Mental health: What's normal, what's not?

Introduction:

To determine the parameters of mental health, it is first necessary to define the norm and its main components. The dimensions of mental health are characterized by how an individual interacts with their inner self and with others. These aspects are further determinants of health versus dysfunction at both the individual and communal level which, in highlighting a comprehensive approach, requires cultural sensitivity and a keen sense of context that underscores an understanding of how individual components establish the norm.

Defining Normal

Defining normality is, perhaps, one of the greatest challenges of mental health and the point from which all definitions of dysfunction, maladaptation, and illness spring. The fact that standards and baselines are subject to sociocultural context rather than a standardized universal reference point simply complicates matters further. That said, it is impossible to establish said baseline without considering environmental and social factors, which vary by time period and cultural norms. For example, the United States and the European Union view mental health in different lights— the former from the perspective of individual functioning (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023) and the latter from the Individual’s relationships with the environment (European Commission, n.d.). In reality, each is but one side of the same coin: individual functioning determines environmental engagement, while environmental factors largely influence an individual’s ability to function within a given context. Simply put, in the words of movie and television series character Morticia Adams, “Normal is an illusion. What is normal for the spider is chaos for the fly.” Hence, what is considered non-normative to one group is a regular occurrence in another, creating a mutable criterion that defines normality or dysfunction contextually.

Viewing mental health from the exclusive lens of performance, however, is a gross misunderstanding and distortion of the individual components and underlying factors of human wellbeing. Further, and as previously posited, it is impossible to separate the individual from the environment; thus, behavioral scientists have finally understood and accepted that both nature and nurture form the individual, their perceptions, and their engagement with life itself. Mental wellbeing, thus, is an extension of social health personified in a society’s individual members and this, in turn determines how each culture responds to the community challenge of mental health. In essence, there are no true absolutes in mental health because it exists along a continuum, subject to the variances of time, event, and individual and cultural perception of both wellness and illness. That said, the underlying common and unifying thread is functionality, without which an individual may not progress— much less thrive, within their unique or global spheres.

In discussing functionality, resilience, coping strategies, and perception of reality deeply affect the definition of mental health and wellbeing (Canadian Mental Health Association, 2015; Holland, 2023), with a baseline established at the intersection between the individual norm and sociocultural criteria. For example, in an extraverted culture, an introverted individual may be viewed as dysfunctional, reflecting communal Theory of Mind— which, by virtue of viewing the world from a personal scope, tends to assign equivocal attributes to others based on the self- perception rather than objective fact or observation. If, however, the individual functions within parameters that are ordinary to their person, involving healthy coping strategies, self-agency, critical thinking, and perceptual flexibility within their general scope and ability, this may be considered “normal,” even if it is not in line with the general views of society. Hence, the perpetual conundrum of defining normality, as sociocultural context may clash with the established parameters of behavioral science, a fact that affects mental health and illness identification, as well as the access, availability, and quality of mental health services.

Dimensions of Mental Health

The main dimensions of mental health include psychological, spiritual, emotional, physical, and social wellbeing. Just as the proverbial defective link can compromise the integrity of the entire chain, so too do these dimensions influence one another to the benefit or detriment of the individual. Further, each individual forming a link in the chain reflects on the structure and soundness of society as a whole. To this effect, the importance of understanding the underlying structures of wellness and their interaction with and dependence upon one another cannot be overstated.

Overall wellbeing is about connection. Just as healthy lifestyle habits greatly impact physical health and disease prognosis, mental health relies on the needs of each dimension being met and balanced to the degree that it is possible within a given circumstance. Barring the unlikelihood of perfect balance, mental wellness requires at the very least the activation of functioning compensatory mechanisms to offset the consequences of the situational discrepancy. In simple terms, environmental factors impact both an individual’s wellbeing and their interactions with others, often serving as determinants of maladaptive behaviors, mitigating factors that lend context to the circumstance, or protective elements that can counteract damage. For example, addiction goes beyond the habitual and biochemical processes occurring within the individual, encompassing their regular haunts and relationships, further driving and facilitating access to the damaging substance or the circumstances that lead to addiction as a coping mechanism. To counter this microenvironment, an integrated approach to mental health is necessary, acknowledging the multidimensionality of the individual and addressing the needs that define health and wellness in relation to the self and to others.

Disfunction and Maladaptation

Mental dysfunction and maladaptive behaviors can occur when there is a glitch in ordinary mental functioning, which can be caused by internal or external factors. According to the American Psychiatric Association’s (APA) Diagnostic and statistical manual of mental disorders, 5th edition (DSM-V; 2013), mental disorders are identified by the presence of clinically significant disturbances (p. 20) in an individual’s functional capacity. It is also notable that the same source does not consider culturally normative responses, nor personal deviances or dysfunctions, to fall under the category of mental disturbance unless functionality is seriously affected. This is not to say that adaptations cannot take a dark or unwholesome turn; rather, it reinforces the idea of individuality within the standardized practice of diagnosis and treatment of mental health disorders. For example, an individual in a highly stressful situation or occupation may adapt repetitive actions that may appear illogical to the casual observer, yet this adaptation (or maladaptation) serves a realistic purpose to the individual in question. In short, it is important to bear in mind that every behavior serves a purpose— a point that forms the basis of both diagnostic criteria and the scope intervention, when necessary.

When mental health is affected, personal functionality, while perhaps the first casualty in the mind’s war with itself, is by no means the only victim. The individual’s ability to engage with their environment and sustain healthy relationships are strong markers of failing wellness that may be more apparent than personal functioning. While the effigy of the continuously nervous or unkempt individual may evoke stereotypical images of anxiety or depression, respectively, these no more than misleading tropes that overlook the complexity of the relationships between the underlying mechanisms of overall mental health. Further, this uncomfortable fact can lead to the true signs of maladaptation or distress passing unnoticed and, therefore, unaddressed. To complicate matters, risk factors for mental dysfunction are not always obvious, such as genetic tendencies coupled with environmental stressors that combine to overwhelm the individual’s ability to cope. After all, a marked change in personality (Mayo Clinic, 2021) is easier to identify than a subtle behavioral change that appears gradually over time. Thus, the reaction to an Immediately traumatic event is more plainly visible than the cumulative effects of stress over poor health or financial hardship, both of which may elicit similar behavioral responses though the latter may be more subtle than the former.

So, what are the signs of altered mental functioning? The answer is both simple and complex: when the ordinary patterns of an individual’s most common responses are altered to a significant degree and duration, without appearing to be in direct response to a particular event or circumstance. Some typical alterations include sleep disturbances, debilitating fears or feelings of inadequacy, self-isolation, loss of energy and/ or motivation, engaging in risky behaviors, inability to perform previously routine tasks, severe changes in mood or thought patterns, and cognitive changes, such as altered memory capacity (SAMHSA, 2023). Other markers include illogical thinking, changes in regular routines, and uncharacteristic behaviors coupled with other previously-mentioned symptoms (APA, 2022).

A Holistic Approach

Resilience and psychological flexibility are key to overcoming difficulties, whether natural disasters, social upheaval, or personal crises; however, just as mental health is about connection, so too, should the approach to long-term well-being be considered. This is particularly relevant to a world that is just beginning to recover from a global pandemic that necessitated social distancing, combined with multiple ongoing natural and man-made disasters, which have left behind a multitude of social, economic, and environmental consequences. While it is true that most clinical sources will provide some guidelines stressing the importance of self- care, such as meditation, communing with nature, or journaling, these gems of advice, while well-meaning, may not always be generalizable across the board to personal circumstances or cultural requirements, or even reflect the current realities and possibilities within social constraints. Further, personal wellness is often treated as separate from social integration,

creating a misleading ideal that one is possible without the other, all while lamenting the failing social paradigms that often lead to individual and collective mental crises.

The universality of mental health parameters depends largely on cultural sensitivity and meaning, in which environmental adaptation is bound to social context. For example, to overcome taboos regarding mental disorders and services, it is first necessary to address the underlying structures that created the parameters of social functioning within a cultural context before establishing a connection to wellness that satisfies both the needs of the individual and the designations of the community. Also, community safety nets are built into a society’s perception of the individual as a partial unit of a larger whole, as shown by previous studies that found that the strength of such networks is a determining factor of both individual wellness and the need for mental health services (Triliva et al., 2020). At the individual level, community support affects self-esteem, self-agency, self-worth, and the sense of purpose and belonging, all of which foster resilience by providing group mechanisms for overcoming adversity. This is particularly important to developing nations, where access to regular health services may be limited or beyond most citizens’ reach, and perception of mental health may be distorted through poor information or the need to embrace conformity (World Health Organization [WHO], 2022).

In the Gestalt tradition, the whole is greater than the sum of its parts, wherein each acts upon the other, both affecting and defining the functioning of each through interacting patterns (Rock & Palmer, 1990). This concept was considered ground-breaking at the beginning of the 20th century, wherein the field of behavioral science was just beginning to be recognized and defined. Practitioners began to acknowledge that the components of mental health, beyond the observable manifestations, created an underlying network of mechanisms that is still relevant today— a necessary basis for a holistic approach to wellness. It is an acknowledgment that mental health is not a separate component of the human condition but the starting point of all wellbeing. Mental health is a renowned pillar of epidemiological considerations, human rights development and advancement, and socioeconomic growth (WHO, 2022), making access to relevant quality care a social barometer. The prevention of physical diseases and many social maladies begins with the understanding of mental health and the role it plays in daily life. Hence, the recognition of defining parameters of normality within context serve to shape the future, dispelling misconceptions, reducing misdiagnoses, and improving the overall quality of life at both the individual and community level. Thus, normal mental health should be viewed through the lens of an expression of thriving functionality, relationships, and the enduring spirit of the human condition.

References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
American Psychiatric Association. (2022). Warning signs of mental illness.
https://www.psychiatry.org/patients-families/warning-signs-of-mental-illness
Canadian Mental Health Association. (2015)
What’s the difference between mental health and mental illness? https://www.heretohelp.bc.ca/q-and-a/whats-the-difference-between-mental-health-and-mental-illness
Holland, K. (2023). Mental health basics: Types of mental illness, diagnosis, treatment, and more. https://www.healthline.com/health/mental-health
Mayo Clinic. (2021, December). Mental health: What’s normal, what’s not?
https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/mental-health/art- 20044098
Rock, I., & Palmer, S. (1990). The legacy of Gestalt psychology. Scientific American, 263(6), 84–90. https://doi.org/10.1038/scientificamerican1290-84
Triliva, S., Ntani, S., Giovazolias, T., Kafetsios, K., Axelsson, M., Bockting, C., Buysse, A., Desmet, M., Dewaele, A., Hannon, D., Haukenes, I., Hensing, G., Meganck, R., Rutten, K., Schønning, V., Van Beveren, L., Vandamme, J., & Øverland, S. (2020).
Healthcare professionals' perspectives on mental health service provision: A pilot focus group study in six European countries. International Journal of Mental Health Systems, 14, 16. https://doi.org/10.1186/s13033-020-00350-1
World Health Organization. (2022). World mental health report: Transforming mental health for all.
https://www.who.int/teams/mental-health-and-substance-use/world-mental-health-Report