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When does 'sick' become 'sick enough'?

Trigger warning: This blog contains discussions of mental health struggles (e.g., eating disorders, self-harm) and suicidal thoughts, which some readers may find distressing.

I am Penelope Maran, I have a dual master’s degree in Brain and Mind Sciences from UCL and Sorbonne Université, and I am currently undertaking a conversion postgraduate course in psychology at the University of St Andrews. I wanted to write this blog because, due to my lectures and research, I have been exposed to the importance of early interventions for mental illness, and I have known many people who were afraid of not being considered ‘sick enough’ and doubted their own eligibility for seeking treatment.

Here, I talk about a few reasons why people may shy away from speaking about their mental health, and why it is crucial to access treatment as soon as possible.

People’s ideas on mental health

Whether it is the school shooter with ‘mental health issues’, the neighbour who had history of depression taking his own life, or that one person we know who suffered horrible trauma, we are confronted with extreme and sometimes sensationalised misrepresentations of what mental health problems are supposed to look like.

It is therefore unsurprising that besides the fear of being ostracised, another concern is that one may think that they’re not sick enough to seek help and speak up about their own suffering.

Why should I speak up? I have not suffered any remarkable trauma that would explain why I feel so empty, sad, lonely, anxious most of the time.

Why should I speak up? I’m not on the verge of attempting suicide. Yet.

Knowing that one deserves help means knowing one’s own worth

But when should someone consider themselves “sick enough” for help? This is a tricky question for many affected people.

People struggling with their mental health often try to pin down the pressure of suffering to a set of ‘criteria’. Such criteria consist of having to prove to oneself and to others, that one is indeed ‘sick enough’ to deserve help and unfortunately, this is also a result of the illness. Therefore, ‘feeling sick enough’ is more an expression of a person’s (lack of) self-worth, rather than an assessment of health based on realistic criteria.

I’m not sick enough until I can no longer go to work.

I will only be sick enough when I have lost another 5 kg.

I will only be sick enough when other people notice that I am not well.

Research has shown that a lack of self-worth is a psychological trait which is present in most mental health sufferers and often crucial to the development and maintenance of illness. If people have a low view of themselves, asking for help may feel like they are a ‘waste of resources’ or ‘undeserving’ of it.

Some people may even feel like imposters as they do not meet their own (quite often skewed and extreme) idea of how poor mental health should look like.

Eventually, being ‘sick’ then becomes a new normality. While a healthy outsider would likely not consider this as ‘normal’, people who are dealing with mental health issues, often start to perceive these issues as inevitable and part of the daily routine, despite their suffering.

Other people suffer more.

Things could be worse.

But things could also be better, couldn’t they?

Often the realisation of how bad things actually were, comes during and after treatment, when one starts to feel better again and realises that thoughts, feelings and actions are changeable.

Longer duration of untreated illness makes recovering harder

Seeking and getting the appropriate treatment as soon as possible is crucial for a successful recovery from mental health illnesses.

This not only seems logical and evident at first glance, but has been demonstrated by numerous peer-reviewed studies for a variety of mental illnesses, be it eating disorders, depression, or psychosis. The common conclusion is clear: The longer people do not receive help, the longer the time taken to recover, and the higher the chances of their illness becoming chronic.

Physiologically, mental illnesses can progressively alter brain functioning and directly affect behavioural traits such as attention, concentration, mood, or motivation. These changes in the brain make the recovery harder.

Prolonging the duration of untreated illness can also be psychologically debilitating. The longer people suffer, the more it manifests itself in a disconnection from the social environment, and increases problems at work, school or university and the loss of beneficent structures. The more supporting structures are lost, the more space the illness occupies in their lives.

Ironically, a patient can be even considered ‘too sick’ for psychological outpatient treatment and may require more care, such as hospital stays, than just typical conversation-based therapies.

How dismissal by healthcare services reinforces pathological beliefs- a vicious circle

Considering the overwhelming scientific evidence arguing for early interventions, it is safe to assume that although individuals with the illness might not consider themselves as “sick enough”, clinicians would help them understand that treatment is not something that has to be deserved or earned.


Well actually, no. Unfortunately, the sufferers’ skewed definition of what is sick, and a criteria-based assessment is prevalent in the health care systems as well.

It is not a rarity for cases of affected individuals who have reported not to have been taken seriously in GP offices, because they did not meet specific cut-off points, such as acute suicidality or BMI-thresholds.

With a growing number of patients (especially in these post-pandemic times), underfunded healthcare systems, would more likely treat acute symptoms and provide treatment to the ‘most severely’ affected people. Having only limited resources, the concession is made to go against the scientific evidence which clearly indicates that the later treatment is started, the longer it takes for people to get better, and the chronicity rates increase. This, in turn, means that the very people who were dismissed as ‘not sick enough’ earlier may be the people who then need all the more resources to get better at a later time.

It has also been shown that when people are on the waiting lists for treatment, they tend to use maladaptive strategies, such as self-harm, and report a feeling of a lack of validation from mental health professionals.

The irony is clear: sufferers fear not being considered ‘sick enough’ and they fight their mental illness alone every day. Among them, few muster the remarkable courage to seek help and improve their lives, however, they may be reinforced in their pathological belief system by being rejected by the health services.

This vicious cycle must be stopped.

While it may be part of mental illnesses, to have a lack of self-worth, to doubt that you deserve help yourself and to normalise pathological structures, health services should counteract such beliefs.

Sick is sick. There is no such thing as ‘sick enough’.



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