Being Anxious or Sad Does Not Make You Mentally Ill
We easily pathologize bad feelings, but they’re a normal, even healthy part of human experience.
If you have recently been told that you have a mental-health malady such as depression or anxiety, you are far from alone. The rates at which these diagnoses are being made have exploded over the past few years. A 2021 literature review in The Lancet measured a 26 percent increase in anxiety disorder worldwide during the first year of the pandemic, and a 28 percent increase in depressive disorder. Such symptoms are much higher among some groups, according to the 2021 publication of an extended afterword to the 2018 book The Coddling of the American Mind, by the psychologist Jonathan Haidt and journalist Greg Lukianoff. For example, among politically progressive white women in their 20s, more than half said in early 2020 that they’d been told that they had a mental-health condition.
The coronavirus outbreak and its associated lockdowns isolated people, causing widespread increases in feelings of loneliness and distress, which still persist. But some studies have shown that the phenomenon began before the pandemic, so other reasons for it must exist as well. One commonly identified factor is excessive social-media use, which can substitute for in-person relationships, intensify social comparison, and elevate loneliness. Still another reason (which I have written about previously) is the increase in political polarization, which can lead people to hate one another—feelings of depression and anxiety are elevated in those who direct hatred toward out-groups.
But one other explanation is emerging for the huge increase in population-wide estimates of mental-health diagnoses: the tendency to see stress and sadness as evidence that something is broken inside you. For many who have them, of course, anxiety and depression are medical problems that absolutely require treatment. But other cases exist for which we may have inadvertently pathologized perfectly healthy emotions—leading many people to believe they are ill simply because they’re reacting normally to the challenges in their lives.
When physical disease is concerned, most of us make two basic assumptions. First, feeling bad is evidence of pathology. You never go to a doctor and say, “I’ve been feeling weirdly good these past few weeks, so I figured I’d better come to get it checked out.” Yet we all know that feeling pain or discomfort is not necessarily a good indicator of what might be ailing you. Often, such sensations are an indication that your body is protecting you—for example, you tweaked your back and it wants you to baby it for a few days. You probably have even experienced some beneficial stress—because, for instance, you worked out harder than normal, and now you have sore muscles.
The second assumption we make is that ailments are purely binary: You either have them or you don’t. So you might say, “I have prediabetes,” and although that sounds very specific and clear, suggesting that a reliable treatment must exist, what it really means is that you have a glycated hemoglobin level from 5.7 percent to 6.4 percent. Meeting that diagnostic criterion leads doctors to think that, without some changes to your diet and lifestyle, your level might rise more and create significant health problems for you. But as a condition, it’s not in itself an ailment in any straightforward sense.
As with many health issues, this is a case of a “dial,” not a “switch.” We treat the condition as if it were an on-off switch because we organize diagnostic medicine neatly around the classification of diseases, or nosology, to use the technical term.
These assumptions have become embedded in mental-health treatment in ways that muddle reality even more. Positive mental health is defined by professionals and laypeople alike in no small part by “feeling good,” which means not experiencing too many negative emotions such as anger, sadness, fear, and disgust. But as one social psychologist, responding to normative assumptions about the value of psychological health, asked in a philosophy paper back in the 1950s, “Good for what? Good in terms of middle class ethics? Good for democracy? For the continuation of the social status quo? For the individual’s happiness? For mankind?”
The nosological binary is even more problematic in diagnosing mental disorders. According to the World Health Organization, “In 2019, 1 in every 8 people, or 970 million people around the world were living with a mental disorder.” In other words, seven in eight people aren’t living with a mental disorder. But how would you find out whether you are the one or among the seven? Take any online test for depressive symptoms and you will almost certainly have a positive score, suggesting some degree of depression. But is that level a “disorder” as such? The answer is ultimately subjective: It depends on whom you consult, and whether the symptoms are judged to be interfering with your life “too much.”
More and more researchers are pointing out the high costs of such assumptions. To begin with, high levels of stress and sadness are completely normal, even beneficial. They are a natural reaction to ordinary events in life, a response that evolved to help us behave in useful, functional ways. Again, these emotions can be too active, but everyone will have good reasons to feel stress, which helps us react to an event with focus and energy when needed, just as we respond with appropriate sadness when we experience a loss or disappointment.
In fact, people routinely don’t want to “feel good,” and respond to failure or threat by regulating their emotions downward (in a “negative” direction). For example, in one experiment where participants negotiated with a stranger, researchers confirmed that many of them wanted to feel some degree of anger to be more effective in doing so.
The dial-versus-switch problem has led some health scholars such as Allan V. Horwitz and Jerome C. Wakefield to assert that the current epidemic of depression is at least in part the result of “diagnostic inflation.” In their 2007 book, The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder, they argue that by assuming that feeling bad is bad, we conflate normal sadness with clinical depression.
Some researchers go so far as to claim that the whole system of psychiatric diagnosis should be scrapped. Writing in the International Journal of Clinical and Health Psychology, the British psychiatrist Sami Timimi argued that a label such as “depressive disorder” or “generalized anxiety disorder” “does not aid treatment decisions, is associated with worsening long-term prognosis for mental health problems, and imposes Western beliefs about mental distress on other cultures.”
None of this means that psychiatric or psychological help with emotions is a bad idea. As my Harvard colleague, the psychiatrist Robert Waldinger, reminded me, a problem of underdiagnosis applies as much as one of overdiagnosis, because millions of people—in the U.S. and around the world—lack access to basic mental-health care. Even those of us who do not have a disorder can benefit from help with emotional management, just as physically healthy people can benefit from learning ways to stay fit and take care of their body.
The point is that feeling discomfort and seeking help should not necessarily mean that you are ill. You might instead be emotionally healthy but coping with unusual pressures, a period of change, or just, well, life on Earth.
If you are concerned about your mental health, you should of course seek medical help. As Waldinger put it to me, “Never suffer alone.” You may benefit from any of a variety of treatments, including talking cures and prescription drugs. But here are three things to remember, especially in your lower moments.
1. We are all anxious and sad.
Decades ago, the researcher Christopher Boorse uncovered a seemingly strange fact: By the ordinary criteria for mental disorders, the population at large is no less disturbed than the population of clinical patients. In truth, this isn’t so strange when we recall that distress is a dial, not a switch, and no one’s dial is at zero. The first Noble Truth of Buddhism is, after all, dukkha—that everyone suffers and suffering is part of the world. But forgetting this is easy when you’re told that you have a specific mental condition, and when you feel isolated and alone in your pain.
You are not defective simply for feeling distress.
2. The goal is not to eradicate suffering.
It is normal and healthy to want relief from your suffering, but futile and dangerous to try to eradicate all of your pain. Think of it this way: When you have a headache, you want a Tylenol to take the edge off, but not narcotics strong enough to numb you completely. Emotional self-management—through meditation or prayer, or with the help of therapy—is like Tylenol, so that you can regain a bit more comfort and control.
3. Your happiness requires unhappiness.
The 20th-century self-improvement writer Norman Vincent Peale wrote a wildly best-selling book called The Power of Positive Thinking, in which he exhorted readers to start each day by reciting Psalm 118:24: “This is the day the Lord has made. We will rejoice and be glad in it.” As a young man, I sometimes did this and gave thanks for the positive, happy things in my life as I did so. Today, I realize this was too narrow a reading of that verse. The psalmist is not saying “Be grateful for the fun stuff” but rather “Be grateful for all of it.” That means both the fun parts I want and the hard parts I need, so that I stay alert, mourn loss, learn, and grow.
Some days, giving thanks for the bad feelings is just too hard. But we can at least remember that they exist for a reason; they are normal, we are normal, and we’re all right for feeling them.
Stress and sadness are not automatic evidence that you have a disorder. They are evidence that you are a living, breathing human being living in a complicated world.
