What is a Mental Disorder?
This might seem like a question with an obvious answer, but this question inspires huge debates in academia and beyond. The intention behind this post is to provide insight to anyone who is seeking treatment and is curious about various perspectives on their diagnosis. Anyone that’s licensed to treat a mental disorder is familiar with the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM. In the DSM, the American Psychiatric Association, defines a mental disorder as 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] 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.”
I like this definition for a number of reasons. One reason is that it differentiates between a mental disorder and a “deviancy” although, what is disordered and what is deviant is a little vague. I also like how it emphasizes symptoms that render one “dysfunctional.” According to the DSM, if you have a symptom, this means that your functioning is impaired in some way. In other words, if your functioning is not impaired, maybe the symptom isn’t there, since being impaired is indicative of having a symptom. If there are no symptoms, maybe you are not actually sick.
Despite this definition, people can get diagnosed with a mental disorder even with no symptoms at all. One example of this is Attention Deficit and Hyperactivity Disorder (ADHD). In 2006, a group of researchers found that when you look at children with an ADHD diagnosis and control for actual impairments in their mental functioning, only ⅓ of the children still meet the criteria for ADHD. What this means is that when they actually looked to see if the child’s life was being negatively impacted by ADHD symptoms, ⅔ of the children did not meet the diagnosis . ADHD is one of the most commonly over-diagnosed mental disorders.
Interestingly, not all practitioners agree that mental disorders need to have symptoms. Many only use the DSM because they need to so they can accept insurance. To read about why I do not accept insurance, click here. If you open up the Psychodynamic Diagnostic Manual, second edition, otherwise known as the PDM-II, these practitioners stress that “mental health is more than an absence of symptoms.” They write…
“just as healthy cardiac functioning cannot be defined as an absence of chest pain, healthy mental functioning is more than the absence of observable symptoms of psychopathology. Attempts to depict deficiencies in mental health must consider deficits in many different capacities, including some that are not overt sources of dysfunction.”
This is really interesting. What they are saying is you can still be “sick” or “affected” even without symptoms. How can that be? If you keep with their metaphor comparing mental illness to physical illness, a lot of times we are sick before we notice it. There’s a saying that the most common STD symptom is no symptom at all. You can have cancer and be completely asymptomatic. Therefore, supporters of the PDM-II stress that you need to take the whole person into account and emphasize that something might be off even though everything is “functioning” as it should.
I like this definition too because therapy is not only about eliminating disordered behaviour. It’s about helping people grapple with the complexity of their lives. It can be about self-actualization. It can be about learning to experience life to the fullest instead of getting by on the bare minimum of mental functioning.
The definition I prefer is not found in the DSM-V or the PDM-II. It’s actually not found anywhere in particular, but is alluded to by several theorists and researchers. It’s something like “A mental illness is when perception, cognition, emotion, behavior and values or morals all have a single point of focus.” It’s worth noting that I acknowledge the mind-body connection. I believe in the efficacy of psychiatric medication. Some mental disorders come from chemical imbalances in the brain and body, but some of them come from the mind. In this definition, I am only talking about the mind.
Let’s take eating disorders as an example. Did you know that someone with an eating disorder, whether it is bulimia or anorexia or body dysmorphia, cannot see themselves the way you see them. When they look in the mirror, they likely see a differently shaped body. Their perception does not match reality. In people suffering from anorexia, the closer they get to their “ideal” body weight or shape, the less satisfied they are with their appearance. Someone with anorexia, all they care about is “thinness”— which is their singular point of focus. Their chief value or moral code is “being thin” and they are committed to this above all else. The mortality rate of anorexia is 12 times higher than the death rate of all causes of death for females ages 15 – 24. How can this be possible if it weren’t for all their mental facets being focused on one thing? There you have perception, cognition, behavior, emotion and values all focused on one thing in a mental illness like anorexia.
This definition holds for Obsessive-Compulsive Disorder, or OCD. When somebody has OCD, they are preoccupied with unwanted thoughts so they engage in compulsive behavior to keep those intrusive thoughts at bay. That’s the defining feature of the illness, and it seems to me, that no matter what the obsession or compulsion is, there is almost invariably a singular focus on perfectionism or “away from that which disgusts me.” The research in OCD I have looked at shows that people with severe OCD can have heightened disgust sensitivity. This makes sense because a classic image of someone with OCD is someone constantly washing their hands. Some people who are afflicted with OCD wash their hands to the point that their skin is so thin, it starts to bleed. What could drive someone to do that? Well we’ve answered that with this definition. Their cognition and behavior and emotion are driven by a single force and the more singular they are, the more invasive their obsessions and the more severe their compulsions.
Narcissistic personality disorder— their sole point of focus is the superiority of their own self-image. Histrionic personality disorder— their single point of focus is the relevance or popularity of their self-image. Most trauma disorders have something to do with constantly thinking about the trauma but also constantly trying to avoid the traumatic experience at the same time. Pyromania or kleptomania, that’s easy. Their singular point of focus is: fire and stealing. Addiction: that’s also an easy one because the single point of focus for their perception, cognition, emotion, behavior, and values is their substance of their choosing. Anyone who knows someone suffering from addiction get this because, at a certain point, their whole personality, their whole being, is about the substance. It doesn’t matter if they love you, or if they know their behavior is wrong, they are consumed by whatever it is they are addicted to.
I could go on, but for the most part, this definition fits. Pick any mental illness, whether it’s a formal diagnosis, or just imagine someone you consider pathological, and you will invariably see a pattern of perception, emotion, cognition, behavior and values circle the same drain. At the very least, you see an incredible inflexibility to step outside of that focus, which could be another way of thinking about it.
If you or are a loved one are feeling stuck or inflexible, reach out to schedule a session or contact another qualified professional.
Book a free consultation with me here.