WHAT REALLY IS MENTAL ILLNESS

Mental illness can be described as the exag­geration of personal feelings and consequent behavior to the point where it strikes other people as queer, odd, abnormal, annoying, or dangerous. The distinction between mental health and mental illness is, as we have al­ready noted, a very practical one: a person is mentally ill to the extent that he cannot love or work. Obviously, then, there are all degrees of mental illness, ranging from the very mild to the exceptionally severe.

Two other practical criteria (but not very accurate ones) for evaluating the severity of mental illness can also be set down: (1) Does the victim feel bad enough to seek profession­al or outside help for his distress? (2) Does the physician, usually a psychiatrist, who diag­noses his condition believe that he will benefit by hospital treatment or require hospitalization because he is a risk to himself or a danger to other people?

We have, then, three general classes of mentally ill people. The first, and by far the largest, comprises the millions of odd. emotionally disturbed, continually unhappy peo­ple who stumble through miserable lives without getting or accepting real help for their illness. Many of them are actually sicker than those who see physicians or go to the hospital.

The second class of mentally ill are those who have at least identified their need, often desperate, for help and have sought it. Most neurotics fall in this category.

The third, and smallest, class or group of mentally ill includes those who require or will benefit by hospitalization. A very high proportion of this group are definitely, if tem­porarily, psychotic. This is the class of pa­tients who are generally thought of and shunned as "the mentally ill," but they make up only a small fraction of the total.

The mentally ill are not so evidently differ­ent from mentally healthy, or "normal," peo­ple. Indeed, they are often the same people at different times. When a person finds he can­not eat, sleep, concentrate, or get along with other people for days on end, he is on the road to or in the throes of mental illness and needs help. Mental illness is emotional rather than mental (or intellectual) in origin and content.

It is possible, therefore, to regard mental illness as an extreme protective device adopted by the ego to shield itself from deeper hurts by unconscious conflicts and bludgeoning. To be sure, the cloak of illness is a very poor form of social adaptation and no shield at all against societal disapproval. But for the individual caught in the trap of his own in­ternal emotional strife, mental illness seems for a time at least the best way out of his un­consciously engendered difficulties.

We say "for a time" because the unconscious threats and situational stresses to which mental illness is the response may in time subside, with a disappearance of the symptoms of illness, or the patient may be gradually educated to a better solution than illness to his deep-seated fears. But when he dons the cloak of illness, the patient is saving himself from the inner threat of unthinkable annihilation or deprivation. The illness is an escape. Still when the mind shuts the door on reality, to be governed by inner voices, it is sometimes shut forever.