Medicalizing Mental Health: A Rational Approach to and Emotional Topic

April 17, 2013

A Primer

Imagine the Mental Health Spectrum as a line across this page that spans from Mental Wellness on the left to Psychosis on the right. We all exist somewhere on this spectrum but where? More importantly, how do we achieve mental wellness and support it? To answer this important question, we must first understand just how this mental health spectrum operates:

  • There are two primary symptoms on the mental health spectrum, Depression and Anxiety, and while one of them may predominate, where there is one there is always the other. 
  • Depression has two separate but related components, loss of interest and sad moodas does Anxiety, fear and worry.
  • Depression and Anxiety increase in severity as they migrate from left to right across the spectrum.
  • Physical Symptoms, such as fatigue; muscle pain (fibromyalgia); abdominal and digestive problems (Irritable Bowel Syndrome; Globus); jaw pain (TMJBruxism); headache (Migraine, Tension); difficulty breathing (Hyperventilation); chest pain and neurologic symptoms (paresthesia; light-headedness) often go with Depression and Anxiety.
    • Depression, Anxiety and the Physical Symptoms that go with them, while perceptually distinct from one another, share many common molecular ingredients in their recipes. Thus, while a person with mental illness can have many symptoms, they all originate from a single molecular disorder within his or her Central Nervous System (Brain and Spinal Cord)
  • Since Depression, Anxiety and Physical Symptoms are present along the entire mental health spectrum, it is the severity of these symptoms, and not the symptoms themselves, that determines a person’s diagnosis. As they travel from left to right, or from the least to the most severe along the mental health spectrum, these symptoms form the following syndromes in their wake Dysthymia/NeurosisUnipolar Depression/Anxiety DisordersBipolar DisordersPsychotic Illness.
  • While severity determines their diagnosis, people with a mental illness can express any or all the milder symptoms to the left of their diagnosis on the mental health spectrum. In other words a person with Bipolar Disorder or even with a Psychotic Illness can some days have only  mild symptoms or even be mentally well much of the time.
  • In women, Menstrual Magnification is the increased severity of Depression, Anxiety and Physical Symptoms that occurs several days before their menstrual period.
  • As with all medical disorders:
    • Mental Illnesses is degenerative, becoming more severe the longer it remains undiagnosed and untreated.
    • The most important step in successfully treating it is to first diagnose it.
    • the goal of treatment is complete remission; the “120/80” of mental health.

Conspicuous by its absence on the mental health spectrum is Attention Deficit Hyperactivity Disorder, or ADHD. Unlike all the disorders of the mental health spectrum, people with ADHD were born with ADHD and it exists on its own spectrum from mild to severe. People born with ADHD are more likely to acquire a disorder on the mental health spectrum than those people who were not born with ADHD. As common as ADHD is, we will never see it unless we are looking for it. Stay tuned; this is the topic of my next post.

End

Mitchell R. Weisberg, MD

Internist/Psychopharmacologist

Founder and CEO

Optimal Performance MD

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