York and District Mind

Mental illness is very common. About six million people in Britain have a mental illness diagnosis. But there is a great deal of controversy about what it is, what causes it, and how people can be helped to recover.

What is mental illness?

Basically, people diagnosed as mentally ill have feelings or behave in ways which are unacceptable to themselves or others.

The vast majority are treated with psychotropic drugs - drugs that affect the mind or brain - such as tranquillizers and antidepressants. There are more than 300,000 admissions to psychiatric units each year.

Some people find that drugs and other medical treatments are helpful, others do not. For some the treatment is only part of what helps recovery, and not necessarily the main part. Many who have been diagnosed as mentally ill say that being labelled and treated in this way has caused them a lot of hardship.

Because of this, Mind prefers to talk about mental or emotional distress, rather than mental illness. Seeing people's problems with feelings and behaviour as illnesses which require medical treatment is too narrow a view. It discourages us from thinking about the many different influences on a person's life which can cause this distress. And it stops us from exploring the various non-medical options open to people for overcoming their difficulties.

We have positive feelings, such as joy, love or satisfaction, and negative ones, such as fear hatred or guilt. Sometimes we experience an absence of feelings: emptiness or numbness. As a society we share some assumptions about what feelings we should have.

We expect a mother to love her new-born baby. If someone close to us dies, we expect to feel sad. Sometimes we do not have the feelings we expect. A man may complain, 'I love my family, I'm successful at work, but I'm not happy. I feel empty inside.' Or we do not have the feelings others expect. A teenager may feel total despair about all the tragedies in the world. To her, the feelings are justified, but her parents may think she has got everything out of proportion. Most (if not all) forms of mental distress are extreme versions of feelings and behaviour that many of us experience.

Perhaps you have woken up in the middle of a dream and, for a few moments, not known what is real and what is the dream. Imagine not being able to stop dreaming after you have woken. That will give you some idea of what it is like to experience psychosis: a state of mind in which people cannot distinguish between what is real and what is in their imagination. Often what they imagine is frightening and causes them to behave in strange ways.

When our feelings are disturbing and unacceptable to ourselves or others we can be said to be mentally distressed.

We also share some assumptions about how we should behave. In fact our society is based on a complicated set of rules and conventions which we learn as we grow up. For example, we expect to be capable of walking into a shop, choosing what we need and queuing to pay for it. We expect people to walk on the pavement and not in a busy road.

Sometimes our behaviour becomes different from what we or others anticipate it to be. A person who is usually sociable may stop going out and refuse to answer the door to visitors. A previously reliable employee may become very erratic in their work and make lots of disastrous mistakes.

People whose behaviour changes in such ways may decide for themselves that they are mentally distressed, or it may be suggested to them by others.

But not all people whose behaviour is unacceptable are mentally distressed. Take, for example, people who break the law. Only if they are not considered to be responsible for their actions are they treated as mentally distressed. They may still be locked up, but in mental hospital rather than prison.

Feelings and behaviour are closely related. You probably know what it is like to feel nervous, perhaps before an important event. Up to a point it can be useful, making you feel sharp and alert. Beyond that point it has a negative effect. You may lose sleep because your mind is overactive, get a headache or not be able to think straight. Someone with anxiety neurosis feels like that most of the time. Ordinary activities, such as shopping or making a phone call, can make them feel panic-stricken.

However, we do not all share the same assumptions about feelings and behaviour. Men and women, and people from different social classes or ethnic communities may have different views about what is and is not acceptable. Some individuals have very different beliefs from those around them. This can lead to conflicting opinions about who is mentally distressed.

Psychiatrists have classified mental distress into different categories, or diagnoses. Making a diagnosis helps the doctor assess what treatment is needed, and predict what is likely to happen. It can be a relief to the distressed person to be able to name what is wrong. But too often the diagnosis can become a 'label', as though it defined or summed up the person.

Some diagnoses are words in everyday use, for example depression and anxiety. This makes them easier to understand, although their familiarity can mean that people underestimate just how severe and incapacitating these conditions can be. Phobias are fears of objects or situations that most people can face without anxiety: claustrophobia is a fear of enclosed spaces, agoraphobia is fear of being away from the security of the home. A dramatic disturbance in a person's thoughts and feelings, accompanied by behaviour which appears bizarre to others, may lead to a diagnosis of schizophrenia. Manic depression is characterized by periods of deep depression and of very excited behaviour. Mind's series of Understanding booklets covers the main forms of mental distress (see Further reading).

There are limits to diagnosis, however. Every person is unique and their experience of mental distress is unique. A doctor may misread a person's distress, especially if there is a cultural barrier. Different doctors may diagnose the same person in different ways. Simply diagnosing symptoms may mean that not enough attention is given to the whole person and their situation. A person may find meaning in their experience and feel that a medical diagnosis does not do justice to that. Once a diagnosis has been made, decisions about treatment and care might be made that do not apply in your case.

The other problem is when a diagnosis becomes a label. For example instead of being seen as a parent, writer, mechanic, student or whoever who is diagnosed with schizophrenia, you may be seen as a 'schizophrenic' as though this were all there was to say about you. It is important to remember that a diagnosis does not have to determine the course of your life, and it may come to be a minor part of your identity or history.

It is possible to recover completely from mental distress and many people do. They may even emerge from the experience feeling stronger and wiser. Others get over the worst but remain vulnerable and relapse from time to time. Some do not recover and continue to take medication long term. Psychiatrists are not able accurately to predict what the outcome will be for a particular person. Recovery is possible with all types of distress. Unfortunately, people are sometimes told they will not recover. Such statements can become self-fulfilling, as they add to the person's sense of hopelessness. It is important never to give up, whatever you are told.

There are many opinions about the causes of mental distress, but few proven facts. The debate about its causes is part of a wider one, about what makes us the people we are. Do we inherit characteristics from our parents, or are our personalities formed during the course of our lives? And there is another question to consider -what is the relationship between the mind and the body?

Each person's views about the causes of mental distress are shaped by their life experiences, their political or religious beliefs, or their training. The following are some of the possible causes:

Feeling uncared for, growing up scared of a parent, being sexually abused - if your life got off to a bad start you may grow up feeling insecure, and be vulnerable to mental distress.

As we grow up we are often discouraged from expressing feelings; we may even be punished for getting angry, crying or laughing loudly. But feelings which are held in may cause tensions which affect our physical and mental health.

These may be traumatic events, such as the death of a close friend, or longer-term struggles such as being the victim of constant racial harassment or other forms of oppression.

Our body chemistry affects our minds. For example, if we are frightened we produce a hormone called adrenalin. It prepares us to fight or run away. If it is not used up in our physical activity, our minds are left overactive and our bodies tense.

These are the means by which parents pass on physical characteristics, such as hair colour, to their children. It is possible that our genetic make-up also affects our personalities. There may be genes which cause certain forms of mental distress. Millions of pounds have been spent on research but nothing has been proved.

Mental distress may be caused by any number of these factors, and more.

The most powerful image of the mental health system is the large psychiatric hospital on the edge of town into which people could disappear never to be seen again. It is fast being replaced in the public consciousness by images of violence drawn from news reports about homicides by people with mental health problems 'in the community'. Both are very misleading. The vast majority of people diagnosed mentally ill commit no violence. The Victorian institutions are slowly being closed down because it has become unacceptable to incarcerate people with mental health problems and isolate them from their community. Successive governments have been encouraging care in the community and schemes by which mentally distressed people can continue to live in their own homes. For those still needing hospital admission, psychiatric wards in general hospitals are replacing separate mental hospitals.

By far the most common type of treatment is a prescription of psychotropic drugs, given by a GP There are different sorts to calm you down, help you sleep, lift depression or stop you having disturbing thoughts. They have many benefits but also many disadvantages. The great advantage of these drugs is that they can help you to keep going. Millions of people go to work each day, or look after their children, while taking them. Without the drugs they may have lost their jobs or been separated from their families, causing even more distress.

But these drugs do not 'cure' mental distress. At best they reduce the symptoms, while the underlying problems remain. Often they affect people in ways which make them feel worse rather than better. And there are other problems. People taking minor tranquillizers widely prescribed for anxiety and sleeplessness can become seriously addicted to them. Major tranquillizers (antipsychotic drugs) - often prescribed to people diagnosed with schizophrenia - can cause permanent damage to the central nervous system (see Mind's booklet Making Sense of Treatments and Drugs: Major Tranquillizers, Further reading).

Drugs are the most commonly prescribed mental health treatments but there are also talking therapies, and an increasing interest in complementary therapies. Talking treatments include short-term counselling around specific issues such as bereavement, cognitive therapy to help people overcome depressed ways of thinking or phobias, and longer-term psychotherapy looking at underlying personal issues (see Mind's advice leaflet Understanding Talking Treatments and A-Z of Complementary and Alternatives Therapies, Further reading).

In a small but growing number of areas it is possible to be supported through a major crisis either at home or in a residential crisis centre instead of going into hospital. However, most of what is called community care is about helping people with longer-term mental health problems live day to day. It can include day centres, housing with care and support, help with employment skills, support groups, advocacy, social clubs, befriending schemes and welfare rights advice. Some services recognize and respond to the needs of particular groups such as women or black and minority ethnic communities.

Hospital can provide a place of 'asylum', which offers shelter and protection. It can also be an opportunity for the staff to assess your needs and try and find the best way of helping you. Unfortunately, however, a stay in hospital is often a distressing experience. The hospital ward can be drab with little privacy and it can be frightening to be with other people who are acting in a disturbed way. In addition, there may be few opportunities to talk to staff. Most people go into hospital on a voluntary basis. However there are about 27,500 compulsory admissions each year under the Mental Health Act 1983. If you are in this situation it is important that you know your rights (see Mind's series of Rights Guides, Further reading).

In recent years, people who use the services have been meeting together to think about what they want from the mental health system. Above all, they want to have more say in their own treatment. This means being properly informed about the undesirable effects of drugs, for example. It also means being offered choice: talking treatments as alternatives to drugs, and residential crisis centres as alternatives to hospital. They want to be seen as people, not as passive 'cases'.

People may experience mental distress at times throughout their lives, but still develop ways of coping as they learn what helps them to stay well or to come through the bad times. Many people with mental health problems lead ordinary -or indeed full - lives. One of the biggest problems can be discrimination.

With the movement for civil rights for disabled people there has come a growing recognition that discrimination is unacceptable. Disabled people should be able to access employment, education, recreation, financial services and so on like other citizens, and use their abilities to the full. Like any other disabled person, someone with mental distress is disabled by the combination of their limitations and a hostile (or occasionally over-protective) world. People diagnosed mentally ill now have some protection from unfair treatment through the Disability Discrimination Act.

If someone you are close to becomes mentally distressed it is likely to provoke strong feelings. It can be hurtful to see their suffering and you may feel angry if little help is offered. It can also be frightening to be with a person who is feeling desperate or acting strangely. It can disrupt your life and you may find yourself in a caring role you did not choose.

But there can also be a positive side. A crisis can bring people together. You may find yourself expressing more love for each other than before. Hopefully you will have the pleasure of seeing your friend or relative make a recovery. It will be easier to support them well if you can involve other people to share the caring task. It also helps to find someone to listen to your feelings about the situation (see Mind's advice leaflet understanding Caring, Further reading).

If there is one word which describes the general attitude towards our own mental distress it is fear. We are fearful of experiencing painful emotions, of being out of control or of losing all we have. We may also be scared of drugs or of being locked up in mental hospital. On the whole, therefore, we are scared of or unsympathetic towards other people who are experiencing mental distress. The following are some of the ways they experience that ill-feeling or lack of comprehension.

They are often told 'pull yourself together' or 'make an effort', as if they are being deliberately difficult.

We can put a man on the moon and perform heart transplant operations, but we are not very successful at helping people to overcome mental distress.

Employers are often unwilling to offer work to people who have experienced mental health problems.

All this makes it harder for people to recover from mental distress. Fear also stops us all from thinking well about how we can improve our mental health, because we would rather not think about it at all. But there is positive action we can take, and it is well worth doing so.

We are used to encouraged to look after our physical health, perhaps by being urged to give up smoking, taking regular exercise and cutting down the amount of fat in our diets. By following this advice we may not only avoid serious illness, but also positively improve our sense of physical well-being.

Similarly we can take action to improve our emotional well-being. By doing so we also make ourselves less likely to experience mental distress. The following may be helpful.

Learning to relax

This is a skill we should all acquire. There are many books and cassette tapes available, and classes are organized by adult education institutes. Yoga, meditation and massage can all help with relaxation.

Suppose you are mistreated by someone. How easy do you find it to stand up for yourself? It may feel easier to keep quiet, but then anger builds up inside you, causing tension and anxiety. Assertiveness training classes can help you improve your ability to handle these sorts of situations.

Think about how you want to improve your life. How do you want it to be in ten years' time? What small changes can you begin to make now? It is possible to take action to make your life better, however difficult it feels.

Expressing feelings directly may help us to recover from hurtful experiences (getting angry, crying, shouting).

You may know something has gone wrong - perhaps you are drinking too much or your marriage is not working - but it feels easier to ignore the problem and hope it will go away. It probably won't. Usually the quicker you start to deal with a problem the easier it is to solve it.

Most of the advice given here is easier to follow if you have someone you can talk to openly and honestly. It could be a friend or you may find it useful to meet with people who share a similar problem, in a self-help group. Counsellors and psychotherapists are specially trained to assist people to understand themselves better and overcome difficulties in their lives. The advice leaflet Understanding Talking Treatments (Further reading) gives information about self-help groups, counselling and psychotherapy.

There are many ways of trying to understand mental distress. This leaflet has concentrated on views which are currently held in places such as Europe and the USA. In countries and cultures where religion is more important, attitudes may be very different.

It would be reassuring to have more agreed facts about mental distress. As we do not, we each have to think for ourselves, by reflecting on our own experiences, listening to others and staying open-minded.

Perhaps, though, we can all agree that there are millions of people who lead impoverished lives because of mental distress, and that we need to find better ways of preventing mental distress and assisting people who experience it to help themselves.

There are many organizations who can offer help and advice to people who are experiencing distress, and their families and carers. MindinfoLine, Mind's telephone helpline, can provide information on a range of mental health issues, and put you in touch with other national and local organizations and groups. MindinfoLine 0181 522 1728 inside London, 0345660163 outside London. Mon-Fri 9.15 am - 4.45 pm.