We all know people who suffer from back pain, have at least two hip prostheses (sometimes more), a stiff leg, blood pressure at 20, and a severe arrhythmia, almost at death's door. Most importantly, this information—about people who were previously unknown to us—reaches us through a conversation on the bus, in a taxi, or while waiting in line at the supermarket.

However, although many people suffer from nerves, very few will openly share that they suffer from a mental illness, literally. Even after so many years and so many campaigns, it is still very hard for someone to accept that they may have an illness of this kind. It is not fair to consider mental illnesses different from diseases of the kidneys, hips, or heart. And it is not fair because they are not a moral or character flaw, because many of them have treatments (and note that, unlike most other illnesses, some may even be curable!), and because the lack of understanding adds suffering to an already difficult situation.

Zé Miguel (of course, the name is made up) has, since childhood, experienced recurring fears of vomiting in public. He had never actually vomited in public, and the idea seemed absurd to him, but he couldn’t stop thinking about it. Before leaving the house, he would check the distance to the nearest bathrooms, so he could vomit in private if it happened. He studied how long vomiting would take to see if he had time to get there. He would watch for any signs of nausea and check for strikes, queues, or people who might block access to the bathrooms. Before any outing, he needed these intensive checks and preparations, which could last a week. When he finally felt ready, when he reached the point where everything was under control, he felt relieved and sometimes could even go out. As one might imagine, he thought he was crazy, completely mad, and that his fate was to end up tied to a bed in some horrible 17th-century asylum. None of this made sense to him, and he even had suicidal thoughts.

Zé Miguel had an obsessive disorder, with alterations in certain brain circuits and maintenance mechanisms related to learning. The treatment involved chemically correcting these alterations and doing psychotherapy to learn what these symptoms were and to correct the learning mechanisms involved, which underpinned the disorder.

Mental illnesses result from a complex interaction between biological factors (such as age, gender, genes, hormones, neurotransmitters, physical illnesses, or structural injuries), psychological factors (personality, thought patterns, traumatic experiences, habits, or emotions), and social/environmental factors (unemployment, financial difficulties, the wealth of the surrounding environment, cultural aspects). With few exceptions, the causes are neither singular nor one-directional. For example, a depressed person might start becoming less productive at work and, as a result, be fired. The resulting financial difficulties may perpetuate the depressive illness.

Or not. Due to individual reasons (which very likely include factors beyond a person’s control, such as biology or temperament), another person, in the same circumstances, might have a different outcome and open a beach bar, go to MIT or Wall Street, and win a Nobel Prize, a lot of money, or both.

Mental health professionals (psychiatrists and psychologists) study how these various factors interact to trigger or perpetuate a mental illness in the specific case of a person and their circumstances. In this way, it is possible to address them—biologically, through psychotherapy, or whatever is best—to save one life after another. This conceptualization is based on science, leaving little room for personal or moral opinions.

If needed, you can always ask for help.

Frederico Simões do Couto de Oliveira Fernandes

Associate Professor at the Católica Medical School, President of the Pedagogical Council