Not All Distress is Mental Illness.
Many employers are currently concerned about the mental health of their employees in the wake of the significant disruptions to our lives that the coronavirus pandemic has brought about. There are widespread concerns for the impact that will be felt due to the dramatic changes to our financial viability, physical health and relationships with others, brought about by COVID-19. These concerns are well-founded considering that these stressors have come in the context of an already high incidence of mental ill-health in Australia, with the Australian Productivity Commission estimating that 50% of all Australians will be diagnosed with mental illness in their lifetime (Productivity Commission, 2020).
However, an important question to address in circumstances such as the ones we find ourselves in is “what is a normal reaction to a stressful situation as opposed to a clinically significant reaction that is unlikely to resolve without professional help? “. The truth is, feeling stressed when almost every element of our environment has changed, demonstrates that we are appropriately attuned to our environment and that our minds are functioning quite healthily.
There are established health benefits of normalizing the distress that we feel. Drawing upon the self-compassion literature, we know that being able to recognise that our distress is normal and part of our common humanity, is helpful for remaining resilient in the face of stress. According to self-compassion researchers, “Rather than seeing oneself as a separate, unworthy individual, self-compassion involves recognizing that one’s experience of imperfection is connected to the experience of imperfection shared by all humanity” (Neff and Knox, 2017, p. 1). Researchers have been able to demonstrate that taking a self-compassionate stance towards our emotional experience; recognising that there is nothing “wrong” with us when we experience strong emotions, leads to several positive outcomes including increased social connectedness and decreased depression and anxiety (Neff, Kirkpatrick and Rude, 2007).
However, the question remains. How do we tell whether our reaction to these stressful circumstances is within the normal range or whether we are experiencing a response that we may need some professional help to resolve? There are certain elements of functioning that a clinician will pay attention to, to determine if a psychological diagnosis is warranted. These elements provide clues as to how we can start to tell this difference.
Level of interference
A criterion that is part of almost all diagnoses listed in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) is that of interference. Generally, for psychological symptoms to be considered clinically significant, they need to be interfering in a person’s capacity to engage in the activities that help them to live their life. This could be in the areas of work or study, social functioning, relationships, activities of daily living or other important domains. It is normal for us all to experience low to moderate levels of unpleasant emotions, but if these reach a level where they prohibit us from functioning in important ways, that is a good indication that additional help is required.
Length of time
It is normal to feel stressed in immediate response to a new stressor. In the face of acute stress, experiencing physical sensations such as jitteriness, flushing, churning in the stomach, racing thoughts or tightness in the chest is normal. These symptoms may also be accompanied by emotions such as anxiety, fear, anger, sadness or frustration. However, if these experiences last long beyond the acute phase, this can be a sign that something more serious is going on. Frequent, unpleasant mood states that last for two weeks or more can become more interfering and are likely to require additional assistance to shift.
Lack of shifting
A third important element of functioning that a clinician will pay attention to, when determining if clinical intervention is required, is a person’s ability to find ways of changing their mood. If a person is able to find ways to improve their mood and has a number of strategies which are effective in helping them to lift their mood, they are more likely to be able to cope with intermittent periods of unpleasant emotional states. Whereas people struggling with a mood disorder will often report difficulties in finding ways to help themselves to feel better. It is when psychological distress starts to feel impossible to shift, that clinical help is likely to be of benefit.
This is an important question for employers to consider as they attempt to support and manage the mental health of their employees. A review by researchers at Monash University, outlined an approach that assisted employers to identify the level of distress felt by their employees to determine the level of intervention that is required for them (Iles, Hogan, Craig, and Collie, 2020). It is likely that assisting employers to differentiate between normal reactions and clinically significant reactions can provide them with a road map for determining the level of intervention that is likely to be helpful, lending support for non-clinical interventions in appropriate circumstances. If we can improve everyone’s awareness of these signs of declining psychological functioning, this may facilitate the appropriate allocation of resources, ensuring that the people who require the most help receive it quicker.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA.
Iles, R., Hogan, C., Craig, A. and Collie, A. (2020). Work-connected interventions for people with psychological injuries. Retrieved from https://www.sira.nsw.gov.au/fraud-and-regulation/research/work-connected-interventions-for-people-with-psychological-injuries on 26th August 2020.
Neff, K., Kirkpatrick, K. and Rude, S. (2007). Self-compassion and adaptive psychological functioning. Journal of Research in Personality, 41. 139-154.
Neff, K. and Knox, M. (2017). Self-compassion. Chapter in V. Zeigler-Hill, T.K. Shackelford (eds.), Encyclopedia of Personality and Individual Differences. Springer International Publishing, AG.
Productivity Commission. (2020). Mental Health, Report no. 95, Canberra.