Beyond the diagnosis: Understanding the mental health spectrum

A fresh perspective is challenging the way we think about mental health. Rather than viewing it in terms of “having” or “not having” an illness, experts suggest that mental well-being exists on a spectrum, a fluid journey that we all move along at different points in our lives.

Vanessa Snow, head of Medical Affairs at Johnson & Johnson Innovative Medicine South Africa, explains that this broader view opens up new ways to approach treatment, support, and recovery. “We need to understand mental health not simply in terms of isolated diagnoses but rather, as a dynamic journey that we all navigate to some extent,” she said. “From everyday mental wellness to more complex conditions such as schizophrenia, recognising that there is a spectrum opens new possibilities for treatment, support, and hope.”

This idea challenges the traditional notion of fixed diagnoses, emphasising that mental well-being can shift throughout one’s life. Individuals experiencing mental health challenges are not necessarily born into these conditions, nor are they permanently locked into any particular stage.

At the extreme end of this spectrum lies schizophrenia, a severe mental illness that, if left untreated, can have a devastating impact on a person’s ability to lead a functional social or working life. Schizophrenia typically manifests between the ages of 16 and 30, although rare cases have been diagnosed in children. The disorder is often chronic, requiring long-term medical treatment, therapy, and support.

Symptoms include a significant disconnect from reality, often presenting as auditory or visual hallucinations, delusions, disorganised speech or thinking, personality disorders, and cognitive impairment. These symptoms make it difficult for individuals to maintain stable relationships or remain employable.

“Contrary to popular belief, however, the behaviour of someone with schizophrenia isn’t always dramatic and outward facing,” noted Snow. “This person may actually be less expressive or emotional than one might expect, displaying reduced feelings of pleasure, or showing a diminished desire to socially engage with others. The individual may also struggle to initiate and sustain activities.”

Moving along the spectrum, some individuals experience moderate to severe mental illnesses that cause significant distress and impairment, yet they may enjoy periods of relative stability. Conditions such as Major Depressive Disorder, Bipolar Disorder, Obsessive-Compulsive Disorder (OCD), and Post-Traumatic Stress Disorder (PTSD) fall within this category.

Depression is marked by prolonged and intense feelings of sadness and hopelessness, sometimes leading to suicidal ideation. Bipolar Disorder involves extreme mood swings, from hyperactivity to debilitating depression. OCD presents as intrusive, repetitive behaviours that interfere with daily life, while severe PTSD causes individuals to re-experience trauma in ways that disrupt normal functioning.

Further along the spectrum are individuals who, while experiencing mental health challenges, are able to manage them with counselling, therapy, or medication. These individuals may deal with milder forms of depression, anxiety, OCD, or PTSD, yet can maintain relationships and employment.

At the most optimal end of the spectrum are those who thrive emotionally, socially, and psychologically.

The World Health Organization (WHO) defines mental health as “a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”

“By viewing mental health as a fluid spectrum,” said Snow, “it becomes clear that most people move between different levels at various points in their lives. While some may remain in a specific category, others may shift towards either end of the spectrum, as a result of their life experiences.”

She concluded on a positive note: “Given the correct medical assistance and psychosocial support, most individuals that experience the disruptions within this spectrum can still hope to live fulfilling and meaningful lives.”

If you or someone you know requires counselling support, contact the South African Depression and Anxiety Group on the 24-hour helpline 0800 456 789 or SMS 31393.