Four ways to tell whether someone has a mental issue cover image

Four ways to tell whether someone has a mental issue

Dorian Minors • March 12, 2016

This is an archived article from our predecessor website, The Dirt Psychology. The idea there was to take psychological scholarship and turn it into wisdom. The Armchair Collective tries to go a little further than just psychology. As such, these articles live here in archive form, until they're updated.

Want to know how to tell whether someone's dealing with a mental issue? That's what psychologists are all about. But it's far harder than you might suspect.

In essence, the study of mental disorders or 'psychopathology', is the study of "abnormality". But what makes something 'abnormal'? The term is extremely vague and comes with no objective definition for psychologists. In fact, psychologists and psychiatrists have a very hard time figuring out just what typifies a mental disorder or 'abnormal' behaviour. If it's hard to figure out for them what about the general public? Statistics say just over half of (or as much as two in three) people will meet clinical criteria for a mental health disorder. About 25%  within the last year. And that's likely an underestimate, as all surveys are. That means, more than likely, that's you. So this kind of a big deal. To help you understand how psychologists determine what is 'abnormal', today I'm going to break down the four major 'rules' or models they use to figure it out.

. You're about to learn that diagnosing mental issues is both way easier and way harder that you had any concept of.
“The Cultural/Social model looks at whether the behaviour ‘breaks the rules’ of a society.”

You might be thinking, 'well isn't abnormality just something that people think is weird?' If so, kudos 'cause you're kind of right. Psychologists often use the 'Cultural/Social model' to determine abnormality. Basically, if certain types of behaviour break the implicit rules of a society; that is, if the stuff you're doing is seen as 'strange' or 'inappropriate' by most people then we can use this to diagnose someone. Unfortunately, there are some pretty obvious problems. Firstly, it's super subjective, so how does one measure it? I know plenty of people who act weird but where do we draw the line? How much weirdness is abnormal? Secondly, social norms vary wildly across time and culture. What's abnormal for me or you might not be abnormal the next country over, or fifty years ago, or more pressingly, fifty years from now. It might be a disorder today, but in twenty years it might not be the cultural norm! Finally, this particular model is highly pejorative; by definition it highlights one's isolation from the community.

“The Statistical model tries to find out what’s ‘abnormal’ by the rarity of the behaviour.”

So maybe we look at something that can't pejorative. The 'Statistical model' simply  looks at behaviours that are statistically rare. Lets say only 5% of people are doing something, we might say that's sufficiently rare enough to classify as 'abnormal'. And that doesn't stigmatise either, it's simply the way things are. It's also really easy to measure because it's so objective. But, we mentioned before that things aren't always so rare - one in five people is not a small proportion at all. And where do we determine the cut off for these things? Who gets to decide that 5% of people is sufficiently rare? More to the point though is that rarity doesn't always indicate mental illness. Having 50 close friends is pretty rare, but does that really indicate 'abnormality'?

“The Danger model approaches the issue by determining whether the person is at risk of doing harm to themselves or others.”

Ok, what about if they are a danger to themselves or others? We know that common illnesses like depression and anxiety can lead to suicide. Less common illnesses like schizophrenia can occasionally result in violence too. So perhaps we look at the 'Danger model'. If you pose a risk to yourself or others, then you can be considered 'abnormal' under this rule. And it can be really good, it has an inherent protective value. Instantly, treatment can be organised to reduce that risk of harm. However. it can swing the other way too. Since it's kind of hard to define who is at risk (how many times have you said 'I'm going to kill that person'?), it can be really easy to abuse. How many political prisoners all over the world do you think get incarcerated for reasons like this?

. That said, sometimes it's pretty straight-forward to tell whether someone is a little out of the norm.
“The Distress model simply asks the person how bad they feel it is.”
Alright, so maybe we can just ask the person what they think. Instead of looking at all these external facets of mental illness, Psychologists can just ask the client how they feel. This is called the 'Distress model'. Basically, if the behaviour is personally distressing or interfering significantly with the persons life, it can be seen as 'abnormal'. This is really nice and easy to measure because it's self defined. It's well known that different people have different tolerance to stress and different coping mechanisms. Unfortunately, there is such a thing as a hypochondriac. We've got to be careful we don't convince ourselves that a momentary distress is a mental disorder. I feel like you probably know where I'm going with this. It's impossible to just look at one facet of someone's mental health or presentation and decide whether that person is 'abnormal'. It's got to be a considered approach evaluating each of these four areas to determine what's going on. And in fact, many psychologists will simply decide that despite two or three models fitting something, it still isn't 'abnormal'. It's just a bit odd. Fortunately, two diagnostic tools, the ICD-11 and the DSM-IV have been developed to help psychologists make their decision. Use what you know now to treat mental illness with a bit of respect. Mental Health Professionals don't mess around when it comes to diagnosing and treating disorders and the like. If someone you know has been diagnosed then understanding where that came from can help you understand a little bit of what they are going though. They might feel socially isolated, statistically strange, at risk of hurting themselves or even just having a really hard time. If you liked this article, you might be into learning a bit more about social anxiety and why it might be a thing that's affecting you RIGHT NOW. Or perhaps you want to know what and anxiety disorder is and why you should care? Turning scholarship into wisdom without the usual noise and clutter, we dig up the dirt on psychological theories you can use. Become an armchair psychologist with The Dirt Psychology.

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Dorian Minors

I mostly do brain science. Sometimes I train honeybees. I promise they're related. I made this site because there's no reason why scholars should be the only ones to own knowledge. My special interests are interpersonal relationships, the science of community, spirituality and the brain, and the neural basis of complex behaviour. I hope this stuff is as interesting to you as it is to me. You can find out more about me here.