I’ve seen references to “serious” mental illness here and there. What the heck does that mean? Even Google can’t give me a clear answer. A fantastic blog post by Kaitlin Bell Barnett pretty well says everything I would have said about this topic. Rats. Now I have to come up with something more.
A point I’d like to specifically highlight is that most of the time, this term is reserved for illnesses that involve mania or psychosis: schizophrenia, schizoaffective disorder, and bipolar disorder. The National Institute on Mental Health uses a broader definition:
- A mental, behavioral, or emotional disorder (excluding developmental and substance use disorders)
- Diagnosable currently or within the past year
- Of sufficient duration to meet diagnostic criteria specified within the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
- Resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities
NAMI agrees, and includes several more conditions besides those that are generally understood to be serious. It’s only logical to argue that a DSM diagnosis indicates seriousness, since that’s often one of the diagnostic criteria. One of the key considerations is clearly the level of impairment, which is often measured by the Global Assessment of Functioning. Apparently 60 or lower is a rule of thumb used in some cases (though I’ve lost the link that said so.) Blue Cross Blue Shield of Illinois is very clear about what is considered serious and what is not, and I disagree with their categorization of at least a few of these conditions as non-serious. They also mis-classify ADD/ADHD as a (non-serious) mental illness instead of a developmental disorder.
Another important aspect was discussed by bipolar blogger Natasha Tracy, who is also quoted in the above-mentioned post: if you’re in severe pain due to mental illness, it’s serious. With this, I wholeheartedly agree. But there may still be some value in discriminating between persistently serious conditions and temporary serious conditions. Perhaps if you’re expected to need psychoactive medication your entire life, that might be considered more “serious” than a condition for which short-term medication or therapy-only approaches are appropriate. I really don’t know – it’s a very slippery slope.
If we use the criteria that lean on the GAF, then what? Looking at the details of the mGAF-R (PDF), it seems a bit subjective because all of these things are relative, just like everything else I report to mental health professionals. If a psychiatrist who only sees you for 15 minutes every month or three is making the evaluation, then it’s hard to argue validity to me. I’d want my therapist making this judgment instead.
Since no one has evaluated me with the GAF – to my knowledge, anyway – I’d probably score myself between 41 and 53, depending on when you ask. My level of impairment really varies with mood episodes and medications and about a million other factors, or so it seems. Before Lamictal, I was almost always in the 40’s. Even when I feel that my condition is fairly well controlled with medication, I periodically have moderate mood symptoms and/or problems in work functioning. The meds reduce the frequency and duration of episodes and tamp down the intensity a bit, but I’ve come to realize that bipolar disorder will always be there in the background.
Interestingly, hypomania shows up nowhere on the GAF. It’s only when you get to the Group D categories (in the 40’s) that mania is mentioned. I’d argue that hypomania can cause impairment as well, but perhaps that means that I’m actually manic and not just hypomanic after all. I haven’t yet been able to get a clear fix on that.
Regardless, I fall into the “seriously mentally ill” category. That’s not unexpected since bipolar disorder is consistently considered a serious mental illness, and as a result, my treatment needs will almost always be covered by insurance. Although I’m glad to know that my problems are taken seriously as a medical condition, I’m simultaneously amazed to realize that I was this ill for years and never knew it.
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