What is mental illness?

Is it a collection of symptoms? Is it environmental? It is biological? Is it cultural? Is it spiritual? All of the above?

Is there actually a specific set of chemicals in someone’s body, a “root cause,” for each mental illness? And if so, how do we know that all the people labeled “bipolar” actually have that “root cause” for bipolar, when we diagnose people based on symptoms? What if someone exhibits all the symptoms of bipolar, but does not actually have the “root cause”? Is that person still bipolar? If we are ever able to find that out, will we relabel them something else?

Am I bipolar? Borderline? Both? What’s the difference? What if the “root cause” of borderline and bipolar are the same thing? What if there IS a specific set of chemicals, or ratio of chemicals in the body, that causes mental illness… but the same set of chemicals/ratio of chemicals results in very different symptoms in various people?  What if what we now call “schizophrenia” has the same biological basis as what we now call “borderline personality disorder”?

And what if there is no “root cause?” What if all people with, say, schizophrenia have very different chemical makeups despite exhibiting similar symptoms?

What is mental illness? 

Right now in psychiatry, doctors diagnose a particular mental illness based on behavioral symptoms and feelings. That is not the most scientifically accurate construct. Can you imagine if physical doctors did this? What if you went to your doctor for severe stomach pain that wouldn’t go away? That stomach pain could be the result of numerous biological causes–a cancerous tumor; an ulcer; a burst appendix. Can you imagine if your doctor just looked at your symptoms, asked you to describe your experience of the pain, diagnosed you simply based on those things, and then treated you?

If you’ve got lasting, continuous stomach pain, and it’s clearly not the flu or some other mild-and-ordinary occurrence, any good doctor is going to going to run tests to find out what is actually the problem.  A good doctor would not just assume he knows what the issue is without running an ultrasound, some scans… some kind of physical tests!

Think about the HIV virus and AIDS. AIDS is the disease, but it is caused by the HIV virus. You can’t have AIDS if you don’t have the HIV virus. Even if you’re exhibiting symptoms of AIDS–lesions, the inability to recover from pneumonia or a common cold, etc–no doctor (not a single one!) would diagnose you with having AIDS if you didn’t have the HIV virus.

Yet in the mental health world, that’s what happens. People are regularly diagnosed with an “illness” based on their symptoms, and their symptoms alone. And often, those symptoms aren’t even followed long-term: the psychiatrist gets a snapshot of the symptoms in a one-hour intake appointment, and often, that’s considered sufficient to make a diagnosis. Oh, maybe if, for example, the psychiatrist thinks it’s depression, he’ll thrust the Beck Depression Inventory under your nose and have you answer some multiple choice items; and then he’ll add up your answers; and he’ll check your score; and if you score a certain number of points, he’ll say it’s depression. But the thing about those tests are… they are cyclical. They are designed according to the same construct as the DSM (Diagnostic and Statistical Manual)–so those tests are only searching for the symptoms that the DSM has already laid out as indicating depression. Psychological assessments and the DSM–what psychiatrists and psychologists use to diagnose us–are self-referential.

See how far behind psychiatry is, as a science?

We really don’t know crap about psychiatry. Heck, we don’t even know what “psychiatry” refers to, because we really don’t know the causes of mental “illness.”  Oncology? Refers to cancer. Cardiology? The heart. Psychiatry? Ummm… the mind? What the heck is “the mind,” anyway?

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I am not the first person to ponder these questions, and I won’t be the last. In fact, I think a lot of us with “mental illness” wonder these things, multiple times, throughout our lives.

Still… knowing I’m not alone in these questions, knowing I’m not the only one who questions… still, it doesn’t help with frustration of not knowing the answers to the questions.

In a sense, it doesn’t matter–not to me. Whatever I “have,” I’ve found a way to manage. Regardless of what my diagnosis is, and regardless of whether it’s an actual illness or just a heuristic, all I can do–all I need to do–is stay “well”: and I do that in many different ways.

But man, sometimes I wish we knew these answers. Maybe then we’d better know how to help people recover. Maybe there’d be more effective treatments (whether biological or otherwise) we could develop. Right now, treatment is trial-and-error… we try something and see if it works, and if it doesn’t, we move on to something else. I know some of that goes on in the medical field, too, but here’s the thing–the medical field is able to narrow the range of treatment options much more effectively, it seems to me, than the psychiatry field.

And maybe, if we knew what exactly mental illness is, if we knew what exactly to do to treat it, maybe then I wouldn’t worry so much  about my daughter… wondering if she too will be stricken with whatever this “mental illness” is, and wondering if there will be an effective way to treat it, if she is stricken.

Maybe I wouldn’t be experiencing the “cycles” of “bipolar” right now.

Maybe my husband wouldn’t have to ignore voices he alone is hearing because of his “schizophrenia.”

I don’t know. I don’t know what the answers are… and here’s the thing: psychiatry doesn’t know, either. And I write that to say: if you’re taking meds and they’re not working? If you are trying hard in therapy and it’s not helping? Just remember–this whole world of mental health is so much more complicated than most people would like to believe. It’s much more complicated than your psychiatrist may let on.

So if the meds aren’t working, if the therapies aren’t helping… don’t give up. You can feel better. But don’t depend on doctors to do it. It’s up to you to make yourself feel better. If meds help you, use them. But if they don’t? Don’t despair. It’s not evidence that you’re incurable… it’s just evidence that really, psychiatry doesn’t know much of anything yet. And not knowing much of anything includes not knowing much about you and your prognosis.

So don’t listen to anyone who says you can’t have a happy and fulfilling life. There’s no medical basis for that belief. You can have a good life… if you make it happen for yourself.

Does that mean you won’t have ups and downs? Heck no. Does it mean your “illness” will ever be completely cured? Maybe not–in a lot of cases, probably not. But it does mean that you can keep going, despite the ups and downs. That you can claw a whole heap of enjoyment and experience and fulfillment out of life, despite whatever your “illness” happens to be.