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Mind

What Is Mental Distress?

Neuroskeptic iconNeuroskepticBy NeuroskepticJune 9, 2011 5:05 PM

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"Mental distress" is term which has recentlybecomepopular in Britain. It's most often used as a replacement for "mental illness". I'm rather puzzled by this. In this post, I analyze this phrase.

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The first thing that leaps out about "mental distress" is that the word "mental" seems redundant. What other kind of distress is there? Distress is mental, by default. This awkward wording seems to be a result of the fact that it's an attempt to fuse some of the features of "mental illness" with some of the implications of "distress", using a kind of verbal alchemy. What is mental distress? It's not mental illness, but it's not exactly not mental illness. Fair enough. Mental illness is a problematic concept, so I'm all in favor of rethinking it. But I'm worried. My worry is that "mental distress" takes the worst features of mental illness and perpetuates them in the guise of being a new and radical idea.

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Were I to go around making sweeping statements about "the mentally ill" or "people with mental illness", someone would call me out on it, like this - Mental illness is an umbrella term, for all kinds of different experiences! You can't talk about all those people as if they're the same. They're individuals! Which is quite right. But it's equally bad to talk about "mental distress" in the same way, and this happens as well. I don't know if mental distress is more often used as a blanket statement, but it's certainly not immune and it's no better. See for example the top Google hit for mental distress:

Changes in sleep patterns are a common sign, and appetite may also be affected. Lethargy, low energy levels, feeling antisocial and spending too much time in bed may indicate the onset of depression. Wanting to go out more, needing very little sleep, and feeling highly energetic, creative and sociable, may signal that a person is becoming 'high'. The first time it happens, the effects of hearing or seeing things that other people don't are likely to be especially dramatic...

This is perfectly true of some people, but not all. In this paragraph "mental distress" seems to mean "bipolar disorder", but in the course of the article it morphs into several other forms. All mental distress. It's not good enough to make sweeping statements and say "...Of course, everyone is different, but..." That's a cop-out, not a serious attempt to be helpful. It's like being offensive, and then quickly adding "No offence". If you think everyone's different, talk about them all differently. I think there's a good case to be made that we shouldn't talk about "mental illness" at all. Take, say, bipolar disorder, social anxiety, and antisocial personality. I'm really not sure that these have anything in common. They've only been considered to belong to the single category of "psychiatric disorders" for about 50 years. 100 years ago, bipolar was insanity, social anxiety was a character trait, or a 'nervous' problem, and antisocial behaviour was just evil. Different professionals dealt with each one, and few thought of them as being linked. I'm not saying that we should go back to that. But categories are up for debate. "Mental distress" is a new label, but it's a 50 year old category.

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My second problem is that "mental distress" implies that everyone who has it, is distressed. But they're just not - at least not if you're using that term as a replacement for "mental illness". If you're bipolar, and in a manic or hypomanic episode, you might well be the opposite of distressed. More subtly, if you're severely depressed, you might be too low to be distressed. "Distress" implies an acute emotional response. Severe depression paralyses the emotions. Maybe "mental distress" isn't like normal everyday distress. Maybe mania or depression are mental distress, but not distress. But that's rather confusing. If mental distress isn't distress, what on earth is it? You can't redefine words like that, unless you're Humpty Dumpty.

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If "mental distress" implies that all mental illness is distress, it also works in reverse: it implies that all distress is a form of pathology. Taken seriously, this would lead to absurd conversations: "Are you mentally distressed?""No, I'm fine. I'm just distressed." It would also lead to even more people being treated in the mental health system. Already we're told that 1 in 4 people experience mental illness, but almost everyone gets distressed now and again. You might say that you don't consider mental distress to be a form of pathology. I'm against medicalization! Mental distress isn't an illness! If so, that's fine, but to be consistent, you're going to have to stop talking about treatments. And causes. And symptoms. Those are all medical words. Discussions of mental distress are chock full of them. Indeed, if you want to demedicalize "mental distress", you should probably just call it... distress. The "mental" part is a hangover from "mental illness", after all. If you're serious, you ought to junk that and stick with distress. This would be perfectly clear, it doesn't require us to redefine words or use awkward phrases. Let's give it a go: "Mental illness" is distress. Easy. Unfortunately, when you put it like that, it looks a bit like a sweeping oversimplification, doesn't it? Hmm. On the other hand, if you're not looking to demedicalize mental illness, why throw out the word illness? The problem is that many people like the sound of demedicalization, but they're not sure how far they want to go. And in large organizations, some people will want to go much further than others. Mental health charities seem to be particularly prone to this, so you often see them assuring people that "mental illness is an illness like any other", while simultaneously saying that seeing it just as a medical illness is far too narrow and unhelpful! This is a serious debate, and it deserves a careful discussion. The compromise term "mental distress" seems to bridge this gap, and allows people with very different views to sound like they're agreeing with each other. This is not the best way to resolve debates like this. People still disagree with each other. They just lack the words to talk about it.

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