Mental health has been in the headlines consistently now for about six months, and that’s fantastic. There is no such thing as too much awareness-raising.

However, the ensuing debates have revealed some confusion. Some, for example, seem to think that “mental health” and “mental illness” are the same thing, and use the terms interchangeably. At the other end of the scale, we have those who cannot seem to fathom why “feeling anxious” might eventually result in “anxiety disorder”.

Similarly, the recent murder of Jo Cox has given way to a discussion over whether it’s stigmatising to talk about her killer’s poor mental health, because it portrays people with mental illness as dangerous to the public (when, in reality, only a tiny proportion of them are).

I’m going to attempt to introduce some clarity into what can be a very confusing world, full of jargon and misunderstanding.

First: a disclaimer. I have a Mickey-Mouse psychology qualification and first-hand experience of mental illness – this does not a mental-health professional make. However, at Self-Esteem Team we do have a team of four verified, actual doctors – comprising two psychologists with different specialisms, a psychiatrist and a neuroscientist – who we consult with to ensure the content of our lessons are not only scientifically correct but in keeping with the latest research. Similarly, to write my forthcoming report for the government on education and mental health I consulted extensively with a range of real experts, including educational psychologists and university research teams.

The cumulative knowledge gleaned from the above, as well as from visiting three schools per week and listening to what teachers and pupils have to say about their mental health and what influences it, has given me, I believe, quite a comprehensive overview (as opposed to the average – in the words of Tom Bennett – “well-meaning armchair blogger”).

Mental Health

If you have a brain (which I’m going to assume you do if you are reading this), then you have a mental health.

In just the same way as we have a level of physical fitness, everyone is on a scale of mental health. Your level of mental health will fluctuate throughout your life, because you are human. It will be influenced negatively by things like stress, insecurity, lack of sleep, heartbreak, bereavement and bullying.

While a dip in your mental health might temporarily impair your ability to function, it won’t necessarily lead to a mental illness.

However, if a dip in mental health continues for a long period of time, or has no outlet, then it may lead to symptoms of mental illness (for example, long-term stress can lead to panic attacks and irrational fear of everyday events, both of which are symptoms of anxiety disorder).

There is some dispute among experts as to whether, simply because you exhibit symptoms of a mental illness, you actually have one. Some believe, for example, that depression is caused by a chemical imbalance in the brain that is unrelated to life events, and that is what differentiates it from feeling hopeless, uninspired, sad and lacklustre over a long period of time.

This troubles me, only because so many people begin their stories of mental illness by saying, “my depression began when…” and relate it back to a difficult period or traumatic life event. Most psychologists acknowledge that trauma can cause mental illness, but they will squabble about what the term “trauma” encompasses (some do not consider bullying to be sufficiently traumatic to cause mental illness, for example).

So the leap from poor mental health to mental illness is, at present, a bit of a grey area…

Mental Illness

The problem with the term “mental illness” is that it is far too all-encompassing. This is related to stigma in some ways, since conversations seem to go like this:

A: Why is Fred off work?

B: He has a mental illness.

A: Oh, right. (*Runs away*)

You’d never describe someone as having a “physical illness” without going into specifics. There’s a vast difference if we’re talking about diabetes, or cancer, or a broken leg. Mental illness doesn’t enjoy the same distinctions, and that can lead to confusion.

The four most common mental illnesses are: depression, anxiety, self-harm and eating disorders. There is a misconception that these are the common colds of the mental health world and less serious than other illnesses. However, depression is responsible for 90 per cent of suicides and anorexia has the highest mortality rate of any mental illness. Like most illnesses, they are all about degrees and they are eminently more curable if they are caught early.

Less common, but still widespread enough that you probably know someone with one, are mental illnesses that involve psychosis. Psychosis is hearing, seeing, feeling or tasting things that others can’t, and it is a symptom of cyclothemia (little sister of bipolar), bipolar and schizophrenia. All three of these illnesses are also characterised by periods of mania (feeling on top of the world, like you are invincible, having boundless energy) followed by periods of depression, which is why people with these illnesses are so often referred to euphemistically as having a split personality.

The above are, we can all agree I think, mental illnesses.

Nuanced

Then we have the things that sometimes fall under the umbrella of mental illness but don’t necessarily belong there. Autism, for example: is that a mental illness, a learning difficulty, or simply a different way of looking at the world? Then there are psychopaths and sociopaths, who are unable to feel empathy. But they are, experts believe, born that way. So is that mental illness or more like a disability?

I’m writing this to convey how nuanced mental illness and mental health are and what we are actually playing with when we use these terms.

So when, for example, I say that rigorous testing and stress at school can lead to poor mental health, I am not suggesting that there is a direct link between academic stress and mental illness (although in some cases, of course, there could be). I do, however, think poor mental health is worthy of addressing.

The problem is that a lot of commentators who consider themselves to be faithful to The Science are, in effect, saying the equivalent of “There is no point in trying to find a cure for epilepsy because it isn’t cancer”.

And that’s just silly.

Natasha Devon is the former government mental health champion for schools and founder of the Body Gossip Education Programme and the Self-Esteem Team. She tweets as @NatashaDevonMBE

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