WHAT COUNTS AS A MENTAL ILLNESS?

Many people identify as having some sort of mental illness. Rock stars sing about mental illness. Writers write about it. Characters are described as being “ADD” or “OCD” as if these descriptors are adjectives. 

In some cases - even in many cases, I’ve heard people identify as actually being the mental illness: “I’m ADD.” “I’m OCD” “I’m bipolar.” People who actually suffer from these conditions are the first to tell you: Stop it! 
Nobody is served when people make fun of a mental illness or diagnose themselves. What counts as a mental illness? What makes someone really count as mentally ill, in need of treatment? Or able to respond to treatment? 

The simple answer is that we have some books, compiled by a bunch of self-proclaimed experts, which define mental illness. These are the DSM-V and the ICD-10 which describe, in meticulous detail, the requirements for each of the latest incarnations of every defined mental disorder. 

Of course, some of these include things like nicotine addiction, and some of them are speculative, and some of them are disorders that are so severe that anyone who suffers from them would not even be aware that they are ill, because they would be unconscious or relatively unaware of their surroundings. 

So let’s get started. Does your potential mental illness fall into one of these groups?

MOOD DISORDERS
Mood disorders include all disorders of mood. There are big mood disorders, where the sufferer loses contact with reality. My first patient, as a medical student, had depression. But not any old depression. He had psychotic depression and believed that all his clothes had been stolen and he was being held prisoner. 

In learning his history, I discovered that he had a history of bipolar disorder. He’d had previous manic episodes where he’d believed he was the owner of some sort of business and had millions of dollars. In reality, he was a retired low-level civil servant who’d had multiple previous psychiatric hospitalizations. 

There are smaller mood disorders, that include milder forms of depression, or more serious depression that never swings to mania. Mood disorders can hit anyone, at any age, at any time.

The most important thing, though, is to make sure that your mood disorder really counts as a mental illness and is not a psychiatric manifestation of a medical problem. For this reason, it is very important to see a medical doctor, such as an actual psychiatrist, for a good differential diagnosis. You don’t want your thyroid disorder or your brain tumor misdiagnosed as depression.

ANXIETY DISORDERS

All disorders that present with anxiety are filed under this heading. There are many. 

Obsessive-compulsive disorder (OCD) is probably the most famous one which people self-diagnose when they like things to be tidy. Actual OCD is an often-devastating mental illness which can affect people’s lives so severely that they become unable to leave the house. 

I’ve had patients who cannot finish school, are unable to go to work, and who essentially become invalids because of this devastating disorder. Yet so many people who come in for other reasons casually mention: “I’m OCD” as if it is a joke. It’s not a joke. It’s a horrible mental illness. See the diagnostic criteria I mentioned, above. One Quora user wrote very poignantly about her experiences with OCD and I up

Anxiety, too, can mimic medical disorders, and vice versa. Your thyroid, again, a small gland in your neck, could be responsible. So could any one of a dozen other organs in your body, including your heart. 
Posttraumatic Stress Disorder (yes, that’s how it’s spelled in the DSM) is another anxiety disorder that must be diagnosed according to specific diagnostic criteria. You don’t get to say you have PTSD because you were upset when someone yelled at you. 

You must have a qualifying event, which must be outside of the realm of normal, everyday, human experience. If it’s just a normal upset (up to and including sexual harassment and bullying) then it’s a plain old Adjustment Disorder, a disorder that gets its own category, but still counts as a diagnosis.

SUBSTANCE ABUSE DISORDERS

Speak for themselves. They count as mental illness. Interestingly, the better part of the money spent on mental illness in this country goes toward substance abuse treatment. There is a huge overlap, also known as comorbidity, of substance abuse and other types of mental illness. 

In other words, people who suffer from one psychiatric disorder often also suffer from a substance abuse disorder. These individuals are often best treated in dual diagnosis or co-occurring diagnosis programs.

NEUROCOGNITIVE AND DEVELOPMENTAL DISORDERS

This category includes the famous Attention-Deficit Hyperactivity Disorder, as well as Attention Deficit Disorder without Hyperactivity. These are the same disorder. The distinction about whether or not hyperactivity is present is important mainly to the observer. Teachers and parents are more likely to be annoyed and to notice if someone is afflicted when hyperactivity is present. 

Autism and Autism-Spectrum disorders are in this category. So are intellectual impairment that children are both with and, at the other end of the life cycle, the ones that people acquire later in life, like Alzheimer’s Disease. 

Confusingly, the DSM has lumped all of these under the label of Major and Minor Intellectual and Cognitive Impairment, doing away with the older names of mental retardation and dementia, so finding a specific diagnosis, such as Fragile X syndrome, Lewy Body Disease, or something else, might be a longer time coming. And a traumatic brain injury can occur at any time during the lifespan. Still, if your brain is literally not functioning properly, you get a DSM diagnostic code.

PSYCHOTIC DISORDERS

The most famous psychotic disorder is Schizophrenia. There are various sub-forms of schizophrenia, and other disorders which can include psychosis. The one criterion required for a psychotic disorder is a thought disorder. If you have a thought disorder, you won’t know it, and other people might not realize it either. 

News flash: Believing that everyone in a school deserves to die because you were unhappy when you were a high school student is actually a thought disorder. It’s not a motive, as the news media would like for us to believe. A thought disorder is when your thinking is - disordered. Illogical, makes no sense, messed up. 

The concept of a thought disorder is one that many people, including mental health professionals, often have difficulty understanding. We can all understand hallucinations, and we can understand bizarre delusions (“the satellites are controlling me.”) But many, if not most, patients will never share these thoughts.

Many people who hallucinate are never aware that they are hallucinating. They “hear” words that others speak as if others are really speaking those words. They believe things as if they were actually true. Every day I hear (for real) medical students ask patients: “Do you hear or see things that other people don’t hear or see/that aren’t really there?” If you know that those things are not really there, you are in luck, my friends! You might have some other problem, but you are not psychotic. 

Psychotic people, with their thought disorders and hallucinations, have a profound lack of insight. They are not aware that their delusional worlds are not real. This lack of insight is what makes treating them so difficult, yet so rewarding. If you are suffering from living in a secret world where you get special messages from the TV, where you have been chosen by G-d for a special mission, where you control all the money in the world with your mind, where nanobots have been injected into your body while you sleep, or some other special thing like that - well, it might not have really happened. You might be psychotic. And if you are planning a mass shooting, I promise you - no good will come of it. It’s a terrible idea. Please go to your nearest psychiatric emergency room right now. There is help for you.

SO WHAT COUNTS AS A MENTAL ILLNESS?

We’ve only touched on the biggies - there are many more categories, disorders, and syndromes that we psychiatrists treat. Here’s the take home message. If your thoughts, feelings, and emotions are bothering you, a psychiatrist can help you identify if a mental illness is brewing, and if it is treatable, and how to treat it.

There’s also another perspective. There’s a Russian proverb that goes something like this: If one person at the party tells you you’re drinking too much, well, he’s probably not having a good time. But if two people tell you, maybe it’s time to go home and go to sleep.

In other words, when you see that your life is not going well, when you keep getting fired or your relationships keep failing, or your family situation is going badly, or problems keep happening to you, then it might be worth it to check out the common denominator - YOU! Sometimes figuring out what you are doing at your own party might be a huge help in resolving your problems.

We all deserve to take care of ourselves and have the best lives possible. Call a psychiatrist or a psychologist. The right help is available for you, from medication to therapy to life coaching. I’d love for you to visit  my website at http://www.shnaidman.com for more information.