'Mental illness' needs a rebrand

...for it is neither confined to the mind, nor really an illness

Some things have the wrong name.

The Earth is more sea than earth. The ‘dark’ side of the moon is not dark, just remote. Dry cleaning is not dry, and cheesecake contains no cheese. Public schools are private (in the UK at least). A guinea pig is neither a pig, nor from Guinea. Unfortunately, most of your recycling is not recycled.

And then there is mental illness, a raucous array of symptoms that is neither confined to the mind, nor really an illness.

It needs renaming. The very term ‘mental illness’ is pejorative and counter-productive, part of the stigma that makes recovery harder. Words matter.

But to rebrand ‘mental illness’, we need to define it. And the problem here is that the definition is a slippery fellow, changing depending on who you speak to.

For many scientists, it’s biological - a malfunction in the brain or an inherited, genetic tendency, a matter of neurochemistry¹. Others reference trauma and the impact that difficult experiences can have on the psyche and the thought patterns of the brain². For still others, it’s a socio-economic phenomenon, brought about by difficult living conditions that many people face on an often indifferent planet³.

But even this framework - the bio-psycho-social model⁴ - can’t quite wrap its arms around the thing. Why do some people who live in abject poverty suffer from no obvious mental illness while many affluent people do? Why do some survive trauma, even thrive after it, while others buckle? And if it’s biological, what are the biochemical processes that underpin these terrible conditions?

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‘Mental illness’ has been called many things through the ages.

The ancients saw it as the work of angry deities such as the Furies, and spoke of being touched by the ‘hand of the Gods’. Melancholia was a favourite catch-all for centuries. Neurosis, insanity, depression, monomania, delusion, neurasthenia, madness, lunacy, delirium, nervous breakdown… it is interesting that there have been so many attempts to find a suitable word for this shape-shifting entity. Cancer has just been ‘cancer’ since Roman times.

The term ‘mental illness’ is as blunt as some of the old instruments used to treat it

Perhaps we should look at ‘mental illness’ from the other end of the telescope, and ask first: what is mental health?

For me, a healthy mental state is one that is congruous with the world it faces, able to rise to challenges and endure setbacks without any palpable shift in psychological baseline. It is a banal state of robust steadiness. It will of course be tested from time to time by upset, sadness, ennui, grief and even despair, but it won’t shift. You will regress to the mean before too long.

Helpfully, there are some very measurable factors that can give clues as to the state of your mental health. Sleep patterns, appetite, weight and energy levels are all obvious key performance indicators. If the numbers are off, something is afoot. Other red flags are available, but they are less quantifiable: loss of joy or concentration or enthusiasm, panic attacks, nervousness and/or restlessness, rumination and negativity, tearfulness, thoughts of suicide.

These could all be indicators that your baseline has shifted, that your homeostasis, or steady state of self-regulation, is awry. There are plenty of online questionnaires and tools that can help you assess this⁵.

Homeostasis is a biological state of anatomical steadiness; but I think it’s apt to use it for mental health too. It literally means ‘similar state’, conveying the idea of staying the same. Things are optimal, sound, unshifting.

There is something elegantly abstract about the use of Greek in medical terminology. It doesn’t judge, condemn or stigmatise. Perhaps there’s an answer here. If mental health is homeostasis, then could mental illness be renamed… heterostasis? Literally ‘the other state’.

One advantage of such a term is that it conveys the idea that ‘mental illness’ is not fixed. It is not a life sentence, far from it. Most people diagnosed will go on to recover - to return to ‘homeostasis’. Some may then relapse, finding themselves in the ‘other state’ once again. Heterostasis gives the sense that at the moment I am in the other state, the difficult, dynamic, dangerous one. But that it won’t last. It never lasts. I’ll be back soon enough.

So that’s it.

Heterostasis.

You heard it here first.

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When I first worked for a newspaper it wasn’t as a journalist, but as a crossword compiler. I love a brain teaser, particularly as they are a good workout for our minds, with their powers to divert, stimulate, challenge and delight.

So occasionally Headstrong will conclude its weekly with a little puzzle, which I’m calling Braindrops, to keep you guessing into the weekend.

Braindrops (1)

The following two words differ in spelling only in the letters given. Can you guess what they are from the slightly cryptic clues?

_ _ E _ _ - I _ It’s getting ready for take-off…

_ _ I _ _ E _ It’s never going to take off!

Answer next week. Until then…

1. https://www.sciencedirect.com/science/article/abs/pii/S0092867424010869

2. https://www.uea.ac.uk/about/news/article/new-research-identifies-key-mental-health-risk-factors-for-children-after-trauma

3. https://bmjopen.bmj.com/content/9/11/e027530

4. https://pmc.ncbi.nlm.nih.gov/articles/PMC10755226/

5. https://www.mdcalc.com/calc/1725/phq9-patient-health-questionnaire9#next-steps; https://hfh.fas.harvard.edu/measuring-flourishing