Archivo de la categoría: English

All Health Afflictions Are Disease? WHO May Be Undermining Health Literacy in the Title of the New ICD-11

The International Classification of Diseases is dropping and Health Related Problems from its title in the new ICD-11 — thus calling all ailments diseases. Isn’t this misleading? Aren’t there more proper names for the diversity of mortality and morbidity causes?whoicd11

Many ailments are better referred to as health afflictions, or injuries, or intoxications, or vascular events, etc… The generic name disease especially bothers me regarding mental health problems. To call them all ‘disease’ is not only imprecise: it encourages stygma.

It is true that disease can be used as a generic term. Disease can be applied to any deviation from normal bio-organic form and function. Indeed, two subtly differring definitions for disease can be found in general use and in dictionaries, including Wikipedia: a restricted definition, and the broader definition as a deviation from normality. By including the phrase …and Health Related Problems, the original title of the ICD appertained to both the restricted and the broader definitions. But now that this phrase has been dropped, only the broader definition applies, and it is more vague and less pertinent in specific situations.

Consider a statement that starts You have a disease called… Without sounding odd, this could be said of cancer, lupus, respiratory infections, transmittable (contagious) diseases, etc. Whereas You have a disease called a vascular event would definitely sound odd. In any case it would be better to say You suffered a vascular event and now have a post-vascular event condition, for example.

A second example: You have a disease called insolation (or heatstroke) sounds odd and misleading. In any case, this can be more properly stated as You suffered an insolation. Same applies to dehydration, intoxications, intestinal (or bowel) occlusions, and other such health afflictions.

The first version of the so-called ICD was published in 1949. Before this, it was simply called the International List of Causes of Death. Nowadays a more suitable name for this classiffication could be simply International Standard of Mortality and Morbidity Causes, which is exactly what it is meant to be. Or International Classification of Diseases and Other Health Afflictions, for example. Or, eventually, International Classification of Health Afflictions.

Another noticeable instance of this broad use of the term is the name Non-Communicable Diseases (or NCDs, or Non-Transmissible Diseases). NCDs include cancer, emphysema, and other health afflictions which comply with being non-communicable, and which are classically and unarguably called diseases. But NCDs also include vascular events and mental health disorders. In both of these cases, only the broader definition of ‘disease’ applies. Much has been invested by the WHO and by governments worldwide to raise awareness on NCDs as the leading cause of death, and of a group of risk and protective factors which seem to be common to all NCDs. The purpose may be well-intentioned. But, at least in the case of mental illness, in addition to being imprecise, calling all of these non-communicable health afflictions disease encourages stygma. For example, Mental Illness is commonly but arguably translated into Spanish as Enfermedad Mental. ‘Enfermo mental‘ is widely used as a derogatory term. In English at least, the use of the term mental illness has raised no significant concern: it seems to be more proper to common sense than mental disease.

Doctors know that the ICD and also the NCDs health awareness campaigns have been using the term disease in the broader sense. But the term is misleading for the general population. Language is important because it defines how we deal with reality. Regarding health policies, calling each ailment what it is, instead of sticking with broad oversimplified generalizations, should improve health literacy, population involvement, and prevention practices.

No matter if you are conservative, or liberal, or libertarian. If you really care for health, you will agree people’s involvement is crucial: not only does it improve social and environmental health, it can drastically reduce bureaucracy and public costs.


Reddit r/AskScienceDiscussion post 


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Archivado bajo English, Salud mental

Gun regulation has to improve, but so does mental health literacy

I respect Mr Fareed Zakaria’s work as an analyst in politics and world affairs. But some of his statements in his recent (october 5, 2017) Washington Post article Talking about mental health after mass shootings is a cop-out need to be clarified.

Yes, gun regulation has to improve. But so does mental health literacy. When Mr Fareed states people who have mental disorders are not inherently highly prone to violence, he totally misses the point. His statement may well be true regarding the total population of persons with mental health problems. But there is a segment within this population which is highly prone to violence. The useful question to be answered here would be, What are the mental health conditions of a person capable of such violence against his fellow human beings? Most mental health experts, and the literature as well, would agree the shooter was some sort of psychopath or sociopath — the technical DSM–5 term is Antisocial Personality Disorder. The useful question which follows is, What can we do to prevent such violent behavior? Early detection and attention of these particularly antisocial conditions, as well as of their causes, risk factors and protective factors, should be encouraged when designing and applying safety, educational, and other public policies.

A first version of this post was published as a comment to the original article in the Washington Post.

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Archivado bajo English, Salud mental

Drug Use as a Mental Health Issue: What We Can Do

A call for our mental health culture


Mental health is a public issue not talked about, not dealt with, unexplored, avoided. Like drug use, or perhaps even more so. In the news, in social media, and in daily conversation, we hear and talk about mental health mainly to discredit someone for the lack of it. Just like we still hear and talk about drugs mainly to discredit people who use them. When in search for an explanation or culprit regarding a tragedy, if we barely scratch the surface and find even a hint of mental health issues, we are certain we don’t have to look any further… The topic of mental health evokes the figure of such a convenient public enemy.

The mind and its health are almost a socially forbidden topic, a taboo. So much so that, when health is first mentioned in a conversation, it is generally assumed as physical health. How’s your health doing lately? Good, or I’ve got a flu, or My back has been hurting lately. Oh, you mean my mental health? Of course that’s none of your business! The mind, its workings and components, including feelings and desires, is such a private, intimate issue. But instead of talking about our minds and emotions as the closest experiences to ourselves and thus the ones we are the most familiar with, we assign psychiatrists and neurologists as the only qualified experts because the brain is such a complex mystery. Or maybe it’s like, in a culture dominated by the value of freedom, nobody is allowed to question freedom of choice, or where this freedom comes from…

Whatever the reasons, this lack of public concern for mental health does no good to drug policies. The first thing a person with drug or alcohol problems needs is specialized and kind attention regarding his or her mental health issues: drug use in all its diversity can only be but one aspect of mental and emotional health. And the first thing any person needs to prevent drug or alcohol problems is, once again, specialized and kind, mental and emotional health attention. This includes early detection during childhood and adolescence, not only of disorders such as anxiety or depression, also of other risk factors such as asocial behaviour and violent environments.

Persistance on problematic drug use is a mental health issue, and needs to be addressed as such at the prevention level, at the harm reduction level, and at the treatment level. But mental health is even more stigmatized than drug use. So how do we advance the development of better mental health policies, practices, and culture?

We can shift attention to mental health as an issue broader than mental illness:

  • We can refer to mental health as an issue concerning more than our thought processes; also our emotions, our well-being in the deepest, truest sense of what we are; the state and quality of our subjective experience as human beings.
  • We can point to all the resources we have available. Not only psychiatry and psychotherapy. Human knowledge and practices everywhere have a lot to say and teach to us about mental health, as communities and as society. Maybe it has not been called mental health but Well-Being, or Knowledge, or Philosophy, or Unity with the Spirit, or Buddhism or Christianity or having the Force Be with You. The health of our spirit or, if you are an atheist, the health of our consciousness, has been our main topic of interest since we are humans.
  • And we can attend our common sense of humanity: what our shared morality can do, whether we are “specialists” or not. To identify and reduce the risks, to protect the mental health environment, and to develop it.

Mental health should not evoke mental illness. In the first place, mental health should evoke promotion. It should be taken care of when developing, applying, and measuring the outcome of policies in all areas. It should be considered in every case of human interaction.

At any level, as soon as mental health is regarded in a positive sense, this same proactive attitude will start taking care of drug issues.

September 1st edit: So I’ve changed or added a very few things —including the subtitle— and am coloring them dark cyan.

This blog entry is dedicated to Estudiantes por una política sensata de drogas capítulo México; to Peta de Aztlán in Sacramento, CA (symbolically representing all humane beings which I have met solely through social web media); and to all persons working in mental health and harm reduction. If you find it usefulplease share!

References: Promoting mental health : concepts, emerging evidence, practice : summary report / a report from the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation (VicHealth) and the University of Melbourne. © World Health Organization 2004

Image artwork: María Sabina, by Nico Rosenfeld, in Pijama Surf


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Archivado bajo English, Política de drogas, Salud mental

Protective factors for physical and mental health

Here is a list of protective factors for Health, understood comprehensively as integrating both physical and mental health. Some are fundamental for physical health, but ALL are fundamental for mental health (including of course emotional health). Colored violet, protective factors for both physical and mental health; colored blue, mainly mental health protective factors:

  • Good habits (physical & mental health):
    • good nutrition
    • physical activity
    • good rest
    • hygiene
    • control or lack of alcohol & tobacco, other substances…
    • getting health & medical attention / treatment
    • social interaction
  • Availability of basic goods & services — access to “commonwealth”
    • General health (physical & mental):
      • Access to…
        • air quality
        • water availability and quality
        • nutritious diet
        • rest, housing
        • public safety
        • medical attention (general health)
        • dental, obstetric, other specialized medical attention
      • Controlled access to…
        • accident risks, natural phenomena risks, toxic environments, transmitted diseases… (civil protection)
        • weapons
        • substances and other potential sources of compulsive behaviours
    • Mental health:
      • Personal / Professional development: access to…
        • education
        • knowledge
        • occupation
        • trade
      • Environment: access to…
        • public spaces
        • ecology
        • justice
        • aesthetic experience and expression
      • specialized attention: access to…
        • psychological attention
        • psychiatric attention
        • mental health knowledge, literature, practices…


May such a list serve as a starting guide to explore & identify risk factors in specific individuals or populations. Do your own version of risk & protective factors! Where would you place “healthy sex”, for example? This list is inspired by Promoting Mental Health, WHO 2004

~Ricardo Sala, mental health promoter. Mexico City, August 2016


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Archivado bajo English, Factores de riesgo y protectores, Salud mental