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As someone has practiced clinically for 20+ years and who has partnered in the journey of self-awareness/ movement toward a healthier place/attempts to feel better, I have some concepts to offer to the discussion.

First, a number of the posts reference the idea of whether the individual is discomforted by their experience of their mental/ emotional/ interactional state. In the old Freudian terms, this was referred to as having a condition which is ego dystonic, as opposed to ego syntonic where the person feels perfectly fine just the way they are (think Axis II personality disorders). Now, what does it do to your various definitional attempts to think of people who few like because they do not fit into their social milieu well, but who view everyone else as having the problem?

Another thing to grapple with: Freud once said that mental health was the ability to live, love and work productively- what does that one mean for people who are unable to fulfill one of those capacities due to a physical condition rather than a mental/ emotional one?

There is an article on "The social construction of Normality" by Sophie Freud as well as various critiques of mental health models by Thomas Szasz that indicate, to varying intensities, that what gets deemed as mental health is really just an ability to fit into one's environment (with anything revealing a lack of fit deemed as less healthy). Indeed, the change of homosexuality from viewed as diagnosable to a varied lifestyle is often used as an example of the mutability of definitions of mental health and subsequent diagnoses.

As a clinical social worker, I have found that very little about definitions and diagnoses has relevance to the work I am doing with clients. Granted, I am seldom working with people experiencing "SMI" (severe mental illness) although I am often working with people who are experiencing intense emotions and huge destabilizing life changes. Many of these folks could be "diagnosable" with DSM criteria (and some have to be for insurance purposes), yet I seldom if ever find that this provides anything useful for our work together. Invariably, finding out the client's story, their interpretation of it, the ways they believe this defines who they are, and the areas of pain that exist within the story, all provide a much more useful template for our work together. Notably, that work, unlike medical practice, involves formation of a relationship where working together in authentic, warm and perspective- building ways is what moves the work. Again, unlike medical practice, it is not a matter of the therapist giving advice, directly intervening upon the being of the client, nor functioning UPON the client in anyway- merely continually being willing to be in relationship in a way that supports the client when they feel destabilized and destabilizes and stretches the client when they feel self righteous.

Fodder for the mill....