Mental health: What's normal, what's not (1/3) ---------------------------------------------------------------- By MayoClinic.com What's the difference between mental health and mental illness? Sometimes the answer is relatively clear. Sometimes it isn't. People who hear voices in their heads may have schizophrenia, for instance. And those with grandiose ideas ?who believe they can run the United Nations, even though they have no applicable experience ?may have a form of bipolar disorder. But more often the answer is less clear-cut. If you can't give a speech in public, does it mean you have a disease or simply a run-of-the-mill case of nerves? If you feel sad and discouraged, are you just experiencing a passing case of the blues, or is it full-fledged depression, for which you may need medication? Just what is normal, anyway? The role of culture and science in defining normalcy Determining what's normal and what's not is tricky. Scientists, researchers and mental health experts have wrestled with the issue for hundreds of years, and even today the line between normal and abnormal is often blurred. "There's a huge range of what's normal," says Donald E. Williams, Ph.D., a psychologist at Mayo Clinic, Rochester, Minn. "But there are also many types of mental disorders ?thoughts, feelings or behaviors that are abnormal." What's normal is often determined by who's defining it. Normalcy is ambiguous and often rooted in value judgments particular to a certain culture or society. And even within cultures, concepts of normalcy may change over time, particularly if influenced by evolving societal values or expectations. New medical research and knowledge can also lead to changes in definitions of normalcy. One thing that makes it so difficult to distinguish normal versus abnormal mental health is that you can't simply be tested for it. There's no MRI or blood test for obsessive-compulsive disorder, no ultrasound for depression, no X-ray for bipolar disorder. That's not to say mental disorders aren't biologically based, because they are linked to chemical changes within the brain, and scientists are beginning to map those changes visually. But there's no physiological diagnostic test for mental illness. So how do you define mental illness? Instead of using tests, mental health professionals define mental disorders through their signs, symptoms and the functional impairments they may cause. Functional impairment is the inability to perform certain routine or basic daily tasks, such as bathing or going to work. Signs are what objective observers can document, such as agitation or rapid breathing. Symptoms are subjective, or what you feel, such as sadness or hopelessness. In mental health, signs and symptoms commonly show up as: Behaviors, such as repeated hand washing Feelings, such as sadness Thoughts, such as delusions that the television is controlling your mind Physiological responses, such as sweating Signs, symptoms and functional impairments are spelled out in detail in the Diagnostic and Statistical Manual of Mental Disorders (DSM), a 2-inch thick volume that classifies and describes more than 300 types of mental disorders. The book, published by the American Psychiatric Association, is used by mental health professionals to diagnose everything from anorexia to voyeurism. The first edition of the diagnostic manual was published in 1952, and revisions have been made periodically since. Why is it important to distinguish between normal and abnormal, to attach labels that could ultimately be stigmatizing? Why does a specific diagnosis matter? One reason is that the health insurance industry uses the diagnoses spelled out in the DSM to determine coverage and benefits and to reimburse mental health providers. But more important is that in order to get appropriate treatment, you must know what condition to treat ?and whether it should be treated. How signs, symptoms and function are interpreted... Page 1 of 3 Next >