Mental health: What's normal, what's not

(MayoClinic.com) What's the difference between mental health and mental illness? Sometimes the answer is pretty clear. People who hear voices in their heads may have schizophrenia, for instance. And those with such grandiose ideas as becoming the secretary-general of the United Nations without any experience may be having a manic episode caused by bipolar disorder.

But in some cases, the distinction between mental health and mental illness isn't as clear-cut. If you're afraid of giving a speech in public, does it mean you have a mental illness or simply a run-of-the-mill case of nerves? If you feel sad and discouraged, are you just experiencing the blues, or is it full-fledged depression requiring medication or counseling?

One thing that makes it difficult to distinguish normal mental health from mental illness is that there's no easy test to show if something's wrong. It appears that mental disorders have a biological cause. But for now, there's no clear medical test for mental illness.

For these reasons, diagnosis and treatment of mental disorders is based on signs, symptoms and how much the condition affects day-to-day life. Signs and symptoms commonly show up as:

• Behaviors, such as obsessive hand washing or drinking too much alcohol
• Feelings, such as deep or ongoing sadness, euphoria or anger
• Unusual thoughts, such as delusions that the television is controlling your mind, or thoughts of suicide
• Physical signs and symptoms, such as sweating, racing heartbeat or uncontrolled rapid breathing (hyperventilation)

How do mental health providers determine whether your signs and symptoms are normal or if they indicate mental illness? Experts often use a combination of the following approaches:

• Your signs and symptoms. To diagnose mental disorders, doctors and mental health professionals rely on comparing your signs and symptoms to written guidelines that list signs and symptoms of known mental disorders. Diagnosing a mental disorder is easier in people who have a number of common signs and symptoms, but it can be more difficult in people whose signs and symptoms aren't as clear. Signs and symptoms of a mental disorder can differ from person to person and can change over time. Generally, a mental illness is diagnosed only when signs and symptoms are persistent and bothersome.
• Your own perceptions. How you perceive your own thoughts and behaviors and how much your symptoms affect day-to-day activities can help determine what's normal for you. You may realize that you aren't coping well or that you aren't able to or don't care to do routine activities or the things you used to enjoy. If you have depression, the dishes may go unwashed for days, you may stop bathing or you may lose interest in hobbies. You may feel sad, hopeless or discouraged and realize that something's amiss, that you don't enjoy life anymore. If your sadness is caused by a situation, such as a divorce, for example, your feelings could be a normal, temporary reaction. But if you have signs and symptoms that are severe or don't go away with time, it may be depression.
• Others' perceptions. Your own perceptions alone may not give you an accurate picture of your behavior, thoughts or functioning. Other people in your life, on the other hand, might be able to do so. To you, your life may seem normal, but what you think of as quirks or personality traits may be causing more problems than you realize. To those around you, your behavior may seem odd or disruptive. For example, if you have bipolar disorder, you may think your mood swings are just part of the normal ups and downs of life. But to others, your thoughts and actions may appear abnormal or cause problems at work, in relationships or in other areas of your life.

Signs and symptoms that mark specific mental illnesses are spelled out in detail in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This 2-inch-thick book classifies and describes more than 300 types of mental disorders. Published by the American Psychiatric Association, it's used by mental health providers to diagnose everything from anorexia to voyeurism.

Why does a specific diagnosis even matter if the line between mental health and mental illness is sometimes blurry? One reason is that the health insurance companies use the diagnoses spelled out in the DSM to determine coverage and benefits, to reimburse mental health providers. But more important is that in order to provide appropriate treatment, your health care professional must know what condition to treat — and whether it needs to be treated.

Despite these criteria and efforts to back up diagnoses with sound science, a precise definition of normal mental health remains elusive. The Diagnostic and Statistical Manual defines mental disorders as "behavioral or psychological syndromes or patterns that cause distress, disability in functioning, or a significantly increased risk of death, pain or disability. And that syndrome or pattern can't just be an expected and culturally accepted response to a particular event, such as grieving the death of a loved one."

New medical information can lead to changes in the classification of mental disorders. New disorders will be added, while existing ones will be removed, or the associated signs and symptoms will be modified as new opinions develop over time. For example, experts are considering whether premenstrual signs and symptoms may be added to the DSM as a diagnosable condition called premenstrual dysphoric disorder.

Revisions may also reflect evolving social and cultural attitudes. Homosexuality, for instance, used to be classified as a mental disorder, but it was removed from the Diagnostic and Statistical Manual in 1973.

Even if you do have a diagnosable mental disorder, it may not pose a problem in your daily life to such an extent that it requires treatment. On the other hand, there's no question that certain mental health conditions can have a serious impact on your life and the lives of the people you care about.

Many people with debilitating mental health issues, such as depression, avoid treatment or just consider their signs and symptoms a normal part of life. If you have something going on that's disruptive or that is making you unhappy, don't hesitate to seek advice. A good place to start is by talking with your family doctor about what's bothering you. Another option is to set up an appointment with a counselor or psychologist to discuss your concerns. If you do have a mental health condition that causes problems, treatment such as medications or counseling can probably help.

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