Mental Health

1. Mental Health and Mental Illness

Often, we can recognize visible signs when a person’s physical health has been affected. For example, when a person has an allergic reaction, they might develop puffy eyes and a stuffy nose. Or, if a person has sustained an injury to their body, they might need a cast, a splint, or a bandage.

However, mental health is not as apparent. We can’t judge a person's mental health based on their outward appearance. In the previous lesson, “Psychology and Well-Being,” you learned that the term “mental health,” which is often used interchangeably with the term “psychological health,” is a multidimensional state of well-being affecting our thoughts, feelings, and actions. It is because mental health is a multidimensional continuum that we cannot judge a person's mental health based on the presence or absence of symptoms.

EXAMPLE

It is normal to feel anxiety in many situations, and this can be a productive emotion in helping you face problems. You might feel anxious before taking tests. Realizing the source of anxiety may prompt you to find ways to better manage it, such as structuring your study habits in the days leading up to the test, or having a calming ritual of deep breathing the morning of the test. However, showing no anxiety at all may be more of an unhealthy response, such as failing to recognize when things are problematic (Insel et al., 2022).

We all have mental health concerns from time to time. We may feel prolonged sadness and grief over losing a loved one, or we may feel a specific fear or worry that gets in the way of trying new things we might enjoy. However, a mental illness, also called a mental disorder or mental health disorder, is when ongoing mental signs and symptoms cause frequent stress and impact your ability to function in your daily life by affecting mood, thinking, and behavior (Mayo Clinic, 2022). A serious mental illness (SMI) interferes significantly with a person’s life and ability to function. Some examples of SMIs are major depressive disorder, bipolar disorder, and schizophrenia (American Psychiatric Association, 2023).

Although the terms “mental illness” and “mental health disorder” are often used synonymously, the term “mental health disorder” is typically preferred because it has less negative of an implication and does not label someone the way “mental illness” does. For this reason, we will be using “mental health disorder” throughout the rest of this lesson.

terms to know

Mental Illness (Mental Disorder or Mental Health Disorder)

Ongoing mental signs and symptoms that cause frequent stress and impact your ability to function in your daily life by affecting mood, thinking, and behavior.

Serious Mental Illness (SMI)

A mental illness that interferes significantly with a person’s life and ability to function.

As with many types of conditions, mental health disorders are severe in some cases and mild in others. While signs of mental health disorders may not be visible in many individuals, other people may show more explicit symptoms like confusion, agitation, or withdrawal. Data from the Centers for Disease Control (2023) reflects that mental health disorders are some of the most common health conditions in the United States.

• More than 1 in 5 U.S. adults live with a mental health disorder.
• Over 1 in 5 youth (13–18 years) are currently experiencing, or at some point during their life experienced, a seriously debilitating mental health disorder.
• About 1 in 25 U.S. adults lives with a serious mental health disorder, such as schizophrenia, bipolar disorder, or major depression.

According to the National Alliance on Mental Illness (2023), anxiety disorders are the most prevalent type of mental health disorder in the United States, with just over 19% of the population affected. The second most common type of mental health disorder is major depressive episode, with just over 8% of the population affected.

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2. Mental Health Disorder Diagnosis

So, if mental health signs and symptoms are not always visible, how is a mental health disorder diagnosed? A common tool for mental illness diagnosis is called the DSM, or the Diagnostic and Statistical Manual of Mental Disorders. The DSM is a handbook used as the authoritative guide in the United States and throughout much of the world for diagnosing mental disorders and providing a common language to describe each type of disorder (American Psychiatric Association, 2023).

IN CONTEXT

The DSM has been around since 1952. Its first edition contained 106 mental health diagnoses (Johns Hopkins University Press, 2021). Over the decades, the DSM has gone through revisions based on input from hundreds of mental health experts. The current edition (since 2013) is the DSM-5 or its fifth edition. The DSM-5 now includes information on almost 300 mental health conditions.

A mental health professional may use the DSM paired with a psychological evaluation, such as questionnaires or asking about thoughts, feelings, symptoms, and behavior, to determine the diagnosis of a mental health disorder (Mayo Clinic, 2023). They may also perform a physical exam and/or lab tests to check for physical problems that could be impacting mental health symptoms. Mental health conditions can be treated, and in some cases, a person can improve to the point of fully functioning. In the next few lessons of this Challenge, we’ll further explore specific types of mental health disorders along with their possible treatment options.

learn more

There are multiple national databases to assist with finding the right care for mental health.

Mental Health Databases
FindTreatment.gov	To find a provider treating substance use disorders, addiction, and mental illness.
American Psychiatric Association Foundation	To find a psychiatrist.
American Academy of Child and Adolescent Psychiatry	To find a psychiatrist for kids and teens.
American Psychological Association	To find a psychologist.
Services through 211	In areas where 211 is available, you can dial this number on a phone to confidentially and anonymously explore mental health treatment options or connect with services in your area. Services through this site can also be provided via text or web chat.

term to know

DSM (Diagnostic and Statistical Manual of Mental Disorders)

The authoritative guide in the United States and throughout much of the world for diagnosing mental disorders and providing a common language on each type of disorder.

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3. Risk Factors

There is no single cause for a mental health disorder. Multiple individual and social factors can combine throughout our lifespan to either protect or undermine our mental health (World Health Organization, 2022). However, some factors are linked to a higher risk of developing a mental health disorder: adverse experiences, particularly in childhood, ongoing chronic medical conditions, use of alcohol or drugs, and feelings of loneliness and isolation (Centers for Disease Control, 2023).

• Adverse childhood experiences (ACEs) can be a significant risk factor because they occur during developmentally sensitive periods. ACEs include child abuse or assault, neglect, witnessing violence, experiencing harsh or dysfunctional parenting, and bullying (Centers for Disease Control, 2023; World Health Organization, 2022). The stress of ACEs on a young person’s developing brain can affect how the body responds to stress and change brain development (Centers for Disease Control, 2021). Other adverse experiences, such as poverty, violence, disability, and inequalities are also factors linked with a higher likelihood of mental health disorders.
• Chronic medical conditions, such as cancer, heart disease, or diabetes may make individuals more likely to develop mental health conditions. Receiving a chronic disease diagnosis can come with stress, concern, and discouragement about treatment outcomes and the future (National Institute of Mental Health, 2021).
• Using alcohol or drugs can frequently co-occur with mental health disorders. Substances can cause people to experience mental health symptoms, and mental health problems can lead them to self-medicate with alcohol or drug use (Substance Abuse and Mental Health Services Administration, 2023).
• Loneliness and isolation are both risk factors. Loneliness is the feeling of being alone regardless of the amount of social contact. Social isolation is a lack of social connections (Centers for Disease Control, 2021). Both are particularly linked with depression and personality disorders (Mushtaq et al., 2014). The COVID-19 pandemic provoked widespread isolation with stay-at-home orders and social distancing, and research reflects that the global prevalence of anxiety and depression increased by 25% in the first year of the pandemic (World Health Organization, 2022).

IN CONTEXT

Chemical imbalances are also often implicated as risk factors for mental health conditions. The main idea behind this is that certain chemicals or areas of the brain help regulate mood. For example, a widespread scientific theory has been that people with depression lack serotonin, a chemical in the brain that makes us feel emotionally stable and happy. However, more recent research poses that depression and other mental health disorders are far more complex than low or high levels of certain brain chemicals (Harvard Health Publishing, 2022).

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4. Neurodiversity and Neurodivergence

Since mental health and functioning exist on a continuum, it is important to understand that not everyone’s brain functions the same way. The term neurodiversity indicates that there is no right way of thinking, learning, or behaving and that people experience the world in many different ways (Baumer & Frueh, 2021). Everyone’s brain is different, and even the brains of identical twins can have significant differences. The term conveys that everyone has qualities of being neurodiverse. In fact, the origins of the term “neurodiversity” stem from efforts to promote equality, acceptance, and inclusion of individuals (Baumer & Frueh, 2021).

With the immense variation in the human brain and how it thinks, learns, and behaves, there can be difficulty in separating what is relatively average and what may be a cause for concern with impacting mental functioning, even with tools like the DSM. The term neurodivergence refers to any condition that displays itself through differences in cognitive function, sensory processing, or response to stimulus from what is considered neurotypical or cognitively normal (Yergeau, 2018). While we’ve mentioned that there is no single standard of a normal brain, this concept of being neurotypical or cognitively normal is based on what is in line with the expectations of society (Chapman & Botha, 2023).

Examples of neurodivergence include, but are not limited to, the following:

• Autism spectrum disorders (ASDs) are developmental conditions that can cause social, communication, and behavioral challenges. Individuals with ASDs may have problems with social communication and interaction and restricted or repetitive behaviors and interests.
• Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition often first diagnosed in childhood. Individuals with ADHD may act impulsively or have trouble paying attention and focusing.
• Dyslexia is a type of learning disorder that affects an individual’s ability to read. A person with dyslexia often finds it difficult to process language, so speaking and spelling can also be affected.

Neurodivergent conditions such as these are listed in the DSM, but this does not automatically mean that a neurodivergent person has lower levels of mental health and function. Some people with neurodivergent conditions require extensive care and support, while other people with neurodivergent conditions can live without significant impacts.

EXAMPLE

While neurodivergence is about differences, it is not about deficits. There are many kinds of neurodivergence that have particular strengths. Research has shown that people with ASDs are often very strong at attention to detail and working with complex systems. People with ADHD have greater levels of creativity than populations without it (Armstrong, 2015).

terms to know

Neurodiversity

Describes the idea that there is no right way of thinking, learning, or behaving and that people experience the world in many different ways.

Neurodivergence

Any condition that manifests as differences in cognitive function, sensory processing, or response to stimulus when compared to what is considered neurotypical or cognitively normal.

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5. Avoiding Stigma Related to Mental Health

Countering stigma or negative viewpoints about an individual’s personal characteristics or traits is important to address in the realm of mental health. Despite common misperceptions, having a mental health disorder is not a choice, a lack of willpower, a weakness, or a character flaw (SAMHSA, 2023). However, harmful stereotypes and stigma around mental health disorders still exist. Some stereotypes include views that people with mental health disorders as potentially violent, dangerous, and incompetent, or views that they are seeking attention and should just get over it.

These types of preconceptions about people with mental health disorders are often based on ignorance and false information. Very few people with mental health disorders are dangerous to society. Most can hold jobs, attend school, and live independently. A person with a mental health disorder cannot simply decide to get over it any more than someone with a different chronic disease such as diabetes, asthma, or heart disease.

Stigmas against individuals with mental health disorders lead to injustices, including discriminatory decisions regarding housing, employment, and education. Many people who successfully manage their mental health disorder report that the stigma they face is in many ways more disabling than the illness itself.

IN CONTEXT

Research on mental health stigma in the workplace found that more than one in three employees were concerned about negative effects, or even being fired if they needed mental health care (American Psychological Association, 2023).

Stigmatizing attitudes can lead to feelings of shame and guilt, loss of self-esteem, social dependence, and a sense of isolation and hopelessness. One of the worst consequences of stigma is that people who are struggling with a mental health disorder may be reluctant to seek treatment that, in most cases, would significantly relieve their symptoms.

One way that each of us can combat stigma related to mental health is in the words we choose and use when talking about people with mental health disorders.

Use person-first language rather than labeling someone with their condition. Rather than saying, “She is bipolar”, using the preferred language, we could say, “She is a person with bipolar disorder”. This puts the focus on the person and avoids making their mental health disorder the defining characteristic of who they are (American Psychiatric Association, 2023).

EXAMPLE

Person-first language is preferred when talking about people in general, not just in the context of mental health. Instead of saying, “They are a disabled person”, it is preferred that you say, “They are a person with a disability.” Or, instead of saying, “They are an alcoholic”, it is preferred that you say, “They are a person with an alcohol use disorder.”

• Avoid using phrases like “suffering from” or “victim of” (American Psychiatric Association, 2023). For example, if a person has depression, saying that they are “suffering from” depression implies that their life is negative and full of distress.
• Don’t use mental health terms as adjectives to describe people or behaviors. For example, calling a person “a little OCD” because they like things organized and neat undermines legitimate mental health diagnoses (Greenstein, 2017).
• Be compassionate and nonjudgmental if someone opens up to you about their mental health. Asking how you can help or offering to be present to listen are both ways of showing care. However, it’s unhelpful to dismiss their concerns or to suggest that they try thinking differently.
• Simply talking openly or being willing to talk openly about mental health can reduce stigma. Seeing other people share their stories can make mental health disorders and challenges more relatable (American Psychological Association, 2023).

Providing accurate information is another way to reduce stigmas about mental health disorders. Advocacy groups protest stereotypes, such as requesting that the media stop presenting inaccurate views of mental health disorders. Powerful countering of stereotypes can occur when meeting someone who is effectively managing a serious mental health disorder and is also holding a job, providing for themselves, and living as a contributing member of society. Interaction with people who have mental health disorders can challenge assumptions and change attitudes.

term to know

Stigma

Negative viewpoints about an individual’s personal characteristics or traits.

Disclaimer: The use of any CDC and United States government materials, including any links to the materials on the CDC or government websites, does not imply endorsement by the CDC or the United States government of us, our company, product, facility, service, or enterprise.

REFERENCES

American Psychiatric Association (2023). DSM: frequently asked questions. www.psychiatry.org/psychiatrists/practice/dsm/frequently-asked-questions

American Psychiatric Association (2023). What is mental illness? www.psychiatry.org/patients-families/what-is-mental-illness

American Psychiatric Association (2023). Stigma, prejudice, and discrimination against people with mental illness. www.psychiatry.org/patients-families/stigma-and-discrimination

American Psychiatric Association (2023). Words matter: reporting on mental health conditions. www.psychiatry.org/news-room/reporting-on-mental-health-conditions

Armstrong, T. (2015). The myth of the normal brain: Embracing neurodiversity. AMA Journal of Ethics, 17(4), 348-352. journalofethics.ama-assn.org/article/myth-normal-brain-embracing-neurodiversity/2015-04

Baumer, N., and J. Frueh (2021). What is neurodiversity? Harvard Health Publishing. www.health.harvard.edu/blog/what-is-neurodiversity-202111232645

Centers for Disease Control and Prevention (2021). Adverse childhood experiences (ACEs): preventing early trauma to improve adult health. www.cdc.gov/vitalsigns/aces/index.html

Centers for Disease Control and Prevention (2021). Loneliness and social isolation linked to serious health conditions. www.cdc.gov/aging/publications/features/lonely-older-adults.html

Centers for Disease Control and Prevention (2023). About mental health. www.cdc.gov/mentalhealth/learn/index.htm

Chapman, R., & Botha, M. (2023). Neurodivergence‐informed therapy. Developmental Medicine & Child Neurology, 65(3), 310-317. doi.org/10.1111/dmcn.15384

Greenstein, L. (2017). How you can stop mental illness stigma. National Alliance on Mental Illness. www.nami.org/Blogs/NAMI-Blog/May-2017/How-You-Can-Stop-Mental-Illness-Stigma

Harvard Health Publishing (2022). What causes depression? Harvard Medical School. www.health.harvard.edu/mind-and-mood/what-causes-depression

Horwitz, Allan V. (2021). DSM: a history of psychiatry’s bible. Johns Hopkins University Press. www.press.jhu.edu/newsroom/dsm-history-psychiatrys-bible

Insel, Claire E., Walton T. Roth, and Paul M. Insel (Eds.) (2022). Connect Core Concepts in Health, 17th ed. New York: McGraw-Hill Education. ISBN: 978-1-264-14465-5.

Mayo Clinic (2022). Mental illness: overview. www.mayoclinic.org/diseases-conditions/mental-illness/symptoms-causes/syc-20374968

Mayo Clinic (2022). Mental illness: diagnosis. www.mayoclinic.org/diseases-conditions/mental-illness/diagnosis-treatment/drc-20374974

Mushtaq, R., Shoib, S., Shah, T., & Mushtaq, S. (2014). Relationship between loneliness, psychiatric disorders and physical health ? A review on the psychological aspects of loneliness. Journal of clinical and diagnostic research : JCDR, 8(9), WE01–WE4. doi.org/10.7860/JCDR/2014/10077.4828

National Alliance on Mental Illness (2023). Mental health by the numbers. NAMI. www.nami.org/mhstats

National Institute of Mental Health (2021). Chronic illness and mental health: recognizing and treating depression. www.nimh.nih.gov/health/publications/chronic-illness-mental-health

Substance Abuse and Mental Health Services Administration (2023). Living well with serious mental illness. www.samhsa.gov/serious-mental-illness

Substance Abuse and Mental Health Services Administration (2023). Mental health and substance use co-occurring disorders. www.samhsa.gov/mental-health/mental-health-substance-use-co-occurring-disorders

World Health Organization (2022). Mental health. www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

World Health Organization (2022). COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide

Yergeau, M. (2018). Authoring autism: On rhetoric and neurological queerness. Duke University Press.