CONCEPTIONS OF MENTAL ILLNESS

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CHANGING CONCEPTIONS OF MENTAL ILLNESS
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CONCEPTIONS OF MENTAL ILLNESS

• HOW VIEWS OF MENTAL ILLNESS HAVE CHANGED OVER
  TIME
• CURRENT CONCEPTIONS OF MENTAL ILLNESS
• WHERE DRAW THE LINE BETWEEN MENTAL ILLNESS AND
  NORMALITY?

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PRE 20TH CENTURY
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PRE-20TH CENTURY

• MENTAL ILLNESS IS UNIVERSAL
• MENTAL ILLNESS LIMITED TO SMALL NUMBER OF MOST
  SERIOUS CONDITIONS
• MENTALLY ILL HIGHLY STIGMATIZED

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CAUSES

• NOT MUCH KNOWN
• SUPERNATURAL
• BRAIN DISEASE

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EARLY TREATMENT

• PRE-19TH CENTURY - LEFT TO FEND FOR SELVES
• NO OUTPATIENT TREATMENT
• 19TH CENTURY - SHUT AWAY IN INSTITUTIONS

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PRE-20TH CENTURY

• LIMITED TO SMALL NUMBER OF SEVERE CONDITIONS
• MENTALLY ILL BIZARRE AND DIFFERENT
• CAUSES UNKNOWN
• INSTITUTIONALIZED

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1900 - 1980
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20th CENTURY VIEWS

• FIRST PSYCHIATRIC MANUAL AT BEGINNING OF 20TH
  CENTURY 19 OF 20 CONDITIONS PSYCHOTIC
• DSM NOW - NEARLY 400 DIFFERENT MENTAL ILLNESSES
• TREMENDOUS BROADENING OF CONDITIONS VIEWED AS
  MENTAL ILLNESSES

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EXPANSION OF M.I.

• SIGMUND FREUD
• EVERYONE TO SOME EXTENT IS M.I.
• IDEAS BEGAN TO EXPAND THROUGH THE CULTURE -
  MOVIES, BOOKS, PROFESSIONS

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RESPONSE

• OUTPATIENT TREATMENT IN COMMUNITY
• PSYCHOTHERAPY
• FOR MOST PART, LIMITED TO ELITE

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CURRENT CONCEPTIONS
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CURRENT CONCEPTIONS

• BEGAN WITH DSM-III (1980)
• NOT JUST MOST SEVERE CONDITIONS BUT MANY
  DIFFERENT CONDITIONS

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M.I. WIDESPREAD

• NO LONGER SEEN AS UNUSUAL BUT MANY PEOPLE
  AFFECTED BY THEM
• 50 PERCENT OF POPULATION OVER LIFETIME 20
  PERCENT IN ANY GIVEN YEAR

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NORMALIZATION

• MENTALLY ILL NOT SEEN AS DIFFERENT FROM NORMAL
• MENTALLY ILL NOT CERTAIN KIND OF PERSON BUT
  NORMAL PERSON WITH PARTICULAR DISEASE

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MEDICALIZATION

• NORMAL PEOPLE HAVE MEDICAL CONDITION
• TREATED BY PROFESSIONALS

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BIOLOGICAL CAUSES

• MENTAL ILLNESSES VIEWED AS BRAIN DISEASES
• GENETICS AND BRAIN CHEMISTRY AT FAULT

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TREATMENT

• SSRI - SELECTIVE SEROTONIN REUPTAKE INHIBITORS -
  ANTI-DEPRESSANTS
• HUGE INCREASE IN DRUG TREATMENT - 60 MILLION
  SCRIPTS
• 3 OF 7 MOST PRESCRIBED DRUGS

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THERAPEUTIC CULTURE

• MANY BEHAVIORS MEDICALIZED
• MENTAL ILLNESS IS COMMON
• MENTALLY ILL NOT DIFFERENT
• RISING NUMBERS OF PEOPLE IN TREATMENT AND OF
  MENTAL HEALTH PROFESSIONALS

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RATES OF TREATMENT
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M.H. PROFS. 1980-2000
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SUMMARY OF TRENDS

• FROM ONLY SERIOUS TO MANY CONDITIONS
• FROM RARE TO WIDESPREAD
• FROM STIGMATIZED TO MEDICALIZED
• FROM UNKNOWN CAUSES TO PRESUMED BIOLOGICAL

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SUMMARY OF TRENDS

• FROM INSTITUTIONS TO OUTPATIENT THERAPY TO DRUGS
• FROM SEGREGATION TO PART OF CULTURE

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WHERE DRAW THE LINE?

• ARE TOO MANY CONDITIONS MEDICALIZED NOW?
• HOW CAN WE SEPARATE WHATS M.I. FROM WHATS
  NORMAL?

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SOPRANOS

• BEHAVIORS VIEWED AS DISEASES
• CHANGE OVER TIME FROM ROWDY TO SICK
• CONFLICT WITH MUCH LAY CULTURE
• RISE OF M.H. PROFESSIONALS
• TREATMENT NOT PUNISHMENT