Multidimensional Degrees of Mental Health and Mental Illness

Mental health and mental illness are such vague terms. This informal paper attempts to clarify these and related terms using a multidimensional framework to explore the various degrees of the various dimensions of mental health and mental illness and to serve as a foundation for general discussion of mental health and mental illness issues, especial from a public health policy perspective.

The situation is not black and white but many shades of gray. Even being normal has shades of gray. A key goal of this paper is to explain mental health and mental illness and all related medical jargon in as plain English as possible. In turn, it is hoped that this will help mental health professionals communicate to non-mental health professionals in plain English as well.

This paper will not delve into specific disorders, symptoms, diagnosis, or treatments, and certainly isn’t intended to aid in diagnosing or treating mental health problems, but it is intended to survey the landscape, although more from a public health policy perspective. It will provide a summary of mental health and mental illness to serve as a foundation for discussion of mental health policy. And to more clearly define the problem and to provide a vocabulary and multidimensional framework for discussion of topics related to mental health and mental illness.

Evaluation of policy proposals to address mental health problems and mental illness should ask to what degree aspects of mental health across multiple dimensions are addressed by the policy proposals. Questions could include:

  1. What levels of mental illness are addressed?
  2. What degree of relief can be achieved?
  3. What degrees of mental illness will not be addressed and not relieved?
  4. What degrees of distress will be addressed, and relieved?
  5. What degrees of distress will not be addressed or relieved?
  6. What degrees of impairment of function will be addresses and restored?
  7. What degrees of impairment of function will not be addressed and not restored?

Topics or dimensions of mental health and mental illness covered in this paper:

  1. Definitions of mental health.
  2. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and International Classification of Diseases (ICD-10) as authoritative sources.
  3. Terminology.
  4. Official definition of mental disorder.
  5. Other definitions of mental illness and mental disorder.
  6. Types of mental disorder or mental illness.
  7. Types of symptoms or warning signs of mental disorder or mental illness.
  8. Where there’s smoke (maybe) there’s fire.
  9. Disturbing or troubling behavior.
  10. Challenges and minor traumas of normal life.
  11. When in doubt, ask.
  12. Counseling.
  13. Diagnosis of mental disorders.
  14. Levels of mental health.
  15. Role of mental illness in various social ills.
  16. Difficulty of determining cause.
  17. Causes of mental illness.
  18. Causes for induced mental illness.
  19. Types of mental health professionals.
  20. Qualified mental health professional.
  21. Neurological disorders — not considered mental or psychiatric disorders or mental illness.
  22. Level of intensity or severity.
  23. Forms of distress.
  24. Levels of distress.
  25. Forms of function.
  26. Forms of attitude and outlook on life.
  27. Levels of function.
  28. Forms of behavior which may be impaired.
  29. Degree of cure.
  30. Forms of defensive mechanisms.
  31. Forms of coping.
  32. Levels of coping.
  33. Levels of capacity for coping with trauma.
  34. Is treatment needed?
  35. Forms of treatment.
  36. Forms of management.
  37. Levels of treatment.
  38. Extreme treatment.
  39. Unacceptable forms of treatment.
  40. Forms of self-medication.
  41. Awareness of problem.
  42. Levels of awareness for self.
  43. Levels of awareness for others.
  44. Levels of awareness for mental health professionals.
  45. Degrees of grief.
  46. Levels of normalcy after treatment — relief from distress and restoration of function.
  47. Range of normal.
  48. Degree of control over life.
  49. Scope of attitude.
  50. Cultural dimension of mental illness.
  51. Forms of social norms.
  52. Perspectives of stigma.
  53. Forms of stigma.
  54. Degrees of stigma.
  55. Forms of referral for help on mental health concerns.
  56. The great abyss: the untreated unaware.
  57. Degrees of undiagnosed mental disorder.
  58. Need for much more research.
  59. Topics beyond scope of this paper.

Simple model of mental health, mental illness, and treatment

Here is the simplest model of mental health, mental illness, and treatment:

  1. Normal.
  2. Coping with any unusual or significant stress, challenges, or trauma.
  3. Normalcy. Close to normal life through treatment and management of mental health problems under the guidance of mental health professionals.
  4. Modest struggling. With or without treatment by mental health professionals.
  5. Moderate struggling. With or without treatment by mental health professionals.
  6. Extreme struggling. With or without treatment by mental health professionals.
  7. Unable to cope or get proper treatment, or treatment is ineffective or resisted.
  8. High risk of harm to self or others.
  9. Suicide.

Model of mental health, mental illness, and treatment

A more sophisticated model of the degrees of mental health and mental illness and what degree of treatment may be required:

  1. Normal.
  2. Coping with the regular stresses of daily life — no treatment required.
  3. Coping with significant challenges in life — should not require any treatment other than possibly light counseling.
  4. Coping with trauma — may not require much in the way of treatment per se, but could require significant counseling.
  5. Chronic substance abuse — may or may not be connected to mental illness.
  6. Coping with mental health issues which may be undiagnosed mental illness.
  7. Full normalcy. Degree of mental dysfunction that can successfully be treated to the degree that the individual can be free of any significant distress and capable of living a fully functional life without any significant impairment.
  8. Modest dysfunction — very light treatment by mental health professionals.
  9. Moderate normalcy. Degree of mental dysfunction that can successfully be treated to the degree that the individual feels free of a fair degree of their former distress and impairment and capable of living a reasonably functional life without any dramatic impairment.
  10. Moderate dysfunction — moderate treatment.
  11. Minimal normalcy. Degree of mental dysfunction that can successfully be managed or coped with to the degree that the individual can get by with only moderate distress or moderate impairment of function.
  12. Excessive dysfunction — difficult to treat, little relief, constant, chronic difficulty coping with life. Great difficulty living in a normal home environment.
  13. Hopelessly dysfunctional — not treatable in a home environment. Requires institutionalization or constant supervision, by a mental health professional.
  14. Potential harm to self and others. Likely to attract attention of law enforcement and criminal justice system, where effective treatment is unlikely.
  15. Suicide.

Generally, the first four would fall under normal mental health, while the remaining would fall under mental illness.

Chronic substance abuse could go either way. Technically, the National Institute of Mental Health doesn’t include substance abuse under their definition of Any Mental Illness (AMI), but mental illness occurs at a higher rate among substance abusers than in society as a whole.

Technical nit: The proper term for what many of us call substance abuse is substance use disorder or SAD.

Technically, someone could have a mental health problem but not quite meet the technical criteria for a diagnosable mental illness per se. In fact, that’s a huge open question — how many people have serious mental health issues that are not currently being addressed.

Caveats

  1. I am not a card-carrying mental health professional. I don’t have the education, training, credentials, certification, or licensing to be one. So I cannot speak with their authority. Although I did enjoy two psych courses in college.
  2. That said, I do believe that everything in this paper is accurate, to the best of my ability.
  3. Much of the matter presented in this paper is in my own words, my own distillation of matter presented elsewhere on the Internet, in many cases by professionals in the field. Nonetheless, my interpretations may not always faithfully convey the intentions of those professionals.
  4. Nothing contained herein should be construed to facilitate evaluation, assessment, diagnosis, or treatment of any mental health problem for anyone. Individuals should consult mental health professionals to address any mental health concerns.
  5. The purpose of this paper is to speak to public policy issues concerning mental health and mental illness, rather than speaking to diagnosis or treatment of mental health issues.
  6. This is an informal paper, meaning that it does not have the formal structure of a peer-reviewed journal paper or detailed citations.

Definitions of mental health

There is no definitive definition of mental health.

From the World Health Organization (WHO):

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

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Also from WHO (2001 World Health Report):

Mental health has been defined variously by scholars from different cultures. Concepts of mental health include subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one’s intellectual and emotional potential, among others. From a cross-cultural perspective, it is nearly impossible to define mental health comprehensively. It is, however, generally agreed that mental health is broader than a lack of mental disorders.

Merriam-Webster dictionary definition of mental health:

the condition of being sound mentally and emotionally that is characterized by the absence of mental illness and by adequate adjustment especially as reflected in feeling comfortable about oneself, positive feelings about others, and the ability to meet the demands of daily life

The Free Dictionary definition of mental health:

A state of emotional and psychological well-being in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life.

Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and International Classification of Diseases (ICD-10) as authoritative sources

The bulk of the text in this paper is my own phrasing, but many or most of the essential concepts are derived in large part from the two most authoritative sources of information about mental illness:

The full text of the ICD is available online for free. Bootleg versions of DSM-5 can be found online, but there is no official version available online for free.

Other sources include:

But the DSM and ICD are considered the authoritative sources.

Dimensions of mental health and mental illness

Mental health and mental illness can be approached or considered from a wide variety of different angles, approaches, or aspects, including:

  1. Types of mental disorder or mental illness.
  2. Types of symptoms or warning signs of mental disorder or mental illness.
  3. Overall level of mental health.
  4. Role of mental illness in various social ills.
  5. Symptoms.
  6. Disorders.
  7. Causes of mental illness.
  8. Causes for induced mental illness.
  9. Types of mental health professionals.
  10. Level of intensity or severity.
  11. Forms of distress.
  12. Levels of distress.
  13. Forms of function.
  14. Forms of attitude and outlook on life.
  15. Levels of function.
  16. Forms of behavior which may be impaired.
  17. Degree of cure.
  18. Forms of defensive mechanisms.
  19. Forms of coping.
  20. Levels of coping.
  21. Levels of capacity for coping with trauma.
  22. Forms of treatment.
  23. Forms of management.
  24. Levels of treatment and management.
  25. Levels of awareness.
  26. Levels of awareness for self.
  27. Levels of awareness for others.
  28. Levels of awareness for mental health professionals.
  29. Degrees of grief.
  30. Levels of normalcy after treatment — relief from distress and restoration of function.
  31. Range of normal.
  32. Degree of control over life.
  33. Scope of attitude.
  34. Cultural dimension of mental illness.
  35. Forms of social norms.
  36. Perspectives of stigma.
  37. Forms of stigma.
  38. Degrees of stigma.
  39. Forms of referral for help on mental health concerns.

A section will be devoted to each.

Terminology

More detailed, technical definitions of terms related to mental health, mental illness, and mental disorders can be found in the DSM Glossary of Technical Terms. The goal here is to explain technical terms in as plain language as possible, primarily for the benefit of laypersons and professionals who are not mental health professionals.

  1. Affective disorder. Any mental disorder related to mood, feelings, and attitude. Synonym for mood disorder. Also personality disorder. Related to antisocial behavior in general.
  2. Affective feature. Affective symptom. Symptom related to mood, feelings, emotions, or attitude.
  3. Alcohol-induced disorder. Mental disorder caused by alcohol abuse.
  4. Any Mental Illness (AMI). A mental, behavioral, or emotional disorder (excluding developmental and substance use disorders.)
  5. Antipsychotic. Antipsychotics. Antipsychotic medication. Medication used to treat psychosis. Synonym for Neuroleptic agent.
  6. Antisocial behavior. Inability to act with respect for the wellbeing and interests of others. Associated with personality disorder. Also, psychopathy or sociopathy.
  7. Baseline. Baseline behavior. An individual’s average, typical condition, behavior, and mental state when symptoms of a mental disorder are not present, or before the onset of a mental health episode. Alternatively, what would be considered normal for individuals at the same stage of development or life. Alternatively, what is typically observed for an individual except when a mental health episode is underway.
  8. Baseline personality. Personality of an individual before onset of a personality disorder.
  9. Behavioral effect. Impact of treatment on behavior, or on mental function which controls or influences behavior. May restore function or negatively impact function. See also: mental effect and side effect.
  10. Behavioral health problem. Mental health problem which manifests itself as an unwelcome change in behavior, as opposed to distress which is within the mind and not necessarily directly visible as behavior to others.
  11. Clinical judgment. The discretion and wisdom of a mental health professional (clinician) when making a diagnosis, in contrast to the directly observable or measurable symptoms.
  12. Clinical Significance. Clinically Significant. A mental health problem may not be diagnosed as a mental disorder if it has symptoms which are too mild or too infrequent to qualify as clinically significant. Treatment can still occur if the individual is in significant distress or impaired from normal function.
  13. Clinically significant distress or impairment. Distress or impairment for a mental health problem rise to the level of clinically diagnosed as a mental disorder.
  14. Clinically diagnosable disorder. Disorder which can be diagnosed by a health professional. Some disorders may not be readily apparent or severe or persistent enough to be diagnosed and considered clinically significant.
  15. Clinically diagnosable mental disorder. Mental disorder which can be diagnosed by a mental health professional. Some mental disorders may not be readily apparent or severe or persistent enough to be diagnosed and considered clinically significant.
  16. Clinically diagnosed. Symptoms rise to the level required for clinical diagnosis of a mental disorder.
  17. Clinically diagnosed disorder. Disorder which has been diagnosed by a health professional, typically a clinician such as a doctor.
  18. Clinically diagnosed mental disorder. Mental disorder which has been diagnosed by a mental health professional, a clinician, such as a psychiatrist or psychologist.
  19. Clinical diagnosis. The process of evaluating symptoms to determine if a mental disorder is indicated.
  20. Clinically significant distress or impairment. Clinically significant disturbance. Clinically significant disturbance to mental health. The standard for symptoms for a mental health problem that rise to the level of diagnosing a mental disorder, including both distress and impairment of function.
  21. Clinician. Mental health professional, usually a doctor, who is directly observing, diagnosing, and treating a patient.
  22. Close supervision. An individual with a mental health problem is frequently monitored throughout the day by mental health professionals, in either a hospital, institution, or residential care facility. Alternatively, the individual is managed at home by family members of home-care providers.
  23. Co-occurring disorders. Synonym for comorbidity and dual disorder/diagnosis.
  24. Cognitive deficit. Loss of cognitive function or mental ability. May be full or partial, for some or all cognitive functions.
  25. Cognitive function. Mental abilities and activities. There are five cognitive domains: complex attention (focus), executive function, learning and memory, language, perceptual-motor, and social cognition. Includes reasoning and thought processes in general.
  26. Cognitive impairment. Synonym for cognitive deficit.
  27. Comorbidity. Two of more medical or mental health disorders present at the same time. There may or may not be a causal link between them. Synonym for co-occurring disorders or dual disorder.
  28. Compensation. Compensated. The defense mechanisms that give an individual the ability to respond in a healthy manner to environmental stress, challenges, and trauma, in contrast to decompensation. Synonym for resilience.
  29. Coping. Accepting and dealing with the stresses, challenges, and traumas of normal daily life. Also, accepting and dealing with mental health problems, diagnosed mental health disorders, or even undiagnosed mental health disorders. Also, accepting and dealing with non-mental medical conditions.
  30. Course. Course of the illness. The entire period of time that symptoms are present for a mental disorder or any medical condition.
  31. Course modifier. Indicates some significant change in a mental disorder short of a complete cure. May be in remission or an episode or a period when symptoms are not apparent in an acute manner, or a relapse. The modifier can also specify how often or intense episodes have been.
  32. Crazy. Informal, popular, vernacular term for mental illness. No meaning in the context of mental health professionals.
  33. Culture-related diagnostic issues. Nuances of symptoms or evaluation of symptoms that vary between cultures. What may be normal in one culture may not be normal in another.
  34. Cure. Generally, most mental illness has no true, long-lasting cure. Generally, the best that can be done is treatment and management that moderates the negative effects and permits the illness to be managed. That said, mental disorders which are environmentally or chemically induced (including substance use) can sometimes and even frequently be cured if exposure to the environmental situation or chemical agent can be eliminated, although re-exposure can result in a relapse.
  35. Decompensation. The breakdown or lack of defense mechanisms that otherwise would have given an individual the ability to respond in a healthy manner to environmental stress, challenges, and trauma, in contrast to resilience or compensated where those defense mechanisms enable the individual to respond to in a healthy manner.
  36. Defense mechanisms. Defensive mechanisms. Defense. The ability of the mind to respond to external stress. Some defenses can be be harmful and cause or exacerbate mental disorder, while others can be helpful and healthy.
  37. Deficit. Loss of function. May be full or partial loss. Includes cognitive deficit and speech deficit.
  38. Depression. Low energy state of mind or mood, in contrast with mania. Depressed mood. Loss of interest in activities. Inability to engage in normal functions of daily life due to lack of motivation and mental energy.
  39. Developmental disorder. More properly neurodevelopmental disorder in the context of mental health, since there can be developmental disorders other than the mental variety.
  40. Diagnosed mental health condition. A mental health condition that is diagnosed to be clinically significant to warrant being considered a mental disorder (mental illness.)
  41. Diagnosable mental illness. Diagnosed mental illness. Technically, an individual should not be considered to be suffering from a mental illness unless a diagnosis has been delivered by a mental health professional. The symptoms of a mental health problem may not be severe or persistent enough to be clinically significant to warrant being considered a mental disorder (mental illness.)
  42. Diagnosis. As part of an evaluation or mental health assessment to determine if there are symptoms that rise to the level of clinically significant distress or impairment which are considered a mental disorder, and to detail precisely which mental disorder.
  43. Diagnostic criteria. The set of symptoms or diagnostic features, their intensity, and their persistence that are required to diagnose a particular mental disorder.
  44. Diagnostic feature. A particular symptom of the diagnostic criteria for a mental disorder.
  45. Differential diagnosis. How similar disorders can be distinguished. When symptoms of different disorders are similar, what other symptoms can tell them apart.
  46. Disability. Synonym for impairment. Or complete impairment.
  47. Distress. Mental pain or emotional pain as experienced, expressed, and observed in the individual.
  48. Dual diagnosis. Two medical or mental disorders present in an individual at the same time, each requiring its own distinct treatment. May or may not be a causal link between them.
  49. Dual disorder. Synonym for dual diagnosis.
  50. Duration. The amount of time that a symptom or episode is present and observable or otherwise experienced to a level that is considered clinically significant. Its persistence.
  51. Emotional health. Emotional well-being of the individual. Degree to which an individual is normal or has mental health concerns, issues, or problems related to emotions.
  52. Emotional problem. Mental health problem involving emotions. May or may not rise to the level of being a diagnosable mental disorder.
  53. Emotional well-being. Degree to which an individual is normal or has mental health concerns, issues, or problems related to emotions.
  54. Emotional wellness. Synonym for emotional well-being.
  55. Emotionally disturbed. Emotional disturbance. Emotionally disturbed person (EDP). Any disruptive, disturbing, or erratic behavioral issues that suggest a mental health issue. Commonly used in reference to special needs children, the homeless, and strangers on the street.
  56. Environmental stress. Any external event which causes mental tension in the mind of an individual. See stress.
  57. Episode. Period or duration of time in which symptoms of a mental disorder are being experienced in a particularly heightened form, including distress and impairment of function. Such as a psychotic episode.
  58. Essential features. The most significant or prominent diagnostic features (symptoms) of the diagnostic criteria for a mental disorder.
  59. Essential symptoms. Synonym for essential features, the more proper technical term.
  60. Etiology. The fancy term for cause or origin of a mental disorder or medical condition.
  61. Evaluation. Mental evaluation. Synonym for mental health assessment.
  62. Feature. Synonym for symptom. Short for diagnostic feature.
  63. Function. Mental functions such as memory, attention, focus, reasoning, patience, emotion, communication, learning, social, and motor skills.
  64. Functional consequences. Behavioral effects of a mental disorder. Effect on function.
  65. Functional recovery. Restoration of all or at least a significant fraction of function that was lost due to a mental disorder. Complete or partial reduction in impairment or disability.
  66. Gender-related diagnostic issues. Nuances of symptoms or evaluation of symptoms that vary between genders.
  67. Hospital. Large facility for medical care, including mental health care, generally for relatively short-term treatment, as opposed to long-term care in an institution. See also: residential care facility.
  68. Hospitalization. Admittance of an individual with a mental disorder to a facility for short-term treatment, where there is an expectation of release after some relatively short period of treatment, as opposed to institutionalization, where there is an expectation of long-term treatment.
  69. Hypomania. Less severe form of mania. Significantly elevated, but not extreme mood and activity.
  70. Impairment. Loss or lack of function.
  71. Indication. Indicated. Symptoms point towards a particular mental disorder. A diagnosis.
  72. Induced disorder. Mental disorder induced by a specific cause, including substance-induced, drug-induced, alcohol-induced, medication-induced, toxin-induced, or stress-induced. Many mental disorders are substance/medication-induced.
  73. Induced psychotic disorder. Mental disorder caused by an external substance, medication or other external cause, such as substance/medication-induced psychotic disorder.
  74. Insane. Insanity. Legal term for an individual who is not culpable for criminal actions, due to their inability to tell right from wrong. Informal, popular, vernacular term for mental illness. No meaning in the context of mental health professionals, other than simply to provide the courts with an accurate assessment and diagnosis of which specific mental disorders are indicated for the particular individual.
  75. Institution. Large facility for treatment and close supervision of individuals with severe mental disorders. See also: hospital, residential care facility.
  76. Institutional placement. Synonym for institutionalization.
  77. Institutionalization. Admittance of an individual with a mental disorder to a facility (institution) for long-term treatment and care, as opposed to hospitalization, where there is an expectation of release after some relatively short period of treatment. See also residential care.
  78. Intellectual developmental disorder. Intellectual disability. The more modern term for mental retardation.
  79. Leukotomy. Leucotomy. Proper term for lobotomy. Destroying nervous connections to the prefrontal cortex of the brain to relieve symptoms of psychosis. No longer popular or common due to modern antipsychotic medications, but still has some value in extreme cases.
  80. Lobotomy. Traditional term for leucotomy.
  81. Mad. Madness. Informal, popular, vernacular term for mental illness. No meaning in the context of mental health professionals.
  82. Major neurocognitive disorder. The current, proper, technical term for what was (and still is) commonly known as dementia.
  83. Management. Depending on context of usage, it may refer to all forms of treatment, but generally it excludes the forms of treatment that directly involve a mental health professional or medication, generally those actions that the individual and their family can perform themselves. Includes changes to environment and lifestyle to attempt to avoid situations that can trigger symptoms of a mental disorder.
  84. Mania. Manic. Extremely high energy state of mind or mood and activity, in contrast with depression. Excessive energy and overactivity. Excitement, euphoria, and possibly even delusions. More severe than hypomania.
  85. Medical condition. Disease, illness, injury, genetic or developmental condition, malnutrition, and any other form of disorder, pain or distress, or impairment of bodily function requiring the attention or treatment of a health professional. Depending on context, the term may or may not exclude mental or psychiatric disorders. In a broad sense, mental health is part of health in general, but in the context of mental health, the term is used generally exclusively to refer to health conditions other than mental health. Some non-mental medical conditions can cause or exacerbate some mental disorders, and some mental disorders can cause or exacerbate non-mental medical conditions.
  86. Medical disorder. Synonym for medical condition.
  87. Medication. Medicine or drug used to treat a medical condition or a mental disorder. Synonym for psychiatric drug.
  88. Medication-induced disorder. A mental disorder caused as a side effect of medication.
  89. Medication-induced symptom. A symptom of mental disorder is induced by medication. May or may not be sufficient to induce a clinically diagnosable disorder.
  90. Medication management. Assuring that the patient fully complies with prescribed medication. Including addressing resistance, complaints, and difficulties with compliance.
  91. Medication noncompliance. Refusal or inability to take required dose of medication at required intervals.
  92. Mental capacity. Legal term for the ability of an individual to make their own decisions, including understanding the consequences of the decision and communicating the decision.
  93. Mental defect. Legal term for a mental disorder that has a neurological basis, as opposed to being strictly mental or psychological, including mental retardation (intellectual disability), brain tumor, brain injury, a neurological disorder, or some non-mental medical condition.
  94. Mental defective. Legal term for an individual who has been legally determined to be a threat to themselves or others due to a mental disorder. See also mentally defective.
  95. Mental disorder. A clinically significant disturbance to mental health. The technical term for mental illness. All of the specific forms of mental illness have a specific disorder name. Includes developmental disorders and substance use disorders, even though the NIMH definition of any mental illness (AMI) excludes them.
  96. Mental dysfunction. My own term for the combination of mental illness, undiagnosed mental illness, developmental disorders, substance use disorders, and some of the shades of gray that commonly fall under normal but are not quite as desirable as one might like. Synonym for mental health problem.
  97. Mental effect. Impact of treatment on mental function. May restore function or negatively impact function.
  98. Mental function. Functions of the mind, including memory, attention, focus, reasoning, patience, emotion, communication, learning, social, and motor skills.
  99. Mental health. Psychological and emotional well-being of the individual. Degree to which an individual is normal or has mental health concerns, issues, problems. The full spectrum for all of society — the good, the great, the average, the bad, the really bad, the ugly, the horrific, and every shade of gray between. Includes mental illness, undiagnosed mental health problems, and all normal people. In context, and in contrast with mental illness, refers to an individual who is normal or has been returned to normalcy through treatment. In its more positive form, absent mental health problems, mental health can be referred to as normal mental health, or as per WHO, a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. See also: emotional health.
  100. Mental health assessment. Interview, observe, examine, and test an individual by a mental health professional to assess their mental and emotional state, to determine if there are symptoms that rise to the level of clinically significant distress or impairment that can be diagnosed as a mental disorder.
  101. Mental health care. Assessment and treatment of mental health problems by mental health professionals.
  102. Mental health concern. Ranging down from outright mental health problems to simple anxiety about daily life.
  103. Mental health condition. Possible euphemism for mental disorder to avoid stigma with mental illness. May also be synonym for mental health problem or mental health concern. May also be an undiagnosed mental health issue.
  104. Mental health diagnosis. Diagnosis for a mental disorder.
  105. Mental health disorder. Synonym for mental disorder. Or, a mental health problem that has not yet been evaluated, assessed, and diagnosed by a mental health professional.
  106. Mental health issue. In between mental health concerns and mental health problems, or suggesting a possible mental health problem that should be assessed by a mental health professional.
  107. Mental health problem. Anything about mental health that isn’t normal. Very informal term, but very useful. May be a mental health concern or issue, a diagnosed mental disorder, or an undiagnosed mental disorder.
  108. Mental illness. A clinically significant disturbance to mental health. Diagnosed mental disorder. Technically, Any Mental Illness (AMI) is defined as A mental, behavioral, or emotional disorder (excluding developmental and substance use disorders.)
  109. Mental infirmity. Legal term for mental disorder.
  110. Mental retardation. Outdated term for intellectual developmental disorder or intellectual disability.
  111. Mental state. Informally, everything that’s going on in your head, including perception, memory, thought, attitudes, intentions, feelings, and emotions.
  112. Mental well-being. Synonym for mental wellness and mental health. See also emotional well-being.
  113. Mental wellness. Synonym for mental health. Or in a strictly positive form, normal mental health.
  114. Mentally defective. See mental defective.
  115. Mentally disturbed. Synonym for mentally ill.
  116. Mentally healthy. An individual has normal mental health.
  117. Mentally ill. Popular but loose vernacular term for mental illness, even without any clinical diagnosis of a specific mental disorder, due primarily to casual observation by a layperson of aberrant or unusual behavior or speech. Sometimes used simply to disparage others due to a conflict in social values. Synonym for having a mental illness or having been diagnosed as having a mental disorder.
  118. Mood. General mental state or attitude in the short-term, in contrast with longer-term personality. May be positive, negative, or neutral. Extremes of mania and depression. Popularly, happiness and sadness.
  119. Mood disorder. Any mental disorder related to mood, mood swings, and feelings. Synonym for affective disorder.
  120. Mood swing. Oscillation between very positive and very negative mood, between mania and depression.
  121. Neurocognitive Disorder (NCD). Mental disorder involving any of the five cognitive domains: complex attention (focus), executive function, learning and memory, language, perceptual-motor, or social cognition.
  122. Neurodevelopmental disorder. Mental retardation (intellectual disability), language and learning skill difficulties, communication difficulties, childhood autism, attention deficit/hyperactivity, and motor skills.
  123. Neuroleptic agent. Medication used to treat psychosis. Also known as antipsychotics.
  124. Neurological condition. Synonym for neurological disorder.
  125. Neurological disorder. Medical condition related to brain or nervous system, exclusive of psychiatric or mental disorders.
  126. Neurology. Neurologist. Branch of medicine focused on the brain and nervous system. Focus is on physiology, the biology of the brain, rather than the psychological or mental state of the brain.
  127. Neurosis. Neuroses. Neurotic. Technically, these terms are no longer used to refer to anxiety disorders.
  128. Neurosurgery. Surgery on the brain or nervous system, either to address a neurological disorder or a mental or psychiatric disorder. The latter is referred to as neurosurgery for mental disorder (NMD) or psychosurgery.
  129. Neurosurgery for mental disorder (NMD). Neurosurgery to relieve symptoms of mental disorder, either by destroying tissue (ablative surgery), such as a lobotomy or leucotomy, or implanting an electrical stimulus device, such as Deep Brain Stimulation (DBS.) Synonym is psychosurgery.
  130. Norm. Synonym for normative.
  131. Normal. The range of behavior, thoughts, and feelings that are considered acceptable and preferable for the vast majority of average individuals. Absence of mental health problems. Absence of or minimal and infrequent mental health concerns.
  132. Normal mental health. The positive aspects of mental health, fitting the WHO definition of mental health: a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.
  133. Normative. Common, usual, typical, standard, socially or clinically permissible, or expected, in contrast to uncommon, unusual, atypical, or socially or clinically unacceptable.
  134. Onset. The point in time when the essential symptoms of a mental disorder become apparent and clinically significant. May be either sudden onset without any warning or preceded by one or more prodromal symptoms which warn of the developing disorder. Can be applied to the full course of a mental disorder or to a single episode.
  135. Persistent. A symptom remains present for some extended period of time. Varies between disorders and symptoms, from hours to days to months to years. For a particular disorder the diagnostic criteria may require that a symptom be persistent for some minimum duration.
  136. Personality. Relatively consistent patterns over time and different situations of perceiving, relating to, thinking about, deciding, and behaving with regard to oneself and the external world, as opposed to short-term changes in mood. Cognitive impairment can impact personality.
  137. Personality disorder. Mental disorder which disrupts normal personality function or causes an unexpected or undesired change from baseline personality.
  138. Personality trait. Specific, prominent aspect of personality.
  139. Primary disorder. Primary mental disorder. Underlying primary mental disorders. When more than one mental disorder is present, one or more may be regarded as the primary disorder(s), with any remaining disorders possibly induced or exacerbated by the primary disorder(s).
  140. Prodrome. An early or warning sign or symptom that indicates that a disorder may be developing, in contrast with sudden onset, where the disorder symptoms appear without any warning signs.
  141. Prodromal condition. Symptom which may appear during the prodromal period of a mental disorder, but not necessarily be a symptom of the mental disorder itself.
  142. Prodromal expression. Appearance of prodromal symptoms for a mental disorder.
  143. Prodromal period. Period of time before onset of a mental disorder when prodromal symptoms are likely to manifest themselves to warn of the impending disorder.
  144. Prodromal phase. Synonym for prodromal period.
  145. Prodromal stage. Synonym for prodromal period.
  146. Prodromal state. Synonym for prodromal period.
  147. Prodromal symptom. Synonym for prodrome. Symptom occurring during the prodromal period.
  148. Provisional diagnosis. Preliminary diagnosis for a mental disorder to which the clinician is not yet fully committed, pending additional information.
  149. Psychiatric disorder. Synonym for mental disorder. In contrast with a neurological disorder or other medical condition.
  150. Psychiatric drug. Medication used to treat a mental disorder.
  151. Psychiatrist. Medical doctor (MD) specializing in mental disorder. Unlike a psychologist, a psychiatrist can prescribe medication.
  152. Psychoanalysis. Psychoanalytical approach. See psychodynamics.
  153. Psychodynamics. Psychodynamic psychology. Systematic study of the psychological forces of the mind, particularly the identification and study of past events in the life of the individual and the unconscious operation of the mind. Most commonly associated with Freud and psychoanalysis.
  154. Psychologist. Mental health professional with a graduate degree who evaluates and studies behavior and mental processes, including mental disorder, using psychotherapy and psychological testing. Unlike a psychiatrist, a psychologist cannot prescribe medication.
  155. Psychopathy. General, loose reference to personality disorder or antisocial behavior. Generally treated as a synonym for sociopathy. More proper clinical term is antisocial personality disorder (ASPD) or dissocial personality disorder (DPD). Sometimes a general reference to mental disorder.
  156. Psychosis. Psychoses. Psychotic. The really hard core forms of mental illness (mental disorder), including schizophrenia and bipolar disorder. Experiencing psychotic symptoms such as delusions, hallucinations, hearing voices, depression, and general loss of touch with reality.
  157. Psychosocial well-being. Combination and integration of mental well-being and social well-being.
  158. Psychosurgery. Synonym for neurosurgery for mental disorder (NMD.)
  159. Psychotherapy. See psychodynamics.
  160. Psychotic break. Popular, vernacular term for a psychotic episode. Term is not used by either the DSM or ICD. More proper term is sudden onset, if this is the initial episode of the mental disorder, or possibly, more loosely, for any episode.
  161. Psychotic episode. Period or duration of time or incident during which the symptoms of a psychotic mental disorder are heightened and especially experienced. The individual is especially separated from reality. Popularly, may be referred to as a psychotic break, although that term is not used in the DSM or ICD.
  162. Psychotic feature. Symptom of psychosis, such as delusion, hallucination, hearing voices, or disorganized thinking.
  163. Psychotic mental disorder. Any mental disorder of which a psychotic symptom (psychotic feature) is an essential symptom.
  164. Psychotic symptom. Synonym for psychotic feature, the more proper technical term.
  165. Qualified mental health professional. That a mental health professional is legally and professionally qualified for the job, but also that their particular skills, skill levels, and experience are relevant to the particular individual being assessed and treated.
  166. Racing thoughts. Rapid and uncontrollable jumping around between thoughts and memories, some random and some connected. Interferes with normal, organized thinking, and may prevent sleep.
  167. Rapid onset. Synonym for sudden onset.
  168. Relapse. Recurrence of symptoms of a mental disorder, from a state of remission. Causes can be failure to take medication properly, failure to continue talk therapy, re-exposure to environmental conditions which induced original symptoms, continued substance use or re-exposure to chemical agents, or failure to fully engage in required management.
  169. Relative normalcy. A mental disorder is still present, but is being treated and managed so that the individual can lead a relatively normal home, work, and social life. See also relapse.
  170. Remission. Cessation of the symptoms of a mental disorder or medical condition. Not cured per se, but simply absence of symptoms that can be observed or experienced.
  171. Residential care. Treatment for mental disorder in a home-like facility (residential facility) under close supervision of mental health professionals.
  172. Residential care facility. Home-like facility providing residential care for medical disorder.
  173. Residential facility. Synonym for residential care facility.
  174. Residential setting. Synonym for residential facility, residential care facility.
  175. Residential treatment. Treatment for mental disorder provided in a residential facility.
  176. Resilience. The defense mechanisms that give an individual the ability to respond in a healthy manner to environmental stress, challenges, and trauma, in contrast to decompensation where the ability to respond is impaired. Synonym for compensated.
  177. Sane. Sanity. Legal term for an individual who is culpable for criminal actions, owing to their ability to tell right from wrong. Informal, popular, vernacular term for being mentally healthy. No meaning in the context of mental health professionals, other than simply to provide the courts with an accurate assessment and diagnosis of which specific mental disorders are indicated for the particular individual.
  178. Side effect. Medical condition, symptom, behavioral or mental effect, or mental disorder caused as an unintended result of a treatment, such as medication.
  179. Serious Mental Illness (SMI). As per NIMH, a mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities.
  180. Social well-being. Emotional well-being with regard to wider social experience, including relationships, community, and culture.
  181. Sociopathy. General, loose reference to personality disorder or antisocial behavior. Generally treated as a synonym for psychopathy. More proper clinical term is antisocial personality disorder (ASPD) or dissocial personality disorder (DPD). Sometimes a general reference to mental disorder.
  182. Stress. Mental tension caused by external events that requires extra attention to cope with a situation. Pressure on mood. A moderate amount of stress is normative for daily life. Inability to cope with the stress of daily life would be a symptom for a mental disorder.
  183. Stress-induced. A symptom or mental disorder which is caused or triggered by environmental stress.
  184. Stressor. Environmental condition or event which causes stress in an individual. May not necessarily be traumatic per se. May simply be perceived as stressful or a reminder of past trauma.
  185. Substance abuse. No longer the proper, technical term — the technically proper term is Substance Use Disorder (SUD), but we all know what we mean.
  186. Substance/medication-induced disorder. A mental disorder caused by medication or substance use, including alcohol and drugs.
  187. Substance use. Use of drugs or alcohol. Or misuse of medication.
  188. Substance Use Disorder (SUD). Recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. But… the National Institute of Mental Health doesn’t classify a substance use disorder as a mental illness per se, although it may co-occur with a more specific mental illness, and frequently does.
  189. Sudden onset. Symptoms of a mental disorder appear without warning, without any prodromal symptoms, in contrast with onset preceded by a prodromal phase. Synonym is rapid onset. More proper term for what is popularly known as a psychotic break.
  190. Suicidal ideation. Suicidal thoughts, commonly due to a mental disorder, such as depression or other mood disorders, but also due to traumatic or difficult life events.
  191. Suicidal thoughts. Synonym for suicidal ideation, the more proper term.
  192. Suicide risk. Degree of possibility that a life event or mental disorder will lead to suicidal thoughts or actual suicide.
  193. Supervised residential setting. Emphasizing the close supervision by mental health professionals in a residential care facility.
  194. Symptom. A sign or physical or mental condition or feature that may have significance when diagnosing a medical condition or mental disorder.
  195. Syndrome. A collection of symptoms which collectively indicate a medical condition or mental disorder. Sometimes casually used to refer to a medical condition or mental disorder. Occasionally used in the name of a medical condition or mental disorder.
  196. Talk therapy. Treatment for a mental disorder which is primarily verbal, including professional talk therapy (psychotherapy or psychoanalysis), professional group therapy, professional counseling, peer support, or support groups.
  197. Therapy. Any treatment for a medical condition or mental disorder. Generally, as applied to mental disorders therapy refers primarily to talk therapy, such as psychotherapy, group therapy, or counseling, but may also refer to treatment in general for mental disorder, possibly excluding management that does not involve a mental health professional. Also refers to music therapy, art therapy, drama therapy, and family therapy. Also, Electroconvulsive therapy (ECT) and Cognitive behavioral therapy (CBT).
  198. Transient fear or anxiety. Normal mental and emotional responses to external events, in contrast with persistent anxiety which could be associated with an anxiety disorder.
  199. Treatable. Amenable to treatment. Expectation that treatment will successfully moderate the symptoms of a mental disorder, relieving distress and restoring function.
  200. Treatment. Attempt to moderate the negative effects of distress and impairment of a mental disorder or a medical condition. May include talk therapy, medication, brain stimulation, etc. Depending on context of usage, may exclude management.
  201. Treatment-emergent suicidal ideation. Treatment-emergent suicidality. Suicidal thoughts (suicidal ideation) caused as a side effect of treatment, such as medication.
  202. Underlying primary mental disorders. Primary disorder. When more than one mental disorder is present, one or more may be regarded as the primary disorder(s), with any remaining disorders possibly induced or exacerbated by the primary disorder(s).
  203. Undiagnosed mental disorder. An individual may be suffering from a mental disorder which has not yet been diagnosed formally by a mental health professional, either because a mental health professional has not been consulted or because the diagnostic process is incomplete or inconclusive. The individual and others may or may not be aware that they have mental health problems.
  204. Undiagnosed mental health issue. May be an undiagnosed mental disorder or simply a mental health concern which has not yet been fully and properly evaluated by a mental health professional.
  205. Undiagnosed mental illness. An individual may be suffering from a mental illness (mental disorder) which has not yet been diagnosed formally by a mental health professional. The individual and others may or may not be aware that they have mental health problems.
  206. Unspecified Neurocognitive Disorder. Mental disorder with symptoms of a neurocognitive disorder that causes clinically significant distress or impairment at home, work, or in social interactions but does not meet the full criteria for a specific neurocognitive disorder.

Official definition of mental disorder

The official definition of mental disorder from the Diagnostic and Statistical Manual of Mental Disorders — Fifth Edition — DSM-5 published by the American Psychiatric Association, the recognized authoritative source for information on mental illness, is:

A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.

As the DSM also notes:

no definition can capture all aspects of all disorders in the range contained in DSM-5

A simpler formulation adapted from from the DSM above:

A clinically significant disturbance to mental health.

Hopefully the definitions of terms in the preceding section should be sufficient to aid individuals who are not already mental health professionals in their efforts to understand the scope and overview of mental health and mental illness.

Another authoritative source is the International Classification of Diseases — ICD-10 — Chapter V — Mental and behavioural disorders, from the World Health Organization (WHO), which uses this definition for mental disorder:

The term “disorder” is used throughout the classification, so as to avoid even greater problems inherent in the use of terms such as “disease” and “illness”. “Disorder” is not an exact term, but it is used here to imply the existence of a clinically recognizable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions. Social deviance or conflict alone, without personal dysfunction, should not be included in mental disorder as defined here.

Or more simply put:

Distress and interference with personal functions.

Other definitions of mental illness and mental disorder

From World Health Organization website:

Mental disorders comprise a broad range of problems, with different symptoms. However, they are generally characterized by some combination of abnormal thoughts, emotions, behaviour and relationships with others.

From Wikipedia Mental Disorder article:

A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that may cause suffering or a poor ability to function in life.

From Mental Health America:

A mental illness is a disease that causes mild to severe disturbances in thought and/or behavior, resulting in an inability to cope with life’s ordinary demands and routines.

Types of mental disorder or mental illness

This paper will not delve into the many specific mental disorders, as defined by the DSM and ICD, but the general categories of mental disorder (mental illness) are provided here for convenient reference and completeness, although no claim is made that this list is fully comprehensive and exhaustive:

  1. Anxiety Disorders
  2. Attention Deficit Hyperactivity Disorder (ADHD, ADD)
  3. Autism Spectrum Disorders (ASD)
  4. Bipolar and Related Disorders (Manic-Depressive Illness)
  5. Depressive Disorders (Depression)
  6. Disruptive, Impulse-Control, and Conduct Disorders, including Disruptive Mood Dysregulation Disorder (DMDD)
  7. Dissociative Disorders
  8. Elimination Disorders
  9. Feeding and Eating Disorders
  10. Gender Dysphoria
  11. Medication-Induced Movement Disorders and Other Adverse Effects of Medication
  12. Mental retardation (Intellectual Developmental Disorder)
  13. Neurocognitive Disorders, including dementia and effects of Alzheimer’s disease
  14. Neurodevelopmental Disorders, including mental retardation (Intellectual Developmental Disorder), Communication Disorders, Autism Spectrum Disorders, Attention Deficit Hyperactivity Disorder (ADHD, ADD), Learning Disorders, and Motor Disorders
  15. Other conditions that may be a focus of clinical attention
  16. Other mental disorders — anything not covered by other categories
  17. Paraphilic Disorders
  18. Personality Disorders, including Borderline Personality Disorder and Obsessive-Compulsive Disorder (OCD)
  19. Post-Traumatic Stress Disorder (PTSD)
  20. Schizophrenia Spectrum and Other Psychotic Disorders
  21. Seasonal Affective Disorder
  22. Sexual Dysfunctions
  23. Sleep-Wake Disorders
  24. Somatic Symptom and Related Disorders
  25. Substance-Related and Addictive Disorders
  26. Trauma- and Stressor-Related Disorders

Types of symptoms or warning signs of mental disorder or mental illness

This paper will not delve into the many specific symptoms of particular mental disorders, but a wide range of symptoms are listed here in plain English for convenient reference and completeness, although no claim is made that this list is fully comprehensive and exhaustive.

Presence of a symptom on this list does not necessarily indicate that a mental disorder would be diagnosed, but simply that it could be a possible warning sign of a mental health problem. Presence of multiple symptoms, a particular combination of symptoms, intensity, and persistence may be required for a mental health professional to diagnose a true mental disorder.

  1. Increased or excessive anxiety, worry, fear, or restlessness, out of proportion to actual events. Distress. Mental pain.
  2. Overestimation of danger. Fear, anxiety, or avoidance out of proportion to the actual risk posed.
  3. Fear, anxiety, or avoidance of social situations.
  4. Panic attacks.
  5. Nervousness.
  6. Excessive fears.
  7. Specific phobias.
  8. Feeling overwhelmed.
  9. Excessive disappointment.
  10. Withdrawal and loss of interest in others, avoiding friends and social activities.
  11. Manic episodes, much higher energy than usual, hyperactivity.
  12. Overactivity.
  13. Underactivity.
  14. Depressed, depression, melancholy.
  15. Loss of touch with reality, difficulty perceiving or relating to reality. In the extreme, delusions, hearing voices, or hallucinations.
  16. Inability to perceive or relate to one’s own feelings, behavior, or personality.
  17. Increased or excessive forgetfulness.
  18. Persistent or significant irritability.
  19. Excessive anger.
  20. Angry outbursts, rage.
  21. Losing it on occasion.
  22. Excessive ranting.
  23. Overly critical.
  24. Overreaction.
  25. Fighting.
  26. Edginess.
  27. Agitation.
  28. Decline in functioning or difficulty performing familiar tasks.
  29. Confused or increased difficulty thinking, concentrating, memory, or difficulty expressing thoughts.
  30. Difficulty learning.
  31. Increased inattention.
  32. Great difficulty communicating — speech, hearing, vision.
  33. Disorganized speech.
  34. Unusual speech patterns.
  35. Slurred speech.
  36. Disorganized behavior.
  37. Very limited attention span.
  38. Very limited social skills, difficulty understanding or relating to other people.
  39. Increased difficulty reasoning as an adult.
  40. Heightened sensitivity or avoidance of stimulating situations.
  41. Increased apathy.
  42. Excessive indifference.
  43. Loss of interest in familiar activities.
  44. Feeling disconnected from the world and the familiar in particular.
  45. Unusual or unreasonable behavior.
  46. Irrational behavior.
  47. Sudden changes or difficulty with regular sleep.
  48. Dramatically reduced need for speech.
  49. Persistently and excessively feeling tired and low energy.
  50. Sudden changes in appetite or eating habits.
  51. Loss of appetite.
  52. Commonly overeating.
  53. Commonly undereating.
  54. Excessive focus on eating.
  55. Sudden changes in personal care.
  56. Sudden mood changes.
  57. Inability to regulate or cope with mood.
  58. Excessive sadness.
  59. Feelings of hopelessness.
  60. Extremes of highs and lows in feelings.
  61. Dramatic changes in sex drive.
  62. Excessive interest in sex.
  63. Excessive disinterest in sex.
  64. Sexual dysfunction without a clear medical cause.
  65. Chronic sexual harassment.
  66. Inappropriate substance use, alcohol or drugs, including prescribed medication.
  67. Excessive drinking.
  68. Physical ailments with no clear physical cause.
  69. Excessive complaints of illness or pain.
  70. Suicidal thoughts or attempts.
  71. Indifference to life.
  72. Excessive body image concern.
  73. Preoccupation with appearance.
  74. Sudden or dramatic changes in behavior at home, school, work, or in the community.
  75. Frequent disobedience or aggression.
  76. Frequent temper tantrums.
  77. Difficulty controlling impulses. Excessive impulsiveness.
  78. Disinhibition. Low inhibition. Sudden or significant change in inhibition.
  79. Excessive bereavement, grieving.
  80. Inability to cope with loss.
  81. Flashbacks.
  82. Avoidance of situations.
  83. Heightened reactivity.
  84. Excessive fear of germs.
  85. Excessive selfishness.
  86. Narcissistic behavior.
  87. Chronic attempts to draw attention to self.
  88. Chronically putting own interests ahead of others.
  89. Excessive need to arrange objects.
  90. Excessively repetitive actions. Unnecessary repetition, obsessively or compulsively.
  91. Increased inability to cope with relatively simple responsibilities and challenges in daily life.
  92. Excessive risk-taking.
  93. Excessively talkative.
  94. Excessively quiet.
  95. Excessive seeking of pleasure.
  96. Seeking pain.
  97. Irregular or unusual patterns of behavior.
  98. Intensity or oscillation or patterns of behavior.
  99. Sudden, unexplained, or persistent declines in work or school performance.
  100. Excessively negative thoughts and expression.
  101. Hair-pulling.
  102. Skin picking.
  103. Hoarding.
  104. Dissociation (multiple personalities.)
  105. Excessive avoidance.
  106. Paralysis. Paralyzed mentally, not physically.
  107. Excessive weakness.
  108. Excessive movement.
  109. Abnormal movement.
  110. Excessive or multiple vocal and motor tics.
  111. Memory loss.
  112. Cognitive deficits.
  113. Delays in cognitive development.
  114. Excessive or inappropriate rebellion or resistance to authority.
  115. Intrusion into the activity of others.
  116. Inability to stay seated or sit still. Significant or excessive fidgeting.
  117. Inability to wait. Excessive impatience.
  118. Inability or unwillingness to follow instructions.
  119. Inability or unwillingness to follow commands.
  120. Excessive carelessness and mistakes.
  121. Inability to pay close attention to detail.
  122. Excessive attention to detail.
  123. Difficulty waiting in line.
  124. Frequent interruption of others.
  125. Inability or difficulty awaiting one’s turn.
  126. Inappropriate emotional response for a situation.
  127. Repression of emotional response.
  128. Inability to manage time or other resources.
  129. Inability to respect others.
  130. Boundary problems.
  131. Cruelty.
  132. Cruelty to animals.
  133. Loneliness.
  134. Separation anxiety.
  135. Sadism.
  136. Masochism.
  137. Nonconsensual sex.
  138. Excessive pornography.
  139. Feelings of inferiority or worthlessness, low self-worth.
  140. Feelings of superiority or grandiosity.
  141. Difficulty integrating negative experiences into the self.
  142. Cutting, self-mutilation.
  143. Misogyny.
  144. Expressions of hatred.
  145. Common or frequent truancy.
  146. Difficulty adapting to new situations.
  147. Unrealistically high expectations.
  148. Excessively low expectations.
  149. Feelings of inadequacy.
  150. Neglect.
  151. Abuse.
  152. Excessive, maladaptive perfectionism.
  153. Harsh self-criticism.
  154. Psychosis.
  155. Feelings of persecution.
  156. Poor situational awareness.
  157. Fragile personality, weak sense of self, low self-esteem.
  158. Esteem issues.
  159. Fragile.
  160. Vulnerable.
  161. Mutism.
  162. Excessive dependence, clinging.
  163. Excessive independence, resistant to establishing close relationships or integrating with a team.
  164. Malingering.
  165. Delirium.
  166. Talking incoherently.
  167. Dark or morbid thoughts or fantasies.
  168. Limited or non-existent self-awareness.
  169. Lack of insight.
  170. Limited intuition.
  171. Excessively callous.
  172. Excessively unemotional, shallow emotion.
  173. Excessively manipulative.
  174. Excessively deceitful, chronic pattern of lying.
  175. Excessively egocentric.
  176. Excessively antisocial.
  177. Excessive antagonism.
  178. Excessively defensive.
  179. Excessive meanness, mean-spirited.
  180. Very uneven temperament.
  181. Low empathy.
  182. Inability to empathize.
  183. Significant emotional problems.
  184. Difficulty with rejection.
  185. Difficulty coping with the stresses and minor traumas of daily life.
  186. Excess secrecy.
  187. Hearing voices.
  188. Seeing hallucinations.
  189. Experiencing delusions.
  190. Racing thoughts.
  191. Rapid speech.
  192. Shoplifting.
  193. Vandalism.
  194. Frequent breaking of rules and general disdain for rules.
  195. Excessively organized.
  196. Excessively messy and disorganized.
  197. Notable oddities, quirks, and eccentricities.
  198. Drama queen.
  199. Overly shy.
  200. Overly introverted.
  201. Difficulty in school even when motivated.
  202. Excessively pushy.
  203. Excessively annoying.
  204. Needy.
  205. Codependence.
  206. Overconfidence.
  207. Underconfidence.
  208. Excessive interest in self-help.
  209. Excessive growing pains.
  210. Frequently upset.
  211. Domineering.
  212. Subservient.
  213. Weak or nonexistence of assertiveness.
  214. Excessively contentious.
  215. Prone to conflict.
  216. Frequently offended, easily offended.
  217. Frequently acting out.
  218. Excessive stress.
  219. Too-frequent trauma.
  220. Difficulty coping with trauma. Slow to bounce back.
  221. Particular trauma that was never fully recovered from.
  222. Frequent crying. Possibly with no clear reason.
  223. Voluntarily seeking professional mental health help.
  224. Calling a mental health hotline.
  225. Attempting to breach security, even with no apparent criminal motive.
  226. Excessive workaholic.
  227. Excessive work stress.
  228. Excessive relationship problems, unstable relationships.
  229. Excessive family problems.
  230. Excessive homelife problems.
  231. Domestic abuse.
  232. Frequent or excessive blues.
  233. Excessive moodiness, moody in general.
  234. Excessive or obsessive anxiety over social and political issues.
  235. Excessive use of social media.
  236. Excessive attachment to digital devices.
  237. Excessive hobbies.
  238. Trouble concentrating.
  239. Seasonal blues.
  240. Anxiety over morality, guilt, moral injury.
  241. Very weak moral values, very weak moral compass.
  242. Very low ethical standards.
  243. Excessively high ethical standards.
  244. Excessive need for affirmation, praise.
  245. Consistently or frequently poor judgment.
  246. Excessive struggling with daily life.
  247. Anguish.
  248. Terrified.
  249. Easily manipulated into acting against their own interests, vulnerable.
  250. Behavior frequently outside of social norms.
  251. Defiant.
  252. Short temper.
  253. Prone to temper flares.
  254. High strung.
  255. Need to be physically restrained.
  256. Difficulty making friends and maintaining friendships.
  257. Difficulty making decisions, indecisive.
  258. Difficulty comprehending consequences of decisions.
  259. Difficulty or inability to cope with uncertainty.
  260. Difficulty or inability to cope with ambiguity.
  261. Low or lack of self-motivation or drive.
  262. Excessive difficulty or inability to improvise or deal with the unexpected.
  263. Prone to yelling.
  264. Prone to being argumentative, quarrelsome.
  265. Inappropriate laughter.
  266. Frequently seems in a daze, lacking alertness.
  267. Excessive or chronic lateness.
  268. Excessive fear or worry of being late.
  269. Excessive effort to be early.
  270. Excessive anxiety over being on-time.
  271. Intimidation of others.
  272. Easily intimidated.
  273. Overly cautious.
  274. Overly cavalier.
  275. Unwilling or unable to take serious matters seriously.
  276. Overly controlled.
  277. Overly controlling.
  278. Excessive or chronic complaining.
  279. Low morale.
  280. Stalking.
  281. Cryptic language.
  282. Overly guarded and unwilling to share personal stories.
  283. Too easily embarrassed.
  284. Excessive or persistent shame.
  285. Arrested development.
  286. Difficulty saying no.
  287. Chronically overcommitting.
  288. Difficulty forgiving others.
  289. Difficulty forgiving self.
  290. Difficulty letting things go.
  291. Chronically carrying grudges.
  292. Chronically acrimonious.
  293. Chronically making and then breaking promises.
  294. Chronically overpromising.
  295. Chronic jealousy.
  296. Chronic and excessive lust.
  297. Chronic identity issues.
  298. Gambling.
  299. Excessive gaming. Video games.
  300. Excessive trust issues. Chronically or excessively distrustful of others.
  301. Impostor syndrome.
  302. Excessive need for mental self-care.
  303. Frequent binge shopping.
  304. Amnesia.
  305. Numbness.
  306. Memory gaps.
  307. Feeling that you’re at the end of your rope. Feeling that you can’t take it anymore.
  308. Feelings of desperation.
  309. Obesity.
  310. Poor life choices. Poor judgment.
  311. Postpartum depression.

The mere presence of a symptom or collection of symptoms will not necessarily automatically indicate a mental disorder. Their level of intensity, persistence, frequency, and even number of symptoms may be needed for a diagnosis of a mental disorder, but only a mental health professional can make such a determination.

At best, symptoms are warning signs for individuals who are not mental health professionals.

Symptoms may sometimes be masked by compensatory mechanisms or mental defensive mechanisms.

Where there’s smoke (maybe) there’s fire

Again, any given symptom or even a bunch of symptoms is not a guarantee of a significant mental disorder, but symptoms can definitely be warning signs that maybe there is some clinically significant mental disorder in effect.

This is the traditional metaphor of where there’s smoke there’s fire. Not always, but commonly enough to make it worth consulting with a qualified mental health professional when smoke (symptoms) appear and persist.

Disturbing or troubling behavior

From a layperson’s perspective, specific symptoms are less the issue than whether an individual’s behavior is disturbing or troubling in some way, any way.

Put simply, does it feel like something is off or wrong.

It may be a normal reaction to the normal challenges and minor traumas of normal life in the modern world and completely resolve itself, but if the disturbing or troubling behavior persists or intensifies, then the right course of action is to bring the matter to the attention of a qualified mental health professional.

Challenges and minor traumas of normal life

We live in a complex and challenging world, so it is no surprise that a wide variety of challenges and relatively minor traumas confront us in our daily lives. That’s normal for life in the modern world.

And such challenges and minor traumas can evoke mental, emotional, and behavioral responses which can certainly seem alarming when viewed in isolation, and can certainly seem like legitimate symptoms of mental health issues.

Those reactions may have the necessary intensity or persist or intensify to warrant the attention of a qualified mental health professional.

Or, the apparent symptoms may simply resolve themselves quickly enough.

In short, negative but relatively minor reactions to the challenges and minor traumas of normal life in the modern world are no reason for alarm.

The catch is recognizing and distinguishing such minor reactions from more severe reactions requiring attention of a mental health professional.

When in doubt, ask

Again, appearance of a possible symptom of a mental health problem is no guarantee of a mental disorder requiring treatment and can raise a false alarm, but ignoring or denying mental health concerns can be quite problematic as well, even fatal.

In any case, it never hurts to err on the side of caution. When in doubt, ask.

After all, no mental health professional ever minds informing you that everything is fine, there’s nothing to be concerned with, there’s nothing to worry about, this is well within the wide range of normal, healthy response.

Counseling

The normal challenges and normal traumas of normal life in the modern world can indeed sometimes be a little too much to bear for even a lot of normal people. Some manner of counseling may be appropriate in such situations. That’s all part of maintaining good mental health.

But a modest or even moderate level of counseling should not be as considered mental illness per se, especially if the concerns that prompted counseling can be promptly addressed and the individual can quickly move on with their life.

Diagnosis of mental disorders

Diagnosis of mental disorders based on symptoms is beyond the scope of this paper — and should be left to qualified mental health professionals.

Levels of mental health

  1. Normal.
  2. Normalcy. Mental health problems which are being treated and managed, allowing the individual to return to something resembling a normal daily life.
  3. Coping. Dealing with issues, hanging in there, but short of normal and normalcy.
  4. Mental health concern. Something raising concern, may or may not be a real or significant problem.
  5. Mental health issue. Worry that issue needs treatment.
  6. Mental health problem. Something that indicates that a consultation with a mental health professional is needed.
  7. Mental disorder. Evaluation, assessment, and diagnosis by a mental health professional.
  8. Any mental illness (AMI). Anything requiring treatment by a mental health professional.
  9. Severe mental illness (SMI). A more dramatic mental health problem, requiring aggressive treatment.
  10. Suicide. Death. Evaluation, assessment, diagnosis, and/or treatment failed.

Role of mental illness in various social ills

Mental illness can cause, exacerbate, or otherwise play a role in many social ills, including:

  1. Employment problems — job loss, difficulty getting a job, lower productivity, limited promotability.
  2. Inability to cope with trauma and significant challenges.
  3. Relationship problems.
  4. Interpersonal conflict and aggression.
  5. Marriage problems.
  6. Domestic abuse.
  7. Obesity.
  8. Poor life choices. Poor judgment.
  9. Postpartum depression.
  10. Substance abuse.
  11. Crime.
  12. Suicide.
  13. Terrorism.

Causes of mental illness

There are three broad categories of causes of mental illness, or factors influencing mental illness:

  1. Biological factors.
  2. Life experience and environmental factors.
  3. Psychological and individual factors, including resilience.

Biological factors include:

  1. Genetics.
  2. Prenatal damage.
  3. Infection, disease and toxins.
  4. Injury and brain defects.
  5. Chemical imbalances.
  6. Substance abuse.

Difficulty of determining cause

Etiology is the technical term for determining the cause or origin of a disorder.

One would imagine that by now, with all of the collective experience with so many instances of mental illness, it would be a slam dunk to determine the cause or origin of just about every disorder imaginable, but that is not the case.

In fact, there are only a relative few situations when cause can be firmly established, namely when the disorder is induced by some external event.

Causes for induced mental illness

The types of causes for induced mental disorders include:

  1. Physical trauma. Accident. Injury. Assault.
  2. Non-mental medical condition.
  3. Disease.
  4. Brain tumor.
  5. Brain surgery.
  6. Effect of substance use disorder.
  7. Trauma causing PTSD.
  8. Toxins.
  9. Drugs.
  10. Medication.
  11. Stress.
  12. Abuse. Physical, sexual, emotional.

Even then, the precise etiology (cause) may not be completely determinate. There may be more than one cause as well.

Distinction between psychiatric and neurological disorders

The term psychiatric disorder is simply a synonym for mental disorder.

Although the term neurological disorder would superficially seem to cover anything that is wrong with the brain and nervous system, that is true in a physical sense, but stops short of any mental or conscious disorder.

Psychiatric disorder is concerned primarily with mental or conscious distress or impairment.

Generally, there is the body/mind distinction — neurology is concerned with the body (including the brain), while psychiatry and psychology are concerned primarily with the mind, the mental.

Types of mental health professionals

Mental health issues should be evaluated, assessed, diagnosed, and treated only by qualified mental health professionals, which include:

  • Psychiatrists
  • Psychiatric or mental health nurse practitioners
  • Psychologists
  • Counselors, clinicians, therapists
  • Clinical social workers
  • Primary care physicians — to make referrals
  • Family nurse practitioners — to make referrals
  • Certified peer specialists
  • Social workers — to make referrals
  • Pastoral counselors

Education, training, credentials, certification, and licensing are required.

Qualified mental health professional

A mental health professional should of course be legally and professionally qualified for the job, with the necessary education, training, credentials, certification, and licensing for the task at hand.

Just as important is that their particular skills, skill levels, and experience must be a solid fit for the particular mental health issues for which a particular individual is being assessed and treated.

Assessment and treatment of a particular individual may encompass the services of more than one mental health professional, each qualified in their own way for particular aspects of assessment and treatment.

Some issues or questions to consider:

  1. Is counseling advised?
  2. Is counseling sufficient?
  3. Is specialized counseling required?
  4. Is psychotherapy sufficient?
  5. Is medication required?
  6. How severe is the disorder?

Neurological disorders — not considered mental or psychiatric disorders or mental illness

Neurological disorders are non-mental medical conditions affecting the brain and nervous system.

Generally, they would be treated by a neurologist, not a mental health professional.

Neurological disorders can and frequently do impact mental health or even cause mental disorders, but are not themselves mental disorders.

Neurological disorders are not considered mental illness.

Mental disorders caused by an underlying neurological disorder that cannot itself be treated will require treatment of the resultant mental disorders by mental health professionals.

Examples include:

  1. Trauma to the brain — head injuries.
  2. Brain tumors — cancer or other neoplasms (unexpected tissue growth.)
  3. Epilepsy.
  4. Cerebral palsy.
  5. Multiple sclerosis.
  6. Parkinson’s disease.
  7. Alzheimer’s Disease (AD). The resulting dementia is itself a mental disorder.
  8. Stroke.
  9. Cerebrovascular disease — diminished blood flow in the brain, which can result in stroke.
  10. Fainting, syncope.
  11. Delirium.
  12. Intoxication.
  13. Headaches.
  14. Sleep deprivation.
  15. Drowsiness.
  16. Huntington’s disease.
  17. Encephalitis.

Level of intensity or severity

Intensity and severity can be used as synonyms, but intensity may be more appropriate to quantify degree of distress, while severity might be more appropriate to quantify degree of impairment or loss of function.

  1. Unnoticeable.
  2. Very mild.
  3. Mild.
  4. Moderate.
  5. Moderately severe.
  6. Severe.
  7. Extreme or profound.
  8. Completely disabling.

Formal diagnosis by a mental health professional may only distinguish mild, moderate, and severe, and sometimes moderate-severe, profound, or extreme.

Forms of distress

  1. Anxiety. Mental pain.
  2. Depression.
  3. Guilt.
  4. Shame.
  5. Mood. sadness.
  6. Attitude.
  7. Paranoia.
  8. Isolation.

Levels of distress

Intensity or severity can be used to quantify distress, but it may be more appropriate to characterize the degree of loss of function caused due strictly to distress. See the next section.

Alternatively, degree of distress may be a reaction to impairment or loss of function.

  1. No distress accompanying impairment of function.
  2. Very mild anxiety.
  3. Mild anxiety.
  4. Moderate anxiety.
  5. Moderately severe anxiety.
  6. Severe anxiety.
  7. Extreme anxiety.
  8. Completely disabling anxiety.

Forms of function

Function covers the full range of activities needed to accomplish the tasks of daily life, home, work, and social interactions, and to respond to challenges and traumatic events as well. This includes:

  • Rational thought, clear thinking, and organized thought processes.
  • Good judgment.
  • Clear and effective communication. Language skills.
  • Effective perception.
  • Reasonable expression of emotions and feelings.
  • Coping with the stress and minor traumas of daily life.
  • Resilience in the face of major challenges and traumas.
  • Memory.
  • Positive attitude and outlook on life.
  • Social skills. Effective and satisfying social interactions.
  • Form and maintain satisfying relationships.
  • Accomplish tasks at home, work, and in the community.

The usage for function in this paper is simply the ability to accomplish the tasks of daily life, home, work, and social interactions, and to respond to the level of challenges and traumatic events that an average person can expect to encounter over their lifetime.

Forms of attitude and outlook on life

A positive attitude and outlook on life is essential to live a happy and productive life. Attitude and outlook can be categorized as:

  1. In general.
  2. Towards the future.
  3. Towards others.
  4. To self — self-esteem.

Levels of function

  1. Fully functional. Totally normal.
  2. Slight dysfunction. Very slight but not necessarily noticeable impact on function, work, and relationships. Modest anxiety. Including coping with stress and challenges in daily life.
  3. Modest dysfunction. Modest and noticeable impact on function, work, and relationships. Moderate anxiety. Including coping with significant stress and challenges.
  4. Moderate dysfunction. Moderate impact on function, work, and relationships. Dramatic anxiety. Coping with trauma.
  5. Moderately severe dysfunction. Moderately severe impact on function, work, and relationships. Any mental illness. Coping with severe trauma for a normal person.
  6. Severe dysfunction. Severe impact on function, unable to work effectively, unable to have normal relationships. Severe mental illness.
  7. Minimal function. But not causing harm to self or others. Severe mental illness. But still manageable by non-professionals, such as in a home environment. Some risk of conflict with law enforcement and possible incarceration. Alternatively, significantly withdrawn from interaction with others.
  8. Negligible function. Possibly some risk of causing harm to self or others. Barely manageable by non-professionals. Unable to live without constant assistance from others. Risk of conflict with law enforcement, possible incarceration. Alternatively, almost or completely withdrawn from interaction with others, isolated.
  9. Non-function. Significant risk of causing harm to self and others. Not manageable by non-professionals. Great risk of conflict with law enforcement, and likely incarceration. Alternatively, completely withdrawn from interaction with others, totally isolated.
  10. Have caused harm to self or others. Requires institutionalization, physical, or chemical restraint. Likely to commit criminal act, be charged, and incarcerated.

This hierarchy does not include mental retardation (intellectual developmental disorder), for which the standard, clinical levels are mild, moderate, severe, and profound.

Forms of behavior which may be impaired

Forms of behavior that may be impaired by a mental disorder:

  1. Movement — willingness and ability to move around.
  2. Action — perform tasks and manipulate things.
  3. Communication — speech and gestures.
  4. Restraint — could or should move around, act, or communicate but don’t.
  5. Planning and decisions — as precursor to behavior.

Degree of cure

Generally speaking, mental illness does not have a cure, such that once cured, the illness is gone forever. Instead, mental health professionals speak of treatment and management, or possibly remission.

That said, some forms of mental illness can be cured in a narrow sense, depending on the nature of the illness, the severity, and the resilience of the individual. Includes trauma and substance induced disorders. But even here, the disorders can be very resistant to cure.

For purposes of comparison and discussion, the degrees or levels of cure are:

  1. No effective treatment.
  2. Institutionalization and heavy medication. Possible psychosurgery.
  3. Treatment. Medication. Talk therapy.
  4. Management. Under supervision of a mental health professional.
  5. Coping. Self-management. Some modest to moderate degree of professional supervision. May only partially resolve distress and impairment.
  6. Remission. May or may not have relapses at irregular intervals. Relapses not uncommon, especially under stress.
  7. Near cure. Normalcy. Close to normal. Light management. Light medication.
  8. Total cure. Rare. Not so likely.

Forms of defensive mechanisms

Defensive mechanisms are the mind’s most immediate response to stress and challenges. The mind is seeking to protect itself. Some of these defenses can be helpful and healthy, while others can be harmful and either cause or exacerbate mental disorders.

This paper won’t delve deeply into defensive mechanisms, but just highlight a few.

Mature, positive, helpful, and healthy defensive mechanisms include:

  1. Humor.
  2. Integration.
  3. Sublimation.
  4. Analysis.
  5. Discount. Assuming some degree of evaluation of consequences has been performed.
  6. Ignore. Assuming consequences are not significant.
  7. Altruism.
  8. Anticipation.

Less than helpful, unhealthy defenses include:

  1. Denial.
  2. Repression.
  3. Acting out.
  4. Fantasy.
  5. Withdrawal.
  6. Isolation.
  7. Passive aggression.
  8. Reaction and obsession over the stressor.

Layers of defensive mechanisms can make it difficult to ferret out causes or triggering events, and exacerbate distress and even impairment and loss of function.

Forms of coping

Coping with distress and impairment are independent, although coping with one can facilitate coping with the other.

The goal is to minimize distress and maximize function (minimize impairment.)

  1. Denial.
  2. Repression.
  3. Ignore, hope it goes away.
  4. Isolation from triggers and problematic situations, interactions, and relationships.
  5. Bury oneself in one’s work.
  6. Focus intensely on hobbies.
  7. Exercise, overexercise.
  8. Self-help. Reading. Research.
  9. Peer support.
  10. Support groups.

Levels of coping

Coping may be with or without treatment or management.

  1. Fully coping — with minimal effort or distress.
  2. Fully coping — with only modest effort and distress.
  3. Mostly coping.
  4. Moderately coping.
  5. Modestly coping.
  6. Only slightly coping.
  7. Only able to copy sometimes.
  8. Unable to cope at all.

Levels of capacity for coping with trauma

  1. Quickly recover. But possibly too quickly?
  2. Prompt recovery.
  3. Fairly rapid recovery.
  4. Gradual recovery.
  5. Very slow recovery.
  6. Very extended recovery.
  7. Downward spiral, no recovery.

Is treatment needed?

As per DSM-5:

the diagnosis of a mental disorder is not equivalent to a need for treatment. Need for treatment is a complex clinical decision that takes into consideration symptom severity, symptom salience (e.g., the presence of suicidal ideation), the patient’s distress (mental pain) associated with the symptom(s), disability related to the patient’s symptoms, risks and benefits of available treatments, and other factors (e.g., psychiatric symptoms complicating other illness). Clinicians may thus encounter individuals whose symptoms do not meet full criteria for a mental disorder but who demonstrate a clear need for treatment or care.

In short, even without an actual, clinically significant diagnosis of a mental disorder, treatment may still be warranted, at the discretionary judgment of the clinician (doctor.) And some disorders may not require treatment by the clinician.

Forms of treatment

  1. Self-help. Reading.
  2. Peer support.
  3. Support groups.
  4. Professional talk therapy — psychotherapy, psychoanalysis.
  5. Professional group therapy.
  6. Medication.
  7. Hospitalization.
  8. Institutionalization.
  9. Cognitive behavioral therapy (CBT).
  10. Brain stimulation therapies. Includes, electroshock therapy — Electroconvulsive therapy (ECT), but much more humane and modern than the 1950’s.
  11. Brain implant surgery. Deep Brain Stimulation (DBS).
  12. Neurosurgery. Psychosurgery. To destroy tissue. Again, more humane and modern than in the 1950’s.

Forms of talk therapy

  1. Professional talk therapy — psychotherapy, psychoanalysis, counseling.
  2. Professional group therapy.
  3. Cognitive behavioral therapy (CBT).
  4. Peer support.
  5. Support groups.

Forms of management

Distinct from treatment directly by a mental health professional, but can be considered as part of treatment in a larger sense.

  1. Maintain and build support systems.
  2. Monitor symptoms.
  3. Maintain healthy habits — nutrition, exercise, sleep, rest.
  4. Avoid drugs and alcohol.
  5. Reduce stress, stress management.
  6. Anger management.
  7. Peer support.
  8. Support groups.
  9. Support networks.
  10. Counseling.
  11. Lifestyle changes.
  12. Avoid crowds and noisy environments.
  13. Recognize triggers and avoid them.
  14. Time management, prioritize.
  15. Schedule downtime, outlets.
  16. Timeouts.
  17. Self-management.
  18. Social skills training.
  19. Coping skills training.
  20. Close supervision.

Levels of treatment

  1. Self-help. Reading, support groups.
  2. Counseling.
  3. Talk therapy.
  4. Light medication.
  5. Modest medication.
  6. Moderate medication.
  7. Extreme medication.
  8. Occasional hospitalization.
  9. Extended institutionalization.
  10. Group homes.
  11. Surgery.
  12. Permanent institutionalization.
  13. Chemical restraint.
  14. Physical restraint.

Extreme treatment

These are forms of treatment which are so severe or extreme as to cause alarm that they may be required.

The current need for these forms of treatment strongly suggests a need for research to find new forms of treatment to obviate the need for these extreme forms of treatment.

  1. Permanent institutionalization.
  2. Level of medication which renders the individual incapable of work or normal social interaction.
  3. Neurosurgery which reduces normal function.
  4. Cost is a severe burden on the family of the individual.
  5. The individual is no longer capable of interacting with family and friends in even a halfway reasonable manner.

Unacceptable forms of treatment

These are past forms of treatment have too frequently been characterized as barbaric or inhumane or exploitative.

  1. Euthanasia.
  2. Sterilization.
  3. Excessive or extreme neurosurgery.
  4. Careless, cavalier, or masochistic physical restraint or treatment.
  5. Enables or abets sexual abuse.
  6. Causes significant physical pain.
  7. Causes significant mental anguish.
  8. Neglect.
  9. Profit from ineffective treatment.
  10. Excessive profit from treatment, even if effective.
  11. Lack of treatment or mistreatment for criminal incarceration of the mentally ill. Including lack of proper screening, assessment, and diagnosis.
  12. Self-medication.

Forms of self-medication

Self-medication is also an unacceptable form of treatment. Forms include:

  1. Drinking.
  2. Drugs.
  3. Misuse of medication.
  4. Food. Overeating. Excessive focus.
  5. Gambling.
  6. Excessive gaming. Video games.
  7. Excessive social media.
  8. Extreme hobbies.
  9. Extreme activities.
  10. Excessive risk.
  11. Obsessions and compulsions.
  12. Repetitive and detailed behavior.

Awareness of problem

Degree of awareness of mental disorder can vary greatly.

Awareness can also vary between type of observers:

  • Self.
  • Others.
  • Mental health professionals.

Levels of awareness for self

  1. Imagined, no actual problem.
  2. Too mild for awareness by self.
  3. Apparent to self but not others.
  4. Apparent to others or mental health professionals but not self.
  5. Apparent upon close observation by self.
  6. Rarely apparent.
  7. Occasionally apparent.
  8. Apparent sometimes but not always.
  9. Frequently apparent.
  10. Usually apparent.
  11. Readily apparent at all times.
  12. Self-awareness but sometimes in denial.
  13. Self-awareness but frequently in denial.
  14. Denial by self that anything is wrong.
  15. So severe that self is incapable of recognizing that anything is wrong.

Levels of awareness for others

Others might be friends, relatives, work colleagues, or strangers. Mental health professionals are included in the next section.

  1. Imagined, no actual problem.
  2. Too mild for awareness by others.
  3. Apparent to others but not self.
  4. Apparent upon close observation by self or others.
  5. Rarely apparent to others.
  6. Occasionally apparent to others.
  7. Apparent to others sometimes but not always.
  8. Frequently apparent to others.
  9. Usually apparent to others.
  10. Readily apparent to others at all times.
  11. Others aware, but act as if nothing wrong.
  12. Others aware, but in denial, unless pointed out.
  13. Others aware, but in denial, even if pointed out.
  14. Others aware, but too embarrassed to admit it.
  15. Others aware, but too ashamed to admit it.
  16. Others aware, but unwilling to admit it due to potential career, livelihood, or social stigma implications.
  17. Others aware, but will never admit it.
  18. Others unable to perceive there is a problem despite severity.

Levels of awareness for mental health professionals

  1. Imagined, no actual problem.
  2. Actual problem with distress or impairment, but too mild for awareness by any mental health professionals.
  3. Too mild for awareness by most or many mental health professionals.
  4. Too mild for professional diagnosis. Not clinically significant.
  5. Too mild for diagnosis as other than nonspecific.
  6. Rarely apparent.
  7. Occasionally apparent.
  8. Apparent sometimes but not always.
  9. Frequently apparent.
  10. Usually apparent.
  11. Readily apparent at all times.
  12. Apparent but not considered a mental disorder by the mental health profession.

Degrees of grief

Grieving is a normal reaction to loss or trauma that involves a loss of function, but it can trigger mental health problems.

Various degrees of grieving:

  1. Too minimal. Abnormal or at least deserves professional attention.
  2. Minimal. Significant resilience.
  3. Moderate. To be expected.
  4. Severe. Also to be expected in extreme cases.
  5. Extended. Possibly a problem.
  6. Decline, no recovery. Clearly a problem.
  7. Short and intense. Probably okay, unless too short or otherwise suspicious.
  8. Long and subdued. May be normal, but too long raises suspicion.
  9. Suicidal. Not good.

Levels of normalcy after treatment — relief from distress and restoration of function

The various treatments for mental illness (mental disorders) have various levels of efficacy (effectiveness), both in terms of relieving distress and enabling full function in daily life.

Relief for distress and impairment are somewhat independent and may not be relieved precisely in tandem.

True normalcy would require full relief of both distress and impairment, although with some disorders distress may be the main symptom or even the cause of impairment.

Generally, distress needs to be relieved or at least significantly reduced before function can be restored.

Relief from distress:

  1. Normal. No treatment.
  2. Treatment fully relieves all distress.
  3. Treatment relieves substantially all distress.
  4. Treatment relieves most distress.
  5. Treatment relieves a moderate degree of distress.
  6. Treatment relieves a modest degree of distress.
  7. Little if any effect on distress. Although with enough medication the individual could be rendered completely zombie-like or outright unconscious so that no distress is visible per se. The goal is relief of distress that permits some reasonable degree of function.

Relief from impairment.

  1. Normal. No treatment.
  2. Treatment fully restores function. No impairment.
  3. Able to live at home, work function restored, but limited social interaction.
  4. Able to live at home, but work and social interaction are somewhat limited.
  5. Able to live at home, but work and social interaction are severely limited.
  6. Able to live at home, but not work, and social interaction is somewhat limited.
  7. Able to live at home, but not work, and social interaction is severely limited.
  8. Able to live in a group home or other supervised residential setting, but not work, and social interaction is severely limited.
  9. Little if any relief from impairment. Institutionalization required.

Range of normal

Normalcy may superficially seem rather obvious, but can be as nuanced as outright mental illness.

One definition of normal is the absence of mental disorder.

But that has several difficulties:

  1. Symptoms that are not clear or visible or dramatic enough to be considered worth bringing to the attention of a mental health professional.
  2. Clear and visible symptoms may still not rise to the level of clinical significance to warrant a diagnosis of a mental disorder by a mental health professional.
  3. Symptoms may be present, but for whatever reasons a clinical diagnosis has not been performed by a mental health professional. They may have slipped through the cracks. Happens a lot.
  4. An evaluation by a mental health professional may have been performed but was flawed, such that a real mental disorder was missed.

In short, an individual may have an undiagnosed mental order and not realize it.

Or, the individual and/or those around them may indeed realize that something is wrong, that the individual has mental health issues or at least concerns, but with no proper mental health diagnosis, they are considered okay, and normal.

In short, an individual may be considered normal, but not be as normal as we should more properly consider normal.

Behaviors or mental concerns, issues, and problems that may not rise to the level of a diagnosable disorder and may (or not) be considered normal include:

  1. Worry.
  2. Distraction.
  3. Anxiety.
  4. Obsessive interests.
  5. Difficulty focusing.
  6. Headaches.
  7. Difficulty sleeping.
  8. Difficulty staying awake.
  9. Drinking.
  10. Drug use.
  11. Gambling.
  12. Zealous risk-taking.
  13. Wild or excessive fantasies.
  14. Oddities, quirks, eccentricities.

See also the section detailing the many types of symptoms for mental disorder.

Relatively normal individuals may on occasion exhibit feelings or behaviors on that longer list or this shorter list but not be considered to have a mental disorder per se.

They may not be the peak of normal that we commonly aspire to, but they may still fall within the range of normal that is considered acceptable or at least tolerable in modern society.

Some degree of each of these variations from perfection may be considered okay, even though there can be a very slippery slope between what is considered okay and symptoms which a mental health professional would diagnose as a mental disorder.

There is also the mentality that says that we are all broken in some way.

Degree of control over life

Those with mental health problems frequently feel that their life is out of control, at least in some minimal way that is important to them.

  1. On top of the world, can handle anything.
  2. Normal. Reasonable control. Accept that not everything can be controlled.
  3. Got it. Managing, although with extra effort.
  4. Coping. More effort than most would consider normal.
  5. Barely hanging in there.
  6. Imagine on top of the world and able to handle anything, but not.
  7. Overwhelmed. Unable to cope.

Scope of attitude

An individual (or group) can have a positive or negative attitude about a number of things:

  1. In general, without thinking about anything in particular.
  2. About life in general.
  3. About society as a whole.
  4. About specific groups in society.
  5. Towards the future.
  6. About specific matters or activities.
  7. About specific events.
  8. About specific intentions.
  9. Towards others in general.
  10. About specific individuals.
  11. Towards family members.
  12. Towards friends.
  13. Towards colleagues.
  14. Towards strangers.
  15. Towards self — self-esteem.

Cultural dimension of mental illness

The cultural dimension of mental illness won’t be explored in any depth in this paper, but cultural differences can affect what forms of behavior, expression, or feelings are considered outside of the norm for a given society or social or cultural group. Some cultural issues:

  1. Narrower or broader view of what is considered normal.
  2. Specific behaviors and forms of expression considered normal or abnormal in a given culture or in contrast to other cultures. Exactly what would be considered a mental disorder in a given culture.
  3. Varying degrees and forms of stigma about mental illness.

Forms of social norms

There is no single, absolute, objective standard for many forms of behavior and expression. Instead, we rely on a variety of social norms, such as:

  1. Cultural norms.
  2. Regional and local variations in culture and norms.
  3. Age.
  4. Stage of development.
  5. Gender.
  6. Form of activity.
  7. Form of expression.
  8. Empowerment or licensing by society as a whole or official authority in particular.

Perspectives of stigma

Although stigma is generally defined as disapproval by society as a whole, it can be viewed from various perspectives:

  1. From the perspective of the individual with the stigmatized condition. Internalized stigma.
  2. By family members.
  3. By different family members. Mothers and fathers may have different attitudes. Siblings may have different attitudes from each other and from each parent.
  4. By close friends.
  5. By acquaintances.
  6. By colleagues.
  7. By strangers.
  8. By the community in general.
  9. By various social groups the individual is a member of.
  10. By various social groups the individual is not a member of.
  11. By society as a whole.
  12. By different societies.
  13. By different cultures.
  14. Based on the individual’s role in a group. Specific role, level of responsibility, and prestige can require higher standards of perfection.

Forms of stigma

  1. Acceptance. No stigma.
  2. Partial acceptance. Some degree of stigma.
  3. Ignore. Denial.
  4. Embarrassment.
  5. Shame.
  6. Exclusion from various aspects of society or an organization.
  7. Reduced opportunities for social interaction or social membership.
  8. Limited career opportunities.
  9. Limited promotion opportunities.
  10. Limited political opportunities.
  11. Isolation. Refrain from contact. Shun.
  12. Expel. Outcast. From a particular social group.
  13. Bullying.
  14. Ridicule.
  15. Kill. Legally reserved for extreme criminal activity, but individuals or groups may act outside the law.

Role of social norms in stigma

Social norms for a society play a significant role in the degree to which mental illness is stigmatized. This important aspect of mental illness is beyond the scope of this paper.

Degrees of stigma

Stigma around a diagnosis of mental illness (mental disorder) revolves around the fact that mental illness is worse than a physical injury that can be completely healed so that the individual is as good as new. The fear is that the individual suffering from a mental disorder is now inferior and damaged goods.

In the extreme, stigma may be weaponized and used to attack the individual, such as a political opponent in an election or to stop an individual from advancing to a leadership position in an organization or to a position of prestige in a social organization.

  1. Full acceptance.
  2. Halfhearted acceptance.
  3. Reluctant acceptance.
  4. Modest embarrassment.
  5. Modest shame or guilt.
  6. Significant embarrassment.
  7. Significant shame or guilt.
  8. Extreme shame or guilt.
  9. Fear of some impact on career and livelihood.
  10. Fear of modest to moderate social rejection.
  11. Fear of significant impact on career and livelihood.
  12. Fear of extreme social rejection, shunning, expulsion.
  13. Fear that exposure will destroy career and livelihood.
  14. Willing to hide disorder at all costs, even avoiding treatment, such that the effects of the disorder could put the life of the individual and others at risk.
  15. Rather die, suicide risk.

Moral dimension of mental illness

This paper won’t delve into the moral and ethical aspects of mental illness, as interesting and as important as those topics are.

Moral injury is another interesting topic that is beyond the scope of this paper. It may be very relevant to mental illness, but as of right now it isn’t even in the lexicon of traditional mental health professionals. Not even a mention in DSM-5 or ICD-10.

The moral aspect of social norms is another interesting topic that must also be considered beyond the scope of this paper, for now.

Forms of referral for help on mental health concerns

First, to reiterate, this informal paper is not intended to either diagnose, treat, or assist in the diagnosis or treatment of mental health problems. Or even to assist in referring people who feel that they might need help.

This section is merely intended to represent the range of options which are available.

  1. Referral from a primary care physician. Although many individuals today don’t have a primary care physician who knows their extended health history.
  2. 911 for medical emergencies. Not likely to be very useful for most mental health problems.
  3. Mental health hotlines.
  4. Suicide hotlines. Even specialized for demographic groups, such as teens and veterans.
  5. Mental health information phone lines.
  6. Support groups.
  7. Web sites for professional organizations involved with mental health.
  8. Websites specializing in mental health.
  9. General web sites with relevant content.
  10. Blogs. Range from amateurs to experienced mental health professionals.
  11. Government web sites. Including those specializing in mental health.
  12. Counseling.
  13. Billboard and poster ads offering mental health advice and contact information.
  14. Online ads and PSA.
  15. Google search on specific keywords for mental health.
  16. Google answer boxes providing specific mental health information based on keywords, without the need to dig through search results.
  17. Advice from friends.
  18. Advice from family.
  19. Pastoral advice and possibly counseling.
  20. Interactions with law enforcement. This can be Russian roulette when mental health is a big concern.
  21. Drug rehab. May or may not address underlying non-substance mental health issues.

But, none of these sources of information and assistance will help individuals who may have such severe mental illness that they are unaware of their illness or have a more moderate problem but are in denial or have been lead by friends, family, and society to believe that it is considered okay and normal. Flip a coin whether they have family who are able to sense the nature of the problem and make the proper connection to get the needed help. It is far too easy for people to fall through the cracks.

The great abyss: the untreated unaware

The greatest problem facing those with mental health problems is that those who are unaware that they have a problem will not get the care they need, which kicks off a spiral of accelerating decline from which many will never recover. Anybody wonder why we have a suicide crisis or an opioid crisis?

Even if people are surrounded by well-informed loved ones, care for mental health problems can be problematic at best. But if the symptoms are not yet pronounced enough or if the well-intentioned are in denial, a resolvable situation could similarly spiral out of control.

So often when an individual spirals out of control, the common refrain from those who knew them is so typically “We didn’t know.”

Degrees of undiagnosed mental disorder

This area requires a great more thought since it is really targeting knowledge about the unknown and possibly unknowable.

It covers the gray area which spans the fringe of normal that overlaps the fringe of mental disorder — feelings and behavior which might not be normal but cannot be readily diagnosed as a clear mental disorder.

This list is not claimed to be comprehensive or necessarily strictly in order of significance, but is simply intended to be illustrative of the issue of mental health problems which are not fully diagnosed as a mental disorder:

  1. Apparent difficulty coping with minor traumas of daily life. No clear, bright line between normal coping, difficulty coping, and outright mental disorder.
  2. Unawareness that the individual has experienced significant trauma.
  3. Effectiveness at hiding effects of trauma, possibly due to shame or fear of consequences. Or stigma associated with mental illness.
  4. Denial of trauma.
  5. Individual is in denial and refuses to seek diagnosis or treatment.
  6. Family is in denial and refuses to seek diagnosis or treatment.
  7. Institution is in denial and refuses to seek diagnosis or treatment.
  8. Aberrant feelings and behavior occur sporadically, but too infrequently to warrant a full diagnosis as a mental disorder.
  9. Aberrant feelings and behavior are masked by quirky behavior that itself doesn’t rise to the level of clinical significance to be diagnosed as a mental disorder.
  10. Apparently normal feelings and behavior mask underlying symptoms. More thorough diagnosis might uncover the underlying disorder, or the masking could be too effective.
  11. Resistance by the individual to efforts of mental health professionals to perform a thorough diagnosis.
  12. Resistance by the family to efforts of mental health professionals to perform a thorough diagnosis.
  13. Resistance by an institution to efforts of mental health professionals to perform a thorough diagnosis.
  14. Abnormal feelings or behavior, but not quite rising to the level of significance for a clinical diagnosis.
  15. Diagnosis curtailed due to limited resources and time pressures.
  16. Incompetent diagnosis by an inexperienced, overworked, or overwhelmed mental health professional.
  17. Peculiar or freak symptoms that don’t fit any specific mental disorder and don’t seem to rise to the level of significance of an unspecified mental disorder.
  18. Unwillingness or reluctance of a mental health professional to commit to a diagnosis of unspecified mental disorder.
  19. Diagnosis complete but paperwork lost in the shuffle.
  20. Transcription or data entry errors, even if diagnosis itself was proper.
  21. Individual moves to another area or begins interacting with a new group of people who are unaware of an existing diagnosis of a mental disorder.

Need for much more research

Much more research is needed in all areas of mental health and mental illness.

Prevention is a great gaping hole.

How to do early detection and initiate effective treatment at an early stage is a great need for research.

Monitoring the course of mental illness is in great need of research. Modern digital technology could be a big help if properly focused and utilized. A smartphone could monitor an individual’s behavior and some degree of function. Skin sensors or implanted IoT (Internet of Things) devices could monitor physiological state and some degree of mental state, possibly giving a fairly significant measure of distress and organization of thoughts, as well as hormonal balance which can affect mental state.

Topics beyond scope of this paper

These are all very interesting topics, some of which may be covered in future papers, but are beyond the scope of this paper, which focuses on degrees and dimensions of mental health and mental illness:

  1. Specific disorders.
  2. Symptoms.
  3. Diagnosis of mental disorders.
  4. Treatments for specific disorders.
  5. Diagnosis process.
  6. Treatment process.
  7. Role of mental illness in substance use disorder.
  8. Role of mental illness in PTSD.
  9. Role of mental illness in postpartum depression.
  10. Role of mental illness in domestic abuse.
  11. Role of mental illness in homelessness.
  12. Role of mental illness in criminal activity.
  13. Role of mental illness in terrorist radicalization.
  14. Role of mental illness in distress over gender identity (gender dysphoria.)
  15. Role of mental illness in social acceptance.
  16. Role of mental illness in bigotry and bias.
  17. Role of mental illness in sexual harassment.
  18. Interaction between obesity and mental health and mental illness.
  19. How law enforcement should treat individuals who exhibit symptoms of mental illness, and emotionally disturbed persons (EDP) in general.
  20. How jails, prisons, and courts should treat individuals who exhibit symptoms of mental illness, and emotionally disturbed persons (EDP) in general.
  21. Neurological disorders during fetal development.
  22. Mental health education and training.
  23. Mental health screening.
  24. Mental health insurance.
  25. Mental health monitoring.
  26. Mental health research.
  27. Prevention.
  28. Early warning.
  29. Cultural dimension of mental illness.
  30. Role of social norms in stigma.
  31. Selecting individuals for activities which may have stress and triggering events which could trigger mental disorders. Extent to which personality could predict whether a given environmental trigger or triggers might induce particular mental disorder symptoms. Includes military, emergency responders, disaster relief, pilots, medical staff, mental health staff.
  32. Moral injury.
  33. Moral dimension of mental disorder.
  34. Moral aspect of social norms.
  35. Depth on defensive mechanisms.
  36. Career development, skill/ability analysis and assessment, both when fully mentally healthy and in the presence of varying degrees of mental illness.
  37. Deinstitutionalization and the homeless and mentally ill wandering the streets or in residential facilities without any significant treatment.
  38. Statistics on mental illness.
  39. Psychology in general.
  40. The many positive, productive, and creative aspects of good mental health.
  41. Role of nutrition in mental health and mental illness.
  42. Role of family in mental health. Genetic, homelife environment, abuse, neglect, presence of other individuals suffering from mental health problems.
  43. Human potential and human growth.
  44. Role of spirituality in mental health.

Summary and conclusion

It is hoped that the summary, overview, and description of mental health and mental illness in this paper will be a sufficient foundation to inform those involved in development of public health policy for mental health and mental illness who are not already mental health professionals.

It is also hoped that that this paper can serve as a foundation for discussion of mental health and mental illness in general.

It is hoped that this paper can serve as a foundation for more clear and effective communication between mental health professionals and the public at large.

And finally, it is hoped that ideas and concepts from this paper can help to fuel further research in mental health and mental illness, including technology, early warning, and prevention.

Written by

Freelance Consultant

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