Today we are going to explore the nature of mental health disorders. Mental health disorders are real, prevalent, and can impact anyone. 1 in 5 Americans will experience a diagnosable behavioral health condition this year. They cause emotional, physical, psychic, and relational suffering, and can severely impact life functioning. For the most part mental health disorders are not a disease. Rather, they are normal stress reactions, and expressions of variety within our species. The most common threads linking mental health disorders are stress, trauma, genetics, and access (or lack-there-of) to coping skills and resources.
A lot of times the normal emotions that get labeled as “negative” are often healthy responses to our environment. The sadness and fatigue we experience while we mourn the loss of a loved one, tell us to slow down, rest, and take time to understand our loss and make sense of our new environment. The energy of anxiety can propel us into problem-solving action like studying for that big test. The hypervigilance and wariness that trauma survivors experience help us keep on the lookout for danger, a key to survival while living in an unsafe and threatening environment. Many times it is when these healthy adaptations are present when they are no longer needed, or when they become maladaptive and impact the quality of our lives or impact our functioning, that we label them a mental health disorder.
It makes sense that most of us misconstrue and misunderstand mental health experiences. The majority of funding to provide treatment for mental wellness is paid for by health insurance here in the US. Insurance companies operate by the disease model of mental health. That is to say the way they classify mental health is that you either have a disease that is making you unhealthy, or you are healthy and no longer in need of treatment. Clinicians are expected to take notes that use language which indicates they are assessing and treating a disease. Such a model limits our view of mental health, having us merely focus on symptoms. Such a model does not provide credence to wellness factors like resilience, creativity, socializing, perspective taking, courage and other adaptive mental functions which contribute to health.
Another contributor to the misconception of mental health are the marketing and sales of psychopharmaceuticals. Major pharmaceutical companies medicalize normal human conditions such as sadness and worry. There is a multi-billion dollar market out there trying to convince people across the globe that experiencing human misery is a sickness that can be cured with medicine, and not only that, but long-term medicine. This isn’t to say that you should not pursue medicine. Internal and external stressors can cause our brain chemistry to get out of whack and cause needless suffering. Psychopharmaceuticals have helped millions cope, and if it helps you I am glad you’re taking them. What this is to suggest, is that misery is part of the human condition and the perspective of viewing mental health as a disease is problematic.
The problem is, is that the disease model doesn’t hold up under scrutiny. Mental health disorders are culturally dependent, while diseases are not. Cancer, the flu, HIV and other diseases look the same, no matter where you are in the world. Anthropologists have done many studies and have found that mental health disorder symptoms change depending on the geo-cultural location. Depression, anxiety, and schizophrenia, look different in the US than they do in Japan, Tanzania or India for example. Other studies have demonstrated that depending on the culture, traditional medicine folk are about equally effective in treating mental health disorders as mental health professionals.
Culture plays a significant role in our views of mental health as well. The DSM used to classify being gay as a disorder; today being gay, lesbian, pansexual, or bisexual are widely accepted (as they should be) as part of our normal sexual diversity. Emotional and cognitive responses like sexuality, height, and weight, also exist on a spectrum. Some of us are more emotionally sensitive than others, some of us are more expressive, some of us less. 20% of the population will experience a mental health issue this year. This suggests that these are pretty common stress responses. I have yet to work with a person who is experiencing a mental health issue who was living in a healthy environment, felt secure in their needs, had no experience of trauma, was well connected with their community, existed in healthy relationships, was engaging in meaningful activities, and in good health.
And that leads to another important question. Are mental health disorders unhealthy responses to healthy circumstances, or are they healthy responses to unhealthy circumstances. Nobody has ever proven that the collection of mental health disorders in the DSM or defined by the WHO are unhealthy responses to healthy circumstances. There is plenty of evidence to suggest that disorders PTSD, anxiety, and depression are normal stress responses to unhealthy circumstances like abuse, violence, neglect, or not being able to meet ones needs.
So what does this all mean for how we view mental health? Mental health disorders create suffering, have significant impacts on functioning, and are worthy of being treated as the serious and real conditions that they are. Perhaps this means we as a collective have to re-examine our definitions of wellness and how we as a society want to achieve our individual and collective wellness. Perhaps this means we need to re-examine and redefine how we provide resources to treat suffering. Maybe this means we should be a little more gentle and understanding with others and ourselves, knowing that if we’re not feeling well, behaving well, not thinking well, or not communicating well we are doing our best and probably responding to our internal and external environmental experiences. We are only human, after all.