mental illness in society essay

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No such thing as mental illness? Critical reflections on the major ideas and legacy of Thomas Szasz

Tony b. benning.

1 Maple Ridge Mental Health Center, Maple Ridge, British Columbia, Canada

Enfant terrible of psychiatry and widely known as one of its most indefatigable as well as iconoclastic critics, Thomas Szasz (1961–2012) had a prolific writing career that extended some 51 years beyond the publication of his first book, The Myth of Mental Illness , in 1961. This editorial identifies and critically discusses three major themes in Szasz's writings: his contention that there is no such thing as mental illness, his contention that individual responsibility is never compromised in those suffering from what is generally considered as mental illness, and his perennial interest in calling attention to the political nature of psychiatric diagnosis.

The non-existence of mental illness

Arguing in The Myth of Mental Illness: Foundations of a Theory of Personal Conduct that they are merely ‘indirect forms of communication’, 1 Thomas Szasz posited that so-called mental illnesses cannot legitimately be categorised as diseases. This launched an argument that Szasz would elaborate over the course of a prolific writing career that spanned more than 50 years. Szasz repudiated psychiatry's misappropriation of concepts such as ‘illness’, which he took to be relevant to medicine and its ‘physicalist framework’ 2 but not to matters of mind and human conduct. In The Myth of Mental Illness , 1 after arguing that virtually any entity can have a counterfeit version, Szasz articulated his views with characteristic iconoclasm, contending that only physical illnesses are real and that mental diseases are ‘counterfeit and metaphorical illnesses’ (p. 34). Illnesses are understood, according to Szasz, 3 with respect to deviation from a norm, and in the case of physical illness the norm refers to the structural or functional integrity of the body or some aspect of it. But the norm – deviation from which results in so-called mental illness – is altogether more problematic for Szasz; this norm is a ‘psychosocial and ethical one’. 3 With this as the case, first, the search for a medical remedy seems poorly justified, and second, the points where diagnostic lines are drawn are bound, according to Szasz, to be somewhat arbitrary.

Szasz did not deny that humans have difficulties but he preferred to conceptualise them not as mental illnesses or as diseases, but as ‘problems in living’. 1 Nor did he deny psychiatrists a role in assisting individuals with problems. Psychiatrists could have a legitimate role to play but the ideal relationship between psychiatrist and patient, for Szasz, should be based on consensual contract rather than coercion. Second, the psychiatrist cannot justifiably claim that only he has the expertise to help people experiencing problems in living, since help from ‘family members, friends, clergymen, mental health professionals, physicians, drugs, religion, faith healing, marriage, divorce, and so on’ 4 could be legitimately solicited by or on behalf of those experiencing problems in living, according to Szasz.

As Kendell 5 pointed out in his rebuttal of Szasz's claim that mental illnesses fail to conform to the definition of disease, Szasz's notion of disease, influenced by Virchow, was overly narrow, for it placed excessive importance on the criterion of ‘cellular pathology’. 5 Kendell also claimed that Szasz's argument understated the extent to which ‘suffering and incapacity are fundamental attributes of disease’. 5 He brought attention to the fact that in medicine generally there is no universally agreed upon definition of disease – and if Szasz's criterion were to be widely adopted, several diseases widely recognised in medicine, such as migraine and torticollis (neither of which are associated with lesions or cellular pathology) would fail to qualify.

Beginning in the 1990s, psychiatry saw an unprecedented shift in its culture, with an explosion of interest in biological and neuroscientific research. Shorter, 6 on the basis of the claim that ‘the discipline today acknowledges a neurological basis for much psychiatric illness’ (p. 183), argued that contemporary neurobiological research findings in fact provide support to counter Szasz's argument. This view that Shorter attributed to ‘the discipline’ is arguably overstated, since there is by no means unanimity among psychiatrists in attributing biological aetiologies to mental illnesses. For example, several authors writing as recently as early 2000s have contested the very claim that schizophrenia is a brain disease. 7 , 8

Pathologisation of everyday life

A further area examined by Szasz concerns the proliferation of new psychiatric disorders. Szasz decried ‘fictitious mental diseases’ 9 such as body dysmorphic disorder, multiple personality disorder and frotteurism. What he appeared to be objecting to here is the encroachment of psychiatric discourse upon ever-increasing domains of human life. Szasz adopted a mocking tone, for example, when discussing ‘the behavior we call shoplifting – but psychiatrists call kleptomania’, 9 arguing that the construal of such behaviours as pathological entities for one thing perpetuates an assumption that the individual's actions are devoid of motivation and that they occur outside the orbit of their control. Medicalisation hands responsibility for such behaviours away from the individual concerned to physicians, specifically to psychiatrists.

In this respect, Szasz was cognizant of the interplay between diagnosis and political and social power; medicalisation gives a pre-eminent role to doctors, it privileges the role of medication as a therapeutic intervention and so the pharmaceutical industry stands to profit much by stretching the boundaries of the concept of mental disorder. Several authors in addition to Szasz have brought critical attention to this ever-widening reach of psychiatric diagnosis, and to the pharmaceutical industry's complicity in this phenomenon, 10 – 14 not only by supporting ‘new’ categories of psychiatric disorder (such as adult attention deficit disorder), but by endorsing the lowering of diagnostic thresholds for a host of established psychiatric disorders, such as bipolar disorder.

Mental illness and personal responsibility

Ever interested in the interface between psychiatry and the law, another recurring theme in Szasz's writing concerns the issue of individual agency and personal responsibility. Law, Liberty, and Psychiatry 3 is his first book-length attempt to grapple with these important issues. In it, Szasz articulated a critical position with respect to legal and jurisprudential orthodoxy which assumes that individuals with mental illness, in some cases, are not responsible for their actions (especially with reference to criminal acts). Distinguishing between explanation and responsibility, Szasz argued that regardless of a diagnosis of mental illness, individuals are ‘always responsible for their conduct’. 3

In discussing the hypothetical example of a deluded individual with schizophrenia who shoots several visitors outside the White House acting under the belief that he was pre-emptively shooting communist assassins, Szasz argued that the endorsement of a range of ‘explanations’ does not imply that the person committing the crime did not have responsibility for the act. Critical of what he dubbed the ‘progressive psychiatrization of the law’, 3 Szasz challenged the sorts of assumptions about personal responsibility in mentally disordered individuals that are reflected in such jurisprudential principles as the M'Naghten and Durham rules. There are other, more wide-reaching, implications of this assumption for Szasz – widespread in his view among psychiatrists and in jurisprudence – about the impairment of personal responsibility in the ‘so-called mentally ill’. 3 These he articulated in works such as The Therapeutic State 15 and The Manufacture of Madness , 16 arguing that it is on the basis of the false assumption that the so-called mentally ill person ‘is presumed to be incompetent’ 15 to make decisions about treatment that such paternalistic interventions as involuntary hospitalisation and coercive treatments are justified. These concerns gave rise to such pragmatic developments as his concept of the psychiatric will 15 in which it was proposed that an individual, when well, could document an objection to receiving coercive treatments in the event of falling sick.

Szasz consistently debunked the existence of mental illness on the basis of his assumption of the relevance to mental illness of the criteria of physiological abnormality, or the so-called ‘medical-pathological definition of disease’. 17 But this line of argument is problematic, with Kendell pointing out that this criterion is of dubious merit in physical disorder, let alone mental disorder. The scope of Szasz's erudition was broad but it did not encompass non-Western conceptualisations of mental disorder. Had it done so, the somewhat idiosyncratic nature of his argument would perhaps have become apparent to Szasz himself, for the criterion of physiological abnormality as a means of validating the existence of mental disorder is anathema to non-Western conceptualisations of mental illness. 18 – 22 As such, Szasz could appeal neither to history nor to insights from cultural psychiatry or anthropology as a way of giving credibility to his argument.

Szasz's concerns about the medicalisation of emotional, behavioural and interpersonal problems remain relevant and psychiatrists' engagement with them would be warranted. Vigorous effort continues to be expended in shoehorning a range of human problems into the medical model and resulting over-diagnosis furthers the professional interests of psychiatrists and the pharmaceutical industry. Many contemporary writers 10 , 12 , 13 share a concern for the societal impact of ever-greater number of psychiatric diagnoses and lowering of diagnostic thresholds for existing ones. However, there is a reality and suffering attached to mental illness, to psychological dysfunction, that Szasz's writings simply fail to acknowledge. In this respect, I fully agree with Lieberman: ‘I think Szasz trivializes devastating malfunction – serious mental illness – by dismissing such patients as attention seekers, imposters, and so forth’. 23 Admittedly, the language of histopathological lesions, of cellular pathology and infectious organisms has very little or no relevance to most psychiatric conditions, but to insist that problems with thought, emotions, drive, impulse control, cognition, perception, behaviour and so forth should be exempted from the rubric of illness, and the assertion that there is no such thing at all as psychopathology, seem entirely unjustified. Szasz might have attracted less opprobrium from psychiatrists and others had he acknowledged the reality of psychopathology and of mental illness while conceding that it does indeed have characteristics that set it apart from many – although not all – physical illnesses. These characteristics include phenomenological overlap with spiritual experience, 24 , 25 diagnostic boundaries that are often much less well defined than in physical illness, 12 boundaries that are subject to the influence of such factors as social context, and so forth. Such characteristics behove clinicians to conceptualise mental illness in different ways from physical illness, not to discard altogether the very concept.

Effort needs to be poured into formulating a conceptual definition of mental disorder 12 that does justice to serious mental illness so that such bona fide psychiatric illnesses as schizophrenia and major depression and mere problems in living are not conflated with each other. This would be a far more humane path along which to proceed than following the highly flawed Szaszian strategy of jettisoning the concept of mental illness.

Psychiatric labels have undoubtedly been deployed in the service of a range of political agendas and Szasz was justified in bringing attention to such historical constructs as ‘drapetomania’ and ‘sluggish schizophrenia’, 17 but his contention that contemporary psychiatric diagnoses represent nothing more than the labelling of those who are deviating from ‘psychosocial, ethical, or legal norms’ 17 was overstated. This is not a description that resonates with me as a clinical psychiatrist and I doubt that I am alone in this regard. Psychiatrists, contrary to what Szasz appeared to suggest, do not make judgements about pathology on the basis of arbitrary, socially constructed notions of normalcy, conformity and deviance. This is not to say though that there is no concept of a normative reference point. There is, but it usually is assumed as being an approximation to the patient's previous (so-called premorbid) state of health or level of functioning, deviation from which has resulted in distress and/or concern from the patient or their significant others. This is quite a different scenario from the one conceived by Szasz which would appear to portray psychiatrists as playing some sort of role, as agents of social control or as ‘social engineers’. 3

On the issue of Szasz's views on personal responsibility and on his wholesale dismissal of the claim that individuals diagnosed with mental disorder could ever lack competence to make treatment decisions, I agree with Lieberman 23 that while the default assumption on the part of physicians should be that patients retain competence, in some circumstances this assumption is proven to be false. In cases when a mentally disordered individual lacks decision-making competency psychiatric intervention may prevent them from harming themselves or others.

The specific question of Szasz's legacy became all the more salient following his death in 2012. Williams & Caplan, 26 writing in The Lancet , credited Szasz with the increasing preoccupation among psychiatrists – especially in the latter part of the 20th century – with disease nosology and with the quest to elucidate biological substrates for mental illness. The justifiability of such attribution of credit in this respect and to this extent to Szasz is debatable since the pursuit of a putative biological basis for mental illness is likely to be explained, as Walter 27 points out, by several converging streams of influence, recent as well as remote. They include the localationist imperatives that were advanced by Wernicke and Meynert at the end of the 19th century, the psycho-pharmacological breakthroughs of the mid-20th century, and the genetic studies of schizophrenia that soon followed. Williams & Caplan's argument, then, fails to convince. The more persuasive claim regarding his legacy is that which credits Szasz with engendering greater awareness around issues of psychiatric power. 28 Today, there is growing disquiet about the fact that ‘psychiatric talk’ has come to be a sort of go-to discourse for an ever-widening range of human concerns. 10 , 12 , 13 Undergirding that disquiet is cognizance of the fact that psychiatric power, as Breeding suggests, 28 need not be overt to be pervasive. As a body of writings that can sensitise us to these important issues, I can think of none more compelling than Szasz's.

Declaration of interest None.

• Essay Editor

Mental Health Essay

Introduction

Mental health, often overshadowed by its physical counterpart, is an intricate and essential aspect of human existence. It envelops our emotions, psychological state, and social well-being, shaping our thoughts, behaviors, and interactions. With the complexities of modern life—constant connectivity, societal pressures, personal expectations, and the frenzied pace of technological advancements—mental well-being has become increasingly paramount. Historically, conversations around this topic have been hushed, shrouded in stigma and misunderstanding. However, as the curtains of misconception slowly lift, we find ourselves in an era where discussions about mental health are not only welcomed but are also seen as vital. Recognizing and addressing the nuances of our mental state is not merely about managing disorders; it's about understanding the essence of who we are, how we process the world around us, and how we navigate the myriad challenges thrown our way. This essay aims to delve deep into the realm of mental health, shedding light on its importance, the potential consequences of neglect, and the spectrum of mental disorders that many face in silence.

Importance of Mental Health

Mental health plays a pivotal role in determining how individuals think, feel, and act. It influences our decision-making processes, stress management techniques, interpersonal relationships, and even our physical health. A well-tuned mental state boosts productivity, creativity, and the intrinsic sense of self-worth, laying the groundwork for a fulfilling life.

Negative Impact of Mental Health

Neglecting mental health, on the other hand, can lead to severe consequences. Reduced productivity, strained relationships, substance abuse, physical health issues like heart diseases, and even reduced life expectancy are just some of the repercussions of poor mental health. It not only affects the individual in question but also has a ripple effect on their community, workplace, and family.

Mental Disorders: Types and Prevalence

Mental disorders are varied and can range from anxiety and mood disorders like depression and bipolar disorder to more severe conditions such as schizophrenia.

• Depression: Characterized by persistent sadness, lack of interest in activities, and fatigue.
• Anxiety Disorders: Encompass conditions like generalized anxiety disorder, panic attacks, and specific phobias.
• Schizophrenia: A complex disorder affecting a person's ability to think, feel, and behave clearly.

The prevalence of these disorders has been on the rise, underscoring the need for comprehensive mental health initiatives and awareness campaigns.

Understanding Mental Health and Its Importance

Mental health is not merely the absence of disorders but encompasses emotional, psychological, and social well-being. Recognizing the signs of deteriorating mental health, like prolonged sadness, extreme mood fluctuations, or social withdrawal, is crucial. Understanding stems from awareness and education. Societal stigmas surrounding mental health have often deterred individuals from seeking help. Breaking these barriers, fostering open conversations, and ensuring access to mental health care are imperative steps.

Conclusion: Mental Health

Mental health, undeniably, is as significant as physical health, if not more. In an era where the stressors are myriad, from societal pressures to personal challenges, mental resilience and well-being are essential. Investing time and resources into mental health initiatives, and more importantly, nurturing a society that understands, respects, and prioritizes mental health is the need of the hour.

• World Leaders: Several influential personalities, from celebrities to sports stars, have openly discussed their mental health challenges, shedding light on the universality of these issues and the importance of addressing them.
• Workplaces: Progressive organizations are now incorporating mental health programs, recognizing the tangible benefits of a mentally healthy workforce, from increased productivity to enhanced creativity.
• Educational Institutions: Schools and colleges, witnessing the effects of stress and other mental health issues on students, are increasingly integrating counseling services and mental health education in their curriculum.

In weaving through the intricate tapestry of mental health, it becomes evident that it's an area that requires collective attention, understanding, and action.

  Short Essay about Mental Health

Mental health, an integral facet of human well-being, shapes our emotions, decisions, and daily interactions. Just as one would care for a sprained ankle or a fever, our minds too require attention and nurture. In today's bustling world, mental well-being is often put on the back burner, overshadowed by the immediate demands of life. Yet, its impact is pervasive, influencing our productivity, relationships, and overall quality of life.

Sadly, mental health issues have long been stigmatized, seen as a sign of weakness or dismissed as mere mood swings. However, they are as real and significant as any physical ailment. From anxiety to depression, these disorders have touched countless lives, often in silence due to societal taboos.

But change is on the horizon. As awareness grows, conversations are shifting from hushed whispers to open discussions, fostering understanding and support. Institutions, workplaces, and communities are increasingly acknowledging the importance of mental health, implementing programs, and offering resources.

In conclusion, mental health is not a peripheral concern but a central one, crucial to our holistic well-being. It's high time we prioritize it, eliminating stigma and fostering an environment where everyone feels supported in their mental health journey.

Frequently Asked Questions

• What is the primary focus of a mental health essay?

Answer: The primary focus of a mental health essay is to delve into the intricacies of mental well-being, its significance in our daily lives, the various challenges people face, and the broader societal implications. It aims to shed light on both the psychological and emotional aspects of mental health, often emphasizing the importance of understanding, empathy, and proactive care.

• How can writing an essay on mental health help raise awareness about its importance?

Answer: Writing an essay on mental health can effectively articulate the nuances and complexities of the topic, making it more accessible to a wider audience. By presenting facts, personal anecdotes, and research, the essay can demystify misconceptions, highlight the prevalence of mental health issues, and underscore the need for destigmatizing discussions around it. An impactful essay can ignite conversations, inspire action, and contribute to a more informed and empathetic society.

• What are some common topics covered in a mental health essay?

Answer: Common topics in a mental health essay might include the definition and importance of mental health, the connection between mental and physical well-being, various mental disorders and their symptoms, societal stigmas and misconceptions, the impact of modern life on mental health, and the significance of therapy and counseling. It may also delve into personal experiences, case studies, and the broader societal implications of neglecting mental health.

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There is no doubt that poor mental health takes an immense toll on the lives of affected individuals. Many conditions are barely manageable if not to say debilitating, which prevents mental health patients from taking care of themselves and living their lives to the fullest. What is often left out from the discussion on mental health is how it manifests itself on a larger scale. This paper discusses the impact of mental health on society in terms of education, workforce, and safety.

Mental illnesses have a profound economic impact on society. Suffering from a mental health condition often means reduced productivity and resourcefulness in individuals. It is not to say that mental health patients lack the skills or expertise to fulfill the assigned tasks. However, they struggle to find the energy and motivation to do so. Recent studies have shown that depression reduces activity in the frontal lobe – the part of the human brain that is responsible for higher-order mental faculties such as long-term planning and decision-making. It is readily imaginable how a depressed employee could fall short in these important aspects and underperform. Apart from that, mentally ill employees not only underperform, they may also be endangering the lives of other people. To put things into perspective, a WHO-led study evaluates the losses that the global economy experiences due to depression and anxiety disorders at US$1 trillion.

An individual’s mental health affects his or her educational outcomes. Firstly, the same factors that prevent people from performing well at work – limited decision-making and the inability to plan long-term stifle academic performance. On top of that, it has been found that two other components that often accompany mental illness – anhedonia and social dysfunction’ is the most influential component – play a significant role in shaping educational outcomes. Not being able to take pleasure in learning and function in society often lead to drop-outs.

Lastly, there is a link between psychiatric disorders and criminality and violent behavior, though its nature is still debated. Admittedly, that is not to say that all people with mental conditions are dangerous – that would be a harmful generalization. However, the inability to receive timely and adequate treatment, experiencing illusions and hallucinations as well as suffering from paranoia are all risk factors for delinquent behaviors. Mentally ill individuals are arrested and sent to prisons at a disproportionate rate, primarily because the justice system has not yet figured out the best way to handle them. Conversely, this category of people is also at risk of falling victim to violent crimes. To recapitulate, unmanaged public mental health concerns reduce safety, be the problems caused by mentally ill individuals or not.

Indeed, it is not only the individuals but also society on the whole that suffers from the adverse consequences of deteriorating mental health. Poor mental health is linked to underwhelming work performance, as affected individuals are not able to be as efficient at work as they could be if they were not suffering from their conditions. Academic performance also suffers, mainly from anhedonia and social dysfunction, while the high dropout rate means fewer qualified cadres in the workforce. Mental disorders translate into not tremendous economic losses worldwide. Lastly, unmanaged mental health issues may lead to crime outbreaks as some people can no longer control themselves or put themselves in risky situations.

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Introduction

• Published: February 2008
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The effects of mental disorder are apparent and pervasive, in suffering, loss of freedom and life opportunities, negative impacts on use of education, work satisfaction and productivity, complications in law, institutions of healthcare, intensive scientific research into causes and cures and so on. Suffering, loss of functioning, and perceived threat are among the personal and social experiences that can lead to mental health services. Once the problems are brought to the attention of mental health services and mental disorder is diagnosed, a range of possible outcomes is licensed, including offer of treatment, funding and perhaps, depending on severity and other circumstances, paid leave from work due to illness, possible shame and stigma, and in extreme cases compulsory admission to hospital, or acceptance of no or diminished responsibility in the Courts. Mental health professionals engage with the problems inside institutional structures using manuals for diagnosis and providing treatments that are increasingly required to be backed by scientific evidence of effectiveness. The social and institutional outcomes of assigning a diagnosis are important topics for social scientific theory and research. However, earlier in the chain of events and consequences are the social manifestations of mental disorder, open for all to see, and most importantly the personal and interpersonal effects, experienced by the people with the problems, their families and friends.

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The Importance of Mental Health

It's not just a buzzword

Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

Akeem Marsh, MD, is a board-certified child, adolescent, and adult psychiatrist who has dedicated his career to working with medically underserved communities.

Westend61 / Getty Images

Risk Factors for Poor Mental Health

Signs of mental health problems, benefits of good mental health, how to maintain mental health and well-being.

Your mental health is an important part of your well-being. This aspect of your welfare determines how you’re able to operate psychologically, emotionally, and socially among others.

Considering how much of a role your mental health plays in each aspect of your life, it's important to guard and improve psychological wellness using appropriate measures.

Because different circumstances can affect your mental health, we’ll be highlighting risk factors and signs that may indicate mental distress. But most importantly, we’ll dive into why mental health is so important.

Mental health is described as a state of well-being where a person is able to cope with the normal stresses of life. This state permits productive work output and allows for meaningful contributions to society.

However, different circumstances exist that may affect the ability to handle life’s curveballs. These factors may also disrupt daily activities, and the capacity to manage these changes. That's only one reason why mental health is so important.

The following factors, listed below, may affect mental well-being and could increase the risk of developing psychological disorders .

Childhood Abuse

Childhood physical assault, sexual violence, emotional abuse, or neglect can lead to severe mental and emotional distress. Abuse increases the risk of developing mental disorders like depression, anxiety, post-traumatic stress disorder, or personality disorders.

Children who have been abused may eventually deal with alcohol and substance use issues. But beyond mental health challenges, child abuse may also lead to medical complications such as diabetes, stroke, and other forms of heart disease.

The Environment

A strong contributor to mental well-being is the state of a person’s usual environment . Adverse environmental circumstances can cause negative effects on psychological wellness.

For instance, weather conditions may influence an increase in suicide cases. Likewise, experiencing natural disasters firsthand can increase the chances of developing PTSD. In certain cases, air pollution may produce negative effects on depression symptoms.  

In contrast, living in a positive social environment can provide protection against mental challenges.

Your biological makeup could determine the state of your well-being. A number of mental health disorders have been found to run in families and may be passed down to members.

These include conditions such as autism , attention deficit hyperactivity disorder , bipolar disorder , depression , and schizophrenia .

Your lifestyle can also impact your mental health. Smoking, a poor diet , alcohol consumption , substance use , and risky sexual behavior may cause psychological harm. These behaviors have been linked to depression.

When mental health is compromised, it isn’t always apparent to the individual or those around them. However, there are certain warning signs to look out for, that may signify negative changes for the well-being. These include:

• A switch in eating habits, whether over or undereating
• A noticeable reduction in energy levels
• Being more reclusive and shying away from others
• Feeling persistent despair
• Indulging in alcohol, tobacco, or other substances more than usual
• Experiencing unexplained confusion, anger, guilt, or worry
• Severe mood swings
• Picking fights with family and friends
• Hearing voices with no identifiable source
• Thinking of self-harm or causing harm to others
• Being unable to perform daily tasks with ease

Whether young or old, the importance of mental health for total well-being cannot be overstated. When psychological wellness is affected, it can cause negative behaviors that may not only affect personal health but can also compromise relationships with others. 

Below are some of the benefits of good mental health.

A Stronger Ability to Cope With Life’s Stressors

When mental and emotional states are at peak levels, the challenges of life can be easier to overcome.

Where alcohol/drugs, isolation, tantrums, or fighting may have been adopted to manage relationship disputes, financial woes, work challenges, and other life issues—a stable mental state can encourage healthier coping mechanisms.

A Positive Self-Image

Mental health greatly correlates with personal feelings about oneself. Overall mental wellness plays a part in your self-esteem . Confidence can often be a good indicator of a healthy mental state.

A person whose mental health is flourishing is more likely to focus on the good in themselves. They will hone in on these qualities, and will generally have ambitions that strive for a healthy, happy life.

Healthier Relationships

If your mental health is in good standing, you might be more capable of providing your friends and family with quality time , affection , and support. When you're not in emotional distress, it can be easier to show up and support the people you care about.

Better Productivity

Dealing with depression or other mental health disorders can impact your productivity levels. If you feel mentally strong , it's more likely that you will be able to work more efficiently and provide higher quality work.

Higher Quality of Life

When mental well-being thrives, your quality of life may improve. This can give room for greater participation in community building. For example, you may begin volunteering in soup kitchens, at food drives, shelters, etc.

You might also pick up new hobbies , and make new acquaintances , and travel to new cities.

Because mental health is so important to general wellness, it’s important that you take care of your mental health.

To keep mental health in shape, a few introductions to and changes to lifestyle practices may be required. These include:

• Taking up regular exercise
• Prioritizing rest and sleep on a daily basis
• Trying meditation
• Learning coping skills for life challenges
• Keeping in touch with loved ones
• Maintaining a positive outlook on life

Another proven way to improve and maintain mental well-being is through the guidance of a professional. Talk therapy can teach you healthier ways to interact with others and coping mechanisms to try during difficult times.

Therapy can also help you address some of your own negative behaviors and provide you with the tools to make some changes in your own life.

The Bottom Line

So why is mental health so important? That's an easy answer: It profoundly affects every area of your life. If you're finding it difficult to address mental health concerns on your own, don't hesitate to seek help from a licensed therapist .

World Health Organization. Mental Health: Strengthening our Response .

Lippard ETC, Nemeroff CB. The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders . Am J Psychiatry . 2020;177(1):20-36. doi:10.1176/appi.ajp.2019.19010020

 Helbich M. Mental Health and Environmental Exposures: An Editorial. Int J Environ Res Public Health . 2018;15(10):2207. Published 2018 Oct 10. doi:10.3390/ijerph15102207

Helbich M. Mental Health and Environmental Exposures: An Editorial. Int J Environ Res Public Health . 2018;15(10):2207. Published 2018 Oct 10. doi:10.3390/ijerph15102207

National Institutes of Health. Common Genetic Factors Found in 5 Mental Disorders .

Zaman R, Hankir A, Jemni M. Lifestyle Factors and Mental Health . Psychiatr Danub . 2019;31(Suppl 3):217-220.

Medline Plus. What Is mental health? .

National Alliance on Mental Health. Why Self-Esteem Is Important for Mental Health .

By Elizabeth Plumptre Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

Mental Health Essay for Students and Children

500+ words essay on mental health.

Every year world mental health day is observed on October 10. It was started as an annual activity by the world federation for mental health by deputy secretary-general of UNO at that time. Mental health resources differ significantly from one country to another. While the developed countries in the western world provide mental health programs for all age groups. Also, there are third world countries they struggle to find the basic needs of the families. Thus, it becomes prudent that we are asked to focus on mental health importance for one day. The mental health essay is an insight into the importance of mental health in everyone’s life. 

Mental Health

In the formidable years, this had no specific theme planned. The main aim was to promote and advocate the public on important issues. Also, in the first three years, one of the central activities done to help the day become special was the 2-hour telecast by the US information agency satellite system. 

Mental health is not just a concept that refers to an individual’s psychological and emotional well being. Rather it’s a state of psychological and emotional well being where an individual is able to use their cognitive and emotional capabilities, meet the ordinary demand and functions in the society. According to WHO, there is no single ‘official’ definition of mental health.

Thus, there are many factors like cultural differences, competing professional theories, and subjective assessments that affect how mental health is defined. Also, there are many experts that agree that mental illness and mental health are not antonyms. So, in other words, when the recognized mental disorder is absent, it is not necessarily a sign of mental health. 

Get the huge list of more than 500 Essay Topics and Ideas

One way to think about mental health is to look at how effectively and successfully does a person acts. So, there are factors such as feeling competent, capable, able to handle the normal stress levels, maintaining satisfying relationships and also leading an independent life. Also, this includes recovering from difficult situations and being able to bounce back.  

Important Benefits of Good Mental Health

Mental health is related to the personality as a whole of that person. Thus, the most important function of school and education is to safeguard the mental health of boys and girls. Physical fitness is not the only measure of good health alone. Rather it’s just a means of promoting mental as well as moral health of the child. The two main factors that affect the most are feeling of inferiority and insecurity. Thus, it affects the child the most. So, they lose self-initiative and confidence. This should be avoided and children should be constantly encouraged to believe in themselves.

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• Mental Health Essay

Essay on Mental Health

According to WHO, there is no single 'official' definition of mental health. Mental health refers to a person's psychological, emotional, and social well-being; it influences what they feel and how they think, and behave. The state of cognitive and behavioural well-being is referred to as mental health. The term 'mental health' is also used to refer to the absence of mental disease. 

Mental health means keeping our minds healthy. Mankind generally is more focused on keeping their physical body healthy. People tend to ignore the state of their minds. Human superiority over other animals lies in his superior mind. Man has been able to control life due to his highly developed brain. So, it becomes very important for a man to keep both his body and mind fit and healthy. Both physical and mental health are equally important for better performance and results.

Importance of Mental Health 

An emotionally fit and stable person always feels vibrant and truly alive and can easily manage emotionally difficult situations. To be emotionally strong, one has to be physically fit too. Although mental health is a personal issue, what affects one person may or may not affect another; yet, several key elements lead to mental health issues.

Many emotional factors have a significant effect on our fitness level like depression, aggression, negative thinking, frustration, and fear, etc. A physically fit person is always in a good mood and can easily cope up with situations of distress and depression resulting in regular training contributing to a good physical fitness standard. 

Mental fitness implies a state of psychological well-being. It denotes having a positive sense of how we feel, think, and act, which improves one’s ability to enjoy life. It contributes to one’s inner ability to be self-determined. It is a proactive, positive term and forsakes negative thoughts that may come to mind. The term mental fitness is increasingly being used by psychologists, mental health practitioners, schools, organisations, and the general population to denote logical thinking, clear comprehension, and reasoning ability.

 Negative Impact of Mental Health

The way we physically fall sick, we can also fall sick mentally. Mental illness is the instability of one’s health, which includes changes in emotion, thinking, and behaviour. Mental illness can be caused due to stress or reaction to a certain incident. It could also arise due to genetic factors, biochemical imbalances, child abuse or trauma, social disadvantage, poor physical health condition, etc. Mental illness is curable. One can seek help from the experts in this particular area or can overcome this illness by positive thinking and changing their lifestyle.

Regular fitness exercises like morning walks, yoga, and meditation have proved to be great medicine for curing mental health. Besides this, it is imperative to have a good diet and enough sleep. A person needs 7 to 9 hours of sleep every night on average. When someone is tired yet still can't sleep, it's a symptom that their mental health is unstable. Overworking oneself can sometimes result in not just physical tiredness but also significant mental exhaustion. As a result, people get insomnia (the inability to fall asleep). Anxiety is another indicator. 

There are many symptoms of mental health issues that differ from person to person and among the different kinds of issues as well. For instance, panic attacks and racing thoughts are common side effects. As a result of this mental strain, a person may experience chest aches and breathing difficulties. Another sign of poor mental health is a lack of focus. It occurs when you have too much going on in your life at once, and you begin to make thoughtless mistakes, resulting in a loss of capacity to focus effectively. Another element is being on edge all of the time.

It's noticeable when you're quickly irritated by minor events or statements, become offended, and argue with your family, friends, or co-workers. It occurs as a result of a build-up of internal irritation. A sense of alienation from your loved ones might have a negative influence on your mental health. It makes you feel lonely and might even put you in a state of despair. You can prevent mental illness by taking care of yourself like calming your mind by listening to soft music, being more social, setting realistic goals for yourself, and taking care of your body. 

Surround yourself with individuals who understand your circumstances and respect you as the unique individual that you are. This practice will assist you in dealing with the sickness successfully.  Improve your mental health knowledge to receive the help you need to deal with the problem. To gain emotional support, connect with other people, family, and friends.  Always remember to be grateful in life.  Pursue a hobby or any other creative activity that you enjoy.

What does Experts say

Many health experts have stated that mental, social, and emotional health is an important part of overall fitness. Physical fitness is a combination of physical, emotional, and mental fitness. Emotional fitness has been recognized as the state in which the mind is capable of staying away from negative thoughts and can focus on creative and constructive tasks. 

He should not overreact to situations. He should not get upset or disturbed by setbacks, which are parts of life. Those who do so are not emotionally fit though they may be physically strong and healthy. There are no gyms to set this right but yoga, meditation, and reading books, which tell us how to be emotionally strong, help to acquire emotional fitness. 

Stress and depression can lead to a variety of serious health problems, including suicide in extreme situations. Being mentally healthy extends your life by allowing you to experience more joy and happiness. Mental health also improves our ability to think clearly and boosts our self-esteem. We may also connect spiritually with ourselves and serve as role models for others. We'd also be able to serve people without being a mental drain on them. 

Mental sickness is becoming a growing issue in the 21st century. Not everyone receives the help that they need. Even though mental illness is common these days and can affect anyone, there is still a stigma attached to it. People are still reluctant to accept the illness of mind because of this stigma. They feel shame to acknowledge it and seek help from the doctors. It's important to remember that "mental health" and "mental sickness" are not interchangeable.

Mental health and mental illness are inextricably linked. Individuals with good mental health can develop mental illness, while those with no mental disease can have poor mental health. Mental illness does not imply that someone is insane, and it is not anything to be embarrassed by. Our society's perception of mental disease or disorder must shift. Mental health cannot be separated from physical health. They both are equally important for a person. 

Our society needs to change its perception of mental illness or disorder. People have to remove the stigma attached to this illness and educate themselves about it. Only about 20% of adolescents and children with diagnosable mental health issues receive the therapy they need. 

According to research conducted on adults, mental illness affects 19% of the adult population. Nearly one in every five children and adolescents on the globe has a mental illness. Depression, which affects 246 million people worldwide, is one of the leading causes of disability. If  mental illness is not treated at the correct time then the consequences can be grave.

One of the essential roles of school and education is to protect boys’ and girls' mental health as teenagers are at a high risk of mental health issues. It can also impair the proper growth and development of various emotional and social skills in teenagers. Many factors can cause such problems in children. Feelings of inferiority and insecurity are the two key factors that have the greatest impact. As a result, they lose their independence and confidence, which can be avoided by encouraging the children to believe in themselves at all times. 

To make people more aware of mental health, 10th October is observed as World Mental Health. The object of this day is to spread awareness about mental health issues around the world and make all efforts in the support of mental health.

The mind is one of the most powerful organs in the body, regulating the functioning of all other organs. When our minds are unstable, they affect the whole functioning of our bodies. Being both physically and emotionally fit is the key to success in all aspects of life. People should be aware of the consequences of mental illness and must give utmost importance to keeping the mind healthy like the way the physical body is kept healthy. Mental and physical health cannot be separated from each other. And only when both are balanced can we call a person perfectly healthy and well. So, it is crucial for everyone to work towards achieving a balance between mental and physical wellbeing and get the necessary help when either of them falters.

Mental Health Stigma

Rewrite your story: let go of mental health stigma and shame, by letting go of stigma and shame, you can embrace the life you deserve..

Posted May 10, 2024 | Reviewed by Monica Vilhauer

• Stigma can profoundly change how others see a person and how an individual feels about themself.
• Shame is a by-product of stigma; it is how we internalize the outside world’s beliefs about us.
• Each of us has the capacity to pick up the pen and write our own story to overcome stigma and shame.

The mental health movement has significantly contributed to normalizing and continuing the conversation around mental health, yet despite progress in recent years, a stigma around mental health challenges continues to persist in our society.

Stigma, by definition, is a mark of disgrace associated with a particular circumstance, quality, or person. Mental health stigma is just one form of stigmatization that gets in the way of living a resilient life.

Patrick W. Corrigan and John R. O’Shaughnessy have identified three types of stigma:

Structural stigma is when there are policies or practices within private and public institutions that restrict opportunities or disallow participation for someone distinguished from the norm.

Social stigma is when people within a society hold a bias, avoidance, discomfort, or overt discrimination against a person who is somehow distinguished from the norm.

Self-stigma is when a person internalizes all the messaging about what the norm is, believes the stereotypes, sees how they don’t belong, and then lives with deep shame and social rejection.

A fourth type of stigma has also emerged, called association stigma. This is when a person is stigmatized for being linked to someone else who is stigmatized.

The Effects of Stigma

It is not often that researchers agree, but when it comes to the effects of stigma, they are quite unanimous. Stigma hurts. Stigma is damaging. Stigma ruins lives. Stigma harms potential. The mental health literature demonstrates that the stigma associated with mental health conditions prevents people from accessing services and getting help.

Although we know the stigma is real, how we suffer from it is in our minds, bodies, and souls. It is not imagined, but it can be invisible. And despite our best-laid plans, once we experience stigma, our ability to maintain our sense of self is deeply challenged and our resiliency decreases. We are left living within the blast radius of a force that hits from outside and within.

Stigma Creates Shame

Each one of the four types of stigma creates the same by-product: shame. Stigma is the outside world holding a belief about us; shame is how we internalize that belief. When we explore shame, the conversation often includes guilt . Shame and guilt are not the same thing. Guilt is the feeling that you did something wrong. Shame is the feeling that you are wrong. Guilt means we broke a rule, an expectation, or a standard. Shame is the belief that we are broken. It screams that we are flawed, irreparable, and ultimately unlovable. Shame keeps us in the shadows.

Early in my life, I felt branded as someone who became broken in her childhood and adolescence and was therefore an unlikely candidate for a healthy future. Labels like, “addicted,” “crazy,” “troubled,” and “lost cause” came from the outside world. These labels then moved from the conscious to the subconscious , resulting in the embodied belief that they defined who I was. I internalized the message that people who navigate fractured self-esteem or mental health are broken. I carried this story that the outside world wrote for me for far too long.

Rewriting Your Story

We need to be able to let go of stigma and shame. Is there something you are carrying subconsciously that is holding you back or keeping you stuck? Those parts inevitably bleed into the rest of our lives and hinder the things that actually matter. Letting go of stigma and shame is not only hard work; it is heart work. No one can do this for you.

The reality is that when you own your own story, no one can use it against you. The day I released my story with Unsinkable, an organization working to break down stigma, was the day I truly embraced this idea. I decided I wouldn’t let anyone else hold against me my mistakes, setbacks, mental health challenges, or anything else they do not think is good enough about me. My story is mine. My life is mine.

And you know what? Something amazing happens when you look shame in the eye and say, no more. When you pull yourself out of the shadows and reclaim all of your life, shame loses power over you. You regain your footing. You stand in your truth, fall in love with your imperfect self, and become your own protector and warrior. You stop fighting yourself and start fighting for yourself. You become the person you needed all your life. The one that sees your vulnerability and accepts you completely as you are.

Once you start to believe in your own worth, the voices and the power you let others hold over you begin to fade away. Sometimes, the bravest thing you can do is make the decision to forgive yourself, let go of stigma and destructive self-narratives, and write your own story.

Corrigan, P. W., & O’Shaughnessy, J. R. (2007). Changing mental illness stigma as it exists in the real world. Australian Psychologist, 42(2), 90-97. doi.org/10.1080/00050060701280573

Hanley-Dafoe, R. (2021). Calm within the storm: A path to everyday resiliency. Page Two.

Robyne Hanley-Dafoe, Ed.D. , is a resiliency and wellness scholar and speaker, author of Calm Within the Storm and Stress Wisely , and award-winning instructor and adjunct professor at Trent University.

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Social online training helps against loneliness and depression

Online intervention helps to promote social skills and reduce mental health problems

Mental health problems, loneliness already among the youngest and polarization are rapidly increasing, especially after the Covid19 pandemic. A new large-scale research study, the CovSocial project, led by Tania Singer from the Max Planck Society, is helping people to reconnect with themselves, others and society at large. Recent findings reveal that a ten-week partner-based mental online training program was able to boost resilience, empathy, compassion and deepen social connections. At the same time, these short daily, app-based practices done with another person, so-called Dyads, decreased loneliness, depression, anxiety and a negative outlook in life. Researchers hope that this training can be scaled worldwide to overcome loneliness and social divisions.  

Through the interaction with a counterpart, online training promotes a more positive view of the world and thus helps with depression.

© Coetzee / peopleimages.com / Adobe Stock

Tania Singer, psychologist, social neuroscientist and scientific head of the Max Planck Society's Social Neuroscience Lab in Berlin, Germany, has for many years been developing mental intervention programs based on partner-based daily exercises, known as “Contemplative Dyads” as they resemble a mindfulness meditation done together with a partner in your daily life.

Unlike solitary mindfulness-based meditation practices, Dyads involve structured interactions between pairs of individuals who are taking turn in exploring loudly specific questions while the other is empathically listening without judging and interrupting in any way. The basic Affect Dyad for example consists of two questions which are aiming at both exploring and cultivating a deeper understanding and acceptance of challenging emotions as well as building resilience through the cultivation of gratitude and care.

More tolerance and less prejudice

These daily Dyads are done over ten weeks as social skill learning program and the practice is supported by teacher-lead weekly coaching sessions to help deepen the daily practice. People are randomly paired every week with a new partner to help increase tolerance, help reduce prejudice, overcome boundaries, and foster a sense of common humanity. With roots in ancient meditation traditions and recent advancements in social neuroscience, dyadic practices have emerged as a powerful tool for cultivating social skills and promoting resilience in diverse populations.

Science is now revealing the benefits of such social practices. The CovSocial Project, a large-scale mental health study spearheaded by Tania Singer at the Social Neuroscience Lab of the Max Planck Society and performed during the years of the Covid19 pandemic, revealed in its first phase, by tracking thousands of Berliners recruited from a random draw of the Berlin city register, that loneliness, stress, depression and anxiety increased with each lockdown showing severe lockdown fatigue effects. To reduce this suffering, the team therefore decided to offer in a second phase mental online training programs to those still participating in the study. The team compared the efficiency of two 10-weeks online mental training programs: a classic mindfulness-based and a partner-based socio-emotional Dyad intervention program.

Daily contemplative exercises are effective

A growing body of research is now published, giving impressive evidence that these daily social contemplative exercises done with another person are indeed effective in supporting participants mental wellbeing and health by reducing depression, anxiety and emotion regulation difficulties while at the same time increasing social skills such as empathy, self and other-related compassion. These findings give hope that such social mental practices could help overcome social divides, reducing loneliness, and improving human-to-human social connection.

A recently published paper by first author Godara showed that the ten-week online Dyad program could indeed reduce depression, anxiety and emotion-regulation difficulties while at the same time improve resilience. Interestingly, participants also showed a significant reduction in their “negative interpretation bias” - the likelihood of interpreting other people or situations in a negative way- and this decrease in negativity could actually account for the observed mental health benefits. This means that internalized knee-jerk anxieties about life or different groups or individuals can be tackled and a more positive worldview and outlook on life can be trained. Tania Singer comments on these findings: “While both interventions could decrease mental health problems, it was interesting to see that only in the dyadic social practices the reduction in negative interpreation bias was a strong candidate mechanism underlying the observed decrease in depression. We think that practicing daily gratitude during a Dyad with a partner may help boost this more positive outlook onto live and in turn strengthen one’s resilience and mental health”.

Increasing social connections

In another mental training study from the CovSocial project just published, first author Hannah Matthaeus and colleagues revealed that again only the socio-emotional Dyad practice program, but not the classic mindfulness practice program focusing on meditations done alone, could significantly reduce loneliness. Tania Singer concludes: “As in a previous large-scale mental training study, the ReSource project, we could confirm again that these daily relational practices are a powerful tool to increase social connections and facilitate people to share their difficulties and vulnerability. In the recent study, we could extend these previous findings in showing that even if practicing Dyads only online and only for ten weeks, we can find this deepening of social connections and even reduce loneliness. This offers real hope that recent alarming trends towards social isolation, loneliness and division can be reversed by scaling such inter-relational mental training programs based on Dyads”.

As the evidence for the effectiveness of this Dyad intervention builds, the study’s authors hope that they can develop ways to scale it so that these Dyad training programs can be brought to society at large and especially to domains which suffer mostly under high burn-out rates and stress such as the health-care or educational systems. Their next programs, Edu:Social School and Health will focus on exactly this: testing the effects of such Dyad programs in the context of the classroom and hospitals in the hope to increase not only the resilience of teachers and health-care providers but also boost classroom climate and team spirits and social cohesion.

The principal investigator of the CovSocial study, Tania Singer concludes: “At a time when policy-makers are grappling with a rising tide of poor public mental health and increasing loneliness and social divisions, our study shows it is possible to bring communities back together and promote positive, healthy human interactions. This is what our societies need urgently. People are crying out for a sense of belonging, community, care, and true social connections. I hope we can take the lessons of this study and begin to scale and amplify such interrelation mental training programs to benefit society. This is why we started now a follow-up study, the Edu:Social project to bring these practices into the fields of education and healthcare”.

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Home — Essay Samples — Nursing & Health — Mental Health — The Importance of Mental Health Awareness

The Importance of Mental Health Awareness

• Categories: Mental Health Social Isolation Stress Management

About this sample

Words: 1622 |

Updated: 4 November, 2023

Words: 1622 | Pages: 4 | 9 min read

Table of contents

Introduction, mental health awareness, video version, emotional well-being, psychological well‐being, social well-being.

• Health Effects of Social Isolation and Loneliness. (n.d.). Retrieved from https://www.aginglifecarejournal.org/health-effects-of-social-isolation-and-loneliness/.
• Top of Form Mental Health Myths and Facts https://www.mentalhealth.gov/basics/mental-health-myths-facts
• Mental Health Care Services by Family Physicians Position Paper. American Academy of Family Physicians Web site. http://www.aafp.org/online/en/home/policy/policies/m/mentalhealthcareservices.htm. Accessed February 11, 2013. [Google Scholar]
• Newman, T. (2017, August 24). Mental health: Definition , common disorders, and early signs. Retrieved from https://www.medicalnewstoday.com/articles/154543.php.
• Bottom of Form Rodriguez, B. D., Hurley, K., Upham, B., Kilroy, D. S., Dark, N., & Abreu, E (n.d.).Happiness and Emotional Well-Being. Retrieved from https://www.everydayhealth.com/emotional-health/understanding/index.aspx.
• World Health Organization. The Global Burden of Disease, 2004 Update. Part 4, Burden of Disease, DALYs. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf . Accessed January 10, 2013. [Google Scholar]

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When Prison and Mental Illness Amount to a Death Sentence

The downward spiral of one inmate, Markus Johnson, shows the larger failures of the nation’s prisons to care for the mentally ill.

Supported by

By Glenn Thrush

Photographs by Carlos Javier Ortiz

Glenn Thrush spent more than a year reporting this article, interviewing close to 50 people and reviewing court-obtained body-camera footage and more than 1,500 pages of documents.

• Published May 5, 2024 Updated May 7, 2024

Markus Johnson slumped naked against the wall of his cell, skin flecked with pepper spray, his face a mask of puzzlement, exhaustion and resignation. Four men in black tactical gear pinned him, his face to the concrete, to cuff his hands behind his back.

He did not resist. He couldn’t. He was so gravely dehydrated he would be dead by their next shift change.

Listen to this article with reporter commentary

“I didn’t do anything,” Mr. Johnson moaned as they pressed a shield between his shoulders.

It was 1:19 p.m. on Sept. 6, 2019, in the Danville Correctional Center, a medium-security prison a few hours south of Chicago. Mr. Johnson, 21 and serving a short sentence for gun possession, was in the throes of a mental collapse that had gone largely untreated, but hardly unwatched.

He had entered in good health, with hopes of using the time to gain work skills. But for the previous three weeks, Mr. Johnson, who suffered from bipolar disorder and schizophrenia, had refused to eat or take his medication. Most dangerous of all, he had stealthily stopped drinking water, hastening the physical collapse that often accompanies full-scale mental crises.

Mr. Johnson’s horrific downward spiral, which has not been previously reported, represents the larger failures of the nation’s prisons to care for the mentally ill. Many seriously ill people receive no treatment . For those who do, the outcome is often determined by the vigilance and commitment of individual supervisors and frontline staff, which vary greatly from system to system, prison to prison, and even shift to shift.

The country’s jails and prisons have become its largest provider of inpatient mental health treatment, with 10 times as many seriously mentally ill people now held behind bars as in hospitals. Estimating the population of incarcerated people with major psychological problems is difficult, but the number is likely 200,000 to 300,000, experts say.

Many of these institutions remain ill-equipped to handle such a task, and the burden often falls on prison staff and health care personnel who struggle with the dual roles of jailer and caregiver in a high-stress, dangerous, often dehumanizing environment.

In 2021, Joshua McLemore , a 29-year-old with schizophrenia held for weeks in an isolation cell in Jackson County, Ind., died of organ failure resulting from a “refusal to eat or drink,” according to an autopsy. In April, New York City agreed to pay $28 million to settle a lawsuit filed by the family of Nicholas Feliciano, a young man with a history of mental illness who suffered severe brain damage after attempting to hang himself on Rikers Island — as correctional officers stood by.

Mr. Johnson’s mother has filed a wrongful-death suit against the state and Wexford Health Sources, a for-profit health care contractor in Illinois prisons. The New York Times reviewed more than 1,500 pages of reports, along with depositions taken from those involved. Together, they reveal a cascade of missteps, missed opportunities, potential breaches of protocol and, at times, lapses in common sense.

Prison officials and Wexford staff took few steps to intervene even after it became clear that Mr. Johnson, who had been hospitalized repeatedly for similar episodes and recovered, had refused to take medication. Most notably, they did not transfer him to a state prison facility that provides more intensive mental health treatment than is available at regular prisons, records show.

The quality of medical care was also questionable, said Mr. Johnson’s lawyers, Sarah Grady and Howard Kaplan, a married legal team in Chicago. Mr. Johnson lost 50 to 60 pounds during three weeks in solitary confinement, but officials did not initiate interventions like intravenous feedings or transfer him to a non-prison hospital.

And they did not take the most basic step — dialing 911 — until it was too late.

There have been many attempts to improve the quality of mental health treatment in jails and prisons by putting care on par with punishment — including a major effort in Chicago . But improvements have proved difficult to enact and harder to sustain, hampered by funding and staffing shortages.

Lawyers representing the state corrections department, Wexford and staff members who worked at Danville declined to comment on Mr. Johnson’s death, citing the unresolved litigation. In their interviews with state police investigators, and in depositions, employees defended their professionalism and adherence to procedure, while citing problems with high staff turnover, difficult work conditions, limited resources and shortcomings of co-workers.

But some expressed a sense of resignation about the fate of Mr. Johnson and others like him.

Prisoners have “much better chances in a hospital, but that’s not their situation,” said a senior member of Wexford’s health care team in a deposition.

“I didn’t put them in prison,” he added. “They are in there for a reason.”

Markus Mison Johnson was born on March 1, 1998, to a mother who believed she was not capable of caring for him.

Days after his birth, he was taken in by Lisa Barker Johnson, a foster mother in her 30s who lived in Zion, Ill., a working-class city halfway between Chicago and Milwaukee. Markus eventually became one of four children she adopted from different families.

The Johnson house is a lively split level, with nieces, nephews, grandchildren and neighbors’ children, family keepsakes, video screens and juice boxes. Ms. Johnson sits at its center on a kitchen chair, chin resting on her hand as children wander over to share their thoughts, or to tug on her T-shirt to ask her to be their bathroom buddy.

From the start, her bond with Markus was particularly powerful, in part because the two looked so much alike, with distinctive dimpled smiles. Many neighbors assumed he was her biological son. The middle name she chose for him was intended to convey that message.

“Mison is short for ‘my son,’” she said standing over his modest footstone grave last summer.

He was happy at home. School was different. His grades were good, but he was intensely shy and was diagnosed with attention deficit hyperactivity disorder in elementary school.

That was around the time the bullying began. His sisters were fierce defenders, but they could only do so much. He did the best he could, developing a quick, taunting tongue.

These experiences filled him with a powerful yearning to fit in.

It was not to be.

When he was around 15, he called 911 in a panic, telling the dispatcher he saw two men standing near the small park next to his house threatening to abduct children playing there. The officers who responded found nothing out of the ordinary, and rang the Johnsons’ doorbell.

He later told his mother he had heard a voice telling him to “protect the kids.”

He was hospitalized for the first time at 16, and given medications that stabilized him for stretches of time. But the crises would strike every six months or so, often triggered by his decision to stop taking his medication.

His family became adept at reading signs he was “getting sick.” He would put on his tan Timberlands and a heavy winter coat, no matter the season, and perch on the edge of his bed as if bracing for battle. Sometimes, he would cook his own food, paranoid that someone might poison him.

He graduated six months early, on the dean’s list, but was rudderless, and hanging out with younger boys, often paying their way.

His mother pointed out the perils of buying friendship.

“I don’t care,” he said. “At least I’ll be popular for a minute.”

Zion’s inviting green grid of Bible-named streets belies the reality that it is a rough, unforgiving place to grow up. Family members say Markus wanted desperately to prove he was tough, and emulated his younger, reckless group of friends.

Like many of them, he obtained a pistol. He used it to hold up a convenience store clerk for $425 in January 2017, according to police records. He cut a plea deal for two years of probation, and never explained to his family what had made him do it.

But he kept getting into violent confrontations. In late July 2018, he was arrested in a neighbor’s garage with a handgun he later admitted was his. He was still on probation for the robbery, and his public defender negotiated a plea deal that would send him to state prison until January 2020.

An inpatient mental health system

Around 40 percent of the about 1.8 million people in local, state and federal jails and prison suffer from at least one mental illness, and many of these people have concurrent issues with substance abuse, according to recent Justice Department estimates.

Psychological problems, often exacerbated by drug use, often lead to significant medical problems resulting from a lack of hygiene or access to good health care.

“When you suffer depression in the outside world, it’s hard to concentrate, you have reduced energy, your sleep is disrupted, you have a very gloomy outlook, so you stop taking care of yourself,” said Robert L. Trestman , a Virginia Tech medical school professor who has worked on state prison mental health reforms.

The paradox is that prison is often the only place where sick people have access to even minimal care.

But the harsh work environment, remote location of many prisons, and low pay have led to severe shortages of corrections staff and the unwillingness of doctors, nurses and counselors to work with the incarcerated mentally ill.

In the early 2000s, prisoners’ rights lawyers filed a class-action lawsuit against Illinois claiming “deliberate indifference” to the plight of about 5,000 mentally ill prisoners locked in segregated units and denied treatment and medication.

In 2014, the parties reached a settlement that included minimum staffing mandates, revamped screening protocols, restrictions on the use of solitary confinement and the allocation of about $100 million to double capacity in the system’s specialized mental health units.

Yet within six months of the deal, Pablo Stewart, an independent monitor chosen to oversee its enforcement, declared the system to be in a state of emergency.

Over the years, some significant improvements have been made. But Dr. Stewart’s final report , drafted in 2022, gave the system failing marks for its medication and staffing policies and reliance on solitary confinement “crisis watch” cells.

Ms. Grady, one of Mr. Johnson’s lawyers, cited an additional problem: a lack of coordination between corrections staff and Wexford’s professionals, beyond dutifully filling out dozens of mandated status reports.

“Markus Johnson was basically documented to death,” she said.

‘I’m just trying to keep my head up’

Mr. Johnson was not exactly looking forward to prison. But he saw it as an opportunity to learn a trade so he could start a family when he got out.

On Dec. 18, 2018, he arrived at a processing center in Joliet, where he sat for an intake interview. He was coherent and cooperative, well-groomed and maintained eye contact. He was taking his medication, not suicidal and had a hearty appetite. He was listed as 5 feet 6 inches tall and 256 pounds.

Mr. Johnson described his mood as “go with the flow.”

A few days later, after arriving in Danville, he offered a less settled assessment during a telehealth visit with a Wexford psychiatrist, Dr. Nitin Thapar. Mr. Johnson admitted to being plagued by feelings of worthlessness, hopelessness and “constant uncontrollable worrying” that affected his sleep.

He told Dr. Thapar he had heard voices in the past — but not now — telling him he was a failure, and warning that people were out to get him.

At the time he was incarcerated, the basic options for mentally ill people in Illinois prisons included placement in the general population or transfer to a special residential treatment program at the Dixon Correctional Center, west of Chicago. Mr. Johnson seemed out of immediate danger, so he was assigned to a standard two-man cell in the prison’s general population, with regular mental health counseling and medication.

Things started off well enough. “I’m just trying to keep my head up,” he wrote to his mother. “Every day I learn to be stronger & stronger.”

But his daily phone calls back home hinted at friction with other inmates. And there was not much for him to do after being turned down for a janitorial training program.

Then, in the spring of 2019, his grandmother died, sending him into a deep hole.

Dr. Thapar prescribed a new drug used to treat major depressive disorders. Its most common side effect is weight gain. Mr. Johnson stopped taking it.

On July 4, he told Dr. Thapar matter-of-factly during a telehealth check-in that he was no longer taking any of his medications. “I’ve been feeling normal, I guess,” he said. “I feel like I don’t need the medication anymore.”

Dr. Thapar said he thought that was a mistake, but accepted the decision and removed Mr. Johnson from his regular mental health caseload — instructing him to “reach out” if he needed help, records show.

The pace of calls back home slackened. Mr. Johnson spent more time in bed, and became more surly. At a group-therapy session, he sat stone silent, after showing up late.

By early August, he was telling guards he had stopped eating.

At some point, no one knows when, he had intermittently stopped drinking fluids.

‘I’m having a breakdown’

Then came the crash.

On Aug. 12, Mr. Johnson got into a fight with his older cellmate.

He was taken to a one-man disciplinary cell. A few hours later, Wexford’s on-site mental health counselor, Melanie Easton, was shocked by his disoriented condition. Mr. Johnson stared blankly, then burst into tears when asked if he had “suffered a loss in the previous six months.”

He was so unresponsive to her questions she could not finish the evaluation.

Ms. Easton ordered that he be moved to a 9-foot by 8-foot crisis cell — solitary confinement with enhanced monitoring. At this moment, a supervisor could have ticked the box for “residential treatment” on a form to transfer him to Dixon. That did not happen, according to records and depositions.

Around this time, he asked to be placed back on his medication but nothing seems to have come of it, records show.

By mid-August, he said he was visualizing “people that were not there,” according to case notes. At first, he was acting more aggressively, once flicking water at a guard through a hole in his cell door. But his energy ebbed, and he gradually migrated downward — from standing to bunk to floor.

“I’m having a breakdown,” he confided to a Wexford employee.

At the time, inmates in Illinois were required to declare an official hunger strike before prison officials would initiate protocols, including blood testing or forced feedings. But when a guard asked Mr. Johnson why he would not eat, he said he was “fasting,” as opposed to starving himself, and no action seems to have been taken.

‘Tell me this is OK!’

Lt. Matthew Morrison, one of the few people at Danville to take a personal interest in Mr. Johnson, reported seeing a white rind around his mouth in early September. He told other staff members the cell gave off “a death smell,” according to a deposition.

On Sept. 5, they moved Mr. Johnson to one of six cells adjacent to the prison’s small, bare-bones infirmary. Prison officials finally placed him on the official hunger strike protocol without his consent.

Mr. Morrison, in his deposition, said he was troubled by the inaction of the Wexford staff, and the lack of urgency exhibited by the medical director, Dr. Justin Young.

On Sept. 5, Mr. Morrison approached Dr. Young to express his concerns, and the doctor agreed to order blood and urine tests. But Dr. Young lived in Chicago, and was on site at the prison about four times a week, according to Mr. Kaplan. Friday, Sept. 6, 2019, was not one of those days.

Mr. Morrison arrived at work that morning, expecting to find Mr. Johnson’s testing underway. A Wexford nurse told him Dr. Young believed the tests could wait.

Mr. Morrison, stunned, asked her to call Dr. Young.

“He’s good till Monday,” Dr. Young responded, according to Mr. Morrison.

“Come on, come on, look at this guy! You tell me this is OK!” the officer responded.

Eventually, Justin Duprey, a licensed nurse practitioner and the most senior Wexford employee on duty that day, authorized the test himself.

Mr. Morrison, thinking he had averted a disaster, entered the cell and implored Mr. Johnson into taking the tests. He refused.

So prison officials obtained approval to remove him forcibly from his cell.

‘Oh, my God’

What happened next is documented in video taken from cameras held by officers on the extraction team and obtained by The Times through a court order.

Mr. Johnson is scarcely recognizable as the neatly groomed 21-year-old captured in a cellphone picture a few months earlier. His skin is ashen, eyes fixed on the middle distance. He might be 40. Or 60.

At first, he places his hands forward through the hole in his cell door to be cuffed. This is against procedure, the officers shout. His hands must be in back.

He will not, or cannot, comply. He wanders to the rear of his cell and falls hard. Two blasts of pepper spray barely elicit a reaction. The leader of the tactical team later said he found it unusual and unnerving.

The next video is in the medical unit. A shield is pressed to his chest. He is in agony, begging for them to stop, as two nurses attempt to insert a catheter.

Then they move him, half-conscious and limp, onto a wheelchair for the blood draw.

For the next 20 minutes, the Wexford nurse performing the procedure, Angelica Wachtor, jabs hands and arms to find a vessel that will hold shape. She winces with each puncture, tries to comfort him, and grows increasingly rattled.

“Oh, my God,” she mutters, and asks why help is not on the way.

She did not request assistance or discuss calling 911, records indicate.

“Can you please stop — it’s burning real bad,” Mr. Johnson said.

Soon after, a member of the tactical team reminds Ms. Wachtor to take Mr. Johnson’s vitals before taking him back to his cell. She would later tell Dr. Young she had been unable to able to obtain his blood pressure.

“You good?” one of the team members asks as they are preparing to leave.

“Yeah, I’ll have to be,” she replies in the recording.

Officers lifted him back onto his bunk, leaving him unconscious and naked except for a covering draped over his groin. His expressionless face is visible through the window on the cell door as it closes.

‘Cardiac arrest.’

Mr. Duprey, the nurse practitioner, had been sitting inside his office after corrections staff ordered him to shelter for his own protection, he said. When he emerged, he found Ms. Wachtor sobbing, and after a delay, he was let into the cell. Finding no pulse, Mr. Duprey asked a prison employee to call 911 so Mr. Johnson could be taken to a local emergency room.

The Wexford staff initiated CPR. It did not work.

At 3:38 p.m., the paramedics declared Markus Mison Johnson dead.

Afterward, a senior official at Danville called the Johnson family to say he had died of “cardiac arrest.”

Lisa Johnson pressed for more information, but none was initially forthcoming. She would soon receive a box hastily crammed with his possessions: uneaten snacks, notebooks, an inspirational memoir by a man who had served 20 years at Leavenworth.

Later, Shiping Bao, the coroner who examined his body, determined Mr. Johnson had died of severe dehydration. He told the state police it “was one of the driest bodies he had ever seen.”

For a long time, Ms. Johnson blamed herself. She says that her biggest mistake was assuming that the state, with all its resources, would provide a level of care comparable to what she had been able to provide her son.

She had stopped accepting foster care children while she was raising Markus and his siblings. But as the months dragged on, she decided her once-boisterous house had become oppressively still, and let local agencies know she was available again.

“It is good to have children around,” she said. “It was too quiet around here.”

Read by Glenn Thrush

Audio produced by Jack D’Isidoro .

Glenn Thrush covers the Department of Justice. He joined The Times in 2017 after working for Politico, Newsday, Bloomberg News, The New York Daily News, The Birmingham Post-Herald and City Limits. More about Glenn Thrush

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• About Adverse Childhood Experiences
• Risk and Protective Factors
• Program: Essentials for Childhood: Preventing Adverse Childhood Experiences through Data to Action
• Adverse childhood experiences can have long-term impacts on health, opportunity and well-being.
• Adverse childhood experiences are common and some groups experience them more than others.

What are adverse childhood experiences?

Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years). Examples include: 1

• Experiencing violence, abuse, or neglect.
• Witnessing violence in the home or community.
• Having a family member attempt or die by suicide.

Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding. Examples can include growing up in a household with: 1

• Substance use problems.
• Mental health problems.
• Instability due to parental separation.
• Instability due to household members being in jail or prison.

The examples above are not a complete list of adverse experiences. Many other traumatic experiences could impact health and well-being. This can include not having enough food to eat, experiencing homelessness or unstable housing, or experiencing discrimination. 2 3 4 5 6

Quick facts and stats

ACEs are common. About 64% of adults in the United States reported they had experienced at least one type of ACE before age 18. Nearly one in six (17.3%) adults reported they had experienced four or more types of ACEs. 7

Preventing ACEs could potentially reduce many health conditions. Estimates show up to 1.9 million heart disease cases and 21 million depression cases potentially could have been avoided by preventing ACEs. 1

Some people are at greater risk of experiencing one or more ACEs than others. While all children are at risk of ACEs, numerous studies show inequities in such experiences. These inequalities are linked to the historical, social, and economic environments in which some families live. 5 6 ACEs were highest among females, non-Hispanic American Indian or Alaska Native adults, and adults who are unemployed or unable to work. 7

ACEs are costly. ACEs-related health consequences cost an estimated economic burden of $748 billion annually in Bermuda, Canada, and the United States. 8

ACEs can have lasting effects on health and well-being in childhood and life opportunities well into adulthood. 9 Life opportunities include things like education and job potential. These experiences can increase the risks of injury, sexually transmitted infections, and involvement in sex trafficking. They can also increase risks for maternal and child health problems including teen pregnancy, pregnancy complications, and fetal death. Also included are a range of chronic diseases and leading causes of death, such as cancer, diabetes, heart disease, and suicide. 1 10 11 12 13 14 15 16 17

ACEs and associated social determinants of health, such as living in under-resourced or racially segregated neighborhoods, can cause toxic stress. Toxic stress, or extended or prolonged stress, from ACEs can negatively affect children’s brain development, immune systems, and stress-response systems. These changes can affect children’s attention, decision-making, and learning. 18

Children growing up with toxic stress may have difficulty forming healthy and stable relationships. They may also have unstable work histories as adults and struggle with finances, jobs, and depression throughout life. 18 These effects can also be passed on to their own children. 19 20 21 Some children may face further exposure to toxic stress from historical and ongoing traumas. These historical and ongoing traumas refer to experiences of racial discrimination or the impacts of poverty resulting from limited educational and economic opportunities. 1 6

Adverse childhood experiences can be prevented. Certain factors may increase or decrease the risk of experiencing adverse childhood experiences.

Preventing adverse childhood experiences requires understanding and addressing the factors that put people at risk for or protect them from violence.

Creating safe, stable, nurturing relationships and environments for all children can prevent ACEs and help all children reach their full potential. We all have a role to play.

• Merrick MT, Ford DC, Ports KA, et al. Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017. MMWR Morb Mortal Wkly Rep 2019;68:999-1005. DOI: http://dx.doi.org/10.15585/mmwr.mm6844e1 .
• Cain KS, Meyer SC, Cummer E, Patel KK, Casacchia NJ, Montez K, Palakshappa D, Brown CL. Association of Food Insecurity with Mental Health Outcomes in Parents and Children. Science Direct. 2022; 22:7; 1105-1114. DOI: https://doi.org/10.1016/j.acap.2022.04.010 .
• Smith-Grant J, Kilmer G, Brener N, Robin L, Underwood M. Risk Behaviors and Experiences Among Youth Experiencing Homelessness—Youth Risk Behavior Survey, 23 U.S. States and 11 Local School Districts. Journal of Community Health. 2022; 47: 324-333.
• Experiencing discrimination: Early Childhood Adversity, Toxic Stress, and the Impacts of Racism on the Foundations of Health | Annual Review of Public Health https://doi.org/10.1146/annurev-publhealth-090419-101940 .
• Sedlak A, Mettenburg J, Basena M, et al. Fourth national incidence study of child abuse and neglect (NIS-4): Report to Congress. Executive Summary. Washington, DC: U.S. Department of Health an Human Services, Administration for Children and Families.; 2010.
• Font S, Maguire-Jack K. Pathways from childhood abuse and other adversities to adult health risks: The role of adult socioeconomic conditions. Child Abuse Negl. 2016;51:390-399.
• Swedo EA, Aslam MV, Dahlberg LL, et al. Prevalence of Adverse Childhood Experiences Among U.S. Adults — Behavioral Risk Factor Surveillance System, 2011–2020. MMWR Morb Mortal Wkly Rep 2023;72:707–715. DOI: http://dx.doi.org/10.15585/mmwr.mm7226a2 .
• Bellis, MA, et al. Life Course Health Consequences and Associated Annual Costs of Adverse Childhood Experiences Across Europe and North America: A Systematic Review and Meta-Analysis. Lancet Public Health 2019.
• Adverse Childhood Experiences During the COVID-19 Pandemic and Associations with Poor Mental Health and Suicidal Behaviors Among High School Students — Adolescent Behaviors and Experiences Survey, United States, January–June 2021 | MMWR
• Hillis SD, Anda RF, Dube SR, Felitti VJ, Marchbanks PA, Marks JS. The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death. Pediatrics. 2004 Feb;113(2):320-7.
• Miller ES, Fleming O, Ekpe EE, Grobman WA, Heard-Garris N. Association Between Adverse Childhood Experiences and Adverse Pregnancy Outcomes. Obstetrics & Gynecology . 2021;138(5):770-776. https://doi.org/10.1097/AOG.0000000000004570 .
• Sulaiman S, Premji SS, Tavangar F, et al. Total Adverse Childhood Experiences and Preterm Birth: A Systematic Review. Matern Child Health J . 2021;25(10):1581-1594. https://doi.org/10.1007/s10995-021-03176-6 .
• Ciciolla L, Shreffler KM, Tiemeyer S. Maternal Childhood Adversity as a Risk for Perinatal Complications and NICU Hospitalization. Journal of Pediatric Psychology . 2021;46(7):801-813. https://doi.org/10.1093/jpepsy/jsab027 .
• Mersky JP, Lee CP. Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample. BMC pregnancy and childbirth. 2019;19(1). https://doi.org/10.1186/s12884-019-2560-8 .
• Reid JA, Baglivio MT, Piquero AR, Greenwald MA, Epps N. No youth left behind to human trafficking: Exploring profiles of risk. American journal of orthopsychiatry. 2019;89(6):704.
• Diamond-Welch B, Kosloski AE. Adverse childhood experiences and propensity to participate in the commercialized sex market. Child Abuse & Neglect. 2020 Jun 1;104:104468.
• Shonkoff, J. P., Garner, A. S., Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, & Section on Developmental and Behavioral Pediatrics (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246. https://doi.org/10.1542/peds.2011-2663
• Narayan AJ, Kalstabakken AW, Labella MH, Nerenberg LS, Monn AR, Masten AS. Intergenerational continuity of adverse childhood experiences in homeless families: unpacking exposure to maltreatment versus family dysfunction. Am J Orthopsych. 2017;87(1):3. https://doi.org/10.1037/ort0000133 .
• Schofield TJ, Donnellan MB, Merrick MT, Ports KA, Klevens J, Leeb R. Intergenerational continuity in adverse childhood experiences and rural community environments. Am J Public Health. 2018;108(9):1148-1152. https://doi.org/10.2105/AJPH.2018.304598 .
• Schofield TJ, Lee RD, Merrick MT. Safe, stable, nurturing relationships as a moderator of intergenerational continuity of child maltreatment: a meta-analysis. J Adolesc Health. 2013;53(4 Suppl):S32-38. https://doi.org/10.1016/j.jadohealth.2013.05.004 .

Adverse Childhood Experiences (ACEs)

ACEs can have a tremendous impact on lifelong health and opportunity. CDC works to understand ACEs and prevent them.