Historically we have used different models to explain mental distress and different psychological experiences. Currently the framework we use is largely a medical one and experiences have been seen as symptoms of mental illness. People often assume that mental illnesses ‘exist’ in the same way that physical illness exists, which is a common narrative used when addressing stigma and discrimination found in the area of mental health and wellbeing.
However, there are many different theories as to what causes peoples experiences. The idea that they are symptoms of illness, perhaps caused by some sort of chemical imbalance or other problem in the brain, is just one of the theories. And there is no objective biological test such as a blood test or scan for diagnosing mental illness.
There are studies that have found that promoting biological models of mental illness increased prejudice rather than decreased it. Some writers have suggested that presenting problems as an illness has the effect of making them seem mysterious and unpredictable, and the people experiencing the problems as ‘almost another species’. For example, a recent study showed that over a 10-year period of deliberate use of the biogenetic explanatory model for campaigning to reduce stigma has resulted in worsening of most, if not all, aspects of public attitudes toward individuals with mental illnesses. And we can see the effect that anti-discrimination campaigns are having on the public by looking at the results of the 2014 New Zealand Social Survey which reported that only 51.7% of New Zealanders would feel comfortable if their new neighbour had a mental illness, compared to 75% who said that they would feel comfortable if their new neighbour was gay, lesbian, transgender or bisexual.
It is important that services offer people the chance to talk in detail about their experiences and to make sense of what has happened to them. Professionals should not insist that people accept any one particular framework of understanding, for example that their experiences are symptoms of an illness. And people who have experienced trauma and mental distress should be allowed to define their experience how they would like to, without having their situation or reaction pathologised.
This is not to say that viewing mental health in terms of an illness model is not useful for people, because often people can find the comparison with other physical illnesses very legitimising when they have been constantly invalidated. Some people welcome a diagnosis because it implies that they are not alone in what they are experiencing. Ideally people need their own language to discuss their experiences that both validate them without relying on poorly defined ‘medical’ diagnoses.