It makes good business sense to label people mentally unwell. The pharmaceutical industry reaps gigantic profits from the sale of drugs touted as fixing, or at least, supporting fractured minds – and we shouldn't think for a minute that all medical professionals are so ethical that incentives don't drive diagnosis.
Still, even though the DSM is packed with (financially lucrative) disorders, there is still debate about what constitutes a mental illness.
Theories abound about who is unwell, how they're unwell, and what manifestations of behavior are worrying or not. Diagnostically, there's still plenty of controversy about mental illness definitions, and that's how it should be. We don't always make decisions in our own lives that are anywhere near a good idea, and even when we're in groups our collective decisions can often be remarkably stupid.
A good example of that, in relation to the definition of mental disorders, is the sheer number of folks who have had visual and auditory hallucinations. One in five is the often touted number of those of us who will experience mental instability in their lives. Sounds reasonable enough to me. However, what is more interesting is the actual number of people who have experienced what would be defined by the DSM as serious mental illness – i.e those visual and auditory hallucinations – is huge. Really huge. Problem is, folks who experience such things are reluctant to disclose to a health professional – and why would they, given the negative weight associated with a 'serious' mental illness, not to mention the stigmatization and consequences.
Turns out, as repeated research has shown, for many people, visual and auditory hallucinations are a feature of their everyday existence, and research like that is interesting because it moves the goal posts in defining what is abnormal. Obviously, for many people visual and auditory hallucinations are a living nightmare, yet, for others, they aren't. It could be for cultural reasons, where seeing the dead or hearing voices is accepted as a spiritual gift, or it could simply be that those voices don't impinge on one's daily life to any significant degree. Either way, it's a diagnostic conundrum, and in an area where diagnosis can be vague at the best, it shines a light on the fact that the human experience continues to outstrip the notions we construct to define it.
The same could be said for historical constructs too. A couple of thousand years ago if I suggested God happened to be nattering away in my ear (and I was charismatic enough) there's a good chance I could have been tagged as prophetic. Not so much these days of course. I'd be quickly assessed, and possibly hospitalized, and while that's a bit of an oversimplification of mental health's historical role, my point is that madness and sanity are historically fluid constructs.