Shirah Vollmer MD

The Musings of Dr. Vollmer

Mental Illness vs. Mental Suffering

Posted by Dr. Vollmer on July 29, 2019



The human condition means that sadness, fear, depression, excitement, enthusiasm, low activity levels and high activity levels are all experiences we cycle through to a greater or lesser extent. Oftentimes, in an effort to help others, providers over-diagnose these mental states by telling the patient that he/she has a mental illness, when in fact, he/she is suffering. Why is this distinction so critical? Mental illness implies psychopathology, that something is terribly wrong with that person. Mental suffering implies a hard time, something we can all relate to. To include others in a shared humanity is the job of providers to help patients in need. To separate out patients with a diagnosis should be done cautiously and rarely, as mental illness, is indeed rare. However with the DSM 5 hitting our trails, and the abundance of medications available to help mental suffering, there has been an explosion of both diagnosis and treatment which I believe has distracted patients and their families from understanding the deep roots of mental awareness. I think we can help those with mental suffering without diagnosing them with a mental illness. I know insurance companies make this hard, but we, as providers, must push back and tell patients that our medications (and now our machines) can help mental suffering, but this by no means implies a mental illness. Putting the locus on the common humanity along with its shared ups and downs, allows us to provide compassion, while still having the goal of minimizing psychic pain. And so I begin to make this point. More to follow. Thanks for reading.

2 Responses to “Mental Illness vs. Mental Suffering”

  1. Shelly said

    Well said, Shirah. You make it seem that psychopathology is a bad thing and mental suffering is not. But psychopathology includes mental suffering, doesn’t it? Mental illness is still an illness and we need to have compassion in both cases (for those suffering with mental illnesses and mental suffering). On the other hand, when a patient has a mental illness, the patient often tries to excuse their behavior as “beyond their control” because of their illness, which often isn’t true. So you are right that it is a balance between helping them in their suffering and offering compassion and understanding and differentiating between those having an illness (psychopathology) and not being in control of their behavior, and those simply undergoing mental suffering at one period in time.

    • Psychopathology is a tragic thing, not a bad thing, I would say. Some people have brains which betray them and thereby cause them to behave and act in ways that they cannot control. Having said that, most people do not have psychopathology but rather are sensitive humans who get hurt and express their psychic pain via anxiety, somatic symptoms, and/or depression. This distinction is critical, because, as you say, it requires a different framework, and a different treatment modality. When these frameworks are confused, there can be a rabbit hole of prolonged medication trials and prolonged conscious and unconscious embracing of the “sick role,” meaning that the patient feels others are failing them, rather than seeing that they have the psychological tools to heal their wounds. I think we are saying the same thing, but this concept is quite nuanced, and it is influenced by psychiatrists and primary care clinicians who need to write down a diagnosis in order to justify treatment. A diagnosis of mental suffering, does not cut it in today’s world of insurance reimbursement and so that is part of the larger problem of offering compassion without superimposing the medical model on the human condition. It is fun to talk about these ideas with you. Thanks.

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