Mental health: What's normal, what's not (3/3) ---------------------------------------------------------------- By MayoClinic.com (Continued...) Mental health as an evolving continuum Despite these criteria, a precise definition of normal mental health remains elusive. The Diagnostic and Statistical Manual acknowledges the difficulty and resorts to defining mental disorders as behavioral or psychological syndromes or patterns that cause distress, disability in functioning, or a significantly increased risk of death, pain or disability. And that syndrome or pattern can't just be an expected and culturally accepted response to a particular event, such as grieving the death of a loved one. The Surgeon General's 1999 report on mental health states that mental disorders are "health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning." By most accounts, mental health and mental illness don't have well-defined boundaries. "I think of it more as a continuum than an absolute," Dr. Fisher says. Not only is it a continuum, but it's an evolving continuum. In some ways, this is no different from the diagnosis or classification of physical disorders. For years, a blood pressure of 120/80 millimeters of mercury was considered normal, for instance. That changed overnight in May 2003. Now with that blood pressure measurement, you'd be diagnosed with the abnormal condition of prehypertension, at risk of life-threatening cardiovascular complications. Just as with blood pressure, new medical information can lead to changes in the classification of mental disorders ?new ones will be added while existing ones will be removed, or the associated signs and symptoms will be modified as new opinions develop over time. Today, some mental health experts, for instance, are proposing that the premenstrual signs and symptoms many women experience every month be classified as a mental disorder ?premenstrual dysphoric disorder. Revisions may also reflect evolving social and cultural attitudes. Homosexuality, for instance, used to be classified as a mental disorder but was removed from the Diagnostic and Statistical Manual in 1973. To treat or not to treat: Therapy not always necessary Even if you do have a diagnosable mental disorder, it may not pose a problem in your daily life to such an extent that it requires treatment. "It can be abnormal but be OK," Dr. Fisher notes. Consider spiders, for example. You may have a terrible fear of spiders, but if you never encounter spiders, or you can get someone else to handle them for you, that phobia may have little or no impact on your life. It doesn't impair your ability to go about your normal routine. "Would we recommend therapy in a case like that?" Dr. Fisher asks. "No. The condition may be diagnosable but not require therapy. You're in need of therapy when something impairs your functioning." Some critics even contend that too many characteristics or quirks are being pathologized ?labeled abnormal ?to make money. The pharmaceutical industry in particular has come under fire for bringing new drugs to market to treat recently labeled conditions that used to be chalked up to harmless eccentricity. But there is a bit of good news amid the controversy. "We have a lot of effective treatments for the things out there that are considered abnormal," Dr. Williams says. "Chances are, something is going to help you." < Back Page 3 of 3