The language of mental health is loaded and complicated. You can start with some quite simple definitions and premises and then, quite quickly, lose yourself in a complex array of sensitivities, viewpoints and issues. So, let me try to walk through what I mean.
Mental health is a straightforward concept that is analogous to physical health. We all have days when we feel better and days when we feel worse. We know that some people are, in some regards, very healthy and others, less so – although such things often mask a huge amount of complexity – e.g. top athletes will often do long-term harm to their bodies in pursuit of short-term physical advantage. Similarly, someone who is very intelligent may not be so strong with regard to their emotional health.
Another definition that is used, for example by the WHO, is MNS, namely Mental, Neurological and Substance Abuse disorders. Mental disorders here being such things as depression, schizophrenia and bipolar disorder. Neurological disorders being diseases of the brain such as Parkinson’s, Epilepsy and Stroke. Finally substance abuse disorders which can relate to alcohol, legally available or illegal drugs.
A third definition worth being aware of is that of psychosocial disability. This is where someone has a mental health condition that affects them within their societal situation in such a way that they are not able to fully participate in what would be considered ‘normal’ life. The interaction with society is here, crucial, because someone who is chained or drugged to prevent them from behaving unpredictably in one setting may be able to manage their condition perfectly ably in another.
You may have noticed that I haven’t used the word “illness” anywhere above. What, in light of the above, is mental illness? To me it is analogous to physical illness but until we live in a society that is as comfortable with people phoning in sick because of anxiety or depression that is clearly not a widely held view. Recognising and respecting people’s descriptions of themselves as having a mental illness is important, with or without a diagnosis. Just as we are able to self-diagnose physical ailments (within limits) so to are we able to understand and identify mental maladies that may affect us.
Some people would dismiss the notion of mental illness, labelling, or even the use of the word ‘condition’ as I have used it above. Each of us has a brain that is unique and lives within our own social and emotional context. How then can a sweeping term such as “depression” or “schizophrenia” be used in the face of such diversity? Especially when our understanding of the causes and treatments for such conditions is so poor. It isn’t like a physical illness where we can (usually) identify what the problem is and have some idea of how to treat it. There is not a gene or a part of the brain that is at fault in someone who is depressed. There may be lower levels of some chemical (e.g. serotonin) in the bodies of many people who are depressed, but not all, not consistently and we have no understanding of the links or causality.
So, where does this leave us? For me, if I am talking about mental health, I tend to give the technical definitions but then try to personalise it and root it in our own experiences. Just as you will probably have experienced a cold or flu in the last year, there will probably be times when you were stressed, anxious or depressed. Maybe not so much that you could be clinically diagnosed so but noticeably below your normal state of functioning. Just as you struggle through a cold for a few days and then crack on with life, so you can struggle through minor mental lows and carry on. Understanding this and reflecting on the difference between that experience and the experience of someone who has a lifelong condition (either mental or physical) is worth doing.
Finally, avoiding derogatory or insulting terms is in some ways obvious but taking cues on this from people who are speaking to their own experience is critical. Mental health terminology can be highly personal and while words such as madness and insanity may feel dated in some cultures there are people who are actively trying to reclaim them. Respect the views and language of the person you are talking to and engage with an open mind
Global Mental Health 