Understanding Mental Health as a Spectrum

Mental health is often thought of in absolute terms: you either have a problem, or you do not. In reality, it is far more complex. Vanessa Snow, Head of Medical Affairs at Johnson & Johnson Innovative Medicine South Africa, explains that mental health is best seen as a continuum.

“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 says. “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.”

Importantly, people are not necessarily born into a particular mental health state, nor are they permanently fixed in one. Life experiences, environment, and access to care can all influence where someone might be on the spectrum at any given time.

At the severe end is schizophrenia, a chronic mental illness that, without treatment, can greatly disrupt a person’s ability to function socially or at work. It usually develops between the ages of 16 and 30, though rare cases occur in children. Symptoms may include hallucinations, delusions, disorganised thinking, personality changes, and cognitive impairment, making everyday life and relationships difficult to maintain.

Snow notes that schizophrenia is not always outwardly dramatic. “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. They may also struggle to initiate and sustain activities.”

Moving along the spectrum are conditions such as Major Depressive Disorder, Bipolar Disorder, Obsessive-Compulsive Disorder (OCD), and Post-Traumatic Stress Disorder (PTSD). These can cause significant distress but may also allow for periods of stability. Depression is marked by prolonged sadness and hopelessness, sometimes leading to suicidal thoughts. Bipolar Disorder involves extreme mood shifts, from high energy to deep depression. OCD brings intrusive and repetitive behaviours, while PTSD can cause people to re-experience trauma in ways that disrupt daily functioning.

Some individuals experience milder forms of mental health challenges. With the right support, such as counselling or medication, they can manage their symptoms while maintaining relationships and work responsibilities.

At the healthiest point on the spectrum are those who are thriving emotionally, socially, and psychologically. The World Health Organization 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,” Snow says, “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 emphasises that with the right medical care and psychosocial support, many people can live fulfilling and meaningful lives, regardless of where they fall on the spectrum.

If you or someone you know needs help, contact SADAG on the 24-hour helpline at 0800 456 789 or SMS 31393. More information is available at www.sadag.org.