Mental illness comes in three major categories: cognitive disorder, mood disorder and/or positive/negative symptoms. While these aren’t the technical boundaries, this is the way that I consider mental illness to help break down the many subtleties into manageable portions. Mental illness isn’t just character trait, or a bit of an oddity. It is where the symptom, for various reasons, interferes with the smooth running of your life.
Cognitive disorder is about how we understand, what we think is real about the world and what we conclude from the evidence that we think is real. A component of this is perception, which comes in two flavours. Is the thing present and what is the threshold of meaning for the thing. If the unicorn is present, then it is something that I need to assess as far as risk and benefit. If it seems present but isn’t, then my assessment is automatically going to be in error. The assessment of risk vs benefit adjusts my behaviour towards the unicorn. If it is a risk to my health, then I need to be careful of it, while if it is there to charm those pesky fairies away, then I don’t need to be worried about the risk of the unicorn, I need to be worried about the risk of the fairies and the benefit the unicorn is going to have because of that risk. If we swap the unicorn, in this thought experiment, to a car, a risk of the car is that it will run me over. A benefit of the car is it can take me places very quickly. If I underestimate the risk of the car, I am in danger of being run over by it. If I overestimate the risk of the car, it may hinder the benefit the car can give me.
Another common cognitive error is faulty pattern recognition such as false beliefs and unclear/confused thinking. We humans are pattern recognition machines. This ability allows us to predict what comes next, such as when the gap in traffic will happen before we cross the road. We try to identify patterns and create heuristics to predict the next occurrences and the best way to deal with them. This gap is too small, this one is taking too long, etc. Sometimes we create patterns where there aren’t patterns. Every time I score beyond 5,000 in this game, a gap in the traffic appears. It may coincidentally happen a few times, but if my crossing the road relies on me scoring over 5,000, then my thought is in error and it hinders my life. Here I have equated to disparate things as if one things causes another, when really it doesn’t. Humans make these mistakes all of the time and only slowly let them go. The difference between a human trait (making this mistake) and a mental disorder is the magnitude of both the gap in connecting the disparate items and the consequence of doing so. As with most human traits, they don’t become a disorder until it creates significant disorder in your life.
Sometimes we create links that are very concrete but wrong, as described above. Sometimes we create links that are very short lived but wrong, such as this pen is a demon that is sucking my soul and spilling its life ink onto the paper. The paper is made from the tongue of a troll which was killed by Jesus when he was walking across the water to make the red sea into blood. When he did this, his finger fell off and was transmuted into a pen, which I now hold. This chain of story is trying to make all the elements that do exist fit into the ever shifting fantasy that is running through my thoughts. It is like trying to reconcile the real world on a dream understanding. This fails the real world test, thus making it very hard to actually make plans for how to better my or other’s lives.
Mood disorders are where the feelings we have are either too low, too high, and/or too rapid to be useful to our ability to work out an appropriate action to the event we are experiencing. First of all, let us separate the feeling from the emotion. We feel things internally, such as anger, fear, sadness, disgust, joy, and surprise. Feelings inform us of the environment and prime us to a default action based on the feeling. We emote (display) emotions, such as anger, fear, sadness, disgust, joy and surprise. Emotions communicate our feelings assessment to others. Be aware that people frequently mix the two up.
Consider something you are seeing. What you are seeing is light photons passing through your eye and hitting your retina. Your retina does some basic processing and passes the signal electrochemically into your brain. It goes via two channels. The fastests is to your danger pattern recognition centre, the amygdala and hypothalamus, located at the top of your spine inside your skull, just above the nape of your neck. It tries to quickly identify potential harm to you. If detected it gives you a suitable feeling and default action to manage this danger. If not detected, then you either don’t feel much, or if the assessment is of general benefit, you feel joy and again have a default action to deal with this. A few fractions of a second later the second channel kicks in.
This second channel is in your occipital region. Place your horizontal hand flat on your skull above the nape of your neck so that your hand is touching that bit that your spine touches your skull. Now place your other hand above that, higher on the back of your skull. That second hand is your occipital region. This is the light processing part of your brain. It is trying to work out what you are seeing and creating a three dimensional (3D) map of the world. It identifies that the thing you are seeing at the moment is a computer screen and what it’s basic use is. This report goes to the thinking part of your brain (ok, the whole brain is thinking, but this is simplified, right?) which is around your forehead. That part of your brain works out what to do based on the feeling and the report from your sensory translation – in this case of light the occipital region, but each sensory input has its own processing centre. So long as it isn’t an emergency you get to chose what to do.
When it is an emergency, the feeling is dialled right up by your danger sense and you automatically do the recommended action, like dodge or run. If it isn’t an emergency then you get a chance to think about your actions in light of the feeling driven recommended reaction. In a mood disorder this feeling is too low, so no warning comes and there is no motivation for you to do anything, no sense of urgency. If the feeling is too high, it is hard to think clearly and you find yourself reacting to everything instead of rationally acting. When the feelings cycle too fast, you can’t settle down on anything concrete for long enough to make a good choice.
We touched on positive symptoms a little earlier when talking about unicorns. If you experience something that most humans don’t, then it is considered a positive symptom. Most humans don’t see the unicorn, but you do. Testing the existence of the unicorn will show that it isn’t actually there, however most people experiencing positive symptoms are incredibly reluctant to test their belief. Other examples of positive symptoms include feeling insects crossing your body or crawling inside your body when they aren’t there, or perceiving people’s faces as whirlpools of smeared colour. Thought positive symptoms can include paranoia (unknown things are out to get you), conspiracy thinking (there is an evil plot by reptiles to control the ape people) and so on. Generally these positive symptoms are referred to as hallucinations and frequently respond very well to medication.
Negative symptoms are things that are missing when compared to the average human. The inability to feel joy, the absence of wanting to speak and no desire to form relationships with people are common examples. Not seeing peoples heads would be a positive symptom rather than a negative one (as it adds to perception rather than being an absence of perception). Unfortunately medication doesn’t help this one as much, so the solution is more complex than “here, take this pill”.
Each of these three branches can lead to mental ill health if they feed a behaviour that interferes with your life in a significant way. That is what changes the trait or experience into a disorder – that you find your life in dis-order. Many people feel the presence of god, which some would argue to be a positive symptom, yet lead perfectly average lives. The presence of this feeling does not mean that they have mentally ill health. Having strong feelings can mean that I am passionate without meaning that I am ill. Believing that the world is flat doesn’t stop me from going on a plane to attend a global conference of flat earthers – it might define me as odd, but not ill.
So, in a nutshell, three different ways that our thought process can hinder our lives. However the processes aren’t the only defining factor for mental illness, the consequence to us for that process is.