Why “mental illness” isn’t a very good name for mental illness…

I know, the title sounds weird. But I promise to explain myself.
It’s true, though: “mental illness” is a poor choice of name. To understand that, let’s take a look at a pretty standard definition of the phrase.

The Oxford dictionaries (which every Nigerian knows, and most likely grew up on—at least the Advanced Learner’s version), defines mental illness thus:

A condition which causes serious disorder in a person’s behaviour or thinking.

And that is totally right, except that as Chimamanda famously said about stereotypes, it is not complete. As I’ve explained in a previous post on this blog, the word refers to illnesses that affect the way people think, feel and act—or emotion, behaviour and thinking. (Notice that “emotion” is missing in the Oxford definition, but that’s not even the incompleteness I’m talking about.)

What is missing is that mental illnesses are not just mental, they are also neurological. They aren’t just problems in the mind, but also in the brain. The idea of “mental” leaves out things in the minds of many who hear it.

First of all, though, a look at misconceptions often included in “mental.”

The problems with “mental”

“Mental” refers to the mind. That’s pretty obvious.

But many people use it with more in mind. Here are a few of the ideas included in many conversations about mental illness.

1. “Are you mental?” Or, “kolo-mental.” Or, “He must be a mental case.” In all of the examples, the word takes on another meaning, as a reference to what we think of as “madness,” or at the least, what we consider eccentric or unusual behaviour.
2. But there is another sense in which the word mental is understood: as a reference to that which is in the mind. Some think that the illness is not something real, the way malaria is real or cough is tangible. Mental illness seems vague and suggestive of something in the person’s mind that is not real to anyone else. “It’s all in their minds,” they believe.
3. And of course, there is the whole issue of possible aggressiveness or violence. The very word “mental,” for many people, conjures up ideas of “Yaba Left” and images of unkempt old people ambling down streets half-naked, muttering to themselves, and prone to irrational and unpredictable behaviour. Not the sort of person anyone would want anything to do with.

The other side of “mental” illness

But all of that is not the real sense of it. Yes, mental illness really does refer to illness of the mind. Except that it’s not just the mind. The brains of people with mental disorders actually show changes depending on the specific disorder.

The changes in schizophrenia are different from those in depression and the ones characteristic of Alzheimer’s are a whole other issue. It’s not clear exactly how the brain changes lead to (or are caused by) to the disorders, but they’re there.

This might look like a small detail, but it’s a really big deal. Because it means what we think of as mental disorders are really physical problems.

They are not just in the mind.

Depression, anxiety disorders, even eating disorders anorexia nervosa, are not merely problems of behaviour or of the mind. They are problems of the brain too. That’s not to say they are nothing more than brain problems, but it does mean that is part of it.

Think of it this way. Your brain contains over 80 billion neurons (or nerve cells) and they are connected to each other in synapses that run into trillions. These connections form circuits that interact with one another in extremely complex ways to coordinate body functions, thinking processes and emotions, and everything else about us.

Now imagine problems with this very intricate circuitry, and you begin to have an idea of not only what may be going on with many mental disorders, but also why they’re so common. It’s not yet clear exactly what is going on, and how specific brain changes lead to particular disorders, but we know enough now to know that a big part of what’s going on with mental disorders is traceable to connection problems.

And we also know that the old theory of chemical imbalance doesn’t cut it. It’s just not that simple.

That’s why we need to start thinking differently about mental disorders. We need to stop seeing them as merely psychological, or even as spiritual, problems. Not because the mind—or even the spirit—is not affected, but because such a focus easily ignores a major part.

It would be like thinking that the headache in malaria is simply a headache, or that the fever is simply a matter of reducing body temperature, when the issue is an infestation of the blood by parasites.

They are not just in the mind—they’re in the body too.

Here is a TEDTalk video by Thomas Insel, director of the National Institute of Mental Health (NIMH), US that explains some of this in more detail. (If you’re having a problem seeing the subtitles, you can get the transcripts here)

Why does all of this matter?

First, here’s what it doesn’t mean:

• It doesn’t mean mental disorders are brain diseases like stroke is. Although brain structure may be affected, the problem is more likely one of circuitry.
• It doesn’t mean that alone is the problem. Like I said in my last post, the experiences a person goes through, and the environment they are in, can affect whether these connection problems actually develop into a disorder.
• It doesn’t mean that medication is always necessary, or that psychotherapy or other forms of treatment are not. Because of the interplay with other factors, these methods remain very helpful.

Why it matters is because:

• It might help us see mental disorders as more than just states of mind, but actual physical problems as real as malaria or sickle cell.
• We might learn to be more sensitive to those dealing with mental illness and not think that they have it because of some weakness in their makeup or from “thinking too much.”
• People might be more willing to consider medical options in addition to whatever spiritual practices they believe in, the same way they (mostly) do with other obviously physical problems.
• With time, and deeper understanding, we could figure out better and better ways to physically deal with it than we have now, and even better understand how the things that work now.

So let’s keep using the words “mental illness,” or “mental disorders,” but let’s not be misled by the words.

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