The most obvious confusion between metaphor and reality is when society labels emotional/interpersonal problems/divergence from norms of society as mental illnesses.In the USA childdhood disobedience is now a mental illness and there are many similar crazy  notions.Homosexuality was labelled as a mental illness for years but no longer.
Now if you are suffering terrible anguish in various forms it may help to be told it is an illness… or it may make you worse.I am sure that often excess fatigue,personal characteristics like overworking constantly,not eating well,being distressed by the state of the world are very common but there are no blood tests nor any other tests to identify such as being illnesses.Though often physical illnesses casuse mental distress and depression either directly or because of shame and anxiety and other reactions to being ill for a long time.
The writer Thomas Szasz identified this confusion many years ago.If you disagree and say how can medication help unless a person is ill then I’d say that the placebo effect is one reason and another is that if someone is exhausted and needs to rest then medication maybe helpful to give them a little peace.
Gerard Manley Hopkins,A Jesuit priest and a poet seemed to be given a job in an Irish University which was exhausting and debilitating but owing to his vow of obedience to his superiors in the Jesuit Order he could not change his life except by dying… so he thought.
The poet Gwyneth Lewis who has been the National Poet for wales wrote a book[Sunbathing in the rain] about her severe bout of depression.In the book she seems to be claiming that there were personal mistakes and decisions in her lifestyle and job which led her into depression.She saw it as necessary for change.However she did use medication in spite of feeling it was a spiritual turning poimt which she needed to get back onto her true path or vocation in life.
Her mother had been depressed frequently when she was a child and so she would have learned by this as a way of problem solving.
Also despite her immense intelligence she had failed to realise that abandoning her strong hopes to have a child [given the age of her husband and the need to earn a living] was going to cause her huge distress.In fact marrying someone who has been sterilised seems unusual for w young woman who wants children.But it is sometimes reversible and maybe she didn’t think so far ahead.
This blindness to our own feelings seems to lead many of us astray.
We sometimes get clues to our hidden feelings in dreams or we could find someone to talk to when going through a major life decision.
Some people don’t know that grief and mourning exist and are stunned when they feel sad and often their families criticise them for “not coping well” Coping here seems to mean remaining happy and calm all the time;this is a selfish demand on a bereaved person or anyone really.
I also noticed over the years that many famous people suffered from depression but when you examine their lives they seem to demand too much from themselves and be afraid to ask for help
.Poor Sylvia Plath wanted to be famous which she is now but alas she is dead. It’s hard to know why she felt the need to work so hard except her upbringing was one where acadenic excellence was valued and why she married someone with no obvious way of providing support either financial or emotional… when it got tough he ran off… but who knows why? The point that interests me is that she was compulsively driven to achieve… and she did so much in her short life… but was it worth it?
We all need to examine our life to see if we are acting stupidly.
But when worn out mentally it seems thinking is a mistake whereas simple manual work is beneficial as is being outdoors or being with kind undemanding friends…. and if a person has few friends coping with emotional trauma is much harder.This affects people who move to another state or country.And older people moving house even can bring on mental confusion.
And if we are people who find friendship and intimacy hard then it’s likely that we will suffer more from any problem we run into.
Finally,is the idea of a vocation for each of us of value?We each have unique gifts plus a need to earn a living.It depends on many factors outside our control whether we can find a job that combines these.Many poets and writers work in menial jobs to earn a living and then they write at night.[Teaching seems to sap creative energy.]
Other people don’t feel they have a calling but train for something they feel will earn a living in a way that suits them.Electricians and plumbers are in great demand…
And apart from finding our own true needs we need to contribute to society in some way.And to have a feeling of enjoying being alive which is perhaps denied those millions in Asia who make our clothes,i phones and other goods.