Are mental illnesses real?

Welcome to the July 2025 edition of the Your Listener Counselling newsletter! This month, we are addressing the myth that mental illnesses are "imaginary" phenomena "invented" by over-zealous professionals seeking to pathologise every aspect of normal human functioning. While not necessarily widespread, these myths may harm vulnerable individuals if adopted by those on whom they rely for support. We will also explain what makes mental illnesses "real".

Mental illnesses are "reifications", meaning that while we can not observe them as physical events, we can infer that they are real by the associated qualities which we can observe. Science requires assumptions to function — notably, that events in nature occur with consistency and have causes in common. Without these assumptions, then at best we would be attempting to re-define reality with every new idea that arose, and at worst would not be able to even conceive of new ideas. This is a purpose of scientific classification: it allows us to accumulate knowledge that provides the basis for explaining new ideas. Your own mind is constantly relying on assumptions based on information you have collected in the past when you undertake your daily activity, and using such assumptions to provide structure to what we perceive and do in a given moment is integral to the mind's functioning. You can imagine that life would be impossible if you could not gather memories and use them to inform what you do.

Consider the illness of depression as an example. We can not physically observe any aspect of a person that could explain or "be" depression (studies may have identified brain activities that correlate with depression, but this neither guarantees that any are a definite cause nor offers usable means of diagnosis). Instead, we observe the individual's reports of feeling constantly sad, worthless, hopeless, or otherwise negatively, withdrawing from normal activity, not feeling able to engage with life, and similar. That this person is able to have this experience at all signifies that there must be a cause and that the problem must be real — the question is of how to address it. Tellingly, countless similar cases of depression have historically been observed. The consistency with which it happens makes for plausible conclusion that depression represents a distinct phenomenon in nature. We do not simply observe remote cases of the phenomenon and "invent" a new illness; there must be sufficient correlation between the features and regularity of their occurrence. By identifying groups of consenting people experiencing this distinct phenomenon, we have created and tested therapies and found that they tend to be effective in helping people with these same experiences. The consistency of both the condition and how the treatments work indicates that addressing similar factors is likely to help other people. Without these paradigms, we would have to investigate the very nature of psychology from the start for every client who presented with depression. While we can not guarantee the exact nature of these phenomena, using scientific theory, structure, and investigation in this way allows us to verify that they are real and devise at least some solutions. Despite these facts, some still express doubt of the reality of mental illness.

Some argue that phenomena such as anxiety, depression, attention deficit and hyperactivity disorder, and narcissistic personality disorder are not "real" illnesses, but part of the human experience. They claim that anyone can experience worry, sadness, forgetfulness, or vanity at times. Notwithstanding any questionable aspects of the diagnoses themselves, this argument is fallacious; other so-called "real" illnesses are also often examples of normal phenomena intensified. That anyone may have acne or a birth mark does not mean that all growths are harmless — some are cancer. That everyone experiences occasional aches does not mean that all pain is insignificant — sometimes it signifies multiple sclerosis or fibromyalgia. Valid health practice is about discerning pathological from normal experiences. Competent practitioners acknowledge that sadness does not necessarily constitute depression, and that to treat it as such might interrupt the person's natural coping mechanisms and distort their perception.

Others express concern that mental illnesses are often treated with medicines without a physical test for them first being conducted, leading people to believe that they constitute a deception staged to sell treatments. There are a number of reasons why we do not conduct physical tests. There are, in fact, a number of brain processes that are known to correlate with certain mental illnesses. But in science, we can not suggest that any of these actually cause the illnesses, because we can not study the human brain in such a way that allows us to observe those processes in isolation; for all we know, any of the brain's countless other processes could be involved. Therefore, if we did test for these processes, not only would it be expensive and impractical, it would also not guarantee that the person had the illness. The reports from the individual themselves are both more accessible and allow us to understand the situation more practically, which then allows us to actually establish strategies to help them. It is true that the indiscriminate use of any treatment is dangerous and that self-reliant management of problems is favourable. However, investigations such as those described above have identified that medicines can alleviate symptoms, and for some people, the relief may help them develop the coping skills that could one day mean they no longer need the medicine.

In reality, a phenomenon constitutes a mental illness when it impairs a person's ability to live a normal life and comfortably regulate their mentality and actions. One type of impairment is in executive functioning, which is the brain's ability to acquire, retrieve, and process information. While we do not realise it, every seemingly simple daily activity requires this ability, and many illnesses impair it even in non-threatening situations. A related experience is that the mental anguish from the illness can intensify when we try to resist it and persist with normal activity, with similar executive functioning impairment resulting. When this happens, the instinctive reaction is often to avoid the activity to keep from aggravating the symptoms. When someone suffering from a severe case of depression or anxiety reports that they could not arise from bed or did not want to attend a social event, it often means that their executive functioning was impaired to the extent that their brain could not retrieve or process the information necessary to engage in the activity — not that they were lazy or lacked determination. Another type of impairment is distortion in how a person processes information. For example, someone with a post-traumatic illness may misinterpret innocuous cues from others as threatening and respond forcefully because they genuinely believe that the person was intending to harm them. Someone with schizophrenia or a related disorder may have sensory experiences which are not real (that is, seeing, feeling, smelling, hearing, or tasting what is not there), called hallucinations, or believe ideas that are untrue (called delusions). To deny that these phenomena are real would be equivalent to suggesting that a human can think without a brain; if the latter is untrue, then why is it difficult to accept that the brain's functioning can be disordered in a way that is not readily controllable by the person?

At this stage, some would still negate this explanation with the vague claim that there is an "explosion" of new mental illnesses that are "made up" and in reality signify malingering and the consequences of bad choices, disguised as illnesses to justify a failing society. While it is true that society manifests numerous failings and even that mental illness diagnoses and labels may be over-used and misused at times, this is separate from the fact that mental illnesses are real. Mental illnesses have always existed, but were historically hidden because the sufferers were considered a burden on society and subsequently subject to stigma, and untreated because psychology was undeveloped. Even if certain diagnoses did not exist at one time, I doubt a proponent of these arguments could produce evidence that the phenomena to which those diagnoses refer also did not exist in people, undetected. As I have discussed in my content, scientific classification of abstract phenomena can at times be problematic, but the purpose itself is to identify when a distinct natural phenomenon exists and discern it from other problems to devise solutions.

If you still are doubtful that mental illnesses are real, know that you are not alone, and that you deserve the opportunity to seek help and receive compassion. I am not selling medicine or miracle cures, but I have a history of helping people to function in the struggles of illness, and a longer history of overcoming those struggles myself. Believe me: the mind is easily harmed, and healing can be a long and challenging process, but with effort, we stand a chance to heal ourselves and others. If the effort to heal nature's own creations is not worthwhile, then what is?

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Thought of the month

If your attitude to the world is one of apathy or spite, make an argument for why anyone's attitude to you should be different.