The fine line on Mental illness

Many of us believe that we are healthy. But when we think of health, do we consider mental health as well as physical health ? For many people what constitutes mental health and mental ill-health is unclear. So what does it mean to be (mentally) healthy, and where do we draw the line between sanity and craziness ? This is an important issue to address as it seems that misunderstandings abound when it comes to health and matters of the mind.

It may be helpful to see mental health as existing on a continuum - with pathology or extreme mental ill-health at one end and optimum functioning or mental wellness at the other. Most of us would then fit in somewhere between these two. The majority of us suffer some form of mental ill-health at some point during our lifetime. For instance, most of us would admit to acting irrationally under periods of extreme (or sometimes slight) stress. In hindsight, we may recognise that at times such as these we were functioning at a level lower than we usually operate, and perhaps there was some impairment to our mental wellbeing.

When deciding what is pathological and what is normal in terms of mental functioning, it is important to keep in mind that psychological function/dysfunction is primarily defined by social norms. These norms are the standards which we tend to live by in society. For example, in our society it would probably be considered abnormal for a male to parade around covered in elaborate make-up and string underwear (although it may be interesting to watch) however this type of behaviour may be quite acceptable, and perhaps even celebrated, in other cultures or societies. It tends to be that in deviating from social norms a person is usually classed 'crazy' or 'insane'. Therefore it is our ideas on what is acceptable and what is not that largely determines those we call 'normal' and those we class as 'abnormal'.

Psychologists not only consider deviation from social norms in classifying abnormal mental functioning, but also look at other aspects of the behaviour the person is exhibiting. For an individual to be considered mentally ill he or she must exhibit a certain level of dysfunction, that is, the person's functioning must be seen to interfere with his/her everyday functioning. Obviously, a depressed person who cannot drag him/herself out of bed would probably be seen as dysfunctional as the behaviour has the capacity to interfere with his/her ability to perform everyday tasks. Another important consideration is the level of danger associated with a person's behaviour. A pyromaniac whose fire-setting activities have the potential to place many lives at risk will be seen as more dangerous than a person who displays obsessive-compulsive tendencies directed toward cleaning the house to ridiculously immaculate standards. Similarly, it is unlikely that someone whose manic phases of a bipolar mood disorder see them creating vast quantities of artwork (as was apparently the case for Vincent van Gogh) would be classed as a danger to themselves or others (unless, perhaps, if this behaviour was associated with a disinterest in eating, drinking or resting and therefore likely to lead to exhaustion, dehydration and/or malnutrition etc).

As a way a making explicit the criteria people must meet to be classified as suffering from a psychological disorder psychologists and psychiatrists use what they refer to as a diagnostic and statistic manual or DSM. This manual contains many disorders and criteria that must be met in order for a person to be classified with a particular disorder and is continually under rigorous revision based on clinical research. This type of instrument is designed to give consistency to diagnoses and to decrease the possibility of misclassification. For each type of schizophrenia, for instance, there are particular symptoms and behaviours that must be displayed in order for a person to be classified with that form of schizophrenia. Although this manual is comprehensive and thorough many clinicians note that each person's disorder is unique and that many forms of mental illness defy categorization.

A problem inherent in diagnosing people with a particular disorder is what is commonly referred to as labeling. It is believed that a person diagnosed or labeled with a particular disorder comes to then 'identify' with that disorder and displays the characteristic behaviours of someone suffering from that disorder. This process is somewhat like a 'self-fulfilling prophecy' whereby symptoms in line with the disorder are looked for and readily acknowledged and emphasized in the sufferer. The person with the 'illness' comes to 'play the role' of a person suffering from the assigned disorder. For instance, if someone is diagnosed as suffering from schizophrenia but is not experiencing bizarre hallucinations, then that person may in time come to do so partially because they believe (perhaps unconsciously) that this type of behaviour fits in with someone suffering from this condition. The labeling phenomenon may be extremely hard to break free of and for this reason many therapists are weary of classifying people with a disorder label, and often do so only when the assignment of a condition is imperative (for instance, for the purposed of legal proceedings).

This is obviously only a brief introduction to mental health and psychological disorders. I think what is important to remember is that the line between one who is mentally well and one who is mentally impaired is often fuzzy - there is a great grey area between optimum functioning and mental illness. Having this type of understanding of mental illness may help to diminish some of the barriers between those classified by society as mentally healthy and those classed as mentally unwell. If we see the capacity for mental illness as existing in all of us, and not just assigned to those unfortunate few, it may then be easier to empathise with, and perhaps even identify with, those suffering from a mental 'illness'.


- Kerryn Wilson