Defining Mental Health
Last updated 20-07-2023
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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 a lot of arguments as to why these compendiums of mental illness are not very helpful.
For me, one of the biggest reasons they are unhelpful is that they don't actually explain anything, which is not a fact that I think is immediately obvious.
As an example, let's say you are one of three people who is suffering from extreme tiredness. You all visit a GP for help. Person A is given a diagnosis of electrolyte imbalance, person B is given a diagnosis of chronic flu, and you are given the diagnosis of "unexplained tiredness". This probably doesn't sound like a very useful appointment - you don't have any more information about what is causing the tiredness or what you can do about it. You already knew you were tired, and the diagnosis didn't change anything.
What most people don't realise is that this is usually what a mental health diagnosis is. Most diagnoses in the DSM or ICD are just labels given to a collection of symptoms, without any indication of what caused them, and without any prescription of what can be done about them.
Another important reason that the DSM and ICD might not be very helpful is that they are pathologising. DSM stands for the Diagnostic and Statistical Manual of Mental Disorders. The ICD stands for the International Classification of Diseases. This implies that something is wrong or broken. However, what is usually the case is that a person's symptoms represent a normal response to a distressing situation, or a build-up of distressing situations. If you are experiencing symptoms consistent with a mental health diagnosis, it is common to feel shame about this, or to feel that your mind isn't working properly or is broken in some way, and the idea that you have a mental illness or disorder or disease just compounds that shame.
Instead, I think it is more helpful to validate that the thoughts, feelings, and behaviours you are experiencing are completely understandable in the context of what you have been though. This might mean abandoning the idea of mental illness or disorder.
However, abandoning the idea of mental illness doesn't necessarily mean we need to abandon the idea of mental health. This might also be invalidating and unhelpful, because some people are really suffering, while others appear to not suffer quite as much.
So what can we do?
I believe it is helpful to view mental health in terms of internal conflict. If we look at the prototypical person who is seeking therapy, this person is usually experiencing some symptoms (such as thoughts, feelings, or behaviours) that they don't want to be experiencing. If we acknowledge that all thoughts, feelings, and behaviours are generated by the brain, as opposed to coming from some sort of external parasite or hostile entity, it makes sense to say that a part of the brain wants the symptoms to exist, and another, possibly more conscious part of the brain does not want the symptoms to exist.
Resolving this internal conflict might mean understanding why a part of the brain wants the symptoms to exist in the first place. What is the function of those symptoms? Why did human brains evolve the capacity to produce those symptoms? This can be complex and idiosyncratic, and is beyond the scope of this post.
This view of mental health in terms of internal conflict is also consistent with many therapeutic paradigms:
- Psychodynamic: therapy is viewed as understanding and resolving the conflict between conscious and/or subconscious drives
- Internal family systems: therapy is viewed as understanding and resolving the internal conflict between parts of the mind
- Coherence therapy: therapy is viewed as understanding the rules put in place by different emotional learnings, and finding a resolution when these rules conflict in their directives for your behaviour
- Others: I have less experience with these, but resolving internal conflict also appears to be a significant part of Schema therapy, Gestalt Therapy, Emotion-focused Therapy, and Dialectical Behaviour Therapy
So, if we forget about diagnoses, illnesses, and disorders (except maybe for the purposes of securing bureaucratic funding) I propose that we view mental health in terms of how much internal conflict you are experiencing. Internal conflict isn't a "bad" thing, we all experience internal conflict to some degree, and it might be a necessary part of existing in an uncertain world. With this perspective, we can start to talk about a person's suffering in a way that is more meaningful, without adding to that suffering with unnecessary judgement and shame.