It may seem blindingly obvious that mental illness is real, but – amazingly – there are some people and web-sites that assert that mental illness is not real and does not exist. They don’t deserve any publicity, and they won’t be getting any here, but even reputable journalistic organs are not averse to using snappy, misleading headlines that imply the same [1].
It is self-evident that states of mental distress as common as depression, anxiety, alcohol and drug problems, and psychosis exist. How could anything so impactful upon humanity be ‘imaginary’ or ‘all in the mind’? The complaints that make up these conditions are not fabricated. They are subjective mental states, no less real than love or pain. They can even have physical manifestations – a sign of the intensity of the experience – when, for example, people are visibly depressed or shaking with anxiety.
Presumably, what people mean when they question the existence of mental illness is whether the diagnostic categories that psychiatrists and other health professionals use have any objective validity. Hopefully, they question the diagnostic concept rather than the subjective reality of the sufferer. It is true that there are very few objective diagnostic tests for mental illness – apart, for example, from the known genetic causes of some learning disabilities and dementias – but the common diagnoses are based upon years of clinical observation that certain complaints or ‘symptoms’ commonly aggregate together, into ‘syndromes’.
Ultimately, if we accept that there are different types of mental distress and different treatments available for them, two premises which are difficult to rationally dispute, then we need some sort of diagnosis and classification system. We need to be able to offer treatments to the people most likely to benefit from them and to study particular problems so as to improve understanding.
Our current classification systems have many well-recognised limitations but they have facilitated useful advances. Most importantly, current diagnoses have facilitated clinical trials and the development of effective pharmacological and psychotherapeutic treatments of proven benefit [2]. Researchers have also been able to identify risk genes for e.g. autism, ADHD, depression, bipolar disorder and schizophrenia [3]. There are even neuroimaging correlates of some of these ‘disorders’, which cannot be simply explained away as down to the effects of illness or its treatment [4,5].
The diagnosis and classification of mental illness is far from perfect but it is useful. As in the rest of medicine, our conceptualisation of ill-health is a work in progress. But this does not mean that those suffering with mental ills do not have genuine complaints that merit treatment. Ongoing research will hopefully deliver improvements in diagnosis and classification. Some of these may be revolutionary changes. In the meantime, we have the system we have for good, rational reasons.
References
[1] Durward, J. Medicine’s big new battleground: does mental illness really exist? The Observer, Sunday 12 May 2013. [Web-site: http://www.theguardian.com/society/2013/may/12/medicine-dsm5-row-does-mental-illness-exist?CMP=twt_gu#start-of-comments]. Accessed 8th March 2015.
[2] Huhn M, Tardy M, Spineli LM, Kissling W, Förstl H, Pitschel-Walz G, Leucht C, Samara M, Dold M, Davis JM, Leucht S. Efficacy of pharmacotherapy and psychotherapy for adult psychiatric disorders: a systematic overview of meta-analyses. JAMA Psychiatry. 2014 Jun;71(6):706-15. doi: 10.1001/jamapsychiatry.2014.112. PMID: 24789675
[3] Cross-Disorder Group of the Psychiatric Genomics Consortium. Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs. Nat Genet. 2013 Sep;45(9):984-94. doi: 10.1038/ng.2711. PMID: 23933821
[4] Howes OD, Kambeitz J, Kim E, Stahl D, Slifstein M, Abi-Dargham A, Kapur S. The nature of dopamine dysfunction in schizophrenia and what this means for treatment. Arch Gen Psychiatry. 2012 Aug;69(8):776-86. PMID: 22474070
[5] Gryglewski G, Lanzenberger R, Kranz GS, Cumming P. Meta-analysis of molecular imaging of serotonin transporters in major depression. J Cereb Blood Flow Metab. 2014 Jul;34(7):1096-103. doi: 10.1038/jcbfm.2014.82. PMID: 24802331
I’m a mental health care assistant. I never planned to be, but it turned out to be the only job I could get, so I took it. I was plunged into the deep end but I can tell you one thing, it’s a job that has rewarded me every single day.
I suffer from anxiety. I never knew this until I became aware of what mental health was through my job. And even people who are close to me do not believe anxiety to be a mental illness. Frankly, it is because they do not understand what effects it has on the body.
I was in pain, I had diarrhoea, I couldn’t sleep, I’d shake, I’d be irritable when normally I was fine. I had low resilience and tolerance and onsets of depression because little aches and pains that came with the job would become just another thing to worry about, and anxiety makes little things into big problems. A tiny ache became crippling.
I know so many people with anxiety problems, but they do not know/or refuse to believe it is anxiety. Instead, they insist it’s worse. They often believe vital organs are failing, they are in tremendous amounts of pain, have fainting spells and panic attacks and when a doctor gives them the all clear, they refuse to believe it. And they consider all these symptoms to be too great for something as trivial as ‘anxiety’.
We’re better at accepting mental health now-a-days, but it’s in no way good enough yet. Too many people shy away from medicines and treatments because they do not consider mental health a physical illness that needs physical treatment.
But as a sufferer myself I can put my hand on my heart and say with all seriousness, there is no greater strength than the power of the human mind, and the moment the human mind strays or breaks even in the slightest, then you’ll come to know more stress and ailments than any physical condition could ever inflict.
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