The boundaries of mental illness


Isn’t everyone a little mentally ill? This seems to be the prevailing idea on my FB feed via memes. One of these memes says, ” relax…we’re all crazy, its not a competition”. When I see this I feel annoyed but at the same time I wonder is there a clear boundary between normal and abnormal? As someone who has experienced psychotic depression, OCD and Dysthymia I’m annoyed because that large of a spectrum invalidates my difficulty to a large degree. I think these people mean well because they are trying to include me as normal but on the other hand  saying that I don’t have much to complain about.


The competition part of the meme is particularly interesting since this is the feeling that I get from many people regarding mental illness or any other condition like chronic fatigue which is hard to distinguish from normal. I have long learned not to bring up my problems in anticipation of competitive people. Unfortunately this includes medical doctors who think they are more fatigued than anyone else.

The ability to function well has often been where the line has been drawn between normal and abnormal. This is probably the most practical way to make a distinction however I always wonder function at what level? Are you talking about brushing ones teeth or doing calculus? What complicates this further is that depression often strikes when ones abilities are uncertain, often in college.

People on the antipsychiatry side, such as Moncrieff, are not helping this problem either since they emphasize the lack of objective physical evidence for mental illness. This is good in a way since it will encourage new and innovative thinking regarding mental illness but bad because it reinforces the idea that people with mental disorders some how lack will power.

While it is true that physical evidence is lacking via lab tests this doesn’t mean that at some point in the future there won’t be some test. I find this obsession with the past and present on the part of antipsychiatry somewhat odd. Jung might say these people tend to prefer sensing because they focus mainly on the past and present while people who prefer intuition focus more on the future.

As someone who prefers intuition I tend to focus on recent research and consequently the future. At present there appears to be some hope regarding research focusing on inflammation, the microbiome, sleep, diet and a variety of genetic studies.

Here is an excerpt from one article discussing research on inflammation and it’s relationship to glutamate. The idea that glutamate plays a major role in mental illness is not new but it’s relationship to inflammation and depression is new and exciting to me.

“Our results suggest that inflammation markers can guide us to which depressed patients respond best to glutamate blockers,” says lead author Ebrahim Haroon, MD, assistant professor of psychiatry and behavioral sciences at Emory University School of Medicine and Winship Cancer Institute. “This could be an important step toward personalizing treatment for depression.”

“Still, we think that one of the ways that inflammation may harm the brain and cause depression is by increasing levels of glutamate in sensitive regions of the brain, possibly through effects on glia,” he says.

We focused on the basal ganglia because we had previously seen that a treatment for hepatitis C virus that arouses inflammation and can trigger depressive symptoms could also increase glutamate levels there,” Haroon says.

Most recently a gene that is involved in synaptic pruning has been recently implicated in schizophrenia. So, there is still some hope and reason to believe eventually there will be a physical basis for mental disorders. Perhaps the boundaries of pathology will have to change as well since there is still much that we don’t know about the nervous system.