Do you suffer from a mental illness or have suffered from a mental illness? Do you know someone who does or has? Do you feel that people don’t understand your condition?

Let’s bring some clarity around mental health and its various states.

Let’s challenge the semantic confusion

In a previous post I explained that mental health literacy is the way forward to remove fear, stigma and discrimination around topics surrounding mental health.

I also mentioned in another recent article that semantic confusion created by the interchanging use of negative modifiers such as ‘disorder’, ‘crisis’, ‘issue’, ‘problem’ collocated to the word mental health i.e. mental health disorder, mental health crisis, mental health issue, mental health problem’ means that we start believing that we can substitute one modifier for the other and still convey the same meaning.

For example, what is a mental health disorder? If mental health means ‘state of well being’ – would it make any sense for me to say there is a state of well being disorder’ in young people or ‘a state of well being crisis in Education?

Clinicians and experts in the field define these terms very clearly. They also demonstrate that they are not the same thing at all.

Cue in the wonderful work carried out by Dr Kutcher.

The mental health states

Dr Kutcher’s pyramid model enables us to understand the various mental health states. According to their book School Mental Health: Global Challenges And Opportunities [1] (pp. 302-305), mental disorders can ‘exist concurrently with mental well being. None of the domains are exclusory to the other domains at one time and a person can be in more than one domain at the same time. For example, a student can have a mental disorder (such as ADHD), be experiencing a mental health problem (such as the death of a grandparent), be experimenting mental distress (such as an imminent examination); and be in a state of mental equilibrium (such as spending time playing a game with their friends).’

Image Source: @StanKutcher

Let’s take a closer look at these 4 mental health states described in the book (pp. 302-305). I have decided to present it exactly as it has been to ensure exactitude and correctness to avoid any confusion:

• Mental Disorder/Illness

Mental Disorder and illness are defined as synonymous and are defined by the International Classification of disease (World Health Organisation, 2014b) and the Diagnostic and  Statistical Manual (American Psychiatric Association, 2014). They will therefore change when these organisations change their definitions.

As it stands here is how both organisations define mental illness or disorder

A mental disorder is a clinically significant behavioural or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.” (DSM-5)

There are many different mental disorders with different presentations. They are generally characterized by a combination of abnormal thoughts, perceptions, emotions, behaviour and relationships with others. Mental disorders include: depression, bipolar affective disorder, schizophrenia and other psychoses, dementia, intellectual disabilities and developmental disorders including autism. (WHO)

• Mental Health Problem:

These are emotional, cognitive, and behavioural difficulties experienced by an individual arising from a substantive environmental stressor (such as the loss of a loved one, loss of employment, migration, poverty, etc.). While these are substantial differences in how individuals experience and deal with such substantial stressors, all individuals will be impacted to some degree. Frequently, these stressors will result in significant emotional, cognitive, physical, perceptual or behavioural symptoms, and even some short-term decrease in usual functioning, signifying difficulties in adaptation that are commonly addressed by community resources and community traditions (such as religious rituals regarding death, self-help organizations) or by socially sanctioned healers who may or may not be medical professionals (such as counsellors, pastoral care workers, etc.).

The same author adds that mental health problems are not mental disorders, and vice versa. Unfortunately, some jurisdictions confuse the two, and use data from mental disorders to define mental health problems. Such conceptual confusion can lead to medicalization of normal human experience (for example: treating with medications) and conversely, denial of needed treatment for a mental disorder by labelling the difficulties being experienced as a problem and thus not requiring mental health care (more on this in another post).

Depending on the social situation or geographic context, many individuals in a given population may experience a mental health problem during the school-aged years (up to age 25 years).

• Mental distress

Mental distress is the common, ubiquitous, and normal experience of negative emotions, physical, cognitive, and behavioral symptoms that occur every day, arise from environmental challenges (for example: failing to get a job; preparing for an examination; experiencing romantic rejection; etc.) and are ameliorated with successful adaptation (leading to learning) and usual social, interpersonal and family support. All students will experience some degree of distress in everyday life. Individuals experiencing mental distress do not require professional interventions and successful overcoming of distress is an essential component of developing resilience. Avoidance of usual distress can lead to incapacity to deal with ‘the slings and arrows of outrageous fortune… and by [so doing] end them’ (Shakespeare et al., 2006)[2]

• Mental Equilibrium: No Distress, problem or disorder

This is a point in time where the individual (even if they have been experiencing emotional, behavioural, perceptual, cognitive, or physical symptoms are experiencing a positive sense of self, are adapting reasonably well to their environment, and are reasonably content with their state of being, however they define that state of being.

Do you find these definitions and explanation useful?

Do you feel that you know more about the mental health states? I know that I go so much out of reading and discovering Dr Kutcher’s work. What about you?

Please feel free to comment below.

[1] Kutcher, S. (Editor) Wei, Y. (Editor), Weist, M. D. (Editor). School Mental Health: Global Challenges And Opportunities. 1st ed. Cambridge University Press, 2015. Print.

[2] Shakespeare, W., Thompson, A., and Taylor, N. (2006). Hamlet: the Texts of 1603 and 1623. London: The Arden Shakespeare.