Feeling Crazy? Who Wants to Know?

What are the differences between showing “mental illness,” having “emotional problems,” experiencing “life adjustment issues,” and being “crazy?” The answer: It all depends upon whom is asking the question.
     In the legal system, the critical issues are about the ability to understand reality (competence),the difference between right and wrong behavior (culpability) and the ability to make rational decisions. Prosecutors are notoriously skeptical of defendants claiming that, due to mental illness, they did not know they were committing a crime. Public defenders are equally appalled at the large number of individuals in prison who are so obviously mentally ill. The bias of the legal system leans toward judgment and punishment for criminal actions.

     The bias of the mental health system (psychotherapy, pharmacology, and hospitalizations) bends toward treatment and restoration of healthy functioning of the individual in society. To a therapist, “mental illness” is a dramatic term which implies irrational behavior, excessive emotional seesaws, probable family history of mental illness and/or traumatic experiences, and cognitive confusions. If the individual also suffers from pronounced physical abnormalities, the mental health professional would examine the chromosomal (DNA) profile of the individual as well. The first line of treatment is correct diagnosis, brief hospitalization, medication, development of a network of support for the individual, and various supportive therapies to help the individual understand his/her illness and to live a productive life.

     To mental health workers, having “emotional problems” suggests that the individual is having a tough time with relationships and with managing his/her emotions but is basically able to maintain contact with reality. The patient’s perspective on him or herself and others may be skewed and colored by the dominant emotional states. He/she may be angry, depressed, anxious, isolated, obsessive, anti-social, compulsive, suspicious, and/or hypochondriacal - while staying in the “real” world as opposed to a delusional world.

     Depending upon the severity of these emotional problems and the risk of self-injurious or aggressive behaviors, treatment ranges from brief hospitalizations to medications (to stabilize the emotional swings), and various forms of therapy. Psychotherapy aims to help the individual  better understand and prevent triggers to emotional storms, work through the  meanings and memories of traumatic experiences, improve the quality of the  relationships, and help restore a sense of stability and predictability in  his/her life.

     Frankly, it is still unknown as to how much of these stressful “emotional problems” are due to genetic factors or to adult and childhood experiences, but the misery these individuals experience from these emotional problems is only too clear.

     “Life adjustment issues” is another term for the “worried well.” Everyone of us runs into rough patches in our lives - whether it be the death of a loved one, marital problems, domestic abuse, divorce, the loss of a job, a breakdown in physical health etc. Psychotherapy and/or spiritual counseling aim to help individuals work through the meanings of the current life situation, improve self esteem, and facilitate behavioral change in order to maximize a sense of well-being.

     When someone tells you that a person you know is “crazy” - what does that mean?

     Once again the answer: It depends upon who is making that judgment.

     “Crazy” is not a term used by either the mental health or legal systems.

     When someone says that another person is acting or being “crazy,” it can simply mean that the other person is displaying unconventional, excessive behavior. Or that their behavior is offensive to the moral sensibility of the observer. Or that the observer doesn’t understand the reactions and emotions of the other person.

     But being “crazy” could also signal the presence of mental illness, emotional problems, or life adjustment issues.

     So, although words matter and carry meaning, it is always important to know who is doing the speaking.