Defining Mental Health

Last updated 23-11-2024

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Beyond Diagnostic Categories

Mental health is usually thought of as the relative lack of mental illness, so we need to look at what mental illness means. Mental illness is a concept which most people associate with a diagnosis from the DSM or the ICD.

However, there are significant problems with these diagnostic frameworks that we need to consider carefully.

Lack of explanation

One of the biggest issues with diagnostic frameworks is that they don't actually explain anything, though this isn't immediately obvious. Let's look at an example: Imagine three people suffering from extreme tiredness visit their doctor. Person A is diagnosed with an electrolyte imbalance, person B with chronic flu, and person C with "unexplained tiredness." For person C, this diagnosis adds no new information - they already knew they were tired, and the label doesn't explain why or suggest what might help. They have essentially gone to their doctor, told their doctor they are tired, and have had their doctor tell them they are tired.

This is precisely what most mental health diagnoses do. They're essentially descriptive labels for collections of symptoms, offering no insight into causes or meaningful directions for help. However, most people are not aware that this is the case. There is often the assumption that the diagnosis does explain something - I am sad because I have depression, I worry because I have anxiety. This means that not only do the diagnostic labels have no real value in themselves, but they are misleading, can induce a sense of powerlessness or identification with the "illness", and a remove the motivation to look for a further explanation. We are content with the explanation that we have a mental disorder, and no longer look for reasons why we are experiencing life this way.

The Problem of Estrangement

Diagnostic categories create a complex and often paradoxical relationship with our experience. At first glance, receiving a diagnosis can feel deeply validating - there's often an immediate sense of relief in discovering that others share similar experiences and that there's a recognised framework for understanding one's struggles. "I have depression" can initially feel more connecting than isolating, offering membership in a community of others with the same diagnosis and the promise of established treatments.

However, this apparent connection often masks a deeper form of estrangement. Consider the difference between saying "I have depression" versus "I am feeling deeply sad." While both acknowledge suffering, the first statement subtly frames the experience as something external and medical - a condition to be treated rather than a part of oneself to be held and understood. Instead of recognising our feelings as valid responses to life circumstances or as part of the universal human experience of suffering, we come to view them as symptoms of an illness that sets us apart from "normal" people.

This medicalisation can provide temporary comfort through the promise of a "fix," but it often leads to a more profound disconnection over time. Rather than seeing our struggles as part of the broad spectrum of human experience - one that connects us to the shared reality of human suffering - we begin to view them as aberrations to be eliminated. The initial relief of "I'm not alone in having this condition" paradoxically prevents us from reaching the deeper truth: that our feelings, however painful, are normal human responses that don't need to be pathologised at all.

This subtle form of estrangement can lead people to relate to their experiences as something to be gotten rid of rather than aspects of themselves to be met with compassion and understanding. While the diagnostic framework might seem to provide connection through shared labels, it ultimately reinforces the idea that certain feelings and experiences are inherently problematic rather than natural parts of the human journey.

Moving Away From What Heals

Perhaps the most damaging aspect of the medical model is that it actively moves us away from what genuinely helps with psychological suffering. When we frame emotional pain as a disorder or illness, we create an immediate imperative to fix, change, or eliminate it. This takes us away from what actually heals - the experience of being truly witnessed and accepted in our suffering, by ourselves and by others.

When someone's pain is met with a diagnostic label and a treatment plan, we miss the opportunity to simply be with them in their experience, to offer the profound medicine of presence and understanding. The very act of pathologising suffering - of saying "this is a disorder that needs to be fixed" - can recreate the original relational trauma that often underlies psychological distress: the message that our authentic experience is somehow wrong or unacceptable.

Ironically, the medical model's approach to mental health can actually deepen the dynamics that create psychological suffering in the first place. When we treat emotional pain as a problem to be solved rather than a visitor to be held, we reinforce the very pattern of rejection and judgment that often lies at the root of mental health struggles.

A Different Way of Understanding Mental Health

Instead of viewing mental health through the lens of disorder and disease, I have come to view it in terms of our relationship with our internal experience. Mental health, in this view, isn't about the absence of difficult thoughts, feelings, or behaviors - it's about our capacity to acknowledge and accept all aspects of our experience without rejection.

This perspective aligns with many therapeutic approaches:

• Psychodynamic therapy helps people understand and accept previously rejected aspects of themselves
• Internal Family Systems therapy works to welcome and integrate all parts of the psyche
• Person-centered therapy emphasises unconditional acceptance as the key to psychological growth
• If we assume that there is a parallel between the cognitive distortions of CBT and the defence mechanisms of psychodynamic psychotherapy in that both ward us away from vulnerability or uncertainty, then even CBT involves being more accepting of our internal experience

The Path Forward

The alternative to the medical model isn't to deny that people suffer or that some suffer more intensely than others. Rather, it's to recognise that healing comes not from pathologising and trying to eliminate our experiences, but from learning to meet them with presence and understanding. This means:

• Creating space for all aspects of human experience, including the painful one
• Recognising that what we call symptoms often represent intelligent adaptations to difficult circumstances
• Acknowledging that being witnessed with compassion in our suffering can be more transformative than any technique or intervention
• Realising that pathologising and interventions can recreate the relational trauma that led to the psychological distress

When we move beyond diagnostic categories, we can begin to see our psychological struggles not as disorders to be eliminated, but as parts of ourselves calling for understanding and integration. This shift doesn't just change how we think about mental health - it transforms how we respond to suffering, both in ourselves and in others.