factors contribute to mental illness. This broad view is usually referred to as the biopsychosocial model. It says that biological factors (e.g., neurotransmitters, genetics) are part of the story, but not the whole story. Psychological (e.g., coping styles, attachment) and social factors (e.g., financial stress, culture) also play a role. They may all need to be addressed for optimal mental health.
One challenge for people seeking mental health care is finding care providers who address all parts of the biopsychosocial model. We’ll return to this theme in various ways throughout the book.
Not everyone fully embraces the biopsychosocial model. Many agree with the model, but as a practical matter, provide only limited treatment options themselves. A psychiatrist who offers medication but recommends other providers for psychotherapy is an example. At a deeper level, some people reject the model altogether. They don’t believe that all three components contribute to mental illness.
For example, some counsellors or laypeople don’t think that biology has anything at all to do with mental health. At the extreme, they will tell you that since biology is not a factor in mental health, psychiatric medications don’t treat anything, but are instead a government tool for social control.
At the other extreme are those who feel the only valid treatment for mental health is to address underlying biochemical deficiencies, genetics, inflammation, or effects of environmental contamination. Under a strictly biomedical model, mental illness is treated the same way an infection is treated. Bacteria causes the infection, and an antibiotic kills those bacteria.
Neither extreme reflects how mainstream medicine sees mental illness.
It is important to distinguish between a single episode of mental illness that goes away after a short while and a mental illness that lasts longer.
Sometimes, you might experience mental illness for only a short time. This is often, but not always, in response to one or more events or stressors. It may go away on its own or with treatment. After that episode resolves, you may not have any further mental health concerns.
However, you may experience a chronic mental illness which lasts for a much longer period. It may wax and wane in intensity, but it’s usually still there. You may have a recurrent illness, where you go through several distinct episodes of illness, broken up by periods where you’re healthy.
Even a one-time episode of mental illness puts you at greater risk of having another episode in the future. For example, the odds of anyone having a major depressive episode in their lifetime are around 15%.
If you’ve already had one episode, this jumps to 50% (and 70% after a second, and 90% after a third). Understanding the biopsychosocial factors that led to one episode may help reduce the risk of developing another.
When we describe mental illness lasting a “short” time, remember it’s not about regular ups and downs. Instead, it’s far more intense and problematic. Most mental illness diagnoses require you to have experienced symptoms for a certain number of weeks or months.
Severity is one aspect of mental illness that is often under appreciated.
There seems to be a stampede to diagnose any sign of mental turmoil as a mental illness. But for symptoms to represent a mental illness, they need to significantly impact a major area of your life (e.g., school, work, family, self-care). Two people may have the same diagnosis, but it doesn’t mean the impact of that illness is the same. Consider these three individuals:
Someone with social anxiety may be more nervous than the average person before giving a speech or when meeting someone new. But if this anxiety doesn’t majorly impact their life, it’s not mental illness.
Faced with the same speech, someone with mild social anxiety disorder may be so nervous they need to psych themselves up for days beforehand. They may avoid it altogether. Still, they can hold down a job and keep relationships.
That’s very different from someone with severe social anxiety disorder. They may be unable to leave home or use the phone, to the point they can’t look after themselves or their family, or go to work.
It’s more popular than ever to assign diagnoses. Around 19% of teenage boys are now diagnosed with ADHD (Attention-Deficit Hyperactivity Disorder), half before age six. Are people sicker now? Or, is there more pressure in many places to diagnose (and then treat) people? One recent study showed those under 19 in the USA were 72 times more likely to leave the hospital with a bipolar diagnosis than in the UK.3
One hundred per cent of people have room to improve their mental health. Many have specific mental health issues. But only approximately 18% have a diagnosable mental illness at any given time. And only about 4% of people have a severe mental illness. Most people with severe mental illness have a form of schizophrenia, severe bipolar, or severe depression. But if the impact is large enough, nearly any mental illness can be severe.4
This all has major public policy implications. It affects how scarce mental health funds are allocated. If “all mental health is equally important” do you invest in helping everyone “be the best they can be”? Or, do you invest in the vastly different needs of those with severe mental illness? To deliver the best mental health care, everyone can’t be treated the same.
The more severe the illness, the bigger the impact on overall well-being and quality of life. Getting treatment for severe illness may mean the difference between a normal life and homelessness or worse. There are fewer effective treatment options as severity increases. Hardcore medications are needed, with specialists to administer and manage them. Awareness campaigns, peer counselling, and therapy programs may help some people with less severe illness. But these aren’t very effective for those with severe illness.
Helping yourself also assumes you know you’re having a problem and that you want to fix it. One devastating symptom shared by many with severe mental illness is anosognosia. This is a belief that there’s nothing wrong with you—so why would you want to seek treatment in the first place?
This book won’t help those with the most severe mental illness, who may not understand they have a problem, may have few treatment options, or who may be severely impacted by their illness. If dealing with reality is a major challenge, they may struggle to meaningfully participate in their own care. They’re going to require more help from the system, which unfortunately isn’t always there.
If there’s one message we want you to take away, it’s that mental illness is not a “one size fits all” term. Be very careful. What’s right in one situation may be very wrong in another.
Keep this in mind when people give you advice based on their own experience with mental illness. It may be similar to what you’re experiencing but could be very different. The solutions that worked for them may not be helpful for what you’re facing. Whether we’re talking about mental illness in general or even one illness, it’s still a huge number of people. It’s very easy to overgeneralize, merge very different subgroups, or abuse statistics.
Here are two claims about mental illness where more nuance is needed:
Medications aren’t needed to treat mental health. As you saw, the severity of mental health and mental illness can vary greatly. Many with mild mental health issues or mental illness may not need any treatment at all. For many with mild to moderate mental illness, treatment with medications may be a useful option. So might many other types of treatments, alone or in combination. However, as severity increases, the need for treatment increases, while options for effective non-pharmaceutical treatment decrease.
If you have a mental illness, you’ll be committed to a hospital and treated against your will. Actually, very few people are ever forced to stay in hospital or forcibly treated. This happens only in the most severe crisis situations, where there is a risk of imminent danger to self or others. The specifics of involuntary commitment and treatment legislation vary across jurisdictions. With too few inpatient psychiatry beds, the pressure is to help people outside of hospital, not vice versa.
Watch out for people making sweeping generalizations about mental illness. Remember, there are many different mental illnesses. Even two people sharing the same diagnosis may have completely different experiences.
Mental illness is a blanket term for a very large number of individual illnesses, each varying greatly in how it affects individuals.
About one in five people will experience a mental illness, which can have severe effects on their functioning, as well as on those around them.
The biopsychosocial model reflects the view that mental illness is brought on by a mix of biological, psychological, and social factors, and its treatment may require intervention in one or more of these areas.
With such variety in illnesses, symptoms, severity, and causes, there are no “one size fits all” solutions. Take care to avoid generalizations or assuming one person’s experience applies to someone else.
Courtesy the Mayo Clinic
https://www.mayoclinic.org↩
Two separate large studies in the USA provided a good picture of the risk of mental illness and which mental illnesses are more likely to occur together.
Kessler RC, Chiu WT, Demler O, Walters EE. “Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication.” Archives of General Psychiatry. 2005;62(6):617–627.
https://doi.org/10.1001/archpsyc.62.6.617
Hasin DS, Goodwin RD, Stinson FS, Grant BF. “Epidemiology of Major Depressive Disorder: Results From the National Epidemiologic Survey on Alcoholism and Related Conditions.” Archives of General Psychiatry. 2005;62(10):1097–1106.
https://doi.org/10.1001/archpsyc.62.10.1097↩
Thanks to DJ Jaffe for highlighting those examples. The data on ADHD rates were reported in a New York Times article, based on a study by the Centers for Disease Control. The rate for teenage girls was about half that of boys, and half the boys diagnosed were on ADHD medications. The second example was based on databases of hospital discharges over ten years in both the USA and the UK.
Schwarz A, Cohen S. “More Diagnoses of Hyperactivity in New Centers for Disease Control Data.” New York Times. April 1, 2013.
https://mhnav.com/r/nytdxhyp
James A, Hoang U, Seagroatt V, Clacey J, et al. “A Comparison of American and English Hospital Discharge Rates for Pediatric Bipolar Disorder, 2000 to 2010,” Journal of the American Academy of Child BODYamp; Adolescent Psychiatry. 2014;53(6):614–24.
https://doi.org/10.1016/j.jaac.2014.02.008↩
One reliable source of data is the annual U.S. National Survey on Drug Use and Health (NSDUH). This survey is undertaken by the Substance Abuse and Mental Health Services Administration (SAMHSA). It collects data from about 68,000 people, taking into account gender, age, race, geography, income, insurance, and overall health.
The 2016 survey classified 18.3% of respondents as having a mental illness in the past year and 4.2% having a severe mental illness. The full reports and data are available.
https://www.samhsa.gov/data/population-data-nsduh/↩
Now Available! A MSP-supported live course for BC residents based on the book. [Mar/2023]
While you can read it for free online, there are conditions on sharing it with others (see below). You can also still purchase copies in paperback or e-book (PDF, Kindle, Kobo, etc.).
Now Available! A MSP-supported live course for BC residents based on the book.
