Not Everything That Feels Bad is Disordered and That’s Ok

Your mental health still matters.

Longer post today — click to listen to me read it to you.

Let’s talk about mental health. Mental health has been a buzz phrase for the majority of my life, for better and worse. Compared to previous decades, the topic of mental health has taken center stage. Seeking therapy for certain conditions is not as stigmatized, treatment options have expanded, and for some generations (hello, Millennials down to Gen Alpha), it could even be called trendy to know and talk about mental health. Taking a “mental health day” off from work or school—and calling it as such—has only emerged in the last few years as being a legitimate reason to be absent. In America, mental health has become not only a reason to explain our decisions (i.e., to justify a choice we made in the name of prioritizing our mental health) but an aspect of our health potentially riddled with problems: there exists both the social tendency to pathologize our mental health as well as to work endlessly on it.

There are definite pros to this increase in cultural awareness and destigmatizing of mental health disorders. The mind and body are interdependent. This cultural awareness has undoubtedly led many people who struggle with mental health to seek support and make positive changes in their lives. Still, this increased awareness is not without side effects. As we all become more literate in the language of pathology and mental health jargon, we are then more inclined to recognize pathology in ourselves and in others. This can be a good thing, if we are recognizing pathology that is actually there; that individual can then receive an accurate diagnosis and subsequent relevant treatment. However, this recognition of pathological symptoms is not such a good thing if we identify pathology when it is, in fact, not there.

As the anonymous saying goes: when all you have is a hammer, everything looks like a nail. In regards to mental health, we all have a hammer now, equipped with insight into what *some* symptoms of various diagnoses are. You’d better believe we are finding disorders to pound on all around us.

I’m sure many of you have heard, in recent years, the casual reference to people as “narcissists” or “sociopaths”. On the internet, there are hundreds if not thousands of videos coaching viewers through how to self-diagnose oneself with various disorders, including: Depression, Anxiety, ADHD, PTSD, and Autism Spectrum Disorder. The number of young girls diagnosing themselves with Dissociative Identity Disorder (DID) has strangely risen—and, strangely, garners a lot of views on TikTok. DID is possibly the most uncommon, rarely diagnosed disorder out there, and is considered by many clinicians to either not exist or only exist rarely as a response to severe trauma, in which dissociating from reality by creating alternate realities becomes a sort of protective mechanism from abuse.

Most recently, the trend is to label one’s parents as “emotionally immature”, which is, in fact, not even a recognized diagnosis but has certainly become something you do not want to be labeled as. This post from Rachel Haack of

Thoughts from a Therapist

on Substack gets into more detail about this latest pop psychology trend, if you want to read more.

A Crash Course in What Makes a Disorder, a Disorder—Anxiety and Depression Edition

Of course, mental health disorders are real, and certainly some have found their way to a correct diagnosis through an Instagram infographic. And, if we want to preserve the meaning of mental health disorders, we must draw a line between pathology and normal human life experience, which is by nature confusing, challenging, sad, and frustrating. Having just read virtually the entire DSM-V for class (i.e., the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), I have a decent working knowledge of what makes a disorder, a disorder—at least, according to the American Psychiatric Association. (The APA itself is a flawed organization; nevertheless, it is what mental health professionals use, and has been researched extensively, for the most part.) Generally speaking, to be diagnosed with a particular disorder, one must meet a certain number of criteria that, altogether, causes that individual “clinically significant distress and impairment in one or more important areas of life (e.g., occupational, social, academic, etc.).” When considering criterion separately, however, many of the symptoms listed in the DSM-V for various diagnoses reflect aspects of normal or expected human experience. (Exceptions include suicidal ideation, hallucinations, and traumatic flashbacks, among others). Let us take, for example, symptoms such as “trouble focusing and forgetfulness”, or “fatigue and nervousness”, or “low mood and sleep disturbance.” Many people experience these symptoms, and would not automatically qualify for a diagnosis of Attention-Deficit/Hyperactivity Disorder, Generalized Anxiety Disorder, or Major Depressive Disorder, respectively. What makes a disorder a disorder is if the collection of symptoms an individual is experiencing is both prolonged and is causing them clinically significant distress as well as marked impairment in functioning.

The fact that many symptoms reflect different aspects of normal human life screams an important point: not everything that feels bad or is challenging is necessarily abnormal. It is, in fact, quite normal to feel sad, anxious, low, or restless throughout life. I will go so far as to say that even when we do meet criteria for certain disorders such as anxiety or depression, we are often still experiencing a pretty normal or expected variation of life. (Please note that I am talking primarily here about mild- to moderate- versions of depression or anxiety disorders, not, for example, PTSD or Schizophrenia.)

Let us take anxiety, for example. Anxiety, which is rooted in fear, is adaptive: if we get a funny feeling when walking by a dark alleyway, we may become more alert to our surroundings and aware of potential danger. If we’re approaching a final exam, feeling anxious may prompt us to study well. Feeling consistently anxious about a particular situation may very well be how our intelligent bodies let us know that we need to rethink that situation (e.g., stop going out with those people, quit that job, ask for a raise, speak up for ourselves). Experiencing anxiety is not always cause for alarm: it’s a protective response to the outside world. It’s there for a purpose, to keep us (dare I say) safe.

However, if anxiety dominates when we are in completely harmless settings, or if it prevents us from interacting with people socially, or if we can’t leave the house for fear of having a panic attack, or if our anxiety has become pervasive enough that it is interfering distressingly with our daily lives—then we start to look at that individual experiencing an anxiety disorder. Therapy for an anxiety disorder usually includes some sort of exposure: progressively exposing the individual to the feared stimulus, and increasing their capacity for sitting with the anxiety, working through it instead of avoiding it.

If someone is experiencing more anxiety than they’d prefer, it’s possible that there are grounds for a diagnosis, but it’s also possible that something else in life is triggering that anxiety. Viewing anxiety as an adaptive response and a protective mechanism—whether protection is needed or not—can help the individual appraise their mind more positively and collaboratively, rather than be at the anxious whims of it.

Let us move on to look at mood disorders: the most common, of course, is depression. Major Depressive Disorder (MDD) has some pretty specific criteria, but at its core, depression is a low mood that persists daily for at least two weeks, along with a diminished ability to be productive, which reflects a distinct difference from how one typically operates. Depression is, broadly, a slowing of the body and mind: it becomes harder to move, think, feel pleasure, and do things.

Mild- to moderate- depression is increasingly being diagnosed among all age groups, with older age groups more likely to have experienced depression at least once in their lives.¹ In other words, there are certainly adults in your life, including you, who have met the criteria for a depressive episode at one point thus far. Other people still (I do not have exact data on this) would meet subclinical levels of depression, which means they don’t meet all the criteria required for a clinical diagnosis but are still experiencing depressive symptoms. What makes depression ‘abnormal’ is not that it is particularly uncommon, but that it reflects a deviation from someone’s typical experience of life. Being depressed, or experiencing higher levels of mood disturbance than usual, is not always cause for major concern: many cases of subclinical or mild- to moderate- depression will resolve on their own in time or with some therapeutic or lifestyle intervention.

*For the record: The presence of suicidal ideation or of chronically debilitating symptoms turns mild- to moderate- depression into severe depression, which is not as common and should always be treated.

Your Mental Health Makes Sense

While my earlier point on the tendency to hunt for disorders with our mental health hammers remains, I also want to acknowledge that many people do struggle with their mental health, whether or not they meet criteria for a clinical disorder. When it comes to why we may experience these mental health challenges, let us remember that it usually occurs in a context that makes sense. Disorders do not occur in a vacuum, and are not triggered by just one factor. The human body and brain are incredibly complex, and are constantly interacting with incredibly complex, ever-changing life circumstances. Being depressed may actually make sense, when considering the context in which an individual is depressed.

In short, our mental health is dependent on the entire context of who we are; who we have been until now; where we come from genetically and culturally; whether we have our basic needs met; the people we are surrounded by; whether we get enough sleep consistently; and the levels of neurotransmitters like serotonin, norepinephrine, and dopamine in our brains (which are then dependent on a whole host of other factors). You get the point: the list goes on.

Understanding our mental health as a response to myriad environmental and biological factors makes it easier to see that our mental health is not something to be feared; not something we are victims of or need to label as disordered, especially if they are not. Our minds and brains are not the enemy: even if sometimes they stir up a lot of trouble.

Not Everything that Feels Bad is Disordered and That’s Ok

Regardless of if someone has a clinical disorder, everyone experiences mental health as an aspect of health that has the potential to greatly affect one’s quality of life. We don’t need a clinical label to justify that taking care of our mental health is important for all of us.

Because we are human, we will suffer. To deny that fact is to deny life, the nature of which is to reflect everything back to us, the good and the bad. We are here to experience whatever life has to offer, and to learn from all of it. No one said it was supposed to be enjoyable all the time.

The highs include the lows, after all.

That does not mean that we are disordered. It just means that we are human.

Mental health is relevant to everyone. Chances are that each of us already knows what to do about improving ours—so let us do those things. Let us sleep well, eat well, love people, move our bodies, find purposeful work. Rather than hunt around with our hammers, looking for disordered nails to pound, let us take care of ourselves and one another as we are, as best as we can.

Maggie

1. This is a fascinating study estimating how many American adults will experience a doctor-diagnosed Major Depressive episode in their lifetime: the weighted percentage hovers around 15-20% in 2005, which is expected to increase by 42% by 2050.