By David Joel Miller.
Do people have a mental illness or are they in poor mental health?
The language we use influences the way we think about things. Talking about mental illness or talking about mental health is a prime example of this issue. While the two expressions turn up in much of what is currently being called “Behavioral Health” literature the implication embedded in these two terms influence what we expect and how we react to the people being referred to.
The mental illness paradigm.
The older, traditional way of looking at the subject of mental illness was to assume that there were two types of people – the “normal” folk and then those other “mentally ill” people.
One implication of this concept was that people with a mental illness were not able to do things other people could do. The result was programs and policies that assumed those with a diagnosed mental illness would need lifetime help to manage their lives.
There was a time when those with a mental illness were lumped together with those who had significantly lower I.Q., once called the “mentally retarded” or “developmentally delayed.”
If we think in terms of mental issues being a disease or disorder then the first line of treatment as with physical illnesses, should be medication and surgery, the standard treatments of choice for physical illnesses and conditions.
Despite over half a century of treating mental illness with medication and surgery the number of people who are diagnosed with a mental illness continues to rise. Fewer seems to be getting cured but everyone now gets diagnosed.
The Mental Health option.
If we think in terms of mental health, then many other things follow. Many of the things we have been referring to as mental illnesses become a matter of degree rather than an illness that you have or do not have.
Something bad happens to you, you lose a family member or a job, you become sad, a normal human emotion, then eventually you should get over sadness no treatment needed. Should you become too sad or the sadness persist too long then the label and the corresponding treatment would change.
Sadness or grief becomes Major Depressive Disorder when it gets out of hand.
Another example – Anxiety.
We have a range of Anxiety disorders. Now anxiety is a close cousin to afraid or scared. So if people are shooting at you I think you should be scared and duck behind something. That scared, anxious, avoidance of things may save your life.
But should that anxiety begin to get out of control, every time you hear a car door slam or see someone on the street, if you become too anxious to leave your house, that is a problem.
Clearly, most of the things professionals diagnose as an anxiety disorder are much more severe than the things we consider normal but it is easy to see how the two overlap.
Wellness and recovery.
The concepts of wellness and recovery have challenged the way we think about this issue. If we allow that people can move back and forth on the continuum of mental health then there would be times when a particular person was mentally ill and other times when they were in better mental health.
Rather than thinking exclusively in terms of mental illness and diseases we should be thinking about mental health as similar to physical health. There are times we are in better health than at other times. Someone could have “poor mental health” and be in need of prevention or restorative services long before they reached the point of what we have been calling a mental illness.
The Mental Illness Violence dilemma.
The news has been full of accounts of people who became violent and harmed others. The common discussion revolves around whether they were “mental ill” and why no one had detected their illness beforehand and prevented that violence.
What if that person had been in poor mental health for some time and then eventually their mental health deteriorated to the point it could have been diagnosed as what we are currently calling a mental illness?
Could an intervention have been conducted while this person was in the pre-mental-illness stage that would have prevented their condition from deteriorating to a mental and a behavioral issue?
If the mentally ill are somehow different from the normal people then no, no prevention is possible but if there is such a thing as mental health that gets better and then gets worse and then better again there are things that can be done to prevent relapses into active mental illness.
We have had that violence – mental illness connection wrong.
A little more on the mental illness violence connection. Those with a mental illness are far more likely to be the victim of crime rather than the perpetrator.
Most of those workplace and school shootings? Those were often the result of someone who appeared normal or close to it until they were fired from their job, served with divorce papers or found out their partner was cheating on them.
Remember, as reprehensible as it is that even one child died in a school shooting, each year for every child who dies in a school shooting, from ten to twenty children are shot at home by a biological parent who then shoots themselves.
Rather than having had a long-term diagnosable mental illness I believe there is good evidence that many of these violent incidents were the inability of this person to cope with an identifiable stressor. Their problem was not a long-term severe mental illness but their inability to cope with stress that pushed them into a poor mental health state.
Many have suggested that the mental ill is just the way they are not to blame for their having a disorder. I agree that they are not to blame for having gotten a mental illness. I doubt that anyone chooses to be sick mentally or physically. That does not mean that the mentally ill have no hope and need to resign themselves to always being too sick to function. Recovery can happen. We see it happen every day.
Throughout the year I want to talk more about some of the tools that can be used to keep yourself mentally healthy and to reduce the impact of illness when it does occur.
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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books
Let’s work on improving mental health in out programs of treating mental illness.