South First spoke to Dr Alok Kulkarni, Senior Consultant Psychiatrist, Manas Institute of Mental Health and Neurosciences, Hubballi, to discuss these terminologies and the broader understanding of mental health.
Published Oct 10, 2024 | 7:00 AM ⚊ Updated Oct 10, 2024 | 9:19 AM
Mental health terminology has become increasingly prominent in recent times. However, the widespread use of terms like “stress,” “anxiety,” and “depression” has resulted in a lack of clarity.
People often use these terms interchangeably or incorrectly, leading to misunderstandings. This issue is particularly relevant as mental health awareness grows, and societal conversations encourage individuals to talk more openly about their experiences.
The lack of uniformity in mental health language creates confusion. What one person may describe as “stress,” another may label as “anxiety.” Similarly, terms like “burnout” and “depression” are often mixed up—while depression is a serious clinical condition, burnout is usually situational and related to work.
This inconsistency highlights the need for better education and awareness.
While normalizing discussions about mental health is crucial, it is equally important for people to understand the distinctions between different mental health conditions.
This will help improve communication, ensure access to appropriate treatment, and shape societal perceptions more accurately.
South First sat down with Dr Alok Kulkarni, Senior Consultant Psychiatrist, Manas Institute of Mental Health and Neurosciences, Hubballi, to discuss these terminologies and the broader understanding of mental health.
Here are the edited excerpts:
Q: What is mental health, and where do we draw the line between mental health and mental illness?
A. It’s important to understand mental health is a broad terminology because there’s no universal or singular definition.
Broadly, it can be conceptualized as a state of emotional, psychological, and social well-being where an individual can handle day-to-day stresses and challenges, contribute to their community, maintain good interpersonal relationships, and more.
Mental health exists on a complex continuum, and it varies from person to person.
Mental illness, on the other hand, results in clinically significant distress, functional impairment, and often socio-occupational dysfunction.
Q: Can someone experience poor mental health without having a diagnosable mental illness?
A. Absolutely. It’s possible. For instance, if I am given a task with a tight deadline and begin to experience uncontrollable fits of anger, lashing out at my juniors without reason, I may not be clinically distressed, but I’m clearly not coping well with the stress.
This might be considered day-to-day stress, and even though it impacts my behaviour, it wouldn’t necessarily qualify as a diagnosable mental health condition.
So yes, one can experience poor mental health without having a diagnosable mental illness.
Q: Stress, anxiety, and depression are terms frequently used in daily conversations. How do these terms differ clinically?
A. Anxiety is an apprehensive anticipation of future misfortune, often accompanied by feelings of distress, worry, and bodily tension. From an evolutionary perspective, fear and anxiety are adaptive responses to potential threats.
It’s essential to differentiate stress from pathological states like dysfunction and anxiety.
But how do we do this? As of today, we don’t have predictive biomarkers to clearly differentiate stress from these conditions. Research is ongoing in this area.
Right now, we rely on clinical judgment by considering factors such as:
So, it’s primarily a clinical assessment as of today.
Q: What about depression? These days, the term is used quite often, and many people claim to be suffering from depression. In your clinical practice, how do you approach this?
A. There are structured scales and rating instruments for assessing depression, which mental health professionals, especially psychiatrists, are trained to use.
You’re right that clinical depression is very different from how someone might casually say, “I’m depressed.”
Clinical depression is characterized by persistent and pervasive sadness, anhedonia (the loss of pleasure in activities once enjoyed), low energy, easy fatigue, disruption of biological functions, feelings of hopelessness, worthlessness, and sometimes inappropriate guilt.
In severe cases, it may even include suicidal ideation or psychomotor retardation (slowing down of physical movements and speech).
To give an example, someone might no longer enjoy activities they once loved, like watching TV, spending time with their children, or talking to neighbours.
Depression broadly impacts three domains—mood, energy levels, and activity levels. These are dulled during a depressive episode.
It’s essential to seek professional help, as mental health professionals can use structured rating tools to make an accurate diagnosis.
Q: You mentioned there’s a difference between normal sadness and depression. How can someone identify when they need professional help for their mental health?
A. Broadly speaking, the main markers to look for include functional impairment—if the symptoms are affecting day-to-day tasks, social life, or work performance.
Has the individual stopped socializing? Are they facing difficulties at work? Are they unable to perform regular tasks due to overwhelming feelings of sadness or anxiety? These are key signs that professional help may be necessary.
Q: Regarding terminology, how important is it to use the correct terms when discussing mental health? Does this impact the person experiencing the condition or those supporting them?
A. While using the correct terminology is important, I believe the most crucial factor is that people are discussing mental health at all.
These conversations represent a positive shift and have led to greater mental health awareness. They have helped dispel myths and reduce the stigma associated with seeking help.
In my view, I wouldn’t stress too much about using the “right” terminology. What matters is that individuals are becoming more open and comfortable seeking help for their mental health.
The growing discussion around mental health is a welcome change that encourages people to reach out for the support they need.
Q: What advice do you have for people who may be uncertain about the language they use when talking about their own or others’ mental health?
A. As I mentioned earlier, the language and terminologies people use can vary significantly. This is influenced by various factors, including social, cultural, and environmental contexts.
People should feel free to express their distress in whichever language or terminology they’re comfortable with.
However, I would like to emphasize that professionals—especially mental health professionals and those in the media—should be more responsible with the language they use.
By doing so, they can help reduce confusion rather than add to it. Using the correct terms can provide clarity and ensure that people have a better understanding of mental health.
Q: Looking ahead, do you think the terminology used to describe mental health and mental disorders will evolve further? How can professionals and the general public stay aligned with these changes as they occur?
A. Absolutely, terminology in the field of mental health will continue to evolve. Like any field, psychiatry is constantly advancing, and our classification systems are regularly revised and updated. Terminology will naturally shift to reflect those changes.
To stay aligned, it’s important to rely on credible sources of information. One resource I often recommend is the World Health Organization’s website, which is regularly updated.
It’s a great way for both professionals and the public to stay informed about the latest developments in mental health terminology.
Q: With World Mental Health Day, work ethics and evolving work culture are often discussed. The term “burnout” has become more common recently. How would you explain burnout? Is it considered a mental illness, or is it something different in your clinical practice?
A. In psychiatric classification systems, the term “burnout” doesn’t exist as a clinical diagnosis. Burnout can represent a variety of conditions, including stress, emotional exhaustion, or psychological strain. In some cases, it may overlap with clinically significant conditions like anxiety or depression.
While the specific term “burnout” is more of a descriptive term rather than a clinical one, it’s important to raise awareness about it.
Diagnosing mental health conditions should be left to mental health professionals through exhaustive clinical interviews, structured rating tools, and if necessary, additional investigations.
Burnout, in my opinion, can encompass a range of emotional states, but people must recognize the importance of seeking help if these feelings persist. Awareness helps dispel myths and reduce the stigma surrounding mental health.
Q: Over the past 10–12 years, discussions around mental health have significantly evolved. We’ve started prioritizing mental health, both in daily life and on dedicated days like World Mental Health Day. But what do you think is still lacking in these discussions?
A. One key area where we can improve is by involving clinicians more in these discussions. Psychiatrists and other mental health professionals can provide important context, helping to clarify the differences between stress and clinically significant mental health disorders.
Their input can address some of the confusion around terminology and ensure discussions are grounded in a clinical understanding of mental health.
Another gap is the rural-urban divide in these conversations. Most discussions around mental health tend to focus on urban areas, but we must also prioritize rural areas.
A large portion of India’s population—around 80 percent—lives in rural regions, yet mental health awareness and discussions are often limited there. In my practice, I see many patients from rural areas, and it’s evident that more needs to be done to spread awareness and open up conversations about mental health in these communities.
I believe it’s crucial to make our mental health discourse more inclusive by focusing on rural populations, alongside the urban context, to ensure broader reach and impact.
(Edited by Sumavarsha Kandula)
