Notes on Mental Health vs Mental Illness (Transcript-Based)
Distinction: Mental Health vs Mental Illness
You can have positive mental health and also have a mental illness. You can have positive mental health, but still have a mental illness. You can have no symptoms of a mental illness, but have poor mental health.
The talk emphasizes the difference between mental health (a state of well-being) and mental illness (a clinically significant disturbance in cognition, emotion, or behavior).
Examples of ebbs and flows in mental health: high stress, overwhelm, anxiety, or low mood occurring at different times (e.g., during exams) without constituting a mental illness.
The idea: ebbs and flows are normal; illness is a more persistent, clinically significant disturbance that impairs functioning.
Practical on-campus observation: activities like puppy yoga are part of efforts to boost mood, but may not solve underlying mental health issues.
Mental Health Problems vs Mental Illness: Key Concepts
Mental health problems are challenges that interfere with enjoyment of life but are usually short-term and may resolve quickly.
A mental illness involves a clinically significant disturbance and impairment in one or more areas of functioning (cognition, emotional regulation, behavior) and often distress or suffering.
If mental health problems resolve quickly and do not cause significant disability, they do not meet diagnostic criteria for mental illness.
Mental health problems can be reactions to stressors (school pressures, work stress, family conflict). They can be normal ebbs and flows, not necessarily illness.
The talk reinforces the importance of distinguishing temporary mental health challenges from mental illnesses when preparing for exams or evaluating needs.
Mental Status Exam and Psychological Testing: What Clinicians Do
Mental Status Exam (MSE): a structured set of observations and questions to assess current mental state.
Components commonly observed: appearance, attitude, behavior, speech, mood, thought process, perception, memory, concentration, judgment.
Example task for concentration/memory: subtract 7 from 100, then subtract 7 again, then 7 from that result (tests concentration, working memory, calculation).
Psychological tests exist (thousands) to assess specific functions (short-term memory, intelligence, personality). They provide data points in time but may be limited as snapshots and may not capture overall mental health.
A key limitation: a test or brief observation may show a person as well at a given moment even if they experience illness at other times; mental health is dynamic.
Real-Life Illustrations and Narrative Elements
The movie Smile example: a therapist assesses whether crisis symptoms point to mental illness or something else; introduces the idea that early impressions can be misleading.
Howie Mandel and OCD: a public figure’s story illustrates: OCD involves uncontrollable, recurrent thoughts and compulsions that cause distress and impairment; highlights the importance of education, reducing stigma, and accessing appropriate care (e.g., NOCD app and therapy).
Stigma and help-seeking: personal stories show how stigma can delay diagnosis and treatment, and how sharing experiences can reduce stigma and help others seek help.
Epidemiology in Canada: Population-Level Insights
Self-rated mental health data (Statistics Canada): respondents 12+ rate their mental health as excellent, very good, good, fair, or poor.
2019 data (n ≈ 65{,}000): about 65\% rated their mental health as very good or excellent; about 10\% rated it as fair or poor.
Epidemiology: the study of health and illness distribution in populations; helps identify risk factors and targets for interventions.
Mental Health Commission of Canada (MHCC) projections (based on 2011 data): by the time Canadians reach age 40, approximately 50\% will have or have had a mental illness; by age 90, about 65\% of men and 70\% of women will have a mental illness.
These projections imply a large lifetime burden, with many cases shorter in duration and others long-lasting or recurring.
Across age groups, jumps are anticipated, with dementia and schizophrenia among notable increases in older ages; gender differences show men underreporting more than women.
Diagnostic Classification: DSM and Related Concepts
Diagnostic and Statistical Manual of Mental Disorders (DSM): official definitions and criteria for mental disorders used in North America (DSM-5).
DSM-5 controversies: loosening criteria (more people labeled with mental illness) to improve access to treatment, versus concerns about false epidemics and over-medication, higher costs, and potential misuse.
The DSM provides structured categories and criteria but is not without debate about thresholds and societal impact.
Major Diagnostic Categories and Core Concepts
Mood disorders
Depressive disorders (major depressive disorder, persistent depressive disorder): depressed mood, fatigue, sleep changes, worthlessness, hopelessness; variability in severity and disability.
Bipolar disorder (manic-depressive illness): mood cycles between depressive states and manic/hypomanic states, with high energy, risk-taking, etc.
Significance: mood disorders are among the most commonly occurring mental illnesses globally and in Canada; broad spectrum from mild to severe and treatment-resistant forms.
Anxiety disorders
Generalized Anxiety Disorder (GAD): chronic worry and anxiety across multiple domains; symptoms include fatigue, insomnia, irritability.
Panic disorder: recurrent panic attacks.
Social anxiety disorder: fear of specific social situations.
Specific phobias (e.g., fear of heights, clowns): excessive fear of particular objects or situations.
Agoraphobia: fear of environments perceived as unsafe or lacking easy escape.
Lifetime prevalence estimates for GAD range around 15\% - 34\% (varies by study/definition).
Obsessive-Compulsive Disorder (OCD) and related disorders
Obsessions: intrusive, persistent thoughts or impulses.
Compulsions: repetitive behaviors or mental acts performed to reduce distress.
Examples: excessive handwashing, ordering, checking; hoarding; body dysmorphic disorder; hypochondriasis (health anxiety).
Adjustment disorders
Distress and impairment in response to a identifiable stressor (e.g., bereavement, job loss) that exceeds normal bereavement reactions and persists beyond expected timeframes.
Feeding and eating disorders
Not limited to body weight concerns; examples include pica (eating nonedible materials like dirt or paper) and other feeding disorders.
Case discussions highlight that anxiety and OCD can influence eating patterns and body image.
Personality disorders and related traits
Enduring patterns of thinking, feeling, and behaving that cause distress or impairment.
Examples: borderline personality traits (emotional volatility, unstable relationships), detachment, negative affectivity, dissociality, perfectionism.
Substance use disorders (SUD) and related concepts
Spectrum from abstinence to problematic use to dependence and addiction.
Addiction is an older term; modern language emphasizes SUD, dependence, withdrawal, and compulsive use despite harm.
Dependence involves physiological changes and withdrawal; addiction involves compulsive use and impairment even if there is a desire to stop.
Withdrawal symptoms can be severe (e.g., opioids) and drive continued use to avoid withdrawal.
Other relevant topics mentioned
Spectrum of drug use: abstinence, medical/beneficial use, nonproblematic recreational use, potentially harmful use, SUD.
Maintenance therapy examples: methadone or Suboxone for opioids as a harm-reduction/withdrawal-management approach.
Emerging and controversial approaches: ibogaine (psychedelic) discussed as a potential, but debated, option; anticonvulsants and psychedelics (ketamine, MDMA, psilocybin) under study for therapy.
The interplay of biology, psychology, and social factors in SUD and mental health.
Cannabis, Alcohol, and Tobacco: Usage, Effects, and Policy
Cannabis (THC and CBD)
Used recreationally and medically (e.g., chronic pain, nausea during cancer treatment, MS symptoms).
2017 Canadian data: ~11\% of Canadians 15+ reported use in the past year; among past-three-month users, ~32\% used daily or almost daily; ~37\% reported medical use.
Legalized in Canada in 2018 with objectives: (1) protect public health and safety; (2) keep cannabis away from youth; (3) redirect profits to government and curb illegal markets.
Health harms increase with frequency of use; potential links to psychosis/psychosis risk, motor vehicle accidents, respiratory problems, low birth weight when used during pregnancy.
Cannabis use disorder is a concern; harms increase with frequency and potency (THC content).
Alcohol
Widely used and socially accepted; a national poll reported that 80\% of Canadians 15+ drank in the previous year; 20\% drank at levels above low-risk guidelines.
Alcohol-related disease burden remains high and is a leading cause of preventable death; guideline values and terminology vary; low-risk guidelines referenced in class discussions.
The lecturer notes a claim that alcohol is a carcinogen; debates around exact guideline values and public health messaging.
Tobacco (nicotine)
Initiation historically linked to European colonization; nicotine is the main psychoactive substance in tobacco.
Rapid brain effects on dopamine pathways; dependence develops over time.
WHO estimates tobacco use causes about 6\,000{,}000 deaths per year globally; leading preventable cause of death.
Canadian data (2017): ~11\% daily smokers and ~4\% occasional smokers; a historical decline in smoking prevalence.
Other substances and notes
The gap between “beneficial” medical uses and “harmful” use is nuanced; examples include cannabis for pain relief, ketamine-assisted therapy, MDMA for PTSD, psilocybin in research contexts.
The difference between nonproblematic/recreational use and problematic use depends on functioning and impact on life (work, school, relationships).
The need to differentiate between abstinence, medical/beneficial use, and nonproblematic use versus harmful use or SUD.
Low-Risk Guidelines and Public Health Considerations
Canada’s public health framework (CCSA and related bodies): attempt to communicate low-risk guidelines, promote harm reduction, and reduce adverse health outcomes.
Cannabis-specific guidelines:
Start later in life to protect developing brain.
Favor lower-THC products; avoid synthetic cannabis.
Prefer non-smoking routes (edibles, topicals, vaping): note vaping has its own risks; smoking cannabis is more harmful to lungs.
Regularly re-evaluate risks with evolving evidence.
Alcohol guidelines and debates: public health messaging around low-risk drinking, cancer risks, and overall health impacts.
The public health aim: reduce harm, prevent initiation among youth, lower the burden of disease from substances, and recognize broad societal and policy implications.
Real-World and Ethical Implications
Stigma and public perception: personal stories (e.g., OCD, OCD treatment access) emphasize reducing stigma to encourage help-seeking.
Screening and detection: teachers and parents may miss subtle mental health issues during remote learning or limited face-to-face contact; importance of supportive environments and accessible resources.
Policy debates: DSM-5 criteria changes raise concerns about over-diagnosis, over-medication, and cost; proponents argue broader access to treatment and support.
Holistic care: treatment involves medications, psychotherapy, social supports, lifestyle changes (sleep, exercise), and community resources.
Economic and social factors: unemployment, financial stress, and social isolation (exacerbated by pandemics and wars) influence mental health trajectories across populations.
Connecting to Broader Concepts and Practical Implications
Epidemiology links: population-level data helps identify most affected groups (e.g., female and LGBTQ students during the pandemic) and informs targeted interventions.
Mental health literacy and anti-stigma campaigns: understanding conditions, seeking help, and reducing shame promote better outcomes.
Practical exam relevance: understanding the difference between mental health status and clinical illness; recognizing when to refer for professional assessment; appreciating the role of social determinants.
Ethical considerations: ensuring accurate labeling, avoiding false epidemics, balancing access to treatment with appropriate diagnostic criteria, and considering the risks of pharmacological interventions.
Quick Reference: Key Numbers and Concepts (LaTeX-style)
Persistently sad or hopeless among surveyed students: 44\%
Emotional abuse in the home: 55\%
Parents who lost a job: 29\%
National respondent sample (CDC-style study): 8{,}000 students (approx.)
Canadians rating mental health as very good or excellent: 65\%
Canadians rating mental health as fair or poor: 10\%
MHCC projection by age 40: 50\% will have or have had a mental illness
MHCC projection by age 90: 65\% of men and 70\% of women will have a mental illness
Lifetime prevalence for GAD: 15\% - 34\%
Cannabis past-year use (Canadians 15+ in 2017): 11\%; daily or near-daily use among past-3-month users: 32\%; medical use among past-3-month users: 37\%
Alcohol consumers in past year (Canadians 15+): 80\%; above low-risk guidelines: 20\%
Global tobacco deaths per year (WHO): 6\times 10^{6}
Population-level impact: DSM-5 changes and debates, prevalence estimates by category (e.g., mood disorders, anxiety disorders, OCD, phobias, adjustment disorders, eating disorders, personality disorders, SUD)
Note on terminology: Addiction is an older term; contemporary language emphasizes Substance Use Disorder (SUD) and dependence, with withdrawal and tolerance as key features.
Appendix: Glossary of Key Terms
Mental health: a state of well-being in which individuals realize their abilities, cope with normal stresses of life, work productively, and contribute to their community.
Mental illness: clinically significant disturbances in thoughts, emotions, or behaviors that impair functioning and cause distress.
Mental Status Exam (MSE): systematic assessment of a patient’s appearance, mood, speech, thought, memory, concentration, perception, judgment.
DSM-5: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; standard classification system for mental disorders in North America.
Mood disorders: disorders characterized by disturbances in a person’s mood (depression, mania, or both).
Anxiety disorders: disorders characterized by excessive fear or worry.
OCD: Obsessive-Compulsive Disorder; intrusive thoughts with repetitive behaviors.
Pica: eating nonnutritive substances.
Adjustment disorder: emotional or behavioral symptoms in response to an identifiable stressor occurring within 3 months of the onset of the stressor.
Substance Use Disorder (SUD): pattern of use leading to clinically significant impairment or distress.
Dependence: physiological adaptation and withdrawal potential associated with a substance.
Withdrawal: physiological and psychological symptoms that occur when stopping or reducing a substance after regular use.
Harm reduction: policies or practices designed to reduce the negative consequences of drug use, without necessarily requiring cessation.
Stigma: negative attitudes and beliefs that lead to discrimination and barriers to seeking help.
Low-risk guidelines: recommendations intended to minimize health risks associated with substance use.