MENTAL HEALTH - III

Mental Health- III

 

 

Mental health: What's normal, what's not

Deciding what's normal mental health and what's not is tricky. See how feelings, thoughts and behaviors are classified on the ever-evolving continuum of normalcy.

What's the difference between mental health and mental illness? Sometimes the answer is pretty clear.

People who hear voices in their heads may have schizophrenia, for instance. And those with such grandiose ideas as becoming the secretary-general of the United Nations without any experience may have a form of bipolar disorder.

But more often, the distinction between mental health and mental illness isn't as clear-cut. If you're afraid of giving a speech in public, does it mean you have a disease or simply a run-of-the-mill case of nerves? If you feel sad and discouraged, are you just experiencing a passing case of the blues, or is it full-fledged depression requiring medication?

Just what is normal mental health, anyway?

Culture, science and mental health

Scientists, researchers and mental health experts have wrestled with this issue for hundreds of years, and even today the line between normal and abnormal is often blurred. This is why the fields of psychiatry and psychology are sometimes mired in controversy.

"There's a broad range of what's normal," says psychologist Donald E. Williams, Ph.D., a medical specialty editor at Mayo Clinic, Rochester, Minn.

What's normal is often determined by who's defining it. Normalcy is ambiguous and often tied to value judgments particular to a certain culture or society. And even within cultures, concepts of normal mental health may evolve over time if societal values or expectations change. New medical research and knowledge also can lead to changes in definitions of normal mental health.

One thing that makes it so difficult to distinguish normal mental health and abnormal mental health is that there's no easy test to show if something's wrong. There's no blood test for obsessive-compulsive disorder, no ultrasound for depression and no X-ray for bipolar disorder, for example. That's not to say mental disorders aren't biologically based. Most mental health experts do believe that some mental disorders are linked to chemical changes within the brain, and they're beginning to map these changes visually using imaging studies. But for now, there's no physiological diagnostic test for mental illness.

Distinguishing mental health from mental illness

Mental health providers define mental disorders by signs, symptoms and functional impairments. Signs are what objective observers can document, such as agitation or rapid breathing. Symptoms are subjective, or what you feel, such as euphoria or hopelessness. Functional impairment is the inability to perform certain routine or basic daily tasks, such as bathing or going to work.

In mental illness, signs and symptoms commonly show up as:

• Behaviors, such as repeated hand washing
• Feelings, such as sadness
• Thoughts, such as delusions that the television is controlling your mind
• Physiological responses, such as sweating

Signs, symptoms and functional impairments that mark specific mental illnesses are spelled out in detail in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This 2-inch-thick book classifies and describes more than 300 types of mental disorders. The book, published by the American Psychiatric Association, is used by mental health providers to diagnose everything from anorexia to voyeurism. For instance, a mental health provider can evaluate your signs and symptoms and refer to the DSM to see which illness you might have. The first edition of the DSM was published in 1952, and revisions have been made periodically since. The most recent update was published in 2000, and it has been translated into nearly two dozen languages.

Why is it important to diagnose people and attach labels that could be stigmatizing? Why does a specific diagnosis even matter if the line between mental health and mental illness is sometimes blurry? One reason is that the health insurance industry uses the diagnoses spelled out in the DSM to determine coverage and benefits and to reimburse mental health providers. But more important is that in order to get appropriate treatment, you must know what condition to treat — and whether it needs to be treated.