What Counts As Mental Illness?

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What Is Mental Illness? What Psychological & Emotional Health Definitions Miss

As a clinical psychologist, I am forced to grapple with diagnosing my clients every day.

Since all psychologists use a medical model, I must choose a diagnosis code from the Diagnostic and Statistical Manual of Mental Health Disorders, 5th Edition (DSM 5) in order to develop treatment plans and justify billing insurance companies for mental health services.

What is mental illness?

By the Mayo Clinic's basic definition, "Mental illness, also called mental health disorders, refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors."

While all forms of psychotherapy are expected to fit into the medical model, however, it does not always seem appropriate.

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When you visit a medical doctor, there is usually a clear medical/physiological issue. The diagnosis and treatment plan fit easily into the medical model.

With issues related to mental health or mental illness, it is more complex. Therefore, I have always been ambivalent about the process.

I see myself as a mental health advocate, working with people who reach out to me when they feel uncomfortable with parts of their lives.

Most are leading productive lives. They have varying levels of issues that challenge their lives. Some are concerned about how they handle relationships, or are struggling with their parenting skills, and others are recognizing that their drinking has gotten out of hand. Anxiety overwhelms some of my clients, making it hard for them to cope with work and family obligations.

My objective is to teach them or strengthen those positive coping skills they already have and may have lost for a while and restore their mental health, rather than seeing them as "mentally ill."

If clients become depressed, lonely or feel that life is not worth living, I work with them to create a safety plan.

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In more serious instances — such as severe depression, schizophrenia or thought disorders, which appear to have a strong biological component — psychotherapy alone may not be enough.

When that seems to be the case, I refer them to a psychiatrist for medication. Even in these circumstances, I believe that a combination of psychological issues, life circumstances and physiological predispositions are disrupting the delicate balance which keeps one mentally healthy or leads towards dysfunctional behaviors.

My greatest fear in seeing people struggling to stay balanced as "mentally ill" is that society's stigmatizing of their plight and their own fear that they might be "crazy," will keep them from reaching out for help.

I prefer to focus on what will help people maintain adequate levels of mental health rather than on what counts as "mental illness."

Long before positive psychology programs existed, I spent my career uncovering what helps people overcome adversity and become resilient.

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In my mind, the most important question to ask is not "What counts as mental illness?;" it is "What counts as mental health?"

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What is mental health?

Mental health refers to a range of levels of wellness, from highly resilient to less balanced and everything in between.

A mentally healthy person is not perfect.

  • They are human and therefore have flaws
  • They will at times feel anxious or depressed, angry or out of sorts
  • When emotional challenges arise they are able to resolve them either on their own or with the help of family, friends or colleagues
  • They are in touch with and can communicate their feelings
  • They can have an argument without losing control and search for solutions to improve the situation at hand
  • If friends are not enough, they are healthy enough to reach out to ministers or therapists to get additional help

My practice is filled with people who’s mental health is going through a rough patch and who are able to realize that they can use some assistance to rebalance themselves, learn some additional coping skills and get back on track in their lives.

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Dr. Barbara Lavi, PsyD is a licensed clinical psychologist, founder of ACTNowPsychotherapy and author of the bestselling book The Wake Up and Dream Challenge, which helps people reach for and accomplish their dreams. She sees clients in Weston, CT, and online.

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