Four Levels of Psychological and Mental Illness

Everyone has varying degrees of difficulty in coping with different emotional states; in other words, the key issue is not whether one has them or not, but the degree between the two extremes of absolute presence and absolute absence.

—Patricia E. Zurita Ona, Borderline Personality Disorder: ACT for Emotion Dysregulation

An earthworm is a peculiar animal: it has no heart, only five aortic arches. The aortic arches are arterial vessels that branch off from the ventral aorta at the pharynx, linking the dorsal and ventral aortas; they are generally arched, hence the name. The earthworm's aortic arches are ring-shaped, like swollen blood vessels, so they are also called ring vessels. The earthworm relies on these ring vessels to supply blood to its whole body's cells. The earthworm also has no lungs or gills; it breathes through its skin.

These physiological features make earthworms very sensitive to light, temperature, and humidity. Earthworms like to live in dark, damp, fertile soil; they fear light and vibration. They feed on the organic matter in fallen leaves, dead grass, plant roots, and wood chips in the upper layer of soil.

Earthworms are extremely picky about their living environment. If the humidity in the soil is too high and the earthworm is immersed in water, it cannot breathe normally and will crawl out of the soil onto the pavement. That is why in summer rain we often see earthworms on the road. But if the soil is too dry and the earthworm loses a great deal of body water, its life is also threatened. Earthworms require high relative humidity, around 80%; in a dry environment they stop eating and moving to reduce consumption, and even spray coelomic fluid from their dorsal pores to maintain surface moisture. Earthworms are also sensitive to temperature; to escape heat or cold, they adjust their depth in the soil according to the air temperature.

As a child, when I fished at home I often dug up earthworms, so I know their habits well. There are many kinds of earthworms; the most commonly used for fishing is the red wiggler, a relatively docile species that escapes tamely when dug up. But other earthworms are not so docile: when dug out of the soil, they thrash violently to protect themselves and quickly find a safe place to hide.

All living things have irritability; an organism's stress response is closely tied to its own physiological structure and to the external environment. Different physiological structures determine that different organisms need different living environments. When an environment makes an organism very uncomfortable, it finds a way to escape that environment and seek one suited to it. We humans also have irritability toward the environment, and our stress responses are highly similar to those of most mammals; the facial expressions that reveal human sorrow and joy can also be found on the faces of mammals.

Emotion is our natural response under stress. The four common emotions are joy, anger, sorrow, and fear. Facing the same event, some people have a strong emotional response and others a weak one. Some people even fall into a disordered mental state under stress. Those excessive emotional responses give rise to human psychological and mental illness.

How a person reacts to external stimuli is determined by their brain. What our brain is like determines what our personality is like; we have fixed response patterns to stimuli. Usually, the response patterns of ordinary people are broadly similar; these responses are acceptable to most people and do not cause the person themselves serious discomfort. We call such people normal. From a biological standpoint, so-called mentally normal people are those who adapt well to interpersonal relationships and have no severe negative emotions.

But there are also people whose brain's physiological structure deviates from the norm, or who have experienced adverse events during growth and adulthood, causing them to under-react or over-react to external stimuli. If the degree of under- or over-reaction is not severe, merely causing mild melancholy, anxiety, fear, irritability, or insomnia that the person can adjust themselves, or that automatically improves as the surrounding environment changes, these are not serious psychological or mental illnesses but merely maladjustment. Medicine names such phenomena depressive episodes, panic attacks, anxiety attacks, and so on; these sudden emotional episodes are not the same as depressive disorder, phobia, or anxiety disorder. Such episodes are usually transient and last no more than a year.

Under maladjustment, a person may exhibit intense emotional reactions that confuse or frighten others—such as furious rage, incessant weeping, incoherent speech, or total silence. These abnormal reactions look very much like psychotic symptoms, but they differ from true mental illness. Generally speaking, such people need no treatment or only simple treatment, and their emotional reactions resolve on their own. After resolution, if the surrounding interpersonal environment is adjusted appropriately, or if the person successfully regulates their own inner state and returns to calm, they will not relapse. Psychiatrists do not readily diagnose such reactions as a specific psychological or mental illness. The vast majority of normal people may experience such reactions several times in their lives.

If a bad mood—such as depression, anxiety, anger, or panic—lasts more than a year and cannot be relieved through self-regulation, then such a person can be diagnosed with depressive disorder, anxiety disorder, phobia, etc. These patients belong to the category of mood-disorder patients. Some can achieve relief through medication and psychological counseling. Usually such patients have insight into their own problems; they can perceive their own suffering, and some actively seek a doctor's help.

There are also patients who belong to the category of personality disorders. Personality-disorder patients are more complex than patients with simple depression or anxiety. A personality disorder has the following four features: 1. behavior that deviates markedly from the norm and is deeply ingrained; 2. the behavior is wholly unconscious and aimless, and the patient lacks self-control and insight over their own behavior; 3. it usually begins in childhood, adolescence, or early adulthood; 4. it may lead to the development of psychotic illness.

The common personality disorders include the following 12 types: 1. dependent personality disorder; 2. avoidant personality disorder; 3. obsessive-compulsive personality disorder; 4. depressive personality disorder; 5. paranoid personality disorder; 6. schizotypal personality disorder; 7. schizoid personality disorder; 8. passive-aggressive personality disorder; 9. narcissistic personality disorder; 10. histrionic personality disorder; 11. antisocial personality disorder; 12. borderline personality disorder.

Usually a patient may have more than one personality disorder; comorbidity of several personality disorders is possible, and most also have comorbid mood disorders. Personality is like the foundation of a building; once a personality disorder appears, the patient's thinking and behavioral habits easily deviate from the social norm, but the patient has no insight and believes themselves normal, accusing those around them of being abnormal. Personality disorders are hereditary; family members of some patients often have the same or closely related personality disorders. For example, the parents of a borderline personality-disorder patient may themselves have borderline or narcissistic personality disorder.

Personality disorders are more complex to treat than simple depression or anxiety. When such patients have comorbid depression or anxiety, taking the corresponding medications can reduce symptoms but cannot change their personality traits. To change their personality traits requires long-term therapy by a psychological counselor. Usually such therapy yields little obvious result, so many patients have low adherence to therapists and treatment is easily interrupted.

The fourth layer is serious psychosis, such as schizophrenia, severe mania, and bipolar disorder. Such patients require standardized treatment; when their condition is severe, poses a threat to those around them, or involves suicidal ideation, they may even require hospitalization.

Whatever the psychological or mental illness, it relates both to the patient's own brain and to their family environment. If a patient's family atmosphere is good, the life pressure they bear is small, family members have a deep understanding of the illness, and know how better to get along with such patients and reduce stimulation, then these patients can also remain relatively stable. Their illness is not easily triggered, or even if triggered, is easily controlled.

Usually, what triggers a patient's mental illness is precisely a harsh family environment and heavy life pressure. Modern people's lifestyles are increasingly isolated, lacking the rich kinship networks of the past. So if members of a small household are not good at maintaining intimate or parent-child relationships, or if people living alone long lack family warmth, it is especially easy for one or more family members to reach a state of being mentally overwhelmed. They may either have transient outbursts or develop long-unrelieved symptoms. Most long-term psychotic patients are congenital, or influenced by their family of origin, or both; but the severity of their symptoms is also greatly related to the family environment they are in.

How can we ease the mental pressure people bear? On one hand, each of us needs to value mental health and learn methods for handling emotions and intimate relationships; on the other hand, family members also need to work together.

A healthy relationship is balanced, with both sides holding 50% of the rights and obligations. An imbalanced intimate relationship is often the most important external factor that crushes a person's spirit.

Under normal circumstances, a relationship nourishes both parties and satisfies each side's needs. But not everyone can express their needs reasonably; some are used to using mind control, while others are used to suppressing their deepest needs. Moreover, everyone's behavior and thinking have inertia; outside the home they easily fall into the same state. Over time, the fragile person's psychology loses balance, and finally erupts through hysterical behavior. So usually, a patient's psychotic outbreak is easily accompanied by the breakdown of a relationship.

To reduce mental harm, we must in daily dealings with family members strive to be tolerant, understanding, and accepting, and try to keep every relationship in balance. Do not over-accommodate a family member who is skilled at mind control (this will make their mental illness progressively worse), and do not over-exploit a weak family member, which creates imbalance in the relationship.

Long-standing imbalance most often ends in a mental illness outbreak accompanied by relationship breakdown. Some serious mental illnesses should be treated standardly; many mental patients, after taking medication, can live like normal people. The most severely ill cannot live at home and need to be sent to psychiatric hospitals, cared for by professional medical staff.

Major tragic events often lead to secondary mental illness. For example, cancer patients easily develop secondary depression (this must be distinguished from patients who already had depression and then developed cancer as a comorbidity). People who experience car accidents, earthquakes, or fires easily develop post-traumatic stress disorder and similar conditions. For such patients, family members should offer more understanding, care, and love; if the patient's condition is severe, take them to a psychiatric clinic.