Considering there will be attempts by certain political parties (for the moment, it’s manifesting in the right) in the United States to use the existence of a “mental illness” as justification for the violation and revocation of rights and privileges, I’d like to explore what the actual conceptualization of mental illness and psychological disorders are within the field of mental health according to the framework outlined by the Diagnostic and Statistical Manual of Mental Disorders (the DSM-V-TR). It’s my goal to demonstrate that the notion of a disorder is grossly misunderstood by lay people not educated about, working in, or trained within mental health professions, that the conditions for disorder are dependent on the integrity of one’s mind, and that there are certain conditions which are currently classified as disorders because the conditions are unnecessarily pathologized.

The concept of mental illness is an interesting one. To recognize it appropriately, you need to understand it’s opposite, mental health, but incidentally, there are many things that a functional, capable, mind can and will do for regulation that are considered in-themselves mental illnesses when it is more appropriate to recognize them as either mere symptoms or expressions of the attempt by a mind to maintain health and integrity. Using physical health as a metaphor (for now), a fever is not a physical illness, but a sign of illness, possibly an infection. The fever is a symptom, it’s a response from the body to regulate its integrity and cure itself of the infection, which is the real source of illness/ill health. Similarly, faulty coping mechanism, such as dependence on substances for mental or emotional regulation, are not illnesses themselves, but signs of a lack of health or integrity somewhere in the system of the mind and that which it interacts with.

Substance Use Disorders are not simply recognized as the use of substances to regulate one’s mental health; otherwise, everyone on any kind of psychiatric medication would sufficiently meet the criteria for a substance use disorder. Instead, the “essential feature” of these disorders, colloquially referred to as drug addiction, is the presence of a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems (American Psychiatric Association, 2022). There must be a lack of healthy integrity or a loss of functionality associated with the pattern to qualify as a substance use disorder. This requirement of impairment and significant distress and disruption of healthy patterns is exceptionally common in the listed criteria for many if not all classified disorders of the DSM. The implications of the criteria for this type of disorder is notably that drug or substance use alone does not warrant pathological classification.

The Medical Model vs the Wellness Model

While a Medical Model of mental health/illness has been abandoned by some mental health professions, in favor of the Wellness Model, for its tendency to unnecessarily pathologize natural conditions, many metaphors and analogies referring to medical illness, such as the one used above, are still the most common way of describing the nature of mental illness. There are even some professionals who consider the notion of mental “illness” itself to be overly pathologizing and unnecessarily pejorative in its connotation. However, it remains the case that in colloquial terms psychological, personality, and neurological disorders, as well as intellectual disabilities, are often framed as either a disease of the mind or some malfunction or deficiency of the mind. This is even the case for disorders similar to Attention Deficit/Hyperactive Disorder (ADHD), which is actually a neurological disability and not a psychological disorder. The impairment caused by executive dysfunction, a common symptom of ADHD inhibiting the conscious, executive effort and intentionality of a person, cannot be moderated through “trying harder” or attempting to exert more psychological effort into executive discipline. In fact, there is some indication that excessive effort may exacerbate the distress around executive dysfunction, similar to how walking on a broken leg may further damage it. Needless to say however, ignorance of the nature of a disorder or condition is often the cause for misconceptions and misrepresentations of its characteristic symptomology or experience. So once again, a lack of understanding about the nature of a thing often leads to further misconceptions and misinformation surrounding it, further imbedding the ignorance.

While the medical model of mental illness may come with insufficient but somewhat descriptive analogies for describing particular experiences or aspects of dealing with disorders, ultimately, it fails to account for the actual differences between well-adjusted and severely impaired individuals. No one would claim that extraversion is a pathological trait, but in its relative extreme, a constant need for engagement from others without the capacity for inward engagement can be the precursor to the development of maladaptive behaviors, just as excessive introversion can be. This does not mean that either are pathological traits, just that they are specific characteristics that represent different sets of needs and tendencies of an individual. An exceptionally conscientious person may become a workaholic, or they may find that their work is best served if they manage to regulate their preference or urge for work to a reasonable degree. Life is more difficult at the extremes of spectrums, but not necessarily impossible so long as one’s needs can be met and there is still room for fulfillment. This is simply not true of illnesses. The wellness model is, for lack of a better framing, a non-linear spectrum of impairment and ability akin to a horseshoe theory of sanity. Wellness is characteristic of a balance between needs and abilities, challenges and developments. It does not identify a singular state of abstract purity as exemplary health, but acknowledges that there are rightfully many different ways to live a well-adjusted life that do not exclude the existence of extreme qualities, eccentricities, or simple negativities. For anyone dealing with the weight of human consciousness, wondering whether you may succumb to anxiety or depression, please know that this is a fairly ubiquitous experience, and you are not uniquely damned to fend for yourself. You may find reassurance in the compassion and assistance of others. We are, after all, a social species.

Disorder, Resonance and Discord

Now to address the idea of disorder itself. Often used in favor over the term mental illness, “disorder” refers to the impairment and developmental frustration that may accompany or signify pathology, what would otherwise be conceptualized as a mental illness. Posttraumatic Stress Disorder is not itself an illness. It is not something you contract after having been exposed to traumatic experiences as a bacterial infection may be something you contract after having been exposed to pathogens (mainly because there isn’t really such a thing as a mental pathogen). Suffering, generally speaking, could be described as a psychological hazard, but given the prevalence of posttraumatic growth, a phenomenon in which voluntarily struggling through the processing of one’s trauma leads to developmental growth and an increase in many positive psychological traits like resilience, it cannot even be claimed truthfully that exposure to suffering necessarily has negative effects on a person’s psyche. For instance, in order to be traumatized, the experience must firstly be traumatic.

For much of the 20th century, thanks to psychodynamic theorist and therapist Carl Jung, there has been an understanding that for disorders related to traumatic experiences, some aspects of the complex problems associated with trauma disorders can be treated or remedied via a voluntary exploration and integration of the experience and any feelings it evokes from the mind of the person suffering. This is generally known as or associated with shadow integration and describes a phenomenon whereby willfully and intentionally contending with the negative and destructive forces experienced by and within the mind leads to a reciprocal influence of growth and strengthening of the mind. This does not mean suffering is good for you, but it does mean that it is not strictly suffering that is bad for you. Failing to process and integrate the negative experiences and traumas of life is what is causing the impairments. The suffering is simply the pain of the metaphorical psychological wound.

The most common understanding of disorder as a phenomenon, the reliance on faulty coping mechanisms, is truthfully the simplest model. People have problems and needs. People attempt to solve their problems and fulfill their needs with behaviors. Some behaviors are better at doing so than others. Some behaviors are technically successful, but come with additional problems and costs and do not truly satisfy the needs. The lack of efficient regulation and ever-growing costs to functioning create a pattern of behaviors and relationships to one’s environment that characterize the overarching issue, failure to fulfill. The reason mental illness is such a poor concept is because the cause for the failure could be as simple as a lack of knowledge, physical barriers, an antagonistic or unhelpful environment, a poor diet, a lack of sleep, or a lack of social support. The reasons for one’s impairment could very well be external to one’s psyche. As mentioned above, ADHD is a neurological disability. Regardless of how knowledgeable, understanding, well-fed and well-rested, and intentional a person may be, the fact of a neurological disability which directly frustrates the efficacy of effort makes training discipline a secondary therapeutic response at best. What is needed to remedy the disorder is sufficient support from environmental factors that do not seek to remake the person as if they do not have ADHD, but rather seek to adjust the ways in which they and their environment interact in order to optimally organize what was previously disorderly.

Viewing a person struggling with a disorder as a case of problems or like a malfunctioning car which needs correcting is not only ultimately dehumanizing, but fails to properly grasp the actual phenomena often taking place. There are disorders that are characterized by pathological traits of one’s psyche or personality, but such disorder are not reflective of all or even the most common experiences of disorder. Also, not every developmental or inter-/intra-personal impairment qualifies for classification as a disorder. The impairment must be significant and the characteristics must be something other than mild discomfort. A poor sense of humor is not a disorder, but pushing people down stairs to laugh as they fall is certainly indicative of one.

Implications for Society

A lot of old farts and fools who don’t read or listen to others may bemoan the seemingly growing prevalence of some disorders and forms of “neurodivergences”, or atypical neurological profiles to be less stigmatizing and more technically accurate, as an indication of some great conspiracy in the medical industry to destroy the country or some sign of a coming apocalypse. Given all I’ve written so far, it’s probably quite clear what I think of these people. I don’t yet know enough about phenomena such as autism or transgender identities to really describe in detail how these are not dangers to anyone, but I can clearly state this. If all that makes a certain condition a technically sufficient excuse for the classification of a disorder is a lack of optimal integration with society, the conditions of minority racial status or womanhood would have been a disorders before suffrage was acquired for these populations. Temple Grandin is an amazing autistic woman. Like many other people, she deals with challenges and has to balance a set of conditional abilities to solve problems and meet her needs. She is, by colloquial terms, wildly successful and exceptionally capable, especially compared to the average neurotypical. When it comes to the rights and freedoms of others, I see no reason why conditions that are merely atypical should be cause enough for some ignorant people to hastily draft legislation to violate their rights. This is especially pernicious considering the motivation likely stems from nothing more than fear of one’s culture becoming even slightly obsolete or irrelevant in the face of the passage of time, or unfounded idiocy such as the fear that LGBTQ+ communities are somehow necessarily dangerous to children. Is that paranoia really worth crippling our ability as a society to optimize structures and interactions so that more people with different capacities can innovate more for our mutual benefit? Is there ever a reasonable excuse to prevent another person who is causing no harm to others from being able to live freely and associate with institutions and communities of their choosing?