Lesson 4: What is Mental Illness?

What is Mental illness?

Let’s look at the definition provided by the Diagnostic and Statistical Manual, 5th edition (DSM-V), which is the main resource used by clinicians for psychiatric disorders. According to the DSM-V:

"A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition Links to an external site., emotion regulation Links to an external site., or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above (American Psychiatric Association, 2013, p. 20)." 

Let’s break that down a bit:

  • Clinically significant disturbance. This is difficult because the term “clinically significant” is not operationally defined here. Generally, it means a change or status that is important to the individual experiencing it. Therefore it is necessarily subjective. The idea is that some internal change disturbed the individual in an important way.
  • individual's cognition Links to an external site., emotion regulation Links to an external site., or behavior – this disturbance doesn’t need to be overt. For example, someone may carry on and behave as if nothing has changed but is suffering from intense anxiety or have suicidal thoughts. In other words, the disturbance may be entirely internal.
  • dysfunction in the psychological, biological, or developmental processes underlying mental functioning. A dysfunction is an abnormality considered maladaptive. The dysfunction could be psychological (thoughts, feelings, self-esteem, etc. - a dysfunction would mean that the thoughts, feelings, internal status of an individual is different and less healthy), biological (neurotransmitters, hormones, physiological health- a dysfunction here would result in less healthy biological states and processes), or developmental (the progression from one stage of life to another - a dysfunction would delay or alter that progression).
  • usually associated with significant distress in social, occupational, or other important activities. The disturbance usually disrupts some aspect of the individual’s life - which could include social life (family, friends, love relationships), occupational life (work, school), or other important activities (from basic life tasks such as grooming to paying bills to hobbies and other goals).

Mental Illness is NOT, according to the DSM-5 “Socially deviant behavior (e.g., political, religious Links to an external site., or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above” (American Psychiatric Association, 2013, p. 20). Thus, just because behavior is not socially acceptable doesn’t mean it is a mental illness unless it results from clinically significant impairment within that individual. So if one has unconventional political or religious beliefs or just some weird habits like flossing 4 times a day – that doesn’t mean mental illness in itself. If, however, these beliefs come from delusions that keep one in a state of stress or if the flossing comes from obsessively thinking about teeth and it is a compulsion that interferes with life, then it is probably part of a mental illness.

 

Take a minute to Take some notes: What are the elements of a mental disorder defined by the DSM-V?

 

 

How has mental illness been described in the past?

George Becker has extensively researched he origins of the link between mental illness and creativity. He posits that differing views of both concepts have contributed to the popular notion. As mentioned in the previous chapter, the ancient Greeks had a different view of creativity and mental illness. Platonic creativity centered on divine madness or enthousiasmos. In contrast, Aristotelian creativity revolved around melancholia. During the Renaissance, creative people were described as “melancholic” (sad) or “pazzia” (mad). After the Enlightenment, Romantics opted for a more mysterious view of the universe and believed that innate creative genius was the ultimate measure of human achievement, independent as it was from the mundane and banal. According to Becker, the Romantics linked genius with madness – a mark of the individuals divine, separate uniqueness (p.12). Many of our ideas about the link between creativity and mental illness come from this era (Becker, 2014). Around the turn of the century, a branch of psychology was developed called “faculty psychology” which posited that humans have innate natures and drives, leading to the perception that "types" of people were driven toward affliction and madness. Later, mental illness became more clinicalized using the current medical model (pg. 17).