As we continue, I want to make something clear: there are conditions that are closely related to mental disorders, but they are not always mental disorders by themselves. Sometimes they are symptoms. Sometimes they are patterns that show up alongside a diagnosis. Sometimes they are complications that come because a person has been struggling for a long time. This chapter is about those conditions—the ones you keep seeing again and again around mental illness. When you understand them, you stop judging people quickly. You also start noticing danger early, and you can encourage someone to seek help before things get worse.
One major condition that appears in many mental health situations is psychosis. Psychosis is not always a diagnosis on its own. Many times, it is a state a person enters when their mind is no longer able to clearly separate what is real from what is not real. When someone is in psychosis, they can experience hallucinations. Hallucinations mean the person sees, hears, smells, or feels things that are not actually there. They can hear voices when nobody is speaking. They can see people or animals that others cannot see. They can smell things that are not present. Sometimes they even feel things on their skin that are not there.
This is why psychosis becomes so frightening. You cannot simply argue a person out of it. To the person experiencing it, what they are seeing or hearing feels real. That is why many people who live with serious mental disorders have medication that targets psychosis. It is treated because it disrupts safety, communication, and daily life.
Another condition I keep seeing is what is called dual diagnosis. This is when mental illness and substance abuse exist in the same person. Sometimes a person has a mental disorder first, and then they begin using alcohol or drugs as a way to cope. They may use substances to calm their racing thoughts, to silence voices, to reduce anxiety, to numb emotional pain, or simply to escape reality. In those cases, substance use becomes a form of self-medication, even though it often makes the condition worse in the long run.
Other times it starts in the opposite direction. A person begins abusing alcohol or drugs, and over time those substances affect the brain. They disturb sleep, mood, judgment, and thinking. They can trigger psychosis, depression, anxiety, or even long-term psychiatric illness. In that case, substance use becomes the doorway that opens into mental illness.
And I have also seen something that confuses many people: there are individuals who look like they are falling apart when they do not have their substance, but once they take it, they look “normal.” It can make a caregiver wonder, “How is it that the hard drugs makes them look stable?” I will be honest—this is complicated. What I understand is that addiction changes the brain’s reward systems and stress systems so deeply that withdrawal can look like mental breakdown. Then when the substance is taken, it temporarily reduces the withdrawal and agitation, so the person appears calmer. But that calm is not healing. It is the brain being temporarily satisfied, and the cycle continues. That is why people with mental disorders must be careful with alcohol and drugs. They may feel relief for a moment, but many times substances accelerate symptoms and complicate treatment.
Sleep problems are another condition that walks closely with mental illness. Some people cannot sleep enough. Others sleep but still wake up feeling exhausted. Some sleep too much. Others sleep in broken pieces. One common sleep disorder is insomnia. Insomnia is not just sleeping late once in a while. Insomnia is when a person cannot get enough sleep, or good quality sleep, to function normally the next day. They may lie awake for hours. They may wake up repeatedly. They may wake up too early and fail to fall back asleep. Over time, insomnia destroys concentration, mood stability, and energy. This is why sleep medication is common in mental health treatment. Not because sleep is the only problem, but because without sleep, the mind becomes weaker, symptoms become louder, and coping becomes harder.
Another condition I have seen is dementia. Dementia is not a typical mental disorder like depression or anxiety. Dementia is a degeneration of the brain—meaning the brain slowly loses its ability to function the way it used to. I know dementia can happen as people age. But what I have also observed is that people who have lived with mental disorders for a long time can appear to develop dementia-like symptoms earlier, or their risk can feel higher. I have worked with people who had mental illness plus dementia, and I have also worked with someone who had dementia alone. The experience is different, but the confusion, the memory loss, and the personality changes can be painful in both cases.
Self-harm is another condition that is related to mental disorders. Self-harm is when a person injures themselves on purpose, but not necessarily because they want to die. This is important: self-harm is not always a suicide attempt. Sometimes it is a desperate way to cope with emotional distress. A person feels unbearable internal pain, and they try to control it by creating physical pain. Sometimes they do it to feel something when they feel numb. Sometimes they do it to release tension. Sometimes they do it because they feel they deserve punishment. It is still serious. It still needs attention. But understanding the difference helps caregivers respond with wisdom instead of panic or insults.
Suicide risk is real in mental health, but it must be spoken about carefully. Not every person with a mental disorder will attempt suicide. And not every attempt means the person truly wants to die. Many times, it is a desire to end pain—not life. At the same time, many people who die by suicide have an underlying mental health condition, even if it was never diagnosed or treated. That is why we must take suicidal talk seriously. We must listen. We must ask. We must not shame people for confessing dark thoughts. Silence is where danger grows.
Now I want to talk about a condition that explains why many people with mental health problems do not seek treatment, and why many stop taking medication. This condition is called anosognosia. Anosognosia is not stubbornness. It is not pride. It is not someone “refusing to accept help.” It is when a person genuinely cannot recognize that they have a mental illness that need to be addressed.
In this condition, the brain fails to update reality properly. It is like the part of the mind that should say, “Something is wrong, I need help,” is not functioning as it should. The person may strongly believe they are fine, even when everyone around them can clearly see they are struggling. This is why you can find someone living in a different time inside their mind. You ask them what year it is, and they answer with a year from the past. You ask who the president is, and they give you a name that was true long ago. It is not always that they are joking. Sometimes their mind is not updating information the way it should.
And because they believe they are okay, medication does not make sense to them. They may ask, “Why am I taking this?” They may stop treatment. They may refuse help. Not because they want to suffer, but because their brain cannot see the illness. This is one of the hardest things for families and caregivers, because you can love someone deeply, but you cannot force insight into a brain that cannot recognize its own condition.
These conditions—psychosis, dual diagnosis, sleep disorders, dementia, self-harm, suicide risk, and anosognosia—are not always “disorders” by themselves, but they are closely tied to mental illness. They explain behaviors that people misinterpret. They explain why some people do not seek help. They explain why treatment becomes complicated. And the point of understanding is not to judge. The point is to respond better. If we understand these conditions, we stop calling people crazy. We stop mocking. We stop arguing with someone who needs care. Instead, we become informed. We become supportive. We become safe and supportive people around those who are suffering.
One major condition that appears in many mental health situations is psychosis. Psychosis is not always a diagnosis on its own. Many times, it is a state a person enters when their mind is no longer able to clearly separate what is real from what is not real. When someone is in psychosis, they can experience hallucinations. Hallucinations mean the person sees, hears, smells, or feels things that are not actually there. They can hear voices when nobody is speaking. They can see people or animals that others cannot see. They can smell things that are not present. Sometimes they even feel things on their skin that are not there.
This is why psychosis becomes so frightening. You cannot simply argue a person out of it. To the person experiencing it, what they are seeing or hearing feels real. That is why many people who live with serious mental disorders have medication that targets psychosis. It is treated because it disrupts safety, communication, and daily life.
Another condition I keep seeing is what is called dual diagnosis. This is when mental illness and substance abuse exist in the same person. Sometimes a person has a mental disorder first, and then they begin using alcohol or drugs as a way to cope. They may use substances to calm their racing thoughts, to silence voices, to reduce anxiety, to numb emotional pain, or simply to escape reality. In those cases, substance use becomes a form of self-medication, even though it often makes the condition worse in the long run.
Other times it starts in the opposite direction. A person begins abusing alcohol or drugs, and over time those substances affect the brain. They disturb sleep, mood, judgment, and thinking. They can trigger psychosis, depression, anxiety, or even long-term psychiatric illness. In that case, substance use becomes the doorway that opens into mental illness.
And I have also seen something that confuses many people: there are individuals who look like they are falling apart when they do not have their substance, but once they take it, they look “normal.” It can make a caregiver wonder, “How is it that the hard drugs makes them look stable?” I will be honest—this is complicated. What I understand is that addiction changes the brain’s reward systems and stress systems so deeply that withdrawal can look like mental breakdown. Then when the substance is taken, it temporarily reduces the withdrawal and agitation, so the person appears calmer. But that calm is not healing. It is the brain being temporarily satisfied, and the cycle continues. That is why people with mental disorders must be careful with alcohol and drugs. They may feel relief for a moment, but many times substances accelerate symptoms and complicate treatment.
Sleep problems are another condition that walks closely with mental illness. Some people cannot sleep enough. Others sleep but still wake up feeling exhausted. Some sleep too much. Others sleep in broken pieces. One common sleep disorder is insomnia. Insomnia is not just sleeping late once in a while. Insomnia is when a person cannot get enough sleep, or good quality sleep, to function normally the next day. They may lie awake for hours. They may wake up repeatedly. They may wake up too early and fail to fall back asleep. Over time, insomnia destroys concentration, mood stability, and energy. This is why sleep medication is common in mental health treatment. Not because sleep is the only problem, but because without sleep, the mind becomes weaker, symptoms become louder, and coping becomes harder.
Another condition I have seen is dementia. Dementia is not a typical mental disorder like depression or anxiety. Dementia is a degeneration of the brain—meaning the brain slowly loses its ability to function the way it used to. I know dementia can happen as people age. But what I have also observed is that people who have lived with mental disorders for a long time can appear to develop dementia-like symptoms earlier, or their risk can feel higher. I have worked with people who had mental illness plus dementia, and I have also worked with someone who had dementia alone. The experience is different, but the confusion, the memory loss, and the personality changes can be painful in both cases.
Self-harm is another condition that is related to mental disorders. Self-harm is when a person injures themselves on purpose, but not necessarily because they want to die. This is important: self-harm is not always a suicide attempt. Sometimes it is a desperate way to cope with emotional distress. A person feels unbearable internal pain, and they try to control it by creating physical pain. Sometimes they do it to feel something when they feel numb. Sometimes they do it to release tension. Sometimes they do it because they feel they deserve punishment. It is still serious. It still needs attention. But understanding the difference helps caregivers respond with wisdom instead of panic or insults.
Suicide risk is real in mental health, but it must be spoken about carefully. Not every person with a mental disorder will attempt suicide. And not every attempt means the person truly wants to die. Many times, it is a desire to end pain—not life. At the same time, many people who die by suicide have an underlying mental health condition, even if it was never diagnosed or treated. That is why we must take suicidal talk seriously. We must listen. We must ask. We must not shame people for confessing dark thoughts. Silence is where danger grows.
Now I want to talk about a condition that explains why many people with mental health problems do not seek treatment, and why many stop taking medication. This condition is called anosognosia. Anosognosia is not stubbornness. It is not pride. It is not someone “refusing to accept help.” It is when a person genuinely cannot recognize that they have a mental illness that need to be addressed.
In this condition, the brain fails to update reality properly. It is like the part of the mind that should say, “Something is wrong, I need help,” is not functioning as it should. The person may strongly believe they are fine, even when everyone around them can clearly see they are struggling. This is why you can find someone living in a different time inside their mind. You ask them what year it is, and they answer with a year from the past. You ask who the president is, and they give you a name that was true long ago. It is not always that they are joking. Sometimes their mind is not updating information the way it should.
And because they believe they are okay, medication does not make sense to them. They may ask, “Why am I taking this?” They may stop treatment. They may refuse help. Not because they want to suffer, but because their brain cannot see the illness. This is one of the hardest things for families and caregivers, because you can love someone deeply, but you cannot force insight into a brain that cannot recognize its own condition.
These conditions—psychosis, dual diagnosis, sleep disorders, dementia, self-harm, suicide risk, and anosognosia—are not always “disorders” by themselves, but they are closely tied to mental illness. They explain behaviors that people misinterpret. They explain why some people do not seek help. They explain why treatment becomes complicated. And the point of understanding is not to judge. The point is to respond better. If we understand these conditions, we stop calling people crazy. We stop mocking. We stop arguing with someone who needs care. Instead, we become informed. We become supportive. We become safe and supportive people around those who are suffering.
