This is one of the reasons that I reject the label, "mentally ill," being appropriated by everyone who carries a psych diagnosis. Yes, a person in the throws of paranoid schizophrenia can be constructively thought of as mentally ill. But let's refer to "the medical model." Acne is a dermatological disease, but, if your sister has a bad breakout of acne, you wouldn't go around telling people, "My sister is ill." As long as she is functioning within reasonably normal limits, you wouldn't describe her as being very sick, or being diseased. Unless she develops a severe skin infection from her breakout, she's not what most people would call "sick."

We consumers of psych services kind of want to have it both ways. We kind of want to be thought of as "ill," so that when we don't cope well, we can say, "It's not my fault. I'm ill." But, then, we don't want people assuming we can't cope.

There's a price for everything. We all want to be shown maximum compassion. We see fund raising spots on TV, where kids with cancer are called "heroes." Being real sick has become quite the thing. If you can get yourself labeled as being ill, all kinds of good vibes go with it. You're a warrior in the campaign against disease. You don't just suffer from an ailment, you are deemed to be "battling" it.

One way this got off the ground was with alcohol abuse being transformed from an objectionable behavior to an "illness." Much good came out of that, and the problem of excess drinking came out of the closet, where it could be better addressed. Likewise, other problematic behavioral styles have been gathered under the rubric of "mental illness." I think of the "disease model" as metaphoric. I'm not sure the metaphor always holds up. As I've said elsewhere, to my mind "mentally ill" would fittingly describe someone so impaired that they would not be asked to babysit. If reasonable people would feel fine letting you babysit their kids, then I'm not going to call you mentally ill.

I think "functionality" should have a lot to do with defining a state of mental illness. Abraham Lincoln suffered mightily from depression, but no one suggests he was too "sick" to discharge his duties as president. We don't think of the period of the Civil War as that time when we had a mentally ill president. But today lots of folk want to say D. Trump should not be president because he is probably "mentally ill." Compared to suicidal Abe, Donald strikes me as a pretty happy camper.

Part of how words and phrases garner meaning is through common usage. There isn't some language Czar presiding over a team of word experts who issues proclamations about what a word means. The publishers of dictionaries simply consult popular opinion to discover what a term means to the people who use it. For a few centuries, there's been a social consensus that some people's demeanor and behavior puts them in a category that can usefully be thought of as "ill," psychologically ill. It's really a metaphor. It's been useful. Now, however, the category is being expanded to include everyone with "issues." The law of unintended consequences kicks in. The meaning of the term "mentally ill" is becoming plastic, as it changes depending on the agenda of the person using it. Eventually, we're going to have to have more of a national conversation on topics related to this. Examples: Is all undesirable behavior a sign of mental illness? (Try to find a middle class mother who's badly behaved child doesn't have some diagnosed "disorder.") Are perpetrators of evil appropriately thought of as mentally ill? (This comes up every time we have a mass shooting.) Is chronic unhappiness usually "depression?" What is the relationship between "mentally ill" and "mentally incompetent?"