Mental Illness: A Beginner’s Guide

Big disclaimer that I am not a mental health expert, clinical psychologist or trained counselor of any kind. I do have a mental illness, and I’ve worked in mental health education, and I am a social psychologist (graduate student). So I have personal experience, some professional experience and I specifically study emotion, but I’m not a trained expert in clinical diagnoses or mental illness. What you’re going to read is partially what I’ve learned and partially my lived experience.

What is a mental illness? We don’t really know.

My answer is unsatisfying, I’m sure, but I believe it’s the truth. Not that we don’t know anything, but we don’t really know. For example, with the common cold we have a clear causal pathway between infectious agents, transmission, immune response and symptom presentation. We don’t have that for mental illnesses. We certainly have ideas and data, but we don’t know. This is inevitable because we just barely understand the brain. We will learn more through research.

So what are people referring to when they say mental illness? Typically, we are referring to abnormalities in the ABC’s of psychology: affect (feelings), behavior and cognition (thoughts). Key, defining aspects include but are not limited to: the symptoms cause suffering, they prevent the person from engaging in important activities, and it isn’t culturally expected or explained by other physical disorders. These definitions can, of course, still be pretty broad.

What do we know about mental illness? That’s a better question, and we know a lot! A lot of people have them at least once in their life (in any year, it could be as high as 1 in 5 people in the US). Mental illnesses are cross-cultural, but sometimes have culture specific presentations (depression exists in Asia just like it does in Europe, but the way people talk about it and express it may be a bit different). Mental illness is highly correlated with stressful experiences, but don’t have to be caused by any one experience. There are different kinds of mental illnesses, e.g. mood disorders versus psychotic disorders. Mental illness has a genetic component. I could go on, but my point is that we do know stuff. We just don’t know enough to say “Depression is caused by exactly X and has exactly ABC features.”

I heard mental illnesses are chemical imbalances in the brain. Even some well-meaning groups continue to say this, but this isn’t really true. First of all, there’s no such thing as a chemical brain balance. I mean, if you don’t have enough electrolytes or something, sure, that’s bad. But A) everyone’s brain has its own normal limits and B) if it was just an imbalance, medications should just work, but they don’t and it requires trial and error to find one that works; furthermore there’s usually a lag-time of some weeks before people notice improvement and C) psychological intervention wouldn’t work, but it does work for many people. The key thing is that brains are complicated. It’s not like balancing an equation for most mental illnesses, and because the brain is conscious, it can participate in its own treatment much of the time (but not always).

Why don’t mentally ill people just deal with it/control it better? There’s a lot of stigma involved with mental illness, particularly that mental illnesses are “all in people’s heads,” to which I say, “no shit.” Psychology is about brains, and brains are physical. It’s not magic. There’s no psychological space that is separate from the physical space. Mental illness is all in your head the same way that diabetes is all in your pancreas.

There’s a presumption that what is psychological is about “you” and must therefore be controllable. And this is one of those things where society has a view on something that doesn’t make sense. Experiences of color are psychological (for color-seeing folk), but me experiencing red doesn’t allow me to control it. I cannot unsee red with my willpower. Now imagine I have undesired experiences of intense fear just like how I see red without meaning to. That’s where things start to become mental illnesses.

A fundamental aspect of human experience is that we cannot control many of our experiences directly (which makes sense; there’s a lot of brain and only part of it is conscious). Active control takes effort, time and experience. It’s not an on/off switch you flick. And the best way to enable people with mental illnesses to “deal with it” is to accept them, help them get the treatment they need and be supportive. Studies show this works better than being a jerk.

How is mental illness different than a “physical” illness? Why is the common cold not a mental illness? Symptoms of the cold make you feel different, lay around (behave different) and perhaps think more slowly. Well, in my opinion, the difference is exaggerated or not yet known. We certainly understand colds better and don’t attribute any of the symptoms to the person experiencing them. But, in general, mental illnesses “look” psychological; they look like there are no external factors involved, like infectious agents or malfunctioning insulin production. But that’s mostly relying on our lack of knowledge. Someday, we may be able to describe depression and schizophrenia purely in terms of what is going on in the brain. Currently, we cannot. Though for schizophrenia, there are some data related to specific dopamine pathways in the brain. This is beyond my expertise.

Who gets mental illnesses? Anyone. One of the infuriating aspects of mental illness (in my opinion) is that it doesn’t even have to make sense! Now, the likelihood of “randomly” developing a mental illness is quite low. Mental illnesses have genetic components (it runs in families), and for many of them, stress seems to be a trigger. But even within a person (e.g., me) it can be really inconsistent. Sometimes I’m stressed but managing just fine, sometimes I feel like things are going great, but a depressive episode hits me anyway.

Critically, mental illness is an illness of the young. Let me explain: most people who will have a mental illness develop it before they are 18. Here’s a NAMI source.

50% of all lifetime mental illness begins by age 14, and 75% by age 24

National Alliance on Mental Illness, https://www.nami.org/learn-more/mental-health-by-the-numbers

To my knowledge, schizophrenia is one of the exceptions. People develop it typically after 18. This is just an average though; there are definitely cases of younger people developing schizophrenia.

But don’t a lot of people (kids especially) just act out for attention? One, I don’t think this is really true. The handful of cases people think about are just that: a handful of cases. Two, legitimately pretending to be mentally ill is itself a pretty worrying sign. They probably need help of some kind. I can’t think of any kids when I was in middle and high school who “acted out” for no reason. There was often something going on at home or they were also dealing with something psychologically.

Are two people’s depression/schizophrenia/etc the same? Personally, I think it’s better to think of mental illnesses as families of symptoms/experiences. They’re not all identical twins, but two people with depression will have similarities. Furthermore, a person with depression is probably more similar to someone with an anxiety disorder than someone with a psychotic disorder of some kind. Both are related primarily to abnormalities in emotion, whereas schizophrenia has psychotic (halluciations or delusions) elements that make it different.

But it’s still messy. For example, I have depression, but I also have psychotic symptoms. So do I fit in the psychotic disorder family or the mood disorder family? Am I depressed AND psychotic? What gives? As my psychologists and psychiatrists have discussed with me in the past, the best way to think about my specific symptoms are as manifestations of the same cause (whatever we want to call it). When I’m not depressed, no psychosis. When I am depressed, usually no psychosis. When I’m severely depressed, only then do I get psychotic symptoms (and anxiety). Perhaps this is broadly applicable to others, perhaps not. That’s also beyond my knowledge.

What is psychosis/ what does it mean to be psychotic? Psychosis and psychotic are words that people throw around for various reasons, but they refer to very specific things in psychiatry: delusions (fixed, false beliefs) and hallucinations. A delusion is something you can’t really convince someone to stop believing. Hallucinations are sensory perceptions (sound, sight, touch, taste, smell) that have no physical cause (e.g., hearing voices when no one is speaking is the one most people think of).

Psychotic people aren’t inherently more violent or likely to do bad things or anything like that. People with psychosis vary in how much they realize they’re experiencing a mental illness. This is called insight, and even within a person, it can vary. This part is my opinion, but honestly, I think the majority of people with psychosis are at least somewhat aware of what’s happening. It’s incredibly difficult to manage, and they certainly can have moments (or many moments) where they lack the insight. But my experience talking to people, a lot of them know more or less that they have something going on when they’re in a clearer mindset. Of course, my interactions are limited to people I see, which has some obvious confounds since I’m a graduate student who mostly will see other “high-functioning” mentally ill people.

Can I or someone I know get help? Yes.

There are a lot of treatment options available, and they range from learning how to help yourself manage your symptoms, reduce their intensity and make them happen less often to medication or other physical treatments.

Besides the fact that it is absolutely possible to live a nice, fulfilling life with mental illness, I think the next best thing I can communicate to someone seeking help is to acknowledge it can be hard. It’s hard to ask for help. I’m 29 and I still have trouble with that. Somehow, I manage to do it when I know I really need to. Going through the process of treatment can be another challenge, but it’s absolutely worth going through that process. My biggest regret is that it took me so long to try. The link to NAMI’s website I posted above is as good a place as any to start.

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