The wrong track

For fifty years we have told people that mental distress is an illness in the head. Tens of thousands of researchers and billions of euros later, there is no scan, no blood test and no genetic variant that establishes a diagnosis such as depression, psychosis or ADHD. Mental distress takes place in a normal brain. It has got out of hand, but in itself it is an ordinary human experience.

What we do know: people respond with mental distress to what happens to them and to who they are. Every person has a profile of sensitivities and talents. That profile comes into friction with the environment, and that is where distress arises. That is why the first question is always: what happened to you? Only after that comes: what is wrong with you?

How experiencing works

At every moment, two things happen at once. From below comes the raw signal: what you see, hear and feel in your body. From above comes the interpretation: your expectations, memories and learned patterns. These two streams talk to each other all the time. You can think of it as a conversation that never stops.

Your mood, thoughts and feelings are the weather above that conversation. They arise from it. As long as the conversation keeps going, nothing stays for long. You are angry, and an hour later it has subsided. You are sad, and the next morning things work again. Being mentally healthy means feeling something and then feeling something else, without getting stuck.

When the conversation gets stuck

Distress begins when the interpretation from above hijacks the conversation. What comes in no longer fits the story and is rejected or distorted. An example: someone who has often been rejected finds a loving partner. Yet every look from that partner becomes proof that the partner is going to leave. The conversation falls silent and a monologue remains.

You can recognise distress that has got stuck by three things. It is compelling: it wants something from you. It is powerful: you cannot switch it off. And the relationship is unequal: the distress has the power, you do not. Whether it is anxiety, compulsion, low mood, a voice or a craving for alcohol, the form says less than that dynamic.

On top of that, coherence falls away. Time no longer flows and everything becomes always-like-this. You stand beside yourself. Your body feels strange, other people seem far away and the future closes. And it isolates, because you cannot explain to anyone what you are going through.

Not every peak is distress. Grief and trauma have their own pace. Sometimes biology does play a large part, for example in a cannabis-induced psychosis or a depression after childbirth. This is a working model, not a complete explanation. It gives you an account, in your own language, of why there is no hole in your head, even though it feels that way.

Six areas where the friction is

Distress often feels like fog. It helps to cut that fog up into areas. See them as a map to find your bearings.

• Meaning and direction. Is your life going somewhere? Are you in the right place?
• Relationships with others. Do you feel seen? Is there someone you can lean on?
• The relationship with yourself. How do you talk to yourself? What are you ashamed of?
• Body and lifestyle. Sleep, exercise, food, alcohol, pain, screen time.
• What happened in the past. Trauma in the broadest sense, large or small and added up.
• The world around you. Work, money, housing, discrimination, pressure to perform, and sometimes the care system itself.

The areas reinforce each other, in distress and in recovery. Sleeping badly increases loneliness, loneliness increases self-criticism. It also works the other way: sleeping better makes room to reach out to someone. So the question is: where is the most friction right now, and what is the smallest step you can take today?

What another person does

From a hundred years of research we know one thing for certain: another person does more than any technique. The effect of help comes for the most part from relationship, hope, ritual and meaning. That other person does not have to be a professional. A friend, a loved one, an expert by experience or a neighbour can do a lot. What that other person does:

• Co-regulating: being calm beside you when your system is running high.
• Bearing witness: listening without trying to fix things straight away.
• Giving words: helping you to name your experience.
• Lending hope: having confidence in you when you do not have it yourself for a while.
• Repairing a rupture: coming back to a misunderstanding.
• Normalising: showing that other people know this too, without making it small.
• Doing something together: taking a step you would not have dared to take alone.
• Standing beside you: seeing that part of the problem lies outside you.

Change comes about when three things click: you, who want it (the creator), another person (the co-creator) and something concrete that you do together (the ritual). That ritual can be therapy, but also walking, yoga, a group or writing. Which ritual works depends on what fits your view of the world.

Where do you start?

• On half a page, write down in your own words what is going on with you. What happened? What sensitivities and talents do you have? In which area is the friction?
• Find one person who can listen without wanting to fix things. Ask for something concrete: will you talk with me on the phone for half an hour every Friday?
• From there, build a small resource group of 2 to 7 people. You stay in charge.
• Choose one small ritual for every day, at the same time and in the same place.
• Do you have almost no one? Start at a recovery college or a peer support group.

Do you need help now?

PsychosisNet offers information. We do not offer a chat, a helpline or crisis support. If you or someone else is in immediate danger, call the emergency number in your country. If you are thinking about suicide, or you need to talk to someone now, see Need help now? for helplines by country.

Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare. 

Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. In 2026 he published 'Wat psychisch lijden is'.

Want to read more?

Blogs by Jim van Os can be read here

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