To talk of mental illness implies there is a corresponding state of mental health, but what is mental health?

A common definition is ‘emotional, psychological, and social well-being’ but this is a tautology because ‘well-being’ is the same as ‘health’. It’s like saying mental health is mental health.

The World Health Organization defines mental health as: ‘A state of well-being in which the individual realises his or her abilities, can cope with the normal stresses of life, work productively and fruitfully, and is able to make a contribution to his or her community.’

This definition is unclear and overly broad. Do they mean ‘realise abilities’ in the sense of being aware of them or in the sense of putting them into effect? What are ‘the normal stresses of life’ and what do they mean by ‘cope’ with them? What’s the difference between working productively and working productively and fruitfully? Do they mean in theory making a contribution one’s community or in practice making a contribution? How do you define ‘contribution’ anyway? There must be many people who, for lack of education, money, or opportunity, although they may in theory fulfil the criteria for perfect mental health, in practice are unable to do so. Are these unfortunates by definition mentally ill? And who is qualified to judge whether someone is mentally healthy? Is it psychiatrists? Or is it the person himself or herself?

If a man were to retire from the rat race to sit in a cave in the Himalayas and spend all day meditating, he could hardly be said to be coping with the normal stresses of life, working productively and fruitfully, etc., but does this mean he does not possess mental health? Depending on how you look at it, someone in this situation might be said to have superior mental health compared with living a conventional life. He might be said to have reached a higher state of consciousness or ‘become one with the universe’.

If it’s so difficult to define mental health, then it’s equally difficult, or it may be impossible, to define mental illness. Do mental illnesses even exist?

Furthermore, if entities called mental illnesses exist in nature, this implies that patients so diagnosed suffer from some kind of brain disorder. Unfortunately, or rather I should say, fortunately, no reliable objective evidence of a brain disorder or dysfunction has been found in any so-called mental illness.

This situation, however, does not prevent psychiatrists from using mind-numbing neurochemicals, otherwise known as psychiatric drugs, to ‘treat’ patients diagnosed with a mental illness of some kind or other. Worse, patients may be regarded as suffering from an incurable condition, such as so-called psychosis, and requiring lifelong medication.

I am not saying that psychiatric drugs should never be used, but they should be a last resort. It should be made clear to patients and their carers that their purpose is to reduce symptoms and thereby make life easier compared with the undrugged state. They should only be used in the minimum dose and for the minimum time. Relapse of symptoms which may occur on stopping these drugs needs to be distinguished from withdrawal symptoms, though this may be avoided by very gradual withdrawal of the drug(s).

For an in-depth discussion of these matters, readers are referred to A Straight Talking Introduction to Psychiatric Drugs: The truth about how they work and how to come off them by Joanna Moncrieff, PCCS Books, 2020.

Text © Gabriel Symonds

Picture credit: Hieronymus Bosch,  c. 1450–1516. Detail from Extracting the stone of madness. Wikimedia Commons.