Mental Health as a Continuum

Mental Health as a Continuum

by Imei Hsu

What might happen if we changed our view of mental illness and mental health from a problem only a few have, to a health concern that each person checks in with each day? Photo by Imei Hsu.

She shuffled slowly inside of the spare hospital room, eyes alert, and a frightened expression on her contorted lips.

“You see them, don’t you? Shut up, just shut up!” she would snap at the empty space to which she pointed and gestured. Before I could answer, she harumphed, turned on her heel, and headed away from me.

I was 20 years old and working as a student nurse on a psychiatric floor of a large hospital outside of Seattle. At the time, I considered my first months working the evening shift at an in-patient psychiatric ward to be the first time I was face-to-face with people who were diagnosed with a mental illness or were suicidal. I thought that what I was seeing was the real face of mental health and mental illness.

Since then, I’ve come to see those experiences differently. While they were real manifestations of mental health crises and psychiatric disorders, they certainly weren’t the only ones.

What it required from me was to expand my understanding of mental health, moving it from a fixed point when someone expresses all the behaviors and thinking that “checks all the DSM boxes” for one disorder or another, but to see mental health and physical health along a continuum.

What Does That Mean, “Mental Health on a Continuum?” 

Rather than asking a person, “Have you ever been diagnosed as, ‘X disorder?'” we look at your mental health on a range and not a point of arrival.

What this means for the average person who does not show psychopathological behavior (a very small percentage of the population, BTW) is that most of us can recognize a little bit of everything within our capacity of expression.

For example, I can have a day, week, or month where I feel truly saddened by the news of the death of a friend. If I act sad because I feel his absence, I can look at this as pathology (medical model) if it goes beyond a certain amount of time, or my reaction to his death begins to follow a pathway of maladaptive dysfunction. Yet I can also look at this as mental health on a continuum — grief over time — and experience the highs and lows of moving on without my friend. 

I  can say, “I feel depressed and sad,” and that can signal to me that I need to take time to care for my mental health. Mental health care, as seen on a continuum, doesn’t even need a particular trigger in order to employ. One would simply tune in and rate from time to time how one was feeling and responding to the day, and adjust accordingly.

What Could That Look Like?

If we diminished our focus on the stigma and stereotypes of mental illness and replaced it with this continuum model around mental health and mental wellness:

  • maybe we wouldn’t wait so long to ask for care
  • maybe we would encourage one another to talk to someone about how we feel
  • maybe we would slow down and take time to get some of our physical and emotional needs met, big or small
  • maybe we would prioritize “being” over “doing”
  • maybe we would spend less time “chilling out” and more time “tuning in” (less Netflix, more quiet walks?)
  • maybe we would feel more confident to talk about rough times and vulnerable thoughts, instead of dressing up our stories to all be “Instagram-worthy”
  • maybe we would honor mental health hygiene, like we respect toothbrushing and handwashing. Neither of these practices guarantee we’ll never get cavities or a cold, but then we don’t berate people for going to a dentist for extracting a rotten tooth or taking an anti-viral if they get a nasty case of the flu. We applaud them. 

My opinion is not to remove the DSM as a means of recognizing and treating psychiatric disorders, but rather to expand and broaden the picture of how we look at mental health as a society.

If you have a body, you will have mental health concerns across a lifetime. There is no escape. Instead of viewing mental health as something only certain people have to deal with, we can introduce mental health early in education as a natural part of life.


My thanks to Dr. Cynthia Li (functional medicine) and author of Brave New Medicine, for sharing her journey with life-altering chronic illness and pain. Her well-written story includes her own discovery of disease and dis-ease as a double-sided arrow, resisting the idea that illness only occurs when symptoms cross the threshhold of “here.”  You can find her book online and in your local bookstore. 

By Imei Hsu

Imei Hsu is a mental health counselor, active retired RN, AIP Coach and PN1-NC, writer, triathlete and arts promoter in the Seattle area and through online services. With 30+ years in healthcare (22+ years in mental health), Imei has a commitment to helping people discover insight into their health, relationships, and connecting. She is the owner of Seattle Direct Counseling and the blog, a presenter and speaker on a variety of psychological topics, and a positive force on the Internet. She launched her personal project, My Allergy Advocate, in 2018. Imei is a two-time Ironman Finisher (Mont-Tremblant 2016, Ironman Canada 2018); she also finished her first ultramarathon in 2017 and has gone on to race the 100K distance while preparing for 100 Mile trail races and a backyard ultra. You can find her running everywhere and eating all the thingz, watching movies, camping under the stars, and cooking real food.

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