It is about time we examine the nature and manifestations of mental health problems. In previous articles, I picked on aspects of our attitudes towards mental health as a backdrop. This was necessary in order to throw a searchlight on our own beliefs, concepts and pre-conceptions about mental health. Without this, we cannot appreciate or empathise with the extent of distress faced by people experiencing mental health problems.

This is especially so for those without any first-hand experience of mental illness. It is even more true for my primary target readers, those of us in the church – perhaps one of the group of people least aware of the issues of mental health (its nature, triggers, maintaining factors and available treatments) and therefore most prone to ignorance and prejudice.

Why is it important to consider the nature of mental ill health? I understood a long time ago that a problem recognised or identified is a problem half-solved.

A thin line between normal and abnormal

It is true to say that there is a continuum between the experience of good mental health and a poor mental health and it is also true to say that there is a thin line of transition between the two. In the words of my Pastor, “nothing just happens”, there is a process to everything in life and mental ill health is no different. While acknowledging the ordinary day-to-day mental strains and tensions or the moments of emotional anguish or distress that we face as humans, this is in clear contrast to an enduring, incapacitating or debilitating experience of poor mental health. Still, there can be a gradual and sometimes imperceptible transition from one to the other.

More often than not, working out this thin line of transition is difficult. In other words when does a normal, happy looking and healthy person begin to drift into clinical depression, anxiety or psychosis? This is a rather difficult question to answer for all people because we are each different in our resilience (how quickly we are able to recover from a shock) or our ability to cope with life circumstances. Have we not often heard of stories in the media of supposedly happy individuals or families, taking their own lives or the lives of others, leaving the rest of us in shock? God Himself understands this. That is why He will not allow His beloved to go through any trial or temptation that is beyond their ability to bear (1 Corinthians 10:12-13).

The question of where to draw the line between normal and abnormal behaviour is even more blurred when we consider seemingly normal behaviour traits that can also be identified or taken into account when a person is unwell. For example, consider behaviour traits such as excessive cleanliness or orderliness which can be carried out by certain people almost to the point of obsession. Some people are never at ease with themselves unless they have washed their hands straight after returning home from wherever they have been and for others, their shoes have to be arranged in a straight line. Such behaviour is only one of several traits that can be associated with Obsessive Compulsive Disorder (OCD). Are we then to say then that such a person has obsessive compulsive disorder? Not necessarily. (I can sense a relief for some people!).

Consider also the person who nearly panics at every situation and makes a storm out of a tea cup. Or consider the person who is prone to see the negative side of any given situation, looking at every glass as half-empty (rather than half-full) with the result of panic, putting themselves and those around them in a perpetual state of unrest and anxiety. The Scripture states in Proverbs 18:14 (NIV) “The human spirit can endure in sickness, but a crushed spirit who can bear?” Consider the person who usually goes on and on in speech without giving room for others, making it a two way conversation. Will you then say they are exhibiting ‘pressure in speech’, which can be a trait of certain people experiencing psychosis or bipolar affective disorder?

Can you see how easily ‘normal’ behaviour can mirror patterns of behaviour that we label as abnormal when a person’s mental well being is compromised?

The point here is this: there is a continuum between behaviour we all accept as not problematic and behaviour that we begin to notice as worrying or deserving concern. How then do we tell the difference? Where do we draw the line? To do this we may ask: Is there a noticeable change in behavioural patterns that warrant concern? Is it enduring; is it affecting relationships and how one functions normally; is it distressing? This is the point at which one’s mental wellbeing becomes a matter of concern. I now turn to look at some of the changes that may occur when people’s mental wellbeing is compromised.
Signs of Poor Mental Health

In terms of depression, generally speaking, this may start with a change in appearance, perhaps neglect in personal care, being unable to enjoy activities that one used to previously. Not having the energy to complete routine tasks and even simple tasks like opening the mails seem to take too much effort, becoming withdrawn or not wanting to be in the company of others. Feeling alone, even when with others, persistent negative thoughts about oneself, the future and one’s situation, loss of appetite, interrupted sleep and so on. It is important to say that just by noticing any one of these signs, we cannot jump to the conclusion that a person is clinically depressed. So we are not talking about when your favourite football team lose a match and you lost your appetite on the evening. For a person to become clinically depressed, such signs must be present for at least a period of two weeks. Often they may last over several months. The intent here is not to diagnose (besides I am not medically trained to diagnose) but for us to become aware of signs that will cause us to take notice so as to come along others to provide help and support.

Anxiety problems may manifest as in the following:

Obsessive Compulsive Disorder – where one performs repetitive behaviour or mental acts to reduce anxiety. For example, repeatedly checking the doors are locked before going to bed.

Generalised Anxiety Disorder (GAD) – characterised by overwhelming and unfounded anxiety or worry. This may include excessive worry over day-to-day situations such as family, work, finances, and health. The signs of GAD usually last longer than six months.

Panic Disorder – characterised by repeated panic attacks. A panic attack is a sudden onset of intense fear inappropriate to the circumstances. A panic attack has a sense of impending doom or death and many of the physical symptoms appear similar to those of a heart or asthma attack i.e. shaking, sweating, hyperventilation and rapid heartbeat.

Phobias – characterised by persistent and excessive fear, resulting in avoiding or restricting activities due to such fear. This may take the form of social phobias which is the fear of any situation in which public scrutiny is possible. This often develops from childhood in the form of shyness. Phobias could also be specific, for example fear of heights, spiders, cockroaches etc. Another form of phobia is agoraphobia which is an intense fear about being in public places where you feel escape might be difficult. I once worked with a lady who remained in her home for 18 years for fear of having a panic attack in public places. This is how debilitating persistent anxiety and fear can be.

Post Traumatic Stress Disorder (PTSD) & Acute Stress Disorder – these conditions may develop over a distressing or catastrophic event such as a car accident, train crash, physical torture or sexual abuse etc. One need not necessarily be directly involved in the event to experience PTSD or Acute Stress Disorder. These experiences may involve vivid flashbacks, intrusive memories, recurrent dreams, reduced interest in others and the outside world, a persistent state of arousal characterised by being easily startled, outbursts of anger or insomnia. In acute stress disorder, these signs will usually fade away after about a month but in the case of PTSD, they often last longer.

Apart from depression and anxiety, mental health problems can take the form of psychosis. Psychosis is either in the form of schizophrenia or bipolar disorder. These are considered as serious mental illness. Psychosis may emerge with similar behaviour traits to what is normally known as growing pains of adolescence – mood swings, irritability, suspiciousness, appetite changes, withdrawal, etc. However once established, psychosis is usually characterised by three symptoms – hallucinations (to hear, see, taste, smell or feel what is not actually there); delusions (a false belief) and thought disorders.

Bipolar disorder is characterised by extreme mood swings. In bipolar affective disorder (BPAD), people experience periods of depression and mania. In between these periods, people may live normal lives. In periods of mania an individual may be full of energy and literally feel on top of the world; may need less sleep than usual, lack social inhibitions and may experience rapid thinking and speech among other things.

It is sometimes easy for us to say to a person suffering depression, or any form of mental illness, “to pick yourself up.” Often this approach is not as effective as we may think. Our example of empathy is in Jesus Christ our Saviour who came to sit where we sit, i.e. identified Himself with us in our sinful, helpless state, before helping us to pick ourselves up. May I sound a note of caution here that I am not at all condoning the ‘sick role’ for some who are not prepared to take responsibility for getting better. Indeed Jesus often asked people what they wanted before healing them.

Reflecting on the above, you may have noticed the imperative of relationships in helping to notice changes in people. In other words, we must be interested in other people enough to notice any changes in them. This is the starting point in noticing when things begin to go wrong in one’s life.

In the next article, I will from a personal account of a period of depression to demonstrate how the Christian faith can provide some answers.

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