Understanding Mental Illness: What are the basics that I should know?
People often throw around psychological terms when speaking. They say things like “My OCD is showing”, “I’m going crazy”, “My boss is a narcissist”, or “I have PTSD from watching that TV show”. We hear this language every day. And while most of us may have traits of various diagnoses from time to time, many people may ask, when does the OCD quirk signify something more substantial? In other words, what is ‘mental illness’ really, and what does it actually mean to have a mental illness?
Well, the answer to that question is varied and can be different based on culture and/or religion. In most Western cultures, the term ‘mental illness’ generally refers to a maladaptive functioning of an individual mentally/cognitively (their thoughts), emotionally, or at times, behaviorally (e.g. an eating disorder or compulsion) that impedes/impairs an individuals’ functioning in day-to-day life (e.g. relationships, work, education, social functioning and/or appropriate self care). Maladaptive thoughts, emotions, and behaviors often co-exist. Within Western culture, ‘mental illness’ can also refer to an individuals’ understandable response to a traumatic/difficult situation (e.g. grief, phobia, caregiver burnout or post-traumatic stress injury) in which that response is impairing the function in at least one aspect of their life.
Some cultures see certain conditions differently. Some of the diagnoses contained in the Diagnostic and Statistical Manual of Mental Disorders (also known as the DSM-5, the book of all the mental health diagnoses in North America) are seen by other cultures as a connection with the spirit (which is seen as a positive), a possession/curse, “normal grief”, or even not an “illness” at all but rather just “shameful” [to the family] fear/behavior. These differences in definition not only affect the way that the individual with the illness is perceived but may also influence the treatment prescribed and resources available.
While it might be interesting to talk about how other cultures perceive various mental health conditions/illnesses, we simply do not have the ability to cover this topic here. So, let’s stick with Western culture and define some of the most common mental health conditions that people identify themselves and others around them as having.
Narcissistic Personality Disorder
How many times have you heard “my ex is a narcissist”? This is a very commonly used term yet Narcissistic Personality Disorder (NPD) is, in actuality, relatively rare. Estimates suggest that only about 5 to 10% of the population meets the criteria for this personality disorder. It is characterized by the need for excessive admiration (expects special treatment), a pattern of grandiose thoughts and behaviors (fantasizes about success, power, brilliance, or beauty for example) as well as a lack of empathy. Individuals may also present with aggressive or with hypersensitivity and defensiveness. They not only tend to believe that they are special, but they also believe that they can only be understood by other special people.
Major Depressive Disorder
“I didn’t get the job. I’m so depressed.” This statement may actually indicate depression or it may indicate that a person is really bummed that they didn’t get what they were hoping for. But how do you know the difference? Depression is a mood disorder. Clinically, it is generally known as Major Depressive Disorder. People with this disorder notice a change in their thoughts, feelings, and behaviors that last more than two weeks. They feel sad, tearful, empty, and/or hopeless. They notice that their reactions to things are not typical. They find themselves irritable, easily frustrated, agitated, and/or upset. They may have weight changes, lost interest and enjoyment in things, and difficulty concentrating, and/or thinking. They often report feeling that they are worthless and have no purpose. They notice that they are either unable to sleep or they sleep all the time. They often report that they have no energy to the point where the simplest task takes a lot of extra effort. At times, they are so low, that they feel that life is not worth living, and/or self-harm or suicidal thoughts are present.
Generalized Anxiety Disorder
People often feel anxious about things or recognize that they have some trepidation about new or particular types of tasks (e.g., public speaking or heights). But Generalized Anxiety Disorder (GAD) is different in that this is anxiety experienced daily about life events and tasks and is usually associated with a full body response. People with GAD can’t stop thinking about a worry and that one worry often results in a spiral to the next worry, which spirals to the next worry, and so on. They experience a host of physical symptoms as they begin to worry – they might have a fast heart rate, excessive sweating, stomach upset, shakiness, and even a coldness or tingling in their hands and feet. They find themselves on high alert and unable to block out sensory stimuli. This makes focusing and concentration very difficult for them. They might have trouble sleeping or trouble sleeping at appropriate times. They often talk about being exhausted and feeling muscle pain or tension (frequently in the back, shoulders and/or neck). They often report feeling irritable, easily upset, or emotional and snapping at people for what they consider to be minor things. A person without GAD might think “What if I’m late for work?” and recognize that while it’s not a great thing, they are and will be okay. Whereas a client of mine with GAD thought “What if I’m late for work? My boss will be so angry. What if he fires me? How will I pay my rent? Who will ever hire me again? I can’t get a job after being fired. And, no one wants to date someone who is unemployable? I’m going to be an unemployable, homeless, lonely loser.” As this client was going through the spiral, their breath was getting quicker and quicker as well as increasingly shallow. They began visibly sweating and shaking and looked like they were going to cry. You can see how this is different from the more healthy anxiety that people have on a daily basis.
Post-Traumatic Stress Disorder (PTSD)
There have been more times than I can count where I’ve heard someone say “that _____! I have PTSD from it!” in gest. Often when people think of PTSD they think of Vietnam movies where the soldier has terrible flashbacks and auditory hallucinations. While PTSD can present in that way, that is not always the case. PTSD is a serious health condition that is so much more than being afraid, anxious, or angry. Post-Traumatic Stress Disorder can occur after exposure to death, serious threat of death, violence, or serious bodily injury. It can be caused by experiencing these things firsthand, witnessing these things, or even hearing about a loved one being subjected to these types of situations. It can also be experienced after being repeatedly exposed to these types of situations or being informed of these situations. It’s characterized by a number of different symptoms including intrusive symptoms (thoughts, images, or dreams), cognitive and mood-related symptoms (including difficulties with remembering important aspects of the traumatic incident, regulating emotions, and/or exaggerated negative beliefs or expectations about oneself, others, or the world) and arousal and reactivity related symptoms (including hypervigilance, exaggerated startle response, anger outbursts, irritability, and/or difficulties with sleep).
HOW CAN ONE GET DIAGNOSED WITH A MENTAL ILLNESS?
So, if someone thinks that they may have a mental health issue that is more than an everyday experience, what can they do? I usually encourage my clients to start with their general practitioner and be very honest about what they have noticed. Diagnosis is generally done by a psychiatrist, psychologist, or medical doctor. There are a number of factors that they will consider including scores on questionnaires, your responses to questions, and at times, other functional indicators (e.g. eating habits, sleeping habits, relationships, work status). Getting diagnosed can be intimidating as it sometimes seems not only like those performing the assessment ask a ton of questions, but that they are asking the same question a bunch of times. The important thing to remember is to be patient and listen to the questions carefully. Sometimes there are subtle differences. Remember, as much as individuals have certain things in common when diagnosed with a mental health issue, every person has their own unique circumstances and experiences. Typically, the better that they understand you and your unique situation, the better they are able to help.
WHAT TYPES OF TREATMENT ARE AVAILABLE FOR MENTAL ILLNESS?
There are a number of traditional and alternative treatments available for most mental health illnesses. Typically, medication and/or psychotherapy are recommended. Medications vary but usually act on some part of the individual’s brain chemistry. Psychotherapy can also be quite varied depending on the diagnosis. Cognitive behavioral therapy (CBT) and mindfulness are two of the more common treatment modalities. But many therapeutic modalities can be extremely helpful including Dialectical Behaviour Therapy, Emotionally Focused Therapy, and Rapid Resolution Therapy depending on the issue that the individual is dealing with. In addition, if the issues are more severe or pervasive, there are also treatments involving stimulation of certain brain areas (e.g., TMS And ECT). Treatments are also becoming more holistic in nature so many of those treating mental health disorders will also recommend things like a healthy diet, exercise, meditation/prayer, and social time with friends. Research suggests that the more holistic the approach to treating a mental health condition, the more benefit that the individual receives from the different aspects of the treatment.
Alternative and experimental treatments are also showing some promise. Some of my clients have tried things like acupuncture, Traditional Chinese Medicine, sound healing, and Indigenous ceremonies for healing. There are also a number of experimental medications that are showing some promise (e.g., psilocybin which is a naturally occurring psychedelic).
Again, many of us use psychological terms to describe how we are feeling day-to-day. If you are experiencing something mentally that is getting in the way of your functioning, you’re not alone! It’s important to speak to a professional and remember that there are treatment options available to help you cope and function better.
Janna Comrie, MA, Registered Psychotherapist, holds a Master’s degree in Counselling Psychology and has a research background in brain, behavior, and cognitive science. She has been working with individuals, couples, and families who have experienced traumatic circumstances for over 15 years. Comrie is the Director of the Comrie Counselling Corporation in Ontario, Canada. She and her team of Registered Psychotherapists provide extensive support for First Responders and their families.