What Is Mental Illness? (II)

May we call a man “insane” just because the society in which he lives is annoyed with him? In our last article (February–March issue) we saw that a “social” definition of mental illness has its pitfalls.

How may we generally describe the sick or the healthy personality? We also saw in the previous article that the mere fact certain people become patients in a hospital for the men tally ill and the rest of the people do not is no sound basis for the distinction between the mentally ill and the mentally healthy.

There is another popular notion on this score that deserves mention. Very commonly people will make comments like the following when a person becomes mentally sick. People will say of such a person, “He worked too hard,” or “He had too much on his mind,” or “She couldn’t stand a disappointment in love.” All such comments contain a certain notion as to the character of mental health and as to the cause of mental breakdown. Such comments imply the notion that mental health is in large measure a state of freedom from tension, while mental ill-health is caused by and is marked by serious tensions within.



Tension and Mental Health

Is this popular notion correct? Is the personality that may be called healthy, one that is free from tensions?

Such a generalization is perilous. To be sure, we face once again the question of degree. Excessive tension can break a man’s inner fiber. We think of the excessive tensions of modern warfare, for instance.

But we must again be cautious. The mere presence or absence of tension is hardly the decisive factor in determining mental health or illness. Let no over-simplified notions on this score rob us of the notable figures whose inner wrestlings cover the pages of history with great achievements. What would history be and what would our spiritual and cultural heritage be without the tensions experienced by Moses, David, Elijah, St. Paul, Augustine, Luther, Beethoven, Mozart, Handel, Lincoln? Great achievement is impossible without tension, even great tension. After all a moral creature can hardly live without tension if he is to express his moral character. Just as soon as man faces a “Thou shalt” tension is bound to be present.

A public official who gave one of America’s largest cities a most acceptable administration as mayor was once described by another public servant as having the “zeal of St. Paul and the manners of St. Vitus.” That man with his peculiar set of tensions so adroitly described was not mentally ill, nor did he become so.

Destructive Tensions

Tension as such generally need not and does not bring about mental illness. Tension is of the very essence of living and striving and achieving. However, there is a type of tension that is highly injurious to mental health. This kind of tension is illustrated by the following case. A young man whom we will call Roger Smith got into mental trouble. The common observation on his case was that he had worked too hard. The fact was that he had worked very hard. As a college student he had put in many long hours of study. And his industry was commendable. But there were certain things about him that his professors and fellow students had begun to notice. He was very “fussy” about things. He was almost painfully fastidious about his appearance. And he had a tremendous drive for perfection in his work. He had to feel that his work was the best in the class. When he did not get the highest grade or the praise of his teachers he was mortified.

Roger’s father had been an alcoholic. This distressing fact had always hurt very much. Roger felt that people looked down on his family because of the father. He developed deep-seated feelings of inadequacy. He was painfully shy. He could not be free and easy in his contacts with others. He began to find substitute satisfactions for his social failure in feeling that he excelled in his work, that he could do better than others. His crushed ego found much satisfaction in this. And it was this twisted and false drive for perfection and for self-approval that was the main push behind all his industry. The tensions at work in his laborious efforts were not those that come with a wholesome determination to do a good job to the best of one’s ability. Such tensions rarely cause trouble. Roger’s tensions caused trouble because they grew out of a false motivation and out of devotion to a false ideal.

We must take note of another illustration of tension that is of the type that may be and often is involved in a state of mental illness. Such tensions grow out of deep-seated feelings of guilt. Let’s consider Carl for illustration. Carl was eighteen years old. He was not at ease in his social relations. He always seemed tense. Very often he expressed himself awkwardly. He seemed unable to do anything in a casual, deliberate manner. Plainly he was not sure of himself in his remarks and actions.

What was wrong with Carl? He was heading for trouble if relief did not come to him. Was his social situation difficult? It was not more difficult than that of the average young man of his age struggling through the adolescent period to establish a foot-hold in the adult world. Was he laboring under a strain of an excessive load of work and other obligations? His obligations were not extraordinarily heavy. Then what was the trouble?

Carl grew up in a home that might be called prudish. There was never any display of affection. Such things were quietly frowned upon. Any hint of that which pertains to the sex life of man was sharply squelched as being indecent. There was little rollicking laughter in the home. Rather there was an atmosphere of restraint, an atmosphere that tended to make a growing person timid about expressing himself at all.

At the age of twelve the sex drive asserted itself in Carl’s life just as it does in the life of every boy and girl of about that age. He began to feel most guilty about certain thoughts and feelings that came into his life for the first time. The sense of guilt grew as he struggled to stamp out this powerful and “sinful” (as Carl thought of it) force in his life. He began to feel that he was more wicked than any other person in this regard. He became rather secretive in his habits. The feeling began to assert itself that people suspected that he was a failure in his efforts to attain virtue in his private life.

Here again we deal with tensions that are different in kind from those that are involved in meeting the daily demands of life. The destructive tensions in Carl’s life clearly had another source. The sense of guilt felt by every morally sensitive boy in the struggles of puberty and adolescence had been blown up into something destructive by the attitudes developed in the home.

From these two illustrations it should be perfectly clear that we must not look to the ordinary tensions of living and striving to find the forces that make for mental imbalance. Contrariwise it should be clear the tension-free life is not necessarily the life of ideal mental health. In the whole area of personality health the symbol of perfect well-being is not the cud-chewing cow complacently reclining in a clover-studded meadow.

Working Toward a Definition

In the effort to give a general definition of mental illness or mental health we have sought to clear the ground of several notions that have looked like promising material for a definition but had to be rejected when we examined them more closely.

All that has been said so far should help us to realize that it is not easy to give a satisfactory general definition of something so intricate as personality health or ill-health with all the variations and shadings that are present. Any definition will have to be explained, limited and qualified.

In spite of all the difficulties that beset our effort we shall nevertheless hazard a definition. It should be borne in mind that at this stage we shall be giving only a general definition. We will not be saying anything about the process by which mental health breaks down. We will not at this stage be saying anything about just what happens to the psychological machinery of man in a state of mental ill-health.

A “Definition”

Since it is unavoidable to describe mental illness in general terms except in relation to what we consider mental health to be, we shall give our “definition” as a statement regarding the healthy personality. The healthy personality actualizes himself within and in effective rapport with the framework of reality as God has ordered it.

This general “definition” can be illustrated by a diagram as follows:



Some Observations

1. The mentally ill person will therefore be that person who in some considerable measure fails to do what this general statement asserts.

2. A “definition” such as that given here does not limit the class of the mentally ill to those who are in mental hospitals or even to those who are undergoing psychiatric treatment in hospital or with private practitioners. The above “definition” gives the whole field of personality illness a broad enough scope so as to make the development of the healthy personality the concern of all those who are in a position to take a sincere and intelligent interest in the well-being of the individual-such as parents, pastors, teachers, social workers as well as doctors.

3. It will be noted that the healthy personality is described as one who “actualizes himself.” By this we mean to say that the human personality is a dynamic being. He has to live out the energies that are created in him. It is of the very nature of energy to express itself. However, our definition makes abundantly clear that there are definite limitations to this expression of the self’s energies. Also implicit in the definition is appreciation of the fact there are no two personalities alike. Personality health may not be thought of as a rigidly uniform something. We must do justice to the tremendous variation in human personality. Each personality must “actualize” himself.

4. It is freely admitted that the above definition contains question-begging terms. What do we mean by “effective rapport” and “framework of reality?” Should we not dismiss such terms? Who can tell precisely what they mean? Can we give such terms scientific precision? These are questions that many would raise, and reasonably so. But, even though possibly a majority of students in this field would like to dismiss such terms, they cannot escape having to deal with just such matters. Every psychiatrist has to look at his patient in the light of some notion of what an effective adjustment to life is. Even though the psychiatrist may strive conscientiously not to dictate to his patient on this vital point, still in the whole consultation situation some notion on this score must be present. We have purposely used such general terms to allow for a large degree of flexibility. There are no two personalities alike. There are no two life situations alike.

5. Why do we conclude our definition with the words “as God has ordered it?” Involved in all questions of mental health is always the question of the meaning and purpose of life. In every question of human adjustment man must face the question of the meaning of his life. As we have pointed out in a previous article, many of those who have written outstanding works in this field express their sense of need for a philosophy of life as a framework for the business of successful living and adjustment. We claim that the business of living and adjustment is a hopeless relativism and confusion unless all of life be seen in relation to the Lord of all. Man is inescapably a moral and religious being. He is created in the image of God. He was created for fellowship with God. Therefore the will of God must be the supreme rule for his life of natural self-centeredness and rampant (rebellious) desire.

6. It is worthy of note that the above general statement does not allow for that type of religious “adjustment” which seeks to jump over the problems of life by finding an immediate satisfaction in a special and highly private religious experience. Rather, the above statement demands that the fellowship with God which a healthy personality requires have its place in vital relationship with the fullness of life as man is called upon to live it in the structure of God’s creation and providence. Obedience and momentous challenge are marks of sound religion as well as comfort and security. The healthy personality has a healthy religion, not a religion of sickly escapism.