The essence of mental illness

There are many different psychiatric disorders, syndromes or diagnoses. Consider the range of separate diagnoses—depression, anxiety, psychoses, compulsions, ADHD, eating disorders to mention a few. These are all superficially very different. Do they have anything in common?

I will argue that they all involve distortion of reality in some way. It is obvious if one is hearing voices or having visual hallucinations, less so when one is depressed. Even in depression, however, the depressed person perceives slights where none are intended, feels guilt where none is warranted, feels hopeless when objectively there are reasons for hope. Depending on severity depressed people are more or less aware that their feelings are unrealistic. At the most extreme they lack insight and may be psychotic. Often, however, they will volunteer quite readily that their personal pessimism is unwarranted but nevertheless quite compelling.

In anxiety disorders the fears are irrational or clearly excessive. One may worry they are having a heart attack when their heart rate increases or when they are breathless, even when they have had similar symptoms countless times before and have been physically examined to assure that nothing ominous is in fact happening.

In compulsions one may check and re-check or wash and re-wash even when someone is standing beside them telling them that neither is necessary and they have been reassured countless times before.

In ADHD there is an absence of self-discipline, the ability to self-monitor and self-regulate behaviour, even when the consequences of not doing so are clear and negative.

In Anorexia Nervosa people stop eating even when dangerously thin. They may continue to see themselves as overweight in the face of medical and social messages to the contrary.

No wonder the mentally ill are reluctant to seek help or acknowledge their problems. Who wants to admit that they are behaving in an irrational manner that is beyond their control? It is not easy to admit that one’s hurt feelings and anger are irrational and entirely self-inflicted. We all like to think that we are in control of our destinies even when the facts clearly suggest otherwise. Who wants to admit that they are out of control and helpless in the face of their distorted view of reality and self-destructive behaviour?

This is why it is so important in AA, for example, to acknowledge a higher power, however that is interpreted. It is essentially an admission that one is not in control. This applies not only to addictions but to mental illness of all sorts.

This is at the root of why stigma is so hard to get rid of and why so many people go so long without getting help, even when help is freely available and compassionately offered.

This is why seeing a therapist is often beneficial regardless of their particular brand of therapy. The very act of seeking treatment leads to an acknowledgment that there is a problem and that one’s view of reality is distorted. Verbalizing ones concerns almost always leads to a realization that ones thoughts, feelings and perceptions are distorted. A therapist, whatever form of therapy they are practicing gives an alternate interpretation of events and therefore changes the patient’s interpretation of what is happening to them. The mere act of diagnosis does this.

We all distort reality to a degree. So what differentiates the merely distressed from those with a diagnosis? Whether someone qualifies for a diagnosis depends on a somewhat arbitrary, man-made definition that has been agreed to by consensus. It usually involves a judgment that the distortions and distress are severe enough that they are causing impairment of function.


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