What really is mental illness?

Defining mental disorders and illnesses is not straightforward. Notions of whether a certain phenomenon should be classified as an illness (or disorder) or something falling within the category of normal emotional fluctuations have changed significantly over the years, and continue to do so.

What the researchers say

“It’s difficult to draw a definite line between normal and abnormal behavior, or to know when mental symptoms should be called a disease. For instance, grief and anxiety can be normal reactions to a difficult stage in life, but they may also underlie severe depression or an anxiety disorder,” said the principal author of a research article on this topic.

The study, carried out by an international group of researchers, investigated which mental conditions from a group of 20 were considered illnesses, and which were not, by five different groups of people. The questionnaire was distributed to 6,200 individuals, of whom 3,000 were chosen randomly from the Population Register. The rest included 1,500 physicians – including a number of psychiatrists and other specialists – 1,500 nurses and, in addition, all of the 200 members of the Finnish Parliament.

The respondents were asked whether they would define the following conditions as diseases: ADHD, alcoholism, anorexia, autism, bulimia, premature ejaculation, homosexuality, drug addiction, depression, panic disorder, gambling addiction, personality disorder, absence of sexual desire, schizophrenia, social anxiety disorder, grief, transsexualism, burnout, insomnia and generalized anxiety disorder.

At least 75 percent of respondents in all groups considered schizophrenia and autism illnesses, while a corresponding share did not consider homosexuality and grief illnesses.

In all groups, ADHD, anorexia, bulimia, depression, panic disorder, personality disorder and generalized anxiety disorder were classified as diseases by 50-75 percent of respondents. The same number of respondents did not classify premature ejaculation, absence of sexual desire and transsexualism as illnesses.

The widest range of views concerned alcoholism, drug and gambling addiction, social anxiety disorder, insomnia and burnout.

Psychiatrists were most inclined to classify the conditions included in the questionnaire as diseases, followed by other physicians, nurses, members of parliament and laypeople.

“In other words, the more psychiatric training you had, the more likely you were to consider the conditions diseases (you remember the old saying: ‘If the only tool you have is a hammer, everything becomes a nail’). The difference between psychiatrists and laypeople was substantial,” the researchers added.

People’s notions of what is and is not a disease is very important in the discourse on mental health and human behavior. These notions also influence the allocation of society’s resources and the stigmatization of various groups of people.

“Society’s attitude towards alcoholics and drug addicts largely depends on whether substance abuse is considered an illness or a life choice,” the lead author points out.

“The medicalization of various problems is not a positive trend either; it may result in non-medical causes being overlooked, solving problems with an approach that is too reliant on pharmaceuticals.”

We’ve been through this movie before with pharmaceutical approaches to depression – particularly SSRIs drowning out other approaches. Just this week, another study was published showing the dangers of over-prescribing antidepressants – this time particularly to patients over 65.

Increasingly, we see the medicalization of boys’ normal, somewhat boisterous, behavior by labelling it ADHD, in the marketing drive for psychiatric services and Ritalin and similar drugs.