in Misc., Thinking about psychiatry

What is mental illness, mental health, mental disorder?

A more difficult question to answer than one might think. As usual your definition depends on all or some of: your point of view, how deeply you wish to probe, how many people are sitting on your committee and how long you’ve got to write it before you break for lunch.

Before I get stuck in, it’s worth noting that the term ‘health’ is a non-exact term used loosely in everyday speech. Equally ‘mental health’, ‘mental illness’ and ‘mental disorder’ are used with an comparable lack of precision and the latter two most often interchangeably. In addition psychiatric health/illness/disorder are used synonymously with mental health/illness/disorder. A further problem with this concept is that there is no clear cut off point between mental disorder and mental health; indeed one person’s mental health, might be another’s mental disorder.

With this poverty of precision already built in, it is probably unfair to expect too much. For this posting I will be mostly using the phrase ‘mental disorder’. Whatever their definitions, common sense dictates that ‘mental health’ and ‘mental illness’ are at least related such that as one increases, the other decreases. There is no definition of mental disorder which is either entirely satisfactory or uniformly accepted.

For legal purposes, the UK’s Mental Health Act 2007 defines mental disorder succinctly and thusly:

‘Mental disorder’ means any disorder or disability of the mind (page 7)

It is clear here, even to the casual reader, is that there is a marked circularity to this statement. Verbose as ever the World Health Organisation makes the following submission:

Mental health can be conceptualized as a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.

Furthermore they state emphatically:

Mental health is more than the absence of mental disorders (read the rest)

Inspiration for the definition of mental disorder often comes from the world of general medicine. Whether or not a mental disorder can or should be considered in the same way as, say, a viral illness is a discussion for another day but it is a direction that modern psychiatry is wedded to. Looked at this way mental disorder can be:

An absence of mental health.
A stumbling block here is that health is at least as difficult to define as illness. Always willing to have a bash, the WHO have defined ‘health’ as ‘a state of complete physical, social and mental well-being and not merely an absence of disease or infirmity’.

A presence of significant psychopathology.
This is related to the definition ‘disease is what doctors treat’, in that psychopathology would be identified by a nominated professional (but with their own distinct gaze…). It is another rather circular argument which allows for expansion of the concept which it describes, as when treatments become available for a condition it is more likely to be considered a disease (think of depression).

Similar to defining mental disorder as the presence of psychopathology is the wish to define mental disorder as the ‘presence of suffering’. This defines the group of people most likely to consult doctors, or other health care professionals. However unlike the definition relying on psychopathology, it leaves out people with mental disorders whose main effect is not felt by the sufferer at the time, for example during the manic phase of bipolar disorder or schizophrenia without insight.

Finally depending on our agenda, we can also choose to define mental illness out of existence. Enter the philosopher and anti-psychiatrist Thomas Szasz who wished to define a disease purely in terms of its physical pathology. Since most mental disorders do not have any demonstrable physical pathology, they are by this yardstick not illnesses. Although not sunk, this view has come under considerable attack from research which suggests genetic and neurobiological processes are involved in the aetiology of mental illness.

Further reading:

There’s a chapters in this book
Clare AW (1997) in The Essentials of Postgraduate Psychiatry
and a section in
Shorter Oxford Textbook of Psychiatry

Also Wikipedia

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  1. You might be interested in Derek Bolton’s ‘What is mental disorder?”

    Bolton’s a professor of philosophy and psychopathology at the Institute of Psychiatry, and the book gets good reviews in the BJP and other places. He spends a lot of time discussing Wakefield’s evolutionary approach to the problem of definition.

    Anyway as you know I’m close to the ‘presence of suffering’ position (and I think the stuff about harm to others can be dealt with via considerations of autonomy and decision-making capacity).

    With regard to your post, I would ask you “why do we need to define the term ‘mental disorder’ anyway?” Asking such a question presupposes the utility of the concept. Why do we need to know if someone’s suffering qualifies as ‘mental disorder’ before we help them? Surely all that matters is that they are suffering, and that they are asking us for help? We may wish to ask what ‘form’ their suffering takes, but that’s different from asking if their suffering meets mental disorder criteria. People become so bewitched by debates over whether someone has a ‘proper mental illness’ or not, eagerly flicking through their DSM’s or ICD’s for reassurance and moral guidance. In the meantime, the person being discussed continues to experience profound pain and helplessness.

    My own view is that the disadvantages of the term outweigh the advantages. More importantly, when all is said and done, we don’t really need the term anyway. Rather than ask “what is mental disorder?” or “does mental disorder exist?”, a much more useful question to ask is “are we justified in helping this person?” In fact, losing the term mental disorder (with all the negative consequences attached to being ‘diagnosed’) makes it easier for professionals to help. Not having a boundary between the ill and the well (and not having one’s passport repeatedly stamped) makes travelling between different emotional states easier for everyone.

    On the other hand, I definitely do think we need to classify those recognisable processes and patterns which normally (but not always) lead to subjective psychological distress or impaired decision-making capacity, but I’d like to see less evaluative language used. Terms such as ‘phenomena’, ‘process’, ‘pattern’, ‘system’, ‘type’, ‘form’, ‘taxon’, ‘condition’, ‘state’ would all be improvements on existing terms such as ‘pathology’, ‘symptom’, ‘sign’, ‘disorder’, ‘illness’, ‘disease’ or even ‘disability’.

  2. Doc – all of the talk about definitions is very well – within the industry. People on the street only see one term MENTAL ILLNESS and they only take away one meaning from that DANGER.

  3. This is one of the most fascinating things about mental health. The lack of numbers to define “well” and “ill” means you have to be more than just a technician.

  4. . . . Mental Health Act 2007 . . .


    Please, please, please tell me you’re not calling it that in practice, and it was just referenced as a link?

    We’re still using the Mental Health Act 1983 (since the 2007 legislation ammended the primary legislation but wasn’t sufficiently comprehensive to replace the original Act), so although it’s the Mental Health Act 1983 I’d accept that a more pedantic (and legally correct) term would be to refer to it as the ammended Act . . . but to refer to a 2007 Act is just confusing, no?

  5. Shrink –

    erm, I can’t say that I’ve given the matter a lot of thought. Should the above most correctly read:

    ‘The Mental Health Act 1983, amended in 2007…’ ?

  6. Clever lawyer folk (and managers who sleuth these things out) tell me that it should still be called the Mental Health Act 1983. And that’s what folk in clinical practice and confereneces and the like say. And most importantly, what the statutory forms say.

    Hence, my anxiety around shifting terminology from the Mental Health Act 1983 to anything else!

  7. Well, they might but not as far as we don`t PROVE the necessity of such a terminology switch. Whether we agree on the term being employed and the question being asked what matters is the essence of this questioning process: Which condition of mental disorder deserve professional health care? Only experience can answer such question and we shall see its answer emerge with time as we gather more and more facts about the longevity, harmfulness and disadvantages of the so called “mental disorders“. The terminology is a mean not an aim. It is just the process of indicating a phenomenon. I think medical community shall better focus on other arguments such as models of mental illness, like categorical versus dimensional, a promising prospective under which the new DSM is being prepared.

  8. please tell me that ‘ is there any difference between mental illness and mental disorders….? if yes, what is the difference …..please sir….

  9. Hi,
    I would think that the diffinition between mental illness and disorders has to do with heridtage and if the cause of the condition is due to outside factors i.e. trauma of some sort, or if is genetic and biological in its nature. Although the terms can be hard to sort strickly into two cats. Most things are somehow croosconnected.

  10. It is not the ‘UK’ definition, the Mental Health (Care and Treatment) (Scotland) Act 2003 has a very different definition.