mental illness

A mental illness as defined in psychiatry and other mental health professions, is abnormal mental condition or disorder expressing symptoms that cause significant distress and/or dysfunction. This can involve cognitive, emotional, behavioral and interpersonal impairments.

The concept of an 'illness' of the mind is often taken to imply a medical condition with a specific pathology that causes the signs and symptoms, a view that is the subject of much research and debate. Similar but sometimes alternative concepts include: mental disorder, psychological or psychiatric disorder or syndrome, emotional problems, emotional or psychosocial disability. The term insanity, sometimes used colloquially as a synonym for expressing symptoms of a mental health condition or irrationality, is used technically as a legal term.

Specific disorders often described as mental illnesses include major depression, generalized anxiety disorder, bipolar disorder, and schizophrenia, to name a few. Mental health conditions have been linked to both biological (e.g. genetics, neurochemistry, brain structure) and psychosocial (e.g. cognitive biases, emotional problems, trauma, socioeconomic disadvantage) causes. Different schools of thought offer different explanations, although current research employing the term 'mental illness' would most probably originate in a biopsychiatry point of view.

Mental health conditions when symptomatic have been associated with impaired functioning, for example ability to work or manage socially, and sometimes also to high function, for example creativity. Cross-cultural studies suggest that what is seen as (the symptoms of) a mental health conditions in one culture may be accepted or valued in another, may manifest differently, or may not appear at all.

Causes

Main article: Causes of psychiatric disorder

Neurology is not the same as psychiatry: whereas neurology treats diseases that have their aetiology or their physiology known and proven by medical science, psychiatry treats mental conditions where aetiology and physiology are both unknown and unproven. Thus, mental health conditions by definition do not have a known pathology.

If the aetiology or physiology of a mental health condition is discovered, it has to be reclassified. When the physiology of Parkinson's disease was discovered - that it was caused by progressive damage to the substantia nigra in the dopaminergic system - it became redefined as a degenerative neurological disease. Likewise many people were initially diagnosed with schizophrenia in the 1920s until it was discovered that their condition was the result of a virus, encephalitis lethargica.

Consequently it is important to understand that, due to the demarcation between psychiatry and the neurological sciences, from the perspective of medical science the medical cause and physiology of mental health conditions will always remain unknown. This means that any speculation about the medical causes of a mental health condition is just that and nothing further and should not be promoted as medical fact. This includes speculation about brain structures, chemical imbalances, or genetic links.

Mental health conditions may be caused by a number of factors, or the confluence of several factors. Different schools of thought, including the biological, the psychological, and the social, offer different explanations, although current theories usually hold that all three contribute in varying amounts to any individual's symptoms of having a mental health condition.

A person with a mental health condition may have a difference in brain structure or function or in neurochemistry, through either genetic or environmental vulnerabilities. For example, many people diagnosed with schizophrenia have been shown to have enlarged ventricles and reduced grey matter in the brain. On the other hand, many people with schizophrenia have been shown to have perfectly normal vertricles and grey matter. Furthermore, many people with enlarged ventricles and reduced grey matter do not have schizophrenia. Thus, there is no definitive brain abnormality consistently associated with schizophrenia. Finally, genetic studies, including adopted twin studies, have shown strong evidence that mental health conditions such as bipolar disorder (manic depression) and schizophrenia can be partially inherited.

Psychological findings indicate that cognitive abnormalities, emotional problems or interpersonal problems can cause mental health conditions, especially in vulnerable individuals. Mental health conditions may also be caused by significant, traumatic events due to one’s environment. For example, there may be higher incidences of symptoms in areas that are involved in civil or military actions or that have recently suffered a major natural or man-made disaster. Areas that also suffer from endemic poverty, transience, and few resources and supports are also suggested to have higher rates of symptoms than more affluent or stable areas.

There are likely multiple causes of mental health conditions. There has been a focus on the neurotransmitters dopamine, norepinephrine, and serotonin. Each disorder is likely to have its own etiology, or causation. Treatment options include psychiatric medication, psychotherapy, lifestyle adjustments, other supportive measures or a combination of these. People with mental health conditions typically seek treatment only when psychiatric symptoms make it very difficult to function, but early treatment - when symptoms are mild or moderate - will generally lead to a better long-term outcome. The diagnostic process is complex. Diagnosis remains a partially subjective and partially evidence-based practice that can include careful and detailed assessment of patient histories and current and past symptoms.

Psychiatric disorders vary from one individual to another and may be mild, severe, or anything in between. Even in one person, symptoms can vary over time from their most severe to complete remission and back. These conditions often are episodic, and "flare-ups" may be triggered by stress and other factors. If one becomes ill again after a symptom-free period it is not due to a lack of willpower or self-control, but rather the natural waxing and waning of the condition. Appropriate treatment of the disease can help stabilize the course of the condition and reduce or eliminate the waxing and waning of symptoms.

Regarding the major psychiatric disorders (e.g. bipolar disorder, schizophrenia, major depression, obsessive-compulsive disorder) the nature versus nurture debate has generally been settled. The answer is "both". The major psychiatric conditions all show strong evidence of heritability and psychosocial factors have been strongly implicated.

Some question whether the concept of 'mental illness' is coherent or appropriate or is used validly in practice. This can include professionals, and this view is often held by some of the anti-psychiatry movement, as well as by Scientologists.

Prevalence

According to the 2003 report of the U.S. President's New Freedom Commission on Mental Health, major mental illness, including clinical depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder, when compared with all other diseases (such as cancer and heart disease), is the most common cause of disability in the United States. Additionally, according to National Alliance for the Mentally Ill (NAMI), an American advocacy organization which accepts funding from the pharmaceutical industry, 26.2% of North American adults will suffer from a clinically diagnosable mental health condition in a given year, but less than half of them will suffer symptoms severe enough to disrupt their daily functioning (NIMH website). Approximately 9% to 13% of children under the age of 18 experience serious emotional disturbance with substantial functional impairment; 5% to 9% have serious emotional disturbance with extreme functional impairment due to a mental health condition. It is suggested that many of these young people will recover from their conditions before reaching adulthood, and go on to lead normal lives uncomplicated by illness.

Symptoms

In addition to the categorized conditions, there are many well-defined symptoms of mental illness, such as paranoia, that are not regarded as mental health conditions in themselves, but only as indicators of one of the conditions belonging to one of the classes listed above.

Diagnosis

The diagnosis of a mental health condition is usually done by a licensed mental health professional or medical doctor. The diagnosis of a mental health condition usually involves a number of sources and instruments, including a personal history, a physical exam, an evaluation of behavior, a symptom inventory, condition-specific instrument (such as the Beck Depression Inventory), and other information as suggested by the history (including neuroimaging and blood tests) in order to arrive at a diagnosis. In the U.S., criteria for the diagnosis of a specific mental health condition are given in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

At the start of the 20th century there were only a dozen recognized mental health conditions. By 1952 there were 192 and the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV) today lists 374. Depending on perspective, this could be seen as the result of one or more of:

• diagnosis and better characterization of mental health conditions, due to over a century of research in a new field of science and academia.
• A highly increased incidence of symptoms of a mental health condition, due to some causative agent such as substances in the environment, or, as some have argued, the ever-increasing stress of everyday life.
• An over-medicalisation of human thought processes, and an increasing tendency on the part of mental health experts to label individual "quirks and foibles" as illness.
• Increasing politicization of the DSM, perhaps due in part to the Peter principle, which may allow decision-makers with more discriminating, compartmentalizing thought processes to dominate the higher ranks of the medical establishment.

Categories of mental health conditions & disorders

In the United States, mental health conditions have been categorized into groups according to their common symptoms in the Diagnostic and Statistical Manual of Mental Disorders, compiled by the American Psychiatric Association. One important caveat is that all the DSMs have shortcomings. Very often consumer groups or clinical researchers have different criteria for their diagnosis of a disorder. The DSM V due out in 2011 will hopefully address these differences. There are thirteen different categories, some containing a myriad of conditions and others only a few. Selecting any of the Wikipedia categories in the table will allow you access to all the articles and subcategories in that category.

In addition to the shortcomings of DSMs there are cross-cultural behaviors that can result in false positives for a particular disorder. What is considered abnormal behavior in one culture, may be considered perfectly normal and even revered in another. An example of this is Ghost Sickness a preoccupation with death or the deceased in certain Native American cultures.

Most organizations do not view mental retardation as a mental health condition. The Mental Health Association of Southeastern Pennsylvania states: 'Mental illness and mental retardation are not the same thing. Some people are born with mental retardation, a condition characterized by below-average intelligence throughout one's life. Mental illness, however, can affect anyone at any time. In fact, certain mental illnesses are more common among people with high intelligence and creativity.' However, people with developmental disabilities, such as mental retardation, are more likely to experience mental illness than those in the general community ^[1].

Treatment

Forms of treatment for the various types of mental health conditions include medication and therapy. One of the primary purposes of mental health professionals, including psychiatrists, specializing in using the biomedical approach, and psychologists, specializing in providing psychotherapy, is to improve an individual's mental health. If medications are used, a psychiatrist and patient are responsible for monitoring and managing the prescription of these medications and their effects.

Symptoms may disappear, a patient may not suffer from a condition and may seemingly be cured, but the underlying vulnerability of almost any condition remains. With chronic mental health conditions, the chances of the symptoms recurring will be affected by the number of episodes the patient has had in the past, the effectiveness of the treatment, as well as external factors.

If a mental health condition has been identified as a physiological problem, it frequently may be manifested through and/or exacerbated by behavior. Ergo, individuals suffering from physiological disorders may benefit from psychotherapy. The most basic treatment involves identifying maladaptive, self-destructive, or inappropriate behaviors and finding ways, with the patient, of coping with, eliminating, or altering those behaviors to promote overall mental health.

Often individuals with serious symptoms of a mental health condition will engage in several different treatment modalities, all with specific goals. For example, a patient with chronic schizophrenia may be involved in treatment using medication, take part in psychotherapy to help manage their life-long condition, be engaged in case management (sometimes referred to as "service coordination"), use day treatment, utilize a psychosocial rehabilitation program, and/or take part in a assertive community treatment program to help move them towards a more productive and independent role in the community.

Robert Burton wrote in the 16th century in his classic work, The Anatomy of Melancholy, that music and dance were critical in treating mental health sypmtoms, especially melancholia. ^{[2] [3]}

In November 2006, Dr. Michael J. Crawford ^[4] and his colleagues again found that music therapy helped the outcomes of Schizophrenic patients. ^[5]

Controversy

Main articles: Anti-psychiatry and Causes of psychiatric disorder

The practice and science of psychiatry remains controversial. For example, until 1989 homosexuality was considered a mental disorder in American psychiatry (see DSM-III). It can be argued that what psychiatry formally considered a disorder or illness was the result of cultural norms or bias and this perception varies over time and place. However, there was (and still is) no medical evidence whatsoever to suggest that homosexuality was a mental health condition. It was taken off the list of mental health conditions after years of protests.

Psychiatry, however, has always considered itself to be guided by evidence-based medicine. However, some diagnoses remain controversial as do the underlying tenets of psychiatry as well as the lack of physical tests for the majority of mental health conditions. For instance, whilst a person with transsexualism who is not suffering as a result would probably not be considered to be sympomatic of having a mental health condition, a person who is suffering from a belief that they are trapped in the wrong body may be considered to have gender dysphoria. Nevertheless, dysfunction or subjective distress are technically required before such a diagnosis can be made.[4]

Neurochemical studies have revealed abnormalities in neurotransmitter functioning among individuals with certain psychiatric diagnoses, as well as abnormalities in the brains of individuals psychiatry considers normal.

It is widely held that some features that are considered to be within the norm, such as sexual orientation or special talents are also likely to have a neurobiological or genetic basis.

Traumatic life experiences that exceed an individual's coping ability and may result in lasting changes in brain chemistry. Patterns of learned behavior can also alter brain chemistry, for better or for worse. Cognitive behavior therapy focuses on changing patterns of thinking through learning, which relieve anxiety disorders, depressive disorders and to some extent bipolar disorders.

Drug therapies for severe symptoms of having a mental health condition such as schizophrenia, bipolar disorder and clinical depression, consistent with biochemical models, are considered to be effective by the psychiatric establishment. Medicating requires a close collaboration between patient and prescriber, so that people with these conditions understand the difference between being over-medicated and optimally-treated. Psychiatrists who "cripple" their patient's brain response system are actually over-medicating their patients; and patients who allow themselves to be over-medicated aren't discussing the problem with their psychiatrist. Others argue that the effectiveness of drugs does not imply that their use is safe or desirable. However, discussion with one's doctor of a certain drugs safety/side effects profile and intended effect on one's symptoms is one adaptive alternative to not using medications altogether.

Psychiatrists make the analogy that many physical conditions, such as diabetes, must also be controlled with use of medications throughout the individuals lifetime. Moreover, in mental health conditions, studies show that patients' symptoms return once drug treatment is stopped.

It is important to note that the existence of mental health conditions and the legitimacy of the psychiatric profession have not been accepted by some individuals and groups, and this movement gains strength as major celebrities such as Tom Cruise publicly voice their dissatisfaction with psychiatry. Some professionals, notably Thomas Szasz, Professor Emeritus of Psychiatry at Syracuse, are profoundly opposed to the practice of applying the label "mental illness." The anti-psychiatry movement often refers to what it considers to be the "myth of mental illness" and argues against a biological origin for mental health conditins, pointing out that the differences in levels of neurotransmitter, or even in size of brain structures, cannot be taken as indications of illness. Alternatively, some argue that all human experience has a biological origin and so no pattern of behavior can be classified as an illness per se.

There are other branches of the "anti-psychiatry" movement who claim, however, that psychiatry is not biological enough. Symptoms that are considered diagnostic of severe mental health symptoms, such as hallucinations, delusions and severe depression, are actually commonly seen in physical illnesses that interfere with brain function (see Delirium). It has been argued, most vociferously by the late neuropsychiatrist Sydney Walker III, that large numbers of "mentally ill" people are actually suffering from undiagnosed physical illnesses. This is supported by evidence of high rates of physical illness, such as diabetes, cardiovascular problems and infectious diseases in the severely "mentally ill", such as people with schizophrenia. Although some of these problems may result from neuroleptic drugs or poor self-care they are also listed in major organic psychiatry textbooks (e.g. Lishman, 1998) as diseases that can cause psychosis. The distinction between mental and physical illness occurred at a time when it was believed that diseases like schizophrenia were caused by bad parenting and stress. They were deemed mental, as opposed to physical, because they were thought not to be organic in origin. If such symptoms are, however, caused by biochemical imbalances in the brain they are physical diseases, not mental ones. It has been argued, therefore, that the idea of a biologically caused "mental illness" is a contradiction in terms.

Other arguments against psychiatry include the view that electroconvulsive therapy damages the brain, based on the fact that running large amounts of electricity through the brain is obviously damaging.

Some people currently diagnosed with autism are against the notion of a neuropsychiatric disorder. For example, some autistic individuals have organized and formed the autistic rights movement. They claim that autism is a form of neurodiversity.

We are all neurodiverse. That is why we have different personalities, strengths and talents. Some argue that untreated mental health conditions can get in the way of our expressing our signature strengths. On the other hand, neurodiversity advocates argue that there may be more positive potential in recognizing neurodiverse subjects outside the framework of pathology. In other words, it might prove more helpful to acknowledge a broader spectrum of human variation (e.g., "autism" or "schizophrenia" as a different type of "normal" human variation), rather than approaching these variations as "mental illnesses" in need of "cures."

Patient advocacy

Patient advocacy organizations have been helpful in changing the stereotype of psychiatric conditions. These stereotypes are typically made by individuals or groups who know little or nothing about psychiatric conditions and mistakenly believe that these conditions reflect a lack of willpower by the individual. It is important to emphasize that these conditions are not a sign of personal weakness. In fact, the truth is that most psychiatric patients have endured more pain than those that do not have these conditions will ever experience. A case could be made that these individuals are in fact quite strong, even when compromised by symptoms. Discrimination against people who have mental health conditions keeps them from seeking help. Mental health is as important as physical health to the overall well-being of individuals, societies and countries. Yet only a small minority of the 450 million people living with a mental or behavioral disorder is receiving treatment. While one in four Americans lives with a mental disorder in any given year, half of people with severe symptoms of a mental health condition received no treatment in the past 12 months. Fear of disclosure, rejection by friends, and ultimately discrimination are just a few reasons why people with mental health conditions don't seek help. On-line supportive therapy from advocate mental health organizations have helped to educate and eliminate much of the stigma & shame they have felt in their aloneness to continue their journey from shame and isolation to dignity and responsibility by encouraging them to receive treatment and therapy.

Moreover, most individuals would like to be productive and high-functioning. Thus, patient advocacy organizations try to reverse the stereotype problem by educating the public, fighting stigma, supporting local, state and national legislation that is helpful to individuals with psychiatric conditions, encouraging those with symptoms to seek treatment and to instill hope in those afflicted so that they can continue on the path toward recovery, wellness and a fulfilling and meaningful life.

In art and literature

Books

• The Hypomanic Edge by John D. Gartner
• An Unquiet Mind by Kay Redfield Jamison
• Touched with Fire by Kay Redfield Jamison
• A Beautiful Mind by Sylvia Nassar
• One Flew Over The Cuckoo's Nest by Ken Kesey
• Woman on the Edge of Time by Marge Piercy
• The Catcher in the Rye by J. D. Salinger
• The Curious Incident of the Dog in the Night-time by Mark Haddon
• The Bell Jar by Sylvia Plath
• Of Mice and Men by John Steinbeck
• Girl, Interrupted by Susanna Kaysen
• The Green Mile by Stephen King
• She's Come Undone by Wally Lamb
• I Know This Much Is True by Wally Lamb
• Effie's Burning by Valerie Windsor
• I Never Promised You a Rose Garden by Joanne Greenberg
• * Diving into the Wreck by Adrienne Rich
• Sorrows of Werther by Goethe
• Mrs Dalloway by Virginia Woolf
• Remembrance of Things Past by Marcel Proust
• Swann's Way by Marcel Proust
• The Outsider by Albert Camus
• Don Quixote by Miguel Cervantes
• Crime and Punishment by Fyodor Dostoevsky
• Knots by R.D. Laing
• Madame Bovary by Gustave Flaubert
• Amnesia by Douglas Cooper
• Howl by Allen Ginsberg
• Hello, Serotonin by Jon Paul Fiorentino
• Bloodletting by Victoria Leatham
• Darkness Visible by William Styron
• Earth Abides by George Stewart

Plays

• Hamlet by William Shakespeare
• A Midsummer Night's Dream by William Shakespeare
• Macbeth by William Shakespeare
• King Lear by William Shakespeare

Stories

• Ward Number Six by Anton Chekhov (1892) ^[6]

Music

• They're Coming to Take Me Away Ha-Haa! deals with the main singer being brought to mental illness when he loses his dog. The singer believes that the men "in pretty white coats" are coming to take him away, although the singer considers a mental hospital to be a fun place.

Motion Pictures

Many motion pictures portray mental illness in inaccurate ways leading to misunderstanding and heightened stigma. Some movies, however, are lauded for dispelling stereotypes and providing insight into mental illness. In a study by George Gerbner, it was determined that 5 percent of 'normal' television characters are murderers while 20% of 'mentally ill' characters are murderers. 40% of normal characters are violent while 70% of mentally ill characters are violent. Contrary to what is portrayed in films and television, Henry J. Steadman, Ph. D. and his colleagues at Policy Research Associates found that, overall, former mental patients did not have a higher rate of violence than their control group of people who were not formal mental health patients. In both groups, however, substance abuse was linked to a higher rate of violence. (Hockenbury and Hockenbury 2004)

See List of films featuring mental health conditions.

Television

Many popular television shows feature characters with a mental health condition. Often these portrayals are inaccurate and reinforce existing stereotypes, thereby increasing stigma associated with having a mental health condition. Common ways that television shows can generate misunderstanding and fear are by depicting people with these conditions as medically noncompliant, violent, and/or intellectually challenged. However, in recent years certain organizations have begun to advocate for accurate portrayals of mental health conditions in the media, and certain television shows have been applauded by mental health organizations for helping to dispel myths of these conditions...

One show, "Wonderland", went on the air in 2000 and only lasted several episodes. It was largely critically acclaimed, but pressure from mental health advocates and people with mental health conditions who felt that the show perpetuated stereotypes and contributed to the stigma attached to them led to the show's cancellation.

In 2005, the shows Huff, Monk, Scrubs and ER all won Voice Awards from the Substance Abuse and Mental Health Services Administration for their positive portrayal of people who manage mental health conditions. Neal Baer, executive producer of ER and Law & Order: Special Victims Unit also won a lifetime achievement award for his work in incorporating mental health issues into these two shows.

See List of Television Shows Featuring Mental Health Condtions.