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Mental health: What's normal, what's not

Deciding what's normal mental health and what's not is tricky. See how feelings, thoughts and behaviors, as well as culture and society, determine what's normal and what's not.

By Mayo Clinic staff

What's the difference between mental health and mental illness? Sometimes the answer is pretty clear. People who hear voices in their heads may have schizophrenia, for instance. And those with such grandiose ideas as becoming the secretary-general of the United Nations without any experience may be having a manic episode caused by bipolar disorder.

But in some cases, the distinction between mental health and mental illness isn't as clear-cut. If you're afraid of giving a speech in public, does it mean you have a mental illness or simply a run-of-the-mill case of nerves? If you feel sad and discouraged, are you just experiencing the blues, or is it full-fledged depression requiring medication or counseling?

Diagnosing mental disorders

One thing that makes it difficult to distinguish normal mental health from mental illness is that there's no easy test to show if something's wrong. It appears that mental disorders have a biological cause. But for now, there's no clear medical test for mental illness.

For these reasons, diagnosis and treatment of mental disorders is based on signs, symptoms and how much the condition affects day-to-day life. Signs and symptoms commonly show up as:

  • Behaviors, such as obsessive hand washing or drinking too much alcohol
  • Feelings, such as deep or ongoing sadness, euphoria or anger
  • Unusual thoughts, such as delusions that the television is controlling your mind, or thoughts of suicide
  • Physical signs and symptoms, such as sweating, racing heartbeat or uncontrolled rapid breathing (hyperventilation)

Determining whether you have a mental illness

How do mental health providers determine whether your signs and symptoms are normal or if they indicate mental illness? Experts often use a combination of the following approaches:

  • Your signs and symptoms. To diagnose mental disorders, doctors and mental health professionals rely on comparing your signs and symptoms to written guidelines that list signs and symptoms of known mental disorders. Diagnosing a mental disorder is easier in people who have a number of common signs and symptoms, but it can be more difficult in people whose signs and symptoms aren't as clear. Signs and symptoms of a mental disorder can differ from person to person and can change over time. Generally, a mental illness is diagnosed only when signs and symptoms are persistent and bothersome.
  • Your own perceptions. How you perceive your own thoughts and behaviors and how much your symptoms affect day-to-day activities can help determine what's normal for you. You may realize that you aren't coping well or that you aren't able to or don't care to do routine activities or the things you used to enjoy. If you have depression, the dishes may go unwashed for days, you may stop bathing or you may lose interest in hobbies. You may feel sad, hopeless or discouraged and realize that something's amiss, that you don't enjoy life anymore. If your sadness is caused by a situation, such as a divorce, for example, your feelings could be a normal, temporary reaction. But if you have signs and symptoms that are severe or don't go away with time, it may be depression.
  • Others' perceptions. Your own perceptions alone may not give you an accurate picture of your behavior, thoughts or functioning. Other people in your life, on the other hand, might be able to do so. To you, your life may seem normal, but what you think of as quirks or personality traits may be causing more problems than you realize. To those around you, your behavior may seem odd or disruptive. For example, if you have bipolar disorder, you may think your mood swings are just part of the normal ups and downs of life. But to others, your thoughts and actions may appear abnormal or cause problems at work, in relationships or in other areas of your life.
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References
  1. Nurcombe B. Clinical decision making in psychiatry. In: Ebert H, et al. Current Diagnosis and Treatment: Psychiatry. 2nd ed. New York, N.Y.: Lange; 2008:1.
  2. Introduction. In: PDM Task Force. Psychodynamic Diagnostic Manual (PDM). Silver Spring, Md.: Alliance of Psychoanalytic Organizations; 2006:1.
  3. Introduction. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Feb. 2, 2009.
  4. Appendix B: Criteria sets and axes provided for further study. Proposed disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Feb, 2, 2009.

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April 16, 2009

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