Why Call a Person ‘Mentally Ill’ if They Are Happy?

Reader’s Question

I’ve always been curious about the classification of mental “illnesses.” I can understand why a condition would be termed an illness if it makes someone unstable enough to commit murder or cause other types of pain, but what about those situations of “abnormality” where the individual is happy? I was reading about “abnormal” personalities and it led me to ask this question: if you are completely “unusual” (i.e., avoidant or histrionic or anything, really), but you are also completely content, then whence comes the abnormality?

Some people, for example, seem to be very nit-picky about certain things and have very tight standards to which they hold themselves. Is it only because it gets on others’ nerves that they are labeled “obsessive-compulsive”? What if they are perfectly happy? Or those who are emotionally nonchalant and can’t engage in relationships. These may seem abnormal, but if they are content, where is the problem?

I am sure it is more than just the fact that the majority looks at you as being different and wants you to conform. Is there a more mature basis than popular opinion for deciding “abnormality”?

Thanks in advance for your answer!

Our Clinical Psychologist’s Reply

Great question! A “mental illness” is typically a pattern of thinking, feeling, or behaving that creates a significant amount of distress or impairment in the life of the individual. The presence of a “mental illness” would interfere with major life activities such as work, socializing with others, daily routines, romance, etc. Overall, while individuals have a wide range of behaviors, those that tend to create emotional distress and/or a level of impairment or disability would be considered candidates for a diagnosis of mental illness.

If we consider “obsessive-compulsive” behavior as you mention, at one level the individual may be a perfectionist or highly organized — maybe to the extent that he/she irritates co-workers. However, irritating co-workers is not a psychiatric disorder and in fact, many folks do that for entertainment. Being obsessive-compulsive as a personality is actually helpful in many careers, especially those that demand high attention to detail. At the same time, being OC is an inflexible pattern that limits the individual in many ways. For example, a physician who is OC may make a good surgeon…but be a bad choice for the emergency room. I would want an OC accountant but not an OC firefighter.

Clinically, having a variety of “traits” does not create a mental illness. In OC symptoms, a rigid and inflexible pattern of orderliness that creates mild to moderate social/work limitations might be considered a personality disorder. If the OC symptoms create significant anxiety, distress, or impairment — then the diagnosis becomes Obsessive-Compulsive Disorder — a more serious level of those symptoms that would require treatment.

Several psychiatric conditions create very happy individuals, but it becomes a clinical diagnosis when their level of impairment is considered. For example, criminals (Antisocial Personality) are very narcissistic and happy with their personalities yet are unable to function in the majority of common cultural roles such as worker, parent, partner, etc. Individuals with Bipolar Disorder, in a manic mood, are extremely happy yet can’t maintain a casual conversation.

So, a mental illness is based on the degree of distress and impairment created by the symptoms. As you describe, a variety of behavior, attitudes, and social situations are not psychiatric illnesses because they 1) create no distress in the individual and 2) do not impair their functioning. Introversion, for example, is not a psychiatric illness. People experience emotional reactions every day to various losses, stressors, etc. in their life. These are not considered “mental illness” unless their level of distress creates a significant impairment in their life activities.