When should I see a psychologist?

Mental illness is normal. But what exactly is considered a mental illness and what are the signs you need help? 

Are mental illnesses normal?

In Switzerland, half of people suffer from mental illness at least once in their life. Statistically, mental illness is normal. It can affect anyone. 

What is considered a mental illness?

Mental illness is expressed in “atypical” behaviour. What does this mean? How do therapists decide what deviates from the norm?

Behaviour can be deemed atypical based on seven criteria:

1. Distress or disability: someone who can no longer leave their home without anxiety or can no longer sleep at night because of worry, for example, suffers mentally and physically. Their ability to act is limited.

2. Maladaptation: people affected by mental illness ignore their own goals, neglect their well-being or no longer meet the needs of society. For example, those who regularly drink so much that they can no longer work the next morning demonstrate maladaptive behaviour.

3. Irrationality: someone who responds to voices that don’t exist behaves irrationally, for example.

4. Unpredictability: people affected by mental illness may behave in a way that’s difficult or impossible for them to control. Their behaviour is unpredictable and erratic. For example, if you smash a window for no apparent reason, you are behaving unpredictably.

5. Abnormality: this refers to behaviours that are rare and break social expectations or standards. Someone who repeatedly commits criminal acts without feeling remorse, for example, displays socially undesirable behaviour.

6. Observer discomfort: other people may feel threatened or disturbed in some way by the behaviour of the person concerned. Someone who walks down the street screaming loudly, for example, will cause discomfort in others.

7. Breaking moral and social norms: parents who neglect their children, for example, exhibit atypical behaviour. The expectations of social norms (such as parents caring for their own children) are violated in this case.

Taken alone, individual factors are not a sign of atypical behaviour. However, the more extreme and frequent these signs become, the more likely there’s a mental illness.

How are mental illnesses classified?

A psychological diagnosis gives a name to atypical behaviour. Observed behaviour patterns are classified in a diagnostic system. A psychological diagnosis is different from a medical one. A doctor works a lot, but not exclusively, with physical findings (including x-rays, blood tests and tissue samples). A psychological psychotherapist primarily interprets a person’s observable actions, among other things.

The DSM-5 classification system helps the therapist decide whether a person’s behaviour is proof of a particular mental illness. It lists over 200 mental illnesses. For diagnosis, the condition is classified according to five axes. All psychological, social and physical symptoms are taken into account. This makes a comprehensive diagnosis possible.

The five axes of diagnosis according to DSM-5:

1. Clinical disorders / other clinically relevant problems

This disorder involves painful or disabling symptoms.

2. Personality disorders / mental disability

These are inappropriate patterns of perception and behaviour.

3. Medical disease factors

Physical problems and accompanying medical conditions, such as diabetes.

4. Psychosocial and environmental problems

This axis includes stressors that affect the diagnosis, treatment and likelihood of recovery, such as difficult relationships.

5. Global assessment of functioning

This records the ability to function in the psychological, social and professional environment.

How do I know that I need therapy?

Many sufferers feel restricted in how they manage their everyday lives. Social contacts are lost. Concentration problems impede performance at work. The journey to the supermarket triggers anxiety. The sooner help is accepted, the higher the chance of recovery. Everyone suffers from challenging conditions in life. Suffering, however, should not prevent them from living a fulfilling life in the long term.

The following questions can help you assess the need for psychotherapy:

• Is your doctor unable to find a cause for physical discomfort?

• Have you had a traumatic experience (such as serious illness, sexual abuse, accident, environmental disaster or violence)?

• Are the people in your environment worried about you? Have you been approached about any issues?

• Do you use alcohol and drugs to manage your problems?

• Are you struggling to cope with everyday tasks in your life?

• Have you tried unsuccessfully to solve the problem on your own?

• Do your relationships suffer from these issues?

• Are you losing the enjoyment of activities you used to like?

• Do your emotions fluctuate a lot?

Where can I find initial support when I need therapy?

Read the article on therapy services, where you can search for a therapy place quickly and easily. Contact your family doctor for advice. Take advantage of free offers in Switzerland. There you can find out about how to deal with mental health problems and talk to an impartial person.

Dureschnufe (link not available in English) is the platform for mental health in relation to the coronavirus. Here are some tips and offers to help you maintain your mental health during these times.

Psy-Gesundheit (link to available in English) promotes mental health in French-speaking Switzerland and Ticino. Here you will find many contacts. There is a hotline for psychiatric emergencies in the cantons of Fribourg, Geneva, Jura, Neuchâtel, Vaud, Valais and Ticino.

Psychiatric Services Aargau (Pdag, link only available in German)) has set up a public helpline. There you can get in touch if the coronavirus pandemic is causing you psychological problems in particular.

Reden kann retten (link not available in English) provides a platform and emergency hotline for suicidal thoughts. There you will find first aid if you yourself are affected or concerned about someone around you.

Sorgentelefon 143 offers advice by phone, e-mail and chat, around the clock, anonymously and confidentially, as well as telephone counselling for crises and everyday problems.

Wie-gehts-Dir provides many addresses of professional counselling centres throughout Switzerland. The campaign is carried out on behalf of the health promotion organisation Gesundheitsförderung Schweiz. It encourages you to talk about mental health counselling.

Sources (not available in English)

• Gerrig, R. J. & Zimbardo, P. G. (2016). Psychologie (20th edition). Hallbergmoos: Pearson.

• *Schuler, D., Tuch, A. & Peter, C. (2020). Psychische Gesundheit in der Schweiz. Monitoring 2020. (Obsan Report 15/2020). Neuchâtel: Swiss Health Observatory.