Mental Health and Illness

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Mental Health and Illness

• Overview of Approaches, Definitions, Perspectives

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Continuous or discrete?

• Continuous model
• Mental Health Mental Illness
• HealthygtgtgtgtAdjustment reactiongtgtgtgtNeurosisgtgtgtgtPsy
  chosis
• We all have differing degrees of mental health at
  different times in our lives. Most people arent
  at the extremes but fall somewhere in the middle.
• Anyone can become mentally ill, given the right
  circumstances.

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Discrete model

• Some people are mentally healthy others have
  specific mental disorders.
• Decision trees can distinguish who has a
  specific mental disease and who doesnt.

Mentally Healthy
Mentally Ill
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What is mental health?

• In our society, a mentally healthy person
• Has self-esteem, self-acceptance
• Is realizing potential
• Is able to maintain fulfilling relationships
• Has a sense of psychological well-being
• Has sense of autonomy
• Has sense of competence, mastery, purpose
• However, other cultures may have different ideas
  about what mental health is.

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Who has mental health?

• We all fall short to some extent.
• Therefore, advocates of mental health believe
  that a broad range of mental health services
  should be available to general population, not
  just seriously mentally ill.
• They believe that prevention and education, as
  well as treatment, are important.

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What is mental illness?

• Is it a disease, like diabetes or smallpox?
• Is it a form of deviant behaviorlike being
  rebellious, choosing to dress differently, being
  extremely religious, being extremely creative?

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The Medical Model and Concepts of Disease

• When distress or inappropriate behavior is
  thought to be a consequence of a bodily
  dysfunction, it is called a disease. Mechanic,
  p. 14.
• To diagnose diseases in physical medicine,
  doctors perform laboratory tests, do body
  imaging, take medical history, do physical
  examinations.
• Once disease is diagnosed, doctor generally
  knows
• Its cause
• How disease is likely to run its course
• What most appropriate treatment is

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Are mental illnesses like other diseases?

• Mental illnesses cannot be confirmed by objective
  laboratory tests or body imaging.
• Diagnosis in mental illness does not lead to an
  understanding of cause, of the course of the
  illness, or of the most appropriate treatment.
• Some (e.g., Thomas Szasz) have argued that mental
  illnesses are not diseases because of the above
  problems.

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Perspective of DSM

• Mental disorders represent a clinically
  significant behavioral or psychological syndrome
  or pattern that occurs in an individual and that
  is associated with present distress (e.g., a
  painful symptom) or disability.
• DSM tries to make psychiatric diagnoses more
  similar to medical diagnoses. Sees psychiatric
  symptoms as indicators of disease, not deviance.

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DSM

• Strength useful tool for practitioners,
  insurers, courts, agencies, since it allows for
  communication, offers consistent set of
  definitions.
• Limitation However, it is purely descriptive,
  doesnt indicate causes, offers limited
  information about expected course of the disease,
  doesnt suggest appropriate treatment.

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Major DSM-IV categories

• Anxiety disorders
• Somatoform disorders
• Factitious disorders
• Dissociative disorders
• Sexual and gender identity disorders
• Eating disorders
• Sleep disorders
• Impulse-control disorders not elsewhere
  classified
• Adjustment disorders
• Personality disorders
• Other conditions that may be the focus of
  clinical attention

• Disorders usually first diagnosed in infancy,
  childhood, or adolescence
• Delirium, dementia, amnestic, and other cognitive
  disorders
• Mental disorders due to a general medical
  condition not elsewhere classified
• Substance-related disorders
• Schizophrenia and other psychotic disorders
• Mood disorders

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Sociological perspective

• Mental disorders are type of deviant behavior,
  not a disease process.
• Those who are seen as mentally ill are those who
  violate social rules, dont behave appropriately.
• Individuals who become labeled as mentally ill
  are those not powerful enough to resist such
  labels.

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Mental illness as deviant behavior

• Researchers who view mental illness as deviant
  behavior usually study processes and rules used
  to define mental illness rather than symptoms in
  individuals.
• Szasz (1963, 1984)
• Mental illness is not a disease, since there are
  no physical lesions that indicate it.
• Calling people mentally ill denies concepts of
  free will and responsibility for ones actions.

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Bad or mad?

• Why do we call some deviant behaviors bad and
  some mad?
• If there is self-interest involved, we are more
  likely to call the behavior bad.
• Same behavior, different context, can be assigned
  different labelse.g., poor person who shoplifts
  is more likely to be considered bad, whereas a
  very wealthy person who shoplifts is likely to be
  seen as sick.
• Why?

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Assumptions behind bad or mad

• Ambivalent ideas
• Social and behavioral sciences are deterministic,
  assuming that behavior is determinedby prior
  events, social forces, biology
• At the same time, we assume that individuals can
  distinguish between right and wrong and have
  free will and thus can be held responsible for
  their actions.

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Definitions and labeling can be problematic

• Not so much in voluntary treatmentif an
  individual seeks help from a mental health
  professional, then common goals can be identified
  and pursued.
• If an individual is forced into treatment, then
  many ethical dilemmas can arise.

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How can mental illness be measured?

• Some researchers (sociologists, public health
  specialists, social workers) prefer to study how
  mental illness develops in communities, rather
  than its manifestations in those who are being
  treated for mental illness.

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Terms useful in assessment of mental illness in
communities

• Epidemiology study of how illness is
  distributed in a population, rates of disease,
  who appears to be susceptible, in an attempt to
  identify causes and discover interventions
  (example of work of John Snow on cholera in
  London in 1854)
• Morbidity prevalence of diseases in a
  population
• Comorbidity occurrence of more than one disease
  in the same individual

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Terms (continued)

• Prevalence How often the disease occurs
• Point prevalence percentage of population
  affected with an illness at any given point in
  time
• Lifetime prevalence percentage of population
  ever affected with an illness
• Incidence rate at which new cases appear within
  a given time period

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Epidemiological studies of mental illness

• 1st in USA Epidemiologic Catchment Area (ECA),
  1981
• 2nd in USA National Comorbidity Study (NCS)
  1990s
• Also a number of studies of prevalence and types
  of mental illness in other cultures

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Cross-cultural studies

• What is normal in one culture is not necessarily
  normal in another
• Therefore, measurement in cross-cultural studies
  is a real problem
• This holds true in cross-national studies and in
  studies of diverse ethnic groups within nations

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What causes mental illness?

• No one really knows. Research so far is
  inconclusive.
• Research is being carried out from diverse
  perspectives
• Psychological
• Biological
• Sociological

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Biological, developmental, or social?

• Since human beings are both biological and social
  animals, it doesnt make sense to argue about
  what causes mental illness.
• Causes are complex, involving some combination of
  biological vulnerability, environmental
  conditions, social stressors, social network and
  supports, psychological orientations, and learned
  behavior.

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Possible psychological/ developmental causation

• Psychological research into causes of mental
  illness examines individual personality (early
  development, cognitive styles, personal identity)
• Perspectives
• Psychoanalyticalearly developmental influences,
  such as child abuse/neglect, quality of parenting
• Cognitive-behavioral/behavioralhow ways of
  thinking affect behavior, social learning
• Phenomenological/existentialfocus on choice,
  responsibility, meaning
• Family dynamicsfocus on family roles,
  communication patterns

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Possible biological causation

• Factors examined by researchers
• Genetics
• Neurochemisty
• Viral causation

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Possible environmental/social causation

• Factors examined by researchers
• Chronic strains in the environment
• Poverty
• Poor living conditions
• Dangerous neighborhoods
• Overwhelming role responsibilities
• Negative life eventsstress and coping
• Natural disasters
• Unemployment
• Adjusting to new environments and roles

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Environmental/social causation (continued)

• Another factor examined by researchers
• Labeling
• Social controlhow mental health diagnosis and
  treatment acts as an agent of social control
• Relationship between social attitudes toward
  mental illness and the course of mental
  disorderseffects of stigma, discrimination, and
  social exclusion

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Environmental/social causation (continued)

• Collective mobilization
• Notion that society produces disabilities by how
  it
• Defines persons with impairments
• Limits access to community facilities and
  employment
• Discriminates against them
• Impairments can become either a major aspect or
  minor aspect of a persons identity, depending on
  how society and government respond to persons
  with impairments

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Disease or problem in living?

• Some problematic behaviors are given the status
  of disease in DSM
• Alcohol abuse and dependence
• Drug abuse
• Conduct disorders in children
• They may not really fit into the disease model
• It may be more valid to consider them as problems
  in living

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Public definitions of mental illness

• Most people who seek treatment for mental
  disorders do so because they feel distressed.
• Some people, however, feel they do not need help
  but are identified by others (e.g., family,
  friends, police, schools, employers). Evaluators
  have to make difficult judgments in such cases.

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Role of values

• Values of evaluator can influence judgments about
  individuals being evaluated. Evaluators notions
  of what is appropriate behavior are shaped by
  their culture and social context.
• If an evaluator accepts the worldview of his/her
  society, then people with different worldviews
  can be seen as deviantmad or bad.

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Value of the disease model

• Disease model attempts to be objective and
  universal, avoiding value judgments about
  behaviors.
• Psychiatrists attempt to separate out symptoms
  from cultural content (e.g., schizophrenia).

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DSM Decision Tree Mood Disorders