What Does "Mental Health" Really Mean?
What Does "Mental Health" Really Mean?
When we consider or discuss our mental and emotional lives, we tend to talk about mental health and mental illness. But what’s the difference? And what do all those other designations (mental disorder, mental health condition) and buzzwords (mental wellness, mental well-being) mean?
It’s unclear—and searching the internet for answers is ill-advised. People seem to assume that mental health, mental wellness, and mental well-being are interchangeable. On websites, authors will refer to mental health in one paragraph and mental illness in the next, as if they’re synonymous. Definitions of mental well-being and mental wellness often include mental health. Mental well-being is in the World Health Organization’s definition of mental health, and it’s not uncommon to see the definition of mental health carelessly substituted to explain mental wellness and mental well-being.
So what do these terms really mean?
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The Mental Health Trio: Mental Health, Mental Wellness, Mental Well-being
These three terms—mental health, mental wellness, and mental well-being—have positive connotations. They evoke images of sun-kissed fields. Secular holidays and observances are named for them. January is Mental Wellness Month. May is Mental Health Month. October 10 is World Mental Health Day. (Despite the zeal of patient advocacy organizations, studies have found that awareness campaigns may not increase awareness, affect real change, or have an impact.) These terms may apply to everyone, but they aren’t equivalent.
Mental Health
The WHO states that mental health is “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.” It’s a big ask: realize our potential, cope with stress, be productive, and be a good citizen?
Other definitions aren’t as stringent. Mental health can also refer to our overall mental, emotional, social, and behavioral well-being.
Merriam-Webster’s definition is often seen as problematic: “the condition of being sound mentally and emotionally that is characterized by the absence of mental illness.” The WHO and others have taken pains to refute this description, stating that mental health isn’t just the absence of a disorder or a disability.
Mental Wellness
Essentially, mental wellness can be thought of as mental-health-meets-capitalism. It appears on job postings and corporate websites to signal on-the-job perks and “health-focused workplace environments.” It indicates medical benefits, time off, and life insurance, but it tends to connote luxury: corporate massages, in-office meditation breaks, catered gourmet meals. It’s epitomized by Googleplex, a corporate campus flush with tennis and volleyball courts, organic gardens, and “nap pods.”
Mental wellness is a business, an industry, practically an economy of its own that brings in $121 billion each year. It associates our mental stability with our ability to create value and revenue for a company. It’s week-long mental health breaks meant to combat burnout, which will in turn increase profits.
Mental Well-being
Mental well-being may be the latest buzzword, but it has complex layers of meaning and a long history. Simply put, well-being is quality of life. It can be divided into two subtypes: objective well-being (how we’re judged by others) and subjective well-being (how we judge ourselves). Subjective well-being is further divided into two types: hedonic (happiness achieved by seeking pleasure and avoiding pain) and eudaimonic (happiness derived from meaning and purpose).
Although well-being can be traced back to ancient Greece, mental well-being didn’t fully emerge until the post-WWII era. The 1940s saw the ratification of the National Mental Health Act and the creation of the National Institute of Mental Health (NIMH). Mental well-being—particularly hedonic well-being, i.e., how we find meaning, has been a subject of research by psychologists and sociologists ever since.
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The Mental Illness Trio: Mental Illness, Mental Health Condition, Mental Disorder
Mental illness and its doppelgangers mental health condition and mental disorder are also used interchangeably but tend to carry negative connotations. Although mental illness and diagnoses also bear the names of secular observances, these have a sinister edge to them. Mental Illness Awareness Week, World Bipolar Day, National Anxiety and Depression Awareness Week, and ADHD Awareness Month may seem constructive, but they’re sometimes orchestrated by Big Pharma to popularize diagnoses to create more customers to whom to sell more psychotropic drugs.
Like the mental health trio, these terms have very different meanings.
Mental Illness
Mental illness dates to at least the eighteenth century. The Oxford English Dictionary defines it as “a condition which causes serious abnormality in a person’s thinking or behaviour, esp. one requiring special care or treatment; a psychiatric illness.” It didn’t originally indicate a particular diagnosis, certainly not the diagnoses we have today.
Yet we tend to associate mental illness with diagnoses. The American Psychiatric Association (APA) claims that mental illnesses as “health conditions involving changes in emotion, thinking, or behavior…associated with distress and/or problems functioning in social, work, or family activities.” It also ties mental illness to diagnoses and diagnostic categories in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Two categories of mental illness exist: serious mental illness (SMI) and any mental illness (AMI). They aren’t the same. An SMI is defined as a “severe and persistent mental illness or emotional impairment that seriously limits a person’s ability to live independently” or “a mental, behavioral, or emotional disorder resulting in serious functional impairment.” It affects just 5 percent of the population.
Often, serious mental illnesses are associated with DSM diagnoses, including “schizophrenia-spectrum disorders,” “severe bipolar disorder,” and “severe major depression.” Other diagnoses—obsessive-compulsive disorder, major depressive disorder, attention deficit hyperactivity disorder, etc.—aren’t considered SMIs, except in rare cases.
Mental Health Condition
This phrase has no real meaning of its own. It implies the presence of a mental illness (see above) or a mental disorder (see below). But having a mental health condition implies having a DSM diagnosis (also see below).
Mental Disorder
This is the term most directly associated with the DSM, psychiatry’s “bible.” A mental disorder is a DSM diagnosis. After all, it’s in the title of the DSM: Diagnostic and Statistical Manual of Mental Disorders.
The DSM is the book from which all our diagnoses come. It includes over five hundred diagnostic categories. The APA, a private organization, publishes the DSM, which brings in hundreds of millions of dollars.
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I discovered all this while writing my book, Pathological: The True Story of Six Misdiagnoses. I’d struggled to find the right word—or words—to describe my experience of being diagnosed with six different mental illnesses starting when I was twelve. Were they mental illnesses? Mental health conditions? Or mental disorders?
When I discovered that my diagnoses—all our mental health diagnoses—come from the DSM, a book I’d never heard of, I became curious. How could a book—pages, letters, words—determine why we see some thoughts, emotions, and behaviors as problematic or disordered or as signs of mental illness?
This line of questioning led me to uncover surprising and unsettling facts about the ways we think about mental health, mental wellness, mental well-being, mental illness, mental health conditions, and mental disorders. The discoveries I made deserve posts of their own. Stay tuned.
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