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Understanding the mental health and mental illness continuum

Adhika Anindita
Adhika Anindita

Currently practicing at the International Wellbeing Center

Jakarta | Tue, April 3, 2018 | 11:54 am
Understanding the mental health and mental illness continuum

The director of the National Institute of Mental Health, Thomas R. Insel, said mental illness should be thought of the same as heart disease or diabetes, the only difference being that it involves the brain. (Shutterstock/File)

Oftentimes, we get mixed up when discussing mental health and mental illness.

The World Health Organization defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. According to the American Psychiatric Association, mental illnesses are defined as “health conditions involving changes in thinking, emotion or behavior (or a combination of these) associated with distress and/or problems functioning in social, work or family activities”.

These two paradigms give us separate aspects to look at.

Well-being is all about the quality of life a person perceives him or herself to have, regardless of whether a mental illness is present or not. Thus, someone with a mental illness might be able to have optimal mental health, and a person with no mental illness might have difficulty coping with stresses affecting their productivity, experiencing poor mental health.

However, both mental health and illness have their own continuum from mild to severe that we need to measure ourselves, in what state we are at.

Read also: Study challenges 'healthy but obese' theory

Bio-psycho-social aspects of mental illness

Mental illness is related to a set of symptoms and signs that leads to a diagnosis. They could take many forms, from a mild disorder that has limited interference on daily life, to a severe stage that needs some hospital care.

Most people will ask, “How did I get this illness?”

The bio-psycho-social model is one approach to see how an illness, including a mental illness, might arise in a person. This combination of three aspects is among the influencing factors to generate a mental illness.

For example, depression. One might have a genetic factor to develop depression, but it may or may not arise depending on psychological factors such as personality, history of trauma, self-image and other psychological aspects, as well as social factors such as social support, culture, peer group and financial among others.

Another example is a case with siblings born from schizophrenic parents. They might have the same gene to develop the disease; however, schizophrenia might emerge in one, both or none of them depending on their different bio-psycho-social aspects.

Perceiving biological aspects of mental illness

How biological aspects may affect mental illness is somehow still in the process of being fully understood. In recent days, more research is involving genetic tools and neuroimaging that develop progress in deciphering details of the underlying biology of mental disorders.

According to the director of the National Institute of Mental Health Thomas R. Insel, MD, mental illnesses are no different from heart disease, diabetes or any other chronic illness. All chronic diseases have behavioral as well as biological components. He stated that, "The only difference here is that the organ of interest is the brain instead of the heart or pancreas. But the same basic principles apply."

Read also: Are lonely hearts prone to cardiovascular disease?

Recent findings also give us more understanding on the physiology of depression. New findings on activities at the Brodmann 25 area in the brains of people with depression could provide more chances to develop other modalities of therapy, such as deep brain stimulation on a specific area. Another finding about high dopamine in specific areas of the brain related to some symptoms of schizophrenia has enabled us to develop dopamine blocker antagonist medications to suppress the culprit hormone that brings schizophrenia symptoms alive.

However, experts also believe there are variables involved in mental illness and we cannot exclusively view mental illness in biological terms. Richard McNally, PhD, a clinical psychologist at Harvard University stated, “Certain disorders such as schizophrenia, bipolar disorder and autism fit the biological model in a very clear-cut sense, but [for] other conditions, such as depression or anxiety, the biological foundation is more nebulous.

Most definitely, we are a long way from understanding the interplay among biological, psychological and social-environment factors. Therefore, mental health practitioners must look at all involved aspects in a mental illness to give adequate services to patients. A person with a mental illness also needs to be aware and understand the nature of their illness to help them embrace the condition and look for a proper and healthy way to overcome it.

Medication as one of the modalities

Another way to remedy a mental illness is using medication. Some mental illnesses with prominent biological aspects, such as schizophrenia, bipolar disorder and autism require medication to alleviate the symptoms. Other milder illnesses gain benefits from different therapies, such as psychotherapy/talk-therapy, art therapy, play therapy, mindfulness, hypnotherapy and many others.

If we take the diabetes analogy, some people who are on the early continuum of glucose intolerance state might get healthier from changing their lifestyle. Others with chronic diabetes need a combination of changes in lifestyle and diabetic medication to control blood glucose.

Similar principles also apply to mental illness; people on the early continuum can get better from psychological therapies only, whereas people on the advanced continuum need a combination of therapies and medication.

To understand more about what state of continuum you are on, do not hesitate to seek support from mental health practitioners such as psychiatrists or psychologists. These professionals will clarify your condition and assist you to find the best way to cope and overcome it.

There is no reason to feel different and ashamed for bearing a mental illness. If we can say that it is OK to have diabetes, what’s wrong with being bipolar? (dev/kes)

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Adhika Anindita, MD in psychiatry, received her medical degree from the University of Padjadjaran and completed her residency in psychiatry from the University of Indonesia. Dr. Tata has a particular interest in psychotherapy, especially in cognitive behavior therapy, dynamic psychotherapy, mindfulness, MMPI assessment and child/adolescent psychiatry. She is currently practicing at the International Wellbeing Center in the evening providing counseling and psychiatric assistance to adolescent and adult clients. When not working, she shares quality time with her family doing running and hiking to balance her physical and mental health.

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