Mental health and mental illness are distinct, though related, constructs.
With everybody feeling the effects of isolation and heightened anxiety, boredom and reduced activity, the stigma around mental health is at an all-time low (Dewa & Kilkenny, 2020; Gold, 2020).
The recognition that we all have mental health — and that COVID-19 has put that mental health under threat — is more widely acknowledged and discussed than ever before. Even asking for help for these mental health challenges has entered the mainstream. Mental illness, on the other hand, has not benefitted from this awakening. How can this be?
Mental health and mental illness are not two sides of the same spectrum. Instead they are two separate — though related and covarying — constructs.
Mental health is something that we all have. It represents our resililence, stress tolerance and coping mechanisms. Imagine mental health as a scale from minimum mental health (-10) to neutral (0) to maximmum mental health (+10) and over time, it can vary.
Perhaps before the pandemic started you felt that your mental health was great — maybe +8-+9. Life was going pretty well and when bad things did happen or worries mounted you were able to cope with these stressors fairly effectively. But when pandemic hit perhaps you became isolated, fearful and lethargic. Long hours spent doomscrolling and a lack of access to your usual social support led to feelings of anxiety and sadness and you just couldn’t rebound as well as you used to. Perhaps now you would rate your mental health as relatively poor (-5–6).
So you practice some self-care, eat well and exercise, chat with a friend or seek the help of a counsellor and you start to rebuild your resilience back. Slowly your mental health improves, first to neutral and then to good. And perhaps the pandemic gave you a boost when vaccines were rolled out and lockdown measures were eased. Your mental health recovered even more and you found you were ready to face challenges once more (mental health = +3-+6)
Mental illness is a different construct altogether. We do not all have mental illness — only about 1-in-4 of us does at any given time — though as many as half of us will struggle with a mental illness at some point in our lives.
If you are one of the 3-in-4 of people who are not struggling with mental illness, your score remains at zero. But for those who are struggling, your illness lies on a spectrum and will change as time progresses. For some this illness will be acute, manifesting and then resolving in a finite amount of time, with or without treatment, returning you to a score of 0. For others the course of their mental illness is more chronic and they will move between periods with more severe mental illness or less over time, but always having some measure.
Let me illustrate with an example. I live with bipolar 2 disorder which is a chronic and incurable mental illness that is relapsing and remitting throughout life (that means, my symptoms are sometimes worse and sometimes better, changing over time). Right now I am in a depressive episode and would rate the severity of my mental illness at moderate-to-severe, so +7 or so. It waxes and wanes as this depressive episode is prolonged, but I know from experience that once the psychosocial stressors of the pandemic are reduced and I find a good medication combination the symptoms of my mental illness will improve and eventually remit, lowering my score and ultimately returning me to a score of “0” on the mental illness scale. I will remain at zero until at some point in the future I will doubtless relapse once again placing me on the positive side of the spectrum, and so on.
I realize that none of the foregoing is particularly revolutionary, but what may be less understood is the following: even while my mental illness is particularly severe, that doesn’t necessarily mean that my mental health is poor.
Let me say that again another way: a high score on the mental illness scale does not necessarily equate to a low score on the mental health scale. That is often the case (meaning, mental health and mental illness tend to covary) but they are two different constructs and do not necessarily co-occur. The interaction looks like this:
When the pandemic hit, my mental health (like many people’s) worsened with the attendant worry, fear and isolation (down to -8 or so). And concurrently, I entered a depressive episode. My mental health worsened and with it my mental illness took a hit. I wasn’t coping well or showing much resilience (low mental health) and with that the symptoms of my chronic mental illness increased, launching me into a relapse. But as the pandemic went on, I spent a significant amount of time (like many people) working on my mental health — quitting the doomscrolling, paying attention to diet and exercise, being more intentional about connecting with family and friends, and taking time for self-care. And while this improvement in self-care and coping can improve the symptoms of some mental illnesses (again, they covary) this is not always the case. For example, at this point, while I would rate my mental illness at that moderate-to-severe +7, I would rate my mental health at a healthy-and-coping +5.
My best friend, on the other hand, did find her mental health slipping when pandemic started but (perhaps in part due to her being a busy front-line worker) didn’t have the time to mindfully attend to it. She doesn’t have mental illness, she is just languishing — not ill but just not thriving. Her resilience and coping are low and she is run down. A vacation, a bit of self-care (eating healthily and getting some good sleep) and a chat with a counsellor might be all she needs to improve her mental health and start feeling better.
Mental illness remains a mystery to many, one shrouded in fear and shame. Our cultural stigma — “collective wisdom” — tells us that people struggling with mental illness are less capable at least, but possibly also weak, lazy, pessimistic, sucks on the system, dangerous and potentially violent. It takes immense courage and insight to admit to oneself that there is a problem, much less to reach out to others and seek help. Despite the fact that up to one half of us will struggle at some point in our lives, only 43% of those who need help actually have their treatment needs met. Forty-two percent of Canadians are unsure whether they would socialize with a friend who had mental illness, 55% would not marry someone with mental illness, and only 50% of Canadians would tell friends or coworkers that they had an illness (CAMH, 2022).
While it is undoubtedly excellent that the COVID-19 pandemic has stimulated conversation and understanding and has helped to destigmatize mental health, the stigma around mental illness remains pervasive and damaging. The best way to destigmatize mental illness is through what researchers call “Contact”. Attitudes change most effectively when we learn that our family, friends and colleagues are the people we know and love, with or without mental illness. One relationship at a time we share our struggles and learn first hand that the cultural- and self-stigma of mental illness is simply false.
Because we all have mental health, and we all love someone with mental illness.
References:
Centre for Addiction and Mental Health (2022). Mental Illness and Addiction: Facts and Statistics. Accessed from: https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics on January 29, 2022.
Dewa, L.H.; Kilkenny, C. (2020). Rapid response to: Social distancing in covid-19: what are the mental health implications? British Medical Journal. 369:m1379 Accessed from: https://www.bmj.com/content/369/bmj.m1379/rr on January 29, 2022.
Gold, J. (2020). Could COVID-19 Finally Destigmatize Mental Illness? Time. Accessed from: https://time.com/5835960/coronavirus-mental-illness-stigma/ on January 29, 2022.
