Understanding Mental Illness

The most important thing to Understanding Mental Illness is recognising that “Mental Illness” is an umbrella term for everything that isn’t “Mental Health”. That is, it describes a number of different outcomes to a number of different causes that all mean that a person is no longer “mentally healthy”.

Mental Illness, An Over and Miss Used Umbrella Term

Let us look at the things that can cause you to no longer be Mentally Healthy.

Being Mental Well means that you are understanding situations well, making wise choices, and others generally agree that this is true. Mental Illness describes either the experience of having trouble thinking wisely and thus behaving appropriately, and or the perception from other people that your choices and behaviours are not healthy.

For example:

  • You believe you are thinking wisely and behaving well; others perceive you to be making good choices and engaging in good behaviours; therefore you will be considered to be mentally healthy.
  • You may look like you are doing fine; but you feel that you are struggling; so you may not be Mentally Healthy, therefore you may be Mentally Ill
  • You might be judged as very odd by others; you are internally fine, just different. Others may think that you are not Mentally Healthy and call you Mentally Ill, but so long as your actions aren’t hurting you or others, you are Mentally Healthy.
  • You might be internally in poor health and externally appear odd; which more classically fits the description of Mentally Ill.

Frequently people will use the term “Mental Illness” to describe you.

That doesn’t mean that you are sick or ill. Neurodivergent people are often falsely automatically placed in the umbrella term “Mental Illness”, mostly due to the inclusion of some neurological conditions in the american Diagnostic and Statistical Manual of Mental Disorders, which led to their inclusion in the International Classification of Diseases. Neurodiversity conditions such as Autism and ADHD, which are technically neurological conditions, can have traits that mimic common mental illnesses, and co-occur with mental illnesses, such as Autism with Social Anxiety, or co-occurring with another neurological conditions, such as Autism with Intellectual Disability (previously referred to as “low functioning autism”, but should no longer be used).

Nature and Nurture, a False Dichotomy

Mental illness is a nature and nurture problem. In this, we consider Nature the biological aspect of your being and Nurture to be all of your experiences. Most commonly, Nature is the primary cause and Nurture is the secondary cause. Either way, frequently a biological and cognitive approach is best for addressing the problem and getting you back to mental health.

Nature – The Wetware

By Nature, I am referring to the nature of our biology. Frequently, persistent mental ill health is due to nature – that is something biological about us. Biological problems need a biological solution, and that is generally medication.

Biology can be a factor of genetics, neurology, diet and allergies.

Wetware is a cyberpunk style terminology referring to the organic components of your being. We use it here to indicate the biological part of who you are, but in a computer paradigm way. Hardware would be non-biological parts such a pacemaker.

Nurture – The Software

Nurture is not just about how you were raised, it can include your school experience, early work life and all of the factors that led to you developing into an adult. This is more leaning on the village to raise a child idea than only the parents are wholly responsible. While the parents are very important on guiding overall development, part of our village learning is from peers, school teachers, extra curricular activities and family.

Our upbringing is an important factor in a well rounded adult. Unfortunately, this has led to many false ideas about troubled childhoods, poor parenting and some kind of childhood trauma being the root of every problem. Sometimes this is true, but mostly it isn’t.

In this time, we learn what the world is and how to deal with it. If you have excellent teaching and the capacity to learn good world lessons, you will be fortified against the countless slings and arrows that may be slung against you. However, if your childhood environment is filled with adversity, and or poor teachers, we will be effectively unarmed and unprepared against the world. That isn’t to say that the whole world is a fight or fraught with peril, but bad luck happens and some people aren’t very nice, and without some kind of strategy to manage this, heal from hurts, and come back to ourselves, we will suffer.

Some people never need a strategy against adversaries. Unfortunately, most of us are not so privileged and we will either come across some person who tries to take advantage of us, struggle with poverty, get sick or injured, lose a job and so on. Having knowledge of how to manage this gives us resilience and a knowledge of when to ask for and accept help.

Even with the best upbringing, we can find unexpected circumstances that can exceed our ability to cope.

A diagnostic category that I wish existed in the DSM and ICD is “surrounded by toxic people”. Around 30% of the people that come to see me due to anxiety or stress are at least in this category, where they need to learn how to manage toxic people and environments. Check out our fairly extensive Domestic Violence [LINK] play list.

Some of the adversity or circumstances might tip over from life hindering into Trauma. Trauma is actually quite rare and is not the root of all of Mental Ill Health. Read more about Trauma [LINK] here.

Severity – A Sliding Scale of Mental Ill Health

There are a number of people who come to see me who are worried that their experience or difference is a sign or symptom of mental illness. From a medical perspective, mental illness is based on how much this is disrupting your life and or someone else’s, or in the short hand “where is the harm?”. If your experience is not harmful to you or another, and is not disruptive of you or another, then it is just an interesting quirk. It may point towards neurodivergence such as Autism or ADHD, but that isn’t a mental illness per se (it is a neurological difference).

Let us define “severity”. Click on the titles below to expand what each means.

Minor Mental Ill Health (Short term, generally circumstances problems)

Life is mostly good and relatively easy for you. Something occurs outside of expectation that disrupts your life for a bit, such as loss of a job, death of a relative, some personal injury or illness. While this is affecting you, you may find yourself to feel extra sensitive to stress, perhaps anxious, or maybe depressed. You may even feel a combination of these.

If recovering from this anomaly lasts between 3 months to 2 years, this was a mild experience of mentally ill health.

Moderate Mental ill Health (2+ years of problems, semi-managed)

There is a biological factor that is always affecting your life. If not managed well, it will affect your ability to make wise choices, and or it may result in odd behaviours.

The management of this biological factor can be cultural, intellectual and or medication, depending on the biological factor.

Let us use two case examples.

Luke has finally found out that his ongoing depression and occasional over enthusiasm is positively responsive to Lithium medication. This puts the nail in the coffin that Luke has Bipolar Affective Disorder. So long as Luke takes regular Lithium medication and gets his lithium levels checked every 3 months to ensure he isn’t building toxic levels, he doesn’t experience deep depression or high mania. Luke does need to be mindful of some things, like certain foods impact his absorption of his medication, and if he is feeling too depressed for a while or goes past a certain point of enjoyment, Luke needs to check in with his health professional to check that this isn’t entering an episode. Otherwise Luke’s mental health is fine.

Alex worked out as that they are Autistic when he was in his late 30’s. This explained why Alex often took instructions literally, often felt like they had missed the memo of “what are we doing”, and only enjoyed spending time with a few friends for short periods of time. Alex has found that Pristiq really helps with the social anxiety that they had been originally diagnosed with, but now is clearly just a trait from Autism. Alex finds that the biggest impact to their mental health is how people treat them and the basic expectation that somehow Alex will just “know” the rules of each situation and setting. With a bit of therapy, Alex has developed a better heuristic (set of basic rules) for most situations and has learned to compensate for other people better.

Hopefully it can be seen from these two examples that the individual has a life long medical condition that impacts their thinking, feelings and behaviours. However, once identified and managed, this isn’t a big deal. BPAD and Autism are not disabilities, and neither of them are rooted in Traumatic Events.

On average, if a person has been struggling with mental ill health for more than 2 years, then there is a biological factor that needs to be examined.

Major Mental illness (Atypical psychiatry)

Major mental illness includes certain types of schizophrenia, narcissistic personality disorder, certain types of psychopathy, psychosis and a handful of other conditions. Each of these is, at root, biological in nature.

The reason why these are considered to be Major Mental Illnesses is due to their unique natures. Specifically, these are medication and behaviour management resistant.

There are some mental illnesses that do not have effective medications. When that condition includes confusion, distortions to reality or loss of insight, it is very difficult for a person to create and maintain a set of behaviours to compensate. As an analogy, if your car always pulls a bit to the left, you can learn to bias a bit to the right to compensate for that left pull. If you can’t remember that your car does this, you’ll keep driving off the road, never learning to manage that swerve.

Even when there is a medication that can be positively effective, if the condition includes a pervasive or recurring lack of insight, the person won’t continue taking their medication.

Here is another case example.

Steve has been told he has schizophrenia, but clearly they are wrong. Ever since he got out of psych ward, he’s feeling great. He can focus and concentrate fine. He doesn’t hear any voices, and he can make excellent decisions. Steve enjoys seeing his friends and does so regularly. It’s been about two weeks since Steve convinced those crazy doctors at the clinic that he doesn’t belong there, heck he even let them inject him with their fake medicine just so that he could leave. Steve returned to his job, the old boss gave him another go. It’s been a good two weeks, but Steve has found that he doesn’t want to go to work in the last few days. He’d rather hang out with his friends. Work is such a bore. His friends like to smoke weed, but Steve doesn’t want to poison his lungs with that stuff. Steve has just remembered that the clinic nurse is going to come over later today to give him another injection. While Steve remembers that he agreed to this at the time, he had to before they would let him leave the clinic. Clearly he doesn’t need the injection, because everything is fine. The cat says everything is fine, and she’d know. Steve has been enjoying the conversations the he’s been having with the cat. She seems to know a great deal. Cat tells him he should go and visit his friends today, before the nurse comes over, so that he doesn’t have to take that fake injection. Steve grabs his keys and gets out.

Unfortunately Steve lacks the insight to understand that the antipsychotic medication in the injection lasts about 14 days. It tapers off in strength at around 10 days, which explains why he has been skipping work for a few days and now thinks that the cat’s advice is excellent. Steve cannot comprehend that the medication is what made his life work well for the last 10 days. Professionals and family have explained it to him many times, but he just doesn’t believe it.

Schizophrenia is not caused by trauma.

Complex Conditions

A person can experience multiple levels of mental illness.

For example

  • An acquired brain injury can damage a person’s insight and make it hard for them to recognise the consequences of their choices.
  • Enough anomaly events can lead to a large amount of distress which can trigger a long term path to recovery (this one actually is trauma), or a single huge incident can also trigger a long path to recovery (PTSD).
  • A person with a moderate condition can have an anomalous situation (eg losing their job or a break down in a relationship) that destabilises their formally effective coping and management methods. This leads to a worsening of their condition called “decompensating”.

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