Trishul division of mental health: Conveying all sadness or stress of life is NOT a mental illness to people, the public, professionals, and policymakers

In my professional life, I often see that life’s day-to-day stressors are equated to mental illness. As a reviewer, another worrisome area for me is a trend of psychiatrization for the presence of psychosocial stressors when a few screening items are positive but without any confirmatory diagnostic methods. This could be a reason for over-medicalizing/over-psychiatrization for the presence of psychosocial stressors as a mental illness in scientific literature.

The false concept of mental illness among people, the public, professionals, and policymakers

I come across people who call themselves mentally ill, even when they are perfectly normal, stating that “I am depressed/anxious,” especially after the famous Bollywood stars confessed to having mental illness. On deeper clarification, they are conveying that they have one or other life stressors causing few emotional symptoms in the last few days, for which they call themselves having a mental illness in the absence of a clinical depression or anxiety disorder. These situations even end up with a request for a medical certificate(s) to convey the presence of a mental illness because of work stress or other life stressors, etc. The scenarios among the public, medical professionals, and policymakers are not different. We, the psychiatrists, are duty-bound to clear this false concept of mental health and educate everyone that psychiatric disorders are diagnosed based on scientifically established criteria and not based on any psychosocial stressors.

TRISHUL (TRIDENT) division of mental health

I slowly found a way to react professionally, conveying to people that “all sadness or stress is NOT a mental illness,” utilizing an innovative trident division of mental health (proposed below).

In physical health, the bident division of physical wellness and physical illness is evident among all. Similarly, mental health is also understood as mental wellness and mental illness, a bident division of mental health.[1] Often, people with psychosocial stressors are pushed into the category of mental illness. The authors feel that this bident division of mental health is creating a diagnostic orphan for the category of people who are having psychosocial stressors and seeking legitimate help. This could be the main reason for the medicalization or psychiatrization of psychosocial stressors in the absence of psychiatric disorders.[2]

To fill this gap, the author proposes a Trident (Trishul) division of mental health: mental wellness, mental distress (MD), and mental illness. The intermediary “mental distress” is to fill the gap for diagnostic orphans created in the existing bident division of mental health discussed earlier. The authors understand that all psychosocial stressors can cause distress in individuals. To simplify it, “mental distress” refers to any kind of uneasy feeling of individuals in any situation, which sufferers call with different dialects such as stress, anxious, depressed, worried, tense, or tension. The category of MD can also be referred to as “mental health concern” (MHC) as the sufferers are concerned about their uneasy stressful mental status. A prerequisite to diagnose MD or MHC is the concurrent absence of mental illness. The authors understand that individuals with MD or MHC often need some kind of low-intensity psychosocial interventions (LIPIs) ranging from education, reassurance, counselling, etc. Prescription medications are not recommended for MD or MHC. To simplify it for psychiatrists and future research, MD or MHC is a “social concept” and often needs social interventions. In contrast, mental illness is a medical concept and requires medical interventions.

Future research

A diagnostic orphan in mental health can be referred to as MD or MHC to categorize the day-to-day psychosocial stressors without psychiatric disorders. A Trishul/Trident division of mental health is proposed to fill diagnostic orphans. Future research needs to refine the Trishul division of mental health, especially the category of MD or MHC, its operational criteria, reasons (specifiers), and epidemiology, and to design a culturally appropriate single or few session-based LIPI packages. The author contends that the Trishul division of mental health has the potential to reduce the psychiatrization or medicalization of psychosocial stressors among the public, professionals, and policymakers.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.