How to differentiate discomfort caused by adversity from a mental disorder

The recent covid-19 pandemic has had a strong impact on the population as a whole and has put care for mental health problems in the spotlight.

The circumstances that have generated this situation have been multiple: the unexpected death of close family members, the impossibility of saying goodbye to deceased loved ones, or imprisonment and forced cohabitation at home during the period of confinement, which has interfered considerably in the development of the usual life habits.

All this has generated in the most vulnerable people an increase in emotional discomfort, demotivation and, sometimes, hopelessness.

However, human beings have overlearned behavioral habits that are not easily modifiable.

After a forced adaptation to exceptional circumstances, people tend to return to their usual pre-pandemic lifestyle in terms of leisure, social relationships, sports or work.

Being confined at home for a few months is not going to change the routines acquired over many years.

Another thing is that the economic and social reality resulting from this crisis forces a temporary readaptation to a different socioeconomic scenario and teaches people to live in uncertainty about the future.

The emotional discomfort generated by the adversities of daily life does not constitute a mental health problem nor does it necessarily require psychological treatment.

People often experience sadness when they lose someone close to them, fear when they face danger, anger when they feel offended, or outrage when they are mistreated.

These negative emotions are not properly mental disorders, but reactions of normal people to the vicissitudes of everyday life.

Current society, especially children's, should not be medicalized.

The stigma of inappropriate diagnosis of a mental disorder and the prescription of treatments with potential adverse side effects should be avoided as much as possible.

Where is the line between sadness and depression, between shyness and social anxiety,

People often experience sadness when they lose someone close to them, fear when they face danger, anger when they feel offended, or indignation when they are mistreated.

These negative emotions do not properly constitute mental disorders.

Prematurely resorting to psychological therapy or medication means avoiding the traditional paths of natural healing: leave the healing effect of time, seek socio-family support, make the necessary vital changes, get rid of excessive tensions, practice hobbies and playful interests or just change the pace.

In fact, overcoming problems by oneself normalizes the situation, teaches new skills, raises self-esteem and facilitates social relationships.

A particular aspect of our time is that the therapeutic demands of the population have changed considerably.

Now there is a tendency to consult, in addition to traditional clinical conditions (depression, schizophrenia, anorexia, addictions, among others), for problems of emotional suffering or personal dissatisfaction.

Among them are mourning for the loss of a loved one, couple conflicts, problems of work stress or bullying, inappropriate use of social networks, dissatisfaction with one's own image, adaptation to new situations that have arisen ( loneliness, for example) or living with chronic patients.

These new therapeutic demands are related to the need for a better quality of life and a greater intolerance to emotional discomfort on the part of people (aspiration to a "zero suffering" society), but also to the medicalization of daily life and with a greater offer of diverse therapies.

The demographic and social changes of recent decades can account for this reality: the aging of the population, the emergence of new technologies and the consumption of alcohol and drugs at an early age, the increase in the uprooted immigrant population or the weakening of the family support network.

Unhappiness and suffering are part of life.

Therefore, the delimitation between emotional difficulties and mental disorders is not always easy to establish because the lines of demarcation are sometimes blurred.

Psychological suffering must be understood as a continuum, from emotional discomfort, adaptive difficulties and stress reactions to mental disorders themselves, which in these cases require an adequate diagnosis and treatment.

What can help situate the point on this continuum is the type of psychological problem posed;

the intensity, duration and frequency of symptoms;

the degree of interference in daily life (academic, work, family or social adjustment);

the history of previous difficulties;

and the degree of personal and psychosocial vulnerability.

Many of the consultations with clinical psychologists today are not related to mental disorders, but to situations of unhappiness and emotional discomfort.

These are people who feel overwhelmed in their psychological resources to face daily difficulties and who, very often, lack a solid family and social support network.

The objectives of the intervention should be oriented in these cases to emotional support, the implementation of social skills and coping strategies, impulse control and the improvement of self-esteem.

Clinical psychologists have to adapt to this new reality,

Lastly, society, but not necessarily the health system, can and must provide a response to the emotional dissatisfaction of people who have difficulties, for example, in adapting to family reconciliation, to the current demanding work requirements, to the new family models or the care of dependent people.

Thus, numerous NGOs carry out accompaniment programs for the elderly who live alone.

There are self-help groups for patients with addictions or for people in grief or with chronic illnesses in which mental health professionals do not intervene.

In associations against cancer there are usually volunteers who do a great job of accompanying patients who are in complicated situations.

In other words, mental health, beyond a merely professional perspective,

Enrique Echeburúa