When does mental distress become a mental illness?

Human beings experience a range of emotions, some of which are pleasant, such as joy and happiness, and others that are uncomfortable or even painful, such as anxiety, anger or grief. Often, emotional discomfort or pain is temporary and appropriate to the circumstances. It is natural, and even helpful, to experience anxiety when facing a difficult decision, or grief when a loved one dies.

However, when painful mental states are long-lasting and interfere with our ability to function well in our daily lives and relationships, it can mean we are experiencing a form of mental illness.

Mental illnesses usually have other impacts apart from mood, including physical symptoms, changes in thinking, changes in behaviour, and sometimes changes in perception, including hallucinations, severe nightmares or flashbacks.

What causes mental illness?

Mental illness is complex. Medical science, philosophy, psychology and other disciplines are still debating whether the mental “mind” and physical “brain” are separate or integrated. Some researchers believe mental illness originates in the physical body and brain, influenced by genetics, inflammatory processes, neurological development and even hormones in the gut. Other researchers believe mental illness originates in the mind, from learned responses that are unhelpful or damaging, or lived experiences that are traumatic.

Mental health is also influenced by the world in which a person lives, which might include family and kin, community, culture, country or spirituality.

Trauma experiences are important. It is profoundly disrespectful to see a person who has experienced adversity such as intergenerational trauma, domestic violence, racial discrimination, poverty or any other systemic abuse, and apply a disease label like “depression” without acknowledging the crucial role of their trauma experiences in their health.

Managing mental health involves understanding how all these elements fit together.

Why is a diagnosis important?

Psychiatric diagnoses may be only one way of understanding mental illness, but they are important. In severe mental illnesses such as schizophrenia, medication can be essential to wellbeing. The evidence for medication and specific psychological strategies in therapy are often based on making an accurate psychiatric diagnosis. It is also important to make sure mental illness symptoms are not caused by physical diseases.

Most people with mental illness diagnosis should also have a “formulation”, which is a description of why this person may be experiencing mental illness at this time. A formulation may include historical factors (such as childhood trauma), features of their personality (such as perfectionism), details of their lived experience (such as discrimination and harassment based on their gender identity), and acute stressors (such as living through a natural disaster).

Brought together, the diagnosis and formulation should help clinicians, patients and carers understand why they are unwell and develop a plan of action to optimise their mental health. A formulation includes aspects of lifestyle (including avoiding damaging social environments such as mentally unhealthy workplaces), psychosocial strategies (such as therapy) and, in some cases, medication.

Usually, a person with mental illness will choose which strategies to use in collaboration with their treating team.

Recovering from mental illness

Mental illness can range from a single episode to a lifetime condition, and from mild to severe. It can involve a single condition such as depression, but it is common to have more than one illness at a time (such as depression and anxiety). It is also common for physical and mental illnesses to occur together (eating disorders and diabetes, heart disease and depression). Mental illnesses can change over time. For many people, there will be times of stability, times of crisis, and times when mental health is consistently poor.

Because there is so much variation in people’s conditions and lived experiences, different people will have different approaches to treatment. Treatment often involves social interventions such as securing safe housing, addressing lifestyle issues or helping with financial stress. It can also involve self-help strategies, helplines or psychological therapy.

Treatment needs to be individualised. Just because a treatment is said to be “evidence-based” in one context, doesn’t mean it can treat everyone across the entire spectrum. Most evidence is developed through research in urban, middle-class, well-educated, predominantly white people, and it may not necessarily be the best psychological strategy to use for a person from a completely different environment.

When to seek help

If you have thoughts of self-harm or symptoms are severe enough to affect your ability manage everyday life, it is time to work with a mental health professional to get a good, holistic diagnosis and formulate a management plan.

A GP is a good place to start to check there are no physical reasons why your mental health is deteriorating. GPs are likely to have the best understanding of appropriate, accessible and affordable options for care for your needs in your area. Unfortunately, specialised mental health services can be expensive and difficult to access.

Then it is time to identify the key issues impacting your mental health, and plan your recovery. DM/ML

This story was first published in The Conversation.

Louise Stone is a General Practitioner and an Associate Professor at ANU Medical School, Australian National University.