As a society, we are not well informed regarding mental health and illness. This is particularly surprising because we are relatively knowledgeable regarding physical health and illness. Certainly, there is a stigma attached to mental disorder or even unhappiness, despite the politically correct and ostensibly tolerant attitudes of our times. While there have been strides in recent years in going public in certain areas such as substance abuse, the majority of mental illness remains in the closet.
This ignorance regarding mental functioning not only causes great pain and suffering, but imposes limitation on how we live our lives. We may suffer in silence and alone. We may restrict our lives and our vision to a narrow socially acceptable path. As a society, we are stuck in a vicious cycle of ignorance and stigma, fear and denial.
Yet mental illness seems to be a universal fact of human existence. All cultures have some concept of “madness,” abnormal behavior, or mental disorder. In cross-cultural studies, it appears that all cultures have some variant of what we call schizophrenia and also serious depressive illness. These are the classic and debilitating mental disorders, which represent the severe extreme along the spectrum of psychological functioning. These are also the disorders associated with a clear biological component, suggesting an actual physical disease process underlying the mental problems.
There are also syndromes and types of mental disorder that are specific to a certain time and place. Freud’s seminal work was with Victorian women who suffered from “hysteria,” a syndrome rarely seen today. This is probably because it has been associated with sexually repressive cultural attitudes, hardly the case in the twenty-first century. Throughout the late twentieth century in technological societies, there seemed to have erupted an epidemic of what could be called “narcissistic” disorders. These are often lifelong disorders in which the person experiences a lack of meaning and a sense of emptiness inside. This can lead to all sorts of problems such as depression, substance abuse, low self-esteem, and poor relationships.
If we look at the prevalence of mental illness in modern American society, studies range from between one in three to one in six of us may experience a major mental disorder at some point in our lives. In other words, mental illness is not just something that happens to someone else. Also, these studies are talking about serious mental disorder. If we widen the definition to include disorders that are less severe, but still would be considered a diagnosable psychiatric condition according to the mental health establishment, the percentages are even higher.
For example, many of us have maladaptive patterns or “issues” in our personalities, like low self-esteem, that cause us to have difficulties although overall we are able to function well enough. Some of us may undergo a major life transition or trauma that results in a brief period of intense distress, such as after a divorce or the death of a loved one, but then we return to normal living. These types of episodes are very common. If we include these lower-level problems, probably at least half, if not three-fourths of us, will have mental illness at some point in our lives.
Whatever the exact numbers, clearly mental illness is a fact of human existence. This is frightening, given the stigma and ignorance in our society. A large number of us will be significantly affected at some point by things we deny exist or we do not understand. Likely all of us will indirectly be affected by mental illness in the people we love or know or with whom we work.
Because of the stigma and ignorance in our society, typically our ideas about mental illness are “all-or-nothing.” We have this notion that we are either normal and well-adjusted—or we are abnormal, “crazy,” or on the verge of a “nervous breakdown.” However, this kind of all-or-nothing perspective is entirely erroneous.
The landscape of mental illness is similar to the landscape of physical illness. For example, both physically and mentally, we can have chronic or acute disorders. A chronic disorder is one that lasts a long time, maybe throughout the person’s life. In contrast, an acute disorder is one that is time-limited. Like physical disorder, mental disorder can also vary in severity, from devastating to relatively mild.
Mental health and illness, like physical health and illness, may be contributed to by biological predisposition and genetic factors. As with physical disease, it is felt by researchers that individuals may have a predisposition, a psychological vulnerability, to develop mental distress in general or even a specific disorder. As in the physical sphere, it is believed that psychological vulnerability later in life can be caused by early developmental factors.
Beyond the analogy to disease, mental difficulties can also arise from psychological “injury.” If someone is a prisoner of war or raped or loses his family in an accident, he has been psychologically injured. Such injuries can have longstanding effects on a person’s life or provoke purely temporary problems. As in the physical domain, psychological injuries can range from relatively minor—where outside treatment may not be necessary—to severe and life-altering. Like physical injury, psychological injury can also be cumulative (such as the effects of longstanding emotional abuse) as well as occur suddenly (such as being the victim of an assault).
What is clear is that mental illness is not an all-or-nothing situation. It represents a range of problems in various areas, can have minimal to life changing impact, and touches most of us in some way during our lives. In its most severe manifestations, mental illness is also a critical societal concern, as the seriously mentally ill are often dependent and disabled in large numbers. Severe mental illness and how we regard it raise unavoidable issues of social and moral responsibility.
Dr. Judy Marshall received her doctorate in clinical psychology from the University of North Carolina at Chapel Hill. In thirty years of clinical practice in New York and Los Angeles, she has worked with many different groups, from children to the frail elderly, with particular interests including self-esteem, depression, sensitivity, and creativity.
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