Modern psychiatry considers mental health disorders to be thoughts, feelings or behaviors that cause distress or suffering to you or to the people around you. Over the years, psychiatrists have come together to debate the constellations of psychological distress that people often tend to present with, and have grouped them into 'disorders' within classification systems such as the DSM-5 and ICD-11. These systems give clinicians a guideline with which to decide which "disorder" best corresponds to the distress you describe to them.
So, when you are "diagnosed" with a "disorder" what it means is that "humans have commonly expressed psychological distress matching this profile—in fact, so many that it has its own name." On the positive side, this means that what you are going through is a common human experience. Some estimate that 970 million people, or about 13% of humanity, experience such psychological distress at any given time in the world. But what is it then that needs to be "fixed" to alleviate this distress?
Doesn't it mean something has gone "wrong" with my brain?
Because thoughts, feelings and behaviors arise from the brain, it stands to reason that there must be something going on in the brain—a change, dysfunction or pathology maybe—which causes these outcomes or "symptoms." Unfortunately, theories abound but evidence is scant. Research has tried hard to find differences in the brains of those with particular sets of symptoms compared to those without, but the results so far are only suggestive differences that are far from definitive. There is nothing that remotely resembles the conclusiveness of a test for a bacteria or virus, or a lack of something like a vitamin in your blood, where a clinician could declare, "Yes you are positive for X," or, "You have a deficiency in Y."
Why is this so?
Symptoms don't correspond directly to underlying causes
The challenge may be that we are starting from the symptoms. As with various disorders or diseases of the body, the same symptom can reflect a host of different underlying causes. (Think fever or headache.) Conversely, two people with the same underlying infection can present with a different set of symptoms (one person could have a rash and fatigue, the other a fever and headache, for example). The lack of one-to-one correspondence between symptoms and underlying causes is likely even more messy and challenging when it comes to the brain.
The brain is in constant flux, reshaping itself in response to its environment. Thus your brain reflects your unique genetic, developmental, and experiential trajectory, which has created personalized mechanisms and predispositions to certain thoughts, feelings, and behaviors that could differ wildly from others with the same underlying etiology or psychological symptoms.
Causes may go beyond the brain
Of course, you have a body as well as a brain, and the physical processes (healthy or otherwise) in your body have the capacity to influence what is going on north of your shoulders. This means that the root cause could well be outside the brain. Some examples of this: changes in the composition of your gut bacteria may cause psychological symptoms of depression, and the autoimmune response to infections such as Strep and Lyme disease can cause symptoms of OCD.
There is also the challenge of environment. Often your experience of psychological distress reflects your experience of the world around you. We all live lives full of people, situations, and events that naturally have an ongoing impact on our thoughts, feelings, and behaviors, and on the patterns of neural activity inside our brain. And it is also natural for certain life situations to elicit psychologically challenging responses such as sadness, grief, and stress.
To what extent, then, is the environment responsible for these symptoms? Just as poor air quality can cause or exacerbate symptoms of asthma, or elements of diet can exacerbate symptoms of diabetes, so too can elements of the stimulus environment exacerbate mental health symptoms.
Where does that leave patients looking for answers?
Ultimately what matters is the alleviation of your distress. What is also clear is that science has many leads, but not definitive answers. This explains how difficult it is to find the right treatment to match your unique biological and life profile, and why you may have tried several therapies before finding one that works for you (or you may still be looking). That's the bad news. The good news, however, is that although there are still no definitive answers, there are likely many different ways to tackle your distress and many things to try, and therefore no reason to give up hope.
So next time you visit your physician, make sure they are seeing you for the whole person that you are and the context you live in, and that you are both considering all angles when deciding on your treatment plan.
Want to know your mental well-being score?
The Mental Health Quotient or MHQ is an online assessment tool that can give you a sense of your overall mental well-being. It has been developed by Sapien Labs, a not-for-profit organization, to map the diverse landscape of mental health and ill-health across a large cross-section of the global population. Click here to complete your MHQ assessment.