{"id":37421,"date":"2016-09-19T10:19:26","date_gmt":"2016-09-19T09:19:26","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=37421"},"modified":"2016-09-19T10:19:26","modified_gmt":"2016-09-19T09:19:26","slug":"marta-balinska-psychological-distress-versus-mental-illness","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/09\/19\/marta-balinska-psychological-distress-versus-mental-illness\/","title":{"rendered":"Marta Balinska: Psychological distress versus mental illness"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-37423\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/09\/marta-150x148.jpg\" alt=\"marta\" width=\"150\" height=\"148\" \/>&#8220;You will know very few happy moments in life, so make the most of them.&#8221; Those are words I often heard from my late mother, leading me to believe that life was going to be a painful affair. In retrospect, I wonder whether she was dealing with chronic depression or whether she was &#8220;merely&#8221; dogged by unhappiness. In fact, is unhappiness so different from depression? The <a href=\"http:\/\/www.who.int\/about\/definition\/en\/print.html\">World Health Organization<\/a> defines health as \u201ca state of complete physical, mental and social well-being and not merely the absence of disease\u201d from which it is logical to deduce that if you are unhappy, then you are ill.<!--more--><\/p>\n<p>I am annoyed to see the umpteenth book published on how to cure your depression through mindfulness, sports, or improved diet. Someone with major depressive disorder or psychosis is not going to get better simply by meditating or going for a brisk walk. The problem here may well be semantics. Given that, in the quasi-absence of biological markers, we speak of mental <em><i>illness<\/i><\/em> rather than<em><i> disease<\/i><\/em> is part of the reason for confusing sadness (a normal reaction to negative stressors) with depression (a pathological state).\u00a0 The development of scales for mental symptoms have allowed us to progress in measuring degrees of distress, but have not in themselves made clear for most people (including non-specialised healthcare professionals) that mental illness is not a state of mind.<\/p>\n<p>Let me illustrate my point by a metaphor. You may experience elevated levels of blood sugar such that you need to watch your diet; but then one day you go on to develop diabetes for which you must still watch your diet but <em><i>also<\/i><\/em> take insulin. The same is true of mental illness in all its forms and it is to this transition from exposure (worries, for example) to outright disease (major anxiety disorder, for example) that I refer. \u00a0So how do we know when to draw the line between existential hardship and overt mental illness? I will risk stating that even a suffering individual is mentally healthy if he\/she adapts correspondingly to his\/her surroundings and circumstances, and if objective reality is not distorted by his\/her perceptions. Reality is, of course, nearly impossible to define, but\u2026 take the example of someone suffering from acute anxiety who feels the walls of her flat are going to cave in on her: in terms of \u201cobjective\u201d reality, this is unlikely to happen, therefore she has an skewed perception of her surroundings. The same is true of an anorexic who perceives herself in the mirror as overweight.<\/p>\n<p>Since most people must deal occasionally with psychological distress, many seek counselling; however, it is unlikely that most of these individuals are actually mentally ill \u2013 rather, they are dealing with existential hardship. And here it may be useful to understand the limits of psychotherapy: \u00a0I do not believe that bipolar depression or psychosis can be substantially alleviated by words or behavioral advice, however wise and true these may be. \u00a0Quite obviously, grief can lead to depression, unrelenting stress to anxiety, and rape to a range of post-traumatic disorders, but this occurs as part of a <em><i>pathological process<\/i><\/em> in which there is clearly a before and after even if we cannot pinpoint the moment at which this occurs.<\/p>\n<p>Why am I so adamant? Because I feel that many people who are truly mentally ill suffer not only from their symptoms and associated stigma, but also from the patronizing attitudes of those who believe they should just \u201cget on with their lives\u201d.<\/p>\n<p><strong>Competing interests:<\/strong> None declared<\/p>\n<p><span class=\"il\">Marta<\/span>\u00a0Balinska works in the medical department of M\u00e9decins Sans Fronti\u00e8res, Switzerland. While not herself a psychiatrist or psychologist, she was prompted to write this piece owing to her intimate experiences with people with mental illness, and her own reflections on the topic.<\/p>\n<p>&nbsp;<\/p>\n<p><strong><b>\u00a0<\/b><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>&#8220;You will know very few happy moments in life, so make the most of them.&#8221; Those are words I often heard from my late mother, leading me to believe that [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/09\/19\/marta-balinska-psychological-distress-versus-mental-illness\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-37421","post","type-post","status-publish","format-standard","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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