This is one blog in a series where I will be reflecting on the subject of mental illness. My purpose is not to lead the reader to the same conclusions I have, but to facilitate better conversations and reflections on this subject within the church.
What is mental illness? As close as we can get to an accepted definition would be the one given in the Diagnostic and Statistical Manual: 5th Edition (DSM-V) by the American Psychiatric Association (APA):
“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.”
But the accuracy and benefits of this definition are debated, even amongst various groups within secular psychology and psychiatry. That is why it is easy to find nuances of and alternatives to this definition. After the examples below, I will highlight the modifications each organization or author made to the DSM-V definition.
“A mental illness is a medical condition that disrupts a person’s thinking, feeling, mood, ability to relate to others and daily functioning.” National Alliance on Mental Illness[1]
- Notice the narrowed declaration that mental illness is a medical condition.
“Mental illness refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior… Many people have mental health concerns from time to time. But a mental health concern becomes a mental illness when ongoing signs and symptoms cause frequent stress and affect your ability to function.” The Mayo Clinic[2]
- Notice the desire to differentiate normal emotional struggles from those that are clinically significant.
“A disorder of the brain resulting in the disruption of a person’s thoughts, feelings, moods, and ability to relate to others that is severe enough to require psychological or psychiatric intervention (p. 43-44).” Matthew Stanford in Grace for the Afflicted: A Clinical and Biblical Perspective on Mental Illness
- Notice the desire to locate the problem only in the physical organ of the brain (also in next definition).
“A group of brain disorders that cause severe disturbances in thinking, feeling, and relating, often resulting in an inability to cope with the ordinary demands of life (p. 17).” Marcia Lund in When Your Family Is Living With Mental Illness
“A mental illness can be defined as a health condition that changes a person’s thinking, feelings, or behavior (or all three) and that causes the person distress and difficulty in functioning. As with many diseases, mental illness is severe in some cases and mild in others. Not all brain diseases are categorized as mental illnesses. Disorders such as epilepsy, Parkinson’s disease, and multiple sclerosis are brain disorders, but they are considered neurological diseases rather than mental illnesses. Interestingly, the lines between mental illnesses and these other brain or neurological disorders is blurring somewhat. As scientists continue to investigate the brains of people who have mental illnesses, they are learning that mental illness is associated with changes in the brain’s structure, chemistry, and function and that mental illness does indeed have a biological basis. This ongoing research is, in some ways, causing scientists to minimize the distinctions between mental illnesses and these other brain disorders.” National Institute on Mental Health[3]
- Notice the care taken to differentiate that there are brain problems that are not mental illness; the mind is not considered co-terminus with the brain, but an acknowledgement that the mind and brain are so interwoven that it is often difficult to distinguish where the cause for a given struggle may be.
Where do these definitions agree? There is one main point of agreement.
In order to qualify as a mental illness the life-struggle must “impair life functioning.” This reveals that the struggles known as mental illness exist on a spectrum; almost everyone will struggle with these challenges to some degree. However, there comes a point on the spectrum where life is impaired to a degree that it seems wise to classify this struggle differently.
Mental illness means that a common struggle has crossed a threshold and become “clinically significant.” The term is an assessment that outside help is needed; that (a) the passing of time and (b) continuing in the same life pattern will not result in the desired relief from these struggles.
This means, whatever mental illness is, it usually has more in common with sun sensitivity (a common experience that can be severe enough for some people to require specialized intervention) than it does to Chrohn’s disease (an uncommon experience that is only known by a small percentage of the population).
In this sense, what is unique to the person who experiences mental illness is not the experience itself, but the intensity and/or duration of the experience. What is shared in common by these definitions helps us forego an “us-them mentality” that fuels much of the stigmatization of mental illness.
Where do these definitions differ? We will consider two key points of difference.
First, some definitions seem very concerned to identify the location of mental illness in the physical organ of the brain. Other definitions seem less concerned with defining one single location for the struggle. The latter seems wise:
- Many instances of depression are rooted in the glandular system more than the brain.
- Often, with a brain-only focus, attention is exclusively given to brain chemistry to the neglect of neural pathways; which are not treated with psychotropic medications and have more to do with habituation.
- The role genetics plays in some forms of mental illness can be lost by an exclusive brain focus.
- A brain-only focus can reduce our “humanity,” and inadvertently our value, to the strength of our frontal lobe – the aspect of human neural anatomy that is most distinct from other creatures.
- A brain-only focus can distract us from the beneficial influence of exercise, sleep, and other healthy practices; which not only improve brain chemistry, but also improve our quality of mental-emotional-social life through other body systems.
Yes, we want to continue to grow in our understanding of the brain’s role in our emotions. But we must realize there is a modern temptation to reduce people to their brains, which parallels the historic temptation of the church to reduce people to their souls. Whenever we allow one facet of our humanity to trump all others, we become blind to other important factors. We become excellent in the things we do well, but dangerous because of the things we fail to consider or give their full weight.
Second, some definitions seem content with the broader term “syndrome” while others want to use the more narrow term “disease.” Consider the difference in these two definitions.
- Syndrome: “a group of signs and symptoms that occur together and characterize a particular abnormality or condition.”[4]
- Disease: “an impairment of the normal state of the living animal or plant body or one of its parts that interrupts or modifies the performance of the vital functions, is typically manifested by distinguishing signs and symptoms, and is a response to environmental factors (as malnutrition, industrial hazards, or climate), to specific infective agents (as worms, bacteria, or viruses), to inherent defects of the organism (as genetic anomalies), or to combinations of these factors.”[5]
Disease implies a known and verifiable cause. Syndrome is merely a group of recognizable symptoms. With the multitude of factors that can result in depression, anxiety, inattention, addiction, and other experiences commonly called mental illness, it is seems wiser to call mental illness a syndrome rather than a disease.
Is this an attempt to somehow caution people against the use of medication?
No. It is merely an attempt to adjust people’s initial expectations of medication; from curing a problem to relieving symptoms until the cause their struggle can be identified. The present reality is that our prescriptive science (those things we can modify with medication and other biological-influencing treatments) is ahead of our diagnostic science (our ability to verify and measure the things we are modifying).
This expectation-management is important for several reasons. First, understanding a syndrome as a disease can give a false hope for medication; for those who are in an emotionally-fragile state this can be a dangerous thing to do. Second, with a syndrome a medication can be utilized while recognizing that the cause has not yet been found; “symptom alleviation” is a good thing for a syndrome because it reduces suffering while leaving room for continued efforts to identify the cause.[6]