Mental disorder

From New World Encyclopedia


Mental disorder
Mental Disorder Silhouette.png
Other namesPsychiatric disorder, psychological disorder, mental illness, mental disease, mental breakdown, nervous breakdown, mental health conditions[1]
SymptomsAgitation, anxiety, depression, mania, paranoia, psychosis
ComplicationsCognitive impairment, social problems, suicide
TypesAnxiety disorders, eating disorders, mood disorders, personality disorders, psychotic disorders, substance use disorders
CausesGenetic and environmental factors
TreatmentPsychotherapy, medications
MedicationAntidepressants, antipsychotics, anxiolytics, mood stabilizers, stimulants

A mental disorder, also called a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitting, or occur as a single episode. There are a variety of disorders, with signs and symptoms that vary widely. Mental disorders are usually defined by a combination of how a person behaves, feels, perceives, or thinks.

Services are based in psychiatric hospitals or in the community, and assessments are carried out by mental health professionals such as psychiatrists, psychologists, psychiatric nurses, and clinical social workers, using various methods such as psychometric tests but often relying on observation and questioning. Treatments are provided by various mental health professionals. Psychotherapy and psychiatric medication are two major treatment options. Other treatments include lifestyle changes, social interventions, peer support, and self-help. In a minority of cases, there might be involuntary detention or treatment.

 

Social stigma, exacerbated by negative portrayals in the media, often complicates assessment and treatment of mental disorders. Cultural bias against certain behaviors and beliefs has also led to misdiagnosis. In contemporary times, efforts have been made to address and alleviate such misunderstandings, and to allow those suffering from these disorders to receive appropriate and effective treatment so that they may be successful members of society.

Definition

A mental disorder (mental illness or psychiatric disorder) is a behavioral or mental pattern that causes significant distress or impairment of personal functioning.[2] Such features may be persistent, relapsing and remitting, or occur as a single episode. For a mental state to classify as a disorder, it generally needs to cause dysfunction.[3] Such disorders may be diagnosed by a mental health professional.

According to the Diagnostic and Statistical Manual of Mental Disorders DSM-IV edition, a mental disorder was defined as psychological syndrome or pattern which is associated with distress (e.g. via a painful symptom), disability (impairment in one or more important areas of functioning), increased risk of death, or causes a significant loss of autonomy. In 2013, the American Psychiatric Association (APA) redefined mental disorders in the DSM-5 as "a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning."[4] The final draft of ICD-11 contains a very similar definition.[5]

The terms "mental breakdown" or "nervous breakdown" have not been formally defined through a medical diagnostic system. However, they are often used by the general population to mean a mental disorder.[6] Although "nervous breakdown" is not rigorously defined, surveys of laypersons suggest that the term refers to a specific acute time-limited reactive disorder, involving symptoms such as anxiety or depression, usually precipitated by external stressors.[7] Many health experts today refer to a nervous breakdown as a "mental-health crisis."[8]

Some health professionals have argued for a return to the concept of nervous illness:

They go to work but they are unhappy and uncomfortable; they are somewhat anxious; they are tired; they have various physical pains—and they tend to obsess about the whole business. There is a term for what they have, and it is a good old-fashioned term that has gone out of use. They have nerves or a nervous illness. It is an illness not just of mind or brain, but a disorder of the entire body. ... We have a package here of five symptoms—mild depression, some anxiety, fatigue, somatic pains, and obsessive thinking. ... We have had nervous illness for centuries. When you are too nervous to function ... it is a nervous breakdown. But that term has vanished from medicine, although not from the way we speak.... There is a deeper illness that drives depression and the symptoms of mood. We can call this deeper illness something else, or invent a neologism, but we need to get the discussion off depression and onto this deeper disorder in the brain and body. That is the point.[9]

History

Historically, mental disorders have had three major explanations: the supernatural, biological, and psychological.[10] For much of recorded history, deviant behavior has been considered supernatural and a reflection of the battle between good and evil. When confronted with unexplainable, irrational behavior, people have perceived evil. In fact, in the Persian Empire from 550 to 330 B.C.E., all physical and mental disorders were considered the work of the devil.[10]

Physical causes of mental disorders have been sought in history. Hippocrates was important in this tradition as he identified syphilis as a disease and was therefore an early proponent of the idea that psychological disorders are biologically caused.[10] This was a precursor to modern psycho-social treatment approaches to the causation of psychopathology, with the focus on psychological, social, and cultural factors. Well known philosophers like Plato, Aristotle, and others, wrote about the importance of fantasies and dreams, and thus anticipated, to some extent, the fields of psychoanalytic thought and cognitive science. They were also some of the first to advocate for humane and responsible care for individuals with psychological disturbances.[10]

Ancient civilizations

Ancient civilizations described and treated a number of mental disorders. Mental illnesses were well known in ancient Mesopotamia, the royal family of Elam being notorious for its members frequently suffering from insanity, and Mesopotamian doctors kept detailed record of their patients' hallucinations and assigned spiritual meanings to them.[11] Diseases and mental disorders were believed to be caused by specific deities.[12] Because hands symbolized control over a person, mental illnesses were known as "hands" of certain deities. One psychological illness was known as Qāt Ištar, meaning "Hand of Ishtar," while others were known as "Hand of Shamash," "Hand of the Ghost," and "Hand of the God."[12] Descriptions of these illnesses, however, are so vague that it is usually impossible to determine which illnesses they correspond to in modern terminology.

The Greeks coined terms for melancholy, hysteria and phobia and developed the humorism theory. Mental disorders were described, and treatments developed, in Persia, Arabia and in the medieval Islamic world.

Middle Ages

Conceptions of madness in the Middle Ages in Christian Europe were a mixture of the divine, diabolical, magical, and humoral and transcendental.[13] Some people with mental disorders may have been victims of the witch-hunts. While not every witch and sorcerer accused were mentally ill, all mentally ill were considered to be witches or sorcerers.[14]

Eighteenth century

Madwomen of the Salpétrière (Courtyard of the mentally disturbed) by Amand Gautier, showing personifications of dementia, megalomania, acute mania, melancholia, idiocy, hallucination, erotomania, and paralysis in the gardens of the Hospice de la Salpêtrière, Paris.

By the end of the seventeenth century and into the Age of Enlightenment, madness was increasingly seen as an organic physical phenomenon with no connection to the soul or moral responsibility. Asylum care was often harsh and treated people like wild animals, but towards the end of the eighteenth century a moral treatment movement gradually developed.

Nineteenth century

Industrialization and population growth led to a massive expansion of the number and size of insane asylums in every Western country in the nineteenth century. Numerous different classification schemes and diagnostic terms were developed by different authorities. The term psychiatry was coined in 1808, though medical superintendents were still known as "alienists."

Twentieth century

A patient in a strait-jacket and barrel contraption, 1908

The turn of the twentieth century saw the development of psychoanalysis, which would later come to the fore, along with Kraepelin's classification scheme, the most significant aspect of which is the classification of what was previously considered to be a unitary concept of psychosis into two distinct forms. This division was formally introduced in the sixth edition of Emil Kraepelin's psychiatric textbook Psychiatrie: Ein Lehrbuch für Studirende und Aerzte, published in 1899. Known as the Kraepelinian dichotomy, the two forms are:

  • manic depression (now seen as comprising a range of mood disorders such as recurrent major depression and bipolar disorder), and
  • dementia praecox, later renamed schizophrenia.
Insulin shock procedure, 1950s
Electroconvulsive therapy machine on display at Glenside Museum in Bristol, England

Early in the twentieth century in the United States, a mental hygiene movement developed, aiming to prevent mental disorders. Clinical psychology and social work developed as professions.

World War I saw a massive increase of conditions that came to be termed "shell shock." World War II saw the development in the U.S. of a new psychiatric manual for categorizing mental disorders, which along with existing systems for collecting census and hospital statistics led to the first Diagnostic and Statistical Manual of Mental Disorders (DSM). The International Classification of Diseases (ICD) also developed a section on mental disorders. The term stress, having emerged from endocrinology work in the 1930s, was increasingly applied to mental disorders. Asylum "inmates" were increasingly referred to as "patients," and asylums renamed as hospitals.

Electroconvulsive therapy, insulin shock therapy, lobotomies and the "neuroleptic" chlorpromazine came to be used by mid-century.

In the 1960s there were many challenges to the concept of mental illness itself. Challenges came from psychiatrists like Thomas Szasz who argued that mental illness was a myth used to disguise moral conflicts; from sociologists such as Erving Goffman who said that mental illness was merely another example of how society labels and controls non-conformists; from behavioral psychologists who challenged psychiatry's fundamental reliance on unobservable phenomena; and from gay rights activists who criticized the APA's listing of homosexuality as a mental disorder.

Deinstitutionalization gradually occurred in the West, with isolated psychiatric hospitals being closed down in favor of community mental health services. Other kinds of psychiatric medication gradually came into use, such as "psychic energizers" (later antidepressants) and lithium. Benzodiazepines gained widespread use in the 1970s for anxiety and depression, until dependency problems curtailed their popularity.

Advances in neuroscience, genetics, and psychology led to new research agendas. Cognitive behavioral therapy and other psychotherapies developed. The DSM and then ICD adopted new criteria-based classifications, and the number of "official" diagnoses saw a large expansion. Through the 1990s, new SSRI-type antidepressants became some of the most widely prescribed drugs in the world, as later did antipsychotics. Also during the 1990s, a recovery approach developed.

Mental health policies

In the United States, mental health policies have experienced four major reforms: the American asylum movement led by Dorothea Dix in 1843; the "mental hygiene" movement inspired by Clifford Beers in 1908; the deinstitutionalization started by Action for Mental Health in 1961; and the community support movement called for by The CMCH Act Amendments of 1975.[15]

In 1843, Dorothea Dix submitted a Memorial to the Legislature of Massachusetts, describing the abusive treatment and horrible conditions received by the mentally ill patients in jails, cages, and almshouses: "I proceed, gentlemen, briefly to call your attention to the present state of insane persons confined within this Commonwealth, in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience!"[16] In 1866, a recommendation came to the New York State Legislature to establish a separate asylum for chronic mentally ill patients. Some hospitals placed the chronic patients into separate wings or wards, or different buildings.[17]

In 1908, Clifford Whittingham Beers described the humiliating treatment he received and the deplorable conditions in the mental hospital.[18] One year later, the National Committee for Mental Hygiene (NCMH) was founded by a small group of reform-minded scholars and scientists – including Beers himself – which marked the beginning of the "mental hygiene" movement. The movement emphasized the importance of childhood prevention. World War I catalyzed this idea with an additional emphasis on the impact of maladjustment, which convinced the hygienists that prevention was the only practical approach to handle mental health issues.[19] However, prevention was not successful, especially for chronic illness, and the abusive conditions in the hospitals became even more prevalent, especially under the pressure of the increasing number of chronically ill and the influence of the depression.[15]

In 1961, the Joint Commission on Mental Health published a report called Action for Mental Health, whose goal was for community clinic care to take on the burden of prevention and early intervention of the mental illness, therefore to leave space in the hospitals for severe and chronic patients. The court started to rule in favor of the patients' will on whether they should be forced to treatment. By 1977, 650 community mental health centers were built to cover 43 percent of the population and serve 1.9 million individuals a year, and the lengths of treatment decreased from 6 months to only 23 days.[20] However, issues still existed. Due to inflation, especially in the 1970s, the community nursing homes received less money to support the care and treatment provided. Fewer than half of the planned centers were created, and new methods did not fully replace the old approaches to carry out its full capacity of treating power.[20] Besides, the community helping system was not fully established to support the patients' housing, vocational opportunities, income supports, and other benefits.[15] Many patients returned to welfare and criminal justice institutions, and more became homeless. The movement of deinstitutionalization was facing great challenges.[21]

After realizing that simply changing the location of mental health care from the state hospitals to nursing houses was insufficient to implement the idea of deinstitutionalization, in 1975 the National Institute of Mental Health created the Community Support Program (CSP) to provide funds for communities to set up a comprehensive mental health service and supports to help the mentally ill patients integrate successfully in the society. The program stressed the importance of other supports in addition to medical care, including housing, living expenses, employment, transportation, and education; and set up new national priority for people with serious mental disorders. In addition, the Congress enacted the Mental Health Systems Act of 1980 to prioritize the service to the mentally ill and emphasize the expansion of services beyond just clinical care alone.[22] Later in the 1980s, under the influence from the Congress and the Supreme Court, many programs were started to help the patients regain their benefits. A new Medicaid service was also established to serve people who were diagnosed with a "chronic mental illness." People who were temporally hospitalized were also provided aid and care and a pre-release program was created to enable people to apply for reinstatement prior to discharge.[20] Not until 1990, around 35 years after the start of the deinstitutionalization, did the first state hospital begin to close. The number of hospitals dropped from around 300 by over 40 in the 1990s, and a range of treatments became available for patients.[22]

However, critics maintain that deinstitutionalization has, from a mental health point of view, been a thoroughgoing failure. The seriously mentally ill are either homeless, or in prison; in either case (especially the latter), they are getting little or no mental health care. This failure is attributed to a number of reasons over which there is some degree of contention, although there is general agreement that community support programs have been ineffective at best, due to a lack of funding.[21]

Diagnosis

Mental disorders are usually defined by a combination of how a person behaves, feels, perceives, or thinks.[23] The majority of mental health problems are, at least initially, assessed and treated by family physicians (in the UK general practitioners) during consultations, who may refer a patient on for more specialist diagnosis in acute or chronic cases.

Psychiatrists seek to provide a medical diagnosis of individuals by an assessment of symptoms, signs and impairment associated with particular types of mental disorder. Other mental health professionals, such as clinical psychologists, may or may not apply the same diagnostic categories to their clinical formulation of a client's difficulties and circumstances.

Routine diagnostic practice in mental health services typically involves an interview known as a mental status examination, where evaluations are made of appearance and behavior, self-reported symptoms, mental health history, and current life circumstances. The views of other professionals, relatives or other third parties may be taken into account. A physical examination to check for ill health or the effects of medications or other drugs may be conducted. Psychological testing is sometimes used via paper-and-pen or computerized questionnaires. Comorbidity is very common in psychiatric diagnosis, where the same person meets the criteria for more than one disorder. On the other hand, a person may have several different difficulties only some of which meet the criteria for being diagnosed.

The onset of psychiatric disorders usually occurs from childhood to early adulthood.[24] Impulse-control disorders and a few anxiety disorders tend to appear in childhood. Some other anxiety disorders, substance disorders, and mood disorders emerge later in the mid-teens.[25] Symptoms of schizophrenia typically manifest from late adolescence to early twenties.[26]

Classification systems

There are currently two widely established systems that classify mental disorders:

  • ICD-10 Chapter V: Mental and behavioural disorders, since 1949 part of the International Classification of Diseases produced by the WHO,
  • Diagnostic and Statistical Manual of Mental Disorders (DSM) produced by the American Psychiatric Association (APA) since 1952, latest edition DSM-5 published in 2013.

Both of these list categories of disorder and provide standardized criteria for diagnosis. They have deliberately converged their codes in recent revisions so that the manuals are often broadly comparable, although significant differences remain. Other classification schemes may be used in some cultures, for example the Chinese Classification of Mental Disorders, and other manuals may be used by those of alternative theoretical persuasions, for example the Psychodynamic Diagnostic Manual.

Unlike the DSM and ICD, some approaches are not based on identifying distinct categories of disorder using dichotomous symptom profiles intended to separate the abnormal from the normal. There is significant scientific debate about the relative merits of categorical versus such non-categorical (or hybrid) schemes, also known as continuum or dimensional models. A spectrum approach may incorporate elements of both.

Dimensional models

The high degree of comorbidity between disorders in categorical models such as the DSM and ICD have led some to propose dimensional models. Studying comorbidity between disorders has demonstrated two latent (unobserved) factors or dimensions in the structure of mental disorders that are thought to possibly reflect etiological processes. These two dimensions reflect a distinction between internalizing disorders, such as mood or anxiety symptoms, and externalizing disorders such as behavioral or substance abuse symptoms.[27]

A single general factor of psychopathology, similar to the g factor for intelligence, has been empirically supported. The p factor model supports the internalizing-externalizing distinction, but also supports the formation of a third dimension of thought disorders such as schizophrenia.[28]

Disorders

Many disorders have been described, with signs and symptoms that vary widely between specific disorders.[23] There are also many different categories of mental disorder, and many different facets of human behavior and personality that can become disordered.[29]

Anxiety disorder

Anxiety disorder: Anxiety or fear that interferes with normal functioning may be classified as an anxiety disorder.[29] Commonly recognized categories include specific phobias, generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, obsessive-compulsive disorder and post-traumatic stress disorder.

Mood disorder

Mood disorder: Other affective (emotion/mood) processes can also become disordered. Mood disorder involving unusually intense and sustained sadness, melancholia, or despair is known as major depression (also known as unipolar or clinical depression). Milder but still prolonged depression can be diagnosed as dysthymia. Bipolar disorder (also known as manic depression) involves abnormally "high" or pressured mood states, known as mania or hypomania, alternating with normal or depressed moods.

Psychotic disorder

Psychotic disorder: Patterns of belief, language use and perception of reality can become dysregulated (for example, delusions, thought disorder, hallucinations). Psychotic disorders in this domain include schizophrenia, and delusional disorder. Schizoaffective disorder is a category used for individuals showing aspects of both schizophrenia and affective disorders. Schizotypy is a category used for individuals showing some of the characteristics associated with schizophrenia but without meeting cutoff criteria.

Personality disorder

Personality disorder: Personality—the fundamental characteristics of a person that influence thoughts and behaviors across situations and time—may be considered disordered if judged to be abnormally rigid and maladaptive. Although treated separately by some, the commonly used categorical schemes include them as mental disorders, albeit on a separate "axis."

A number of different personality disorders are listed, including those sometimes classed as "eccentric", such as paranoid, schizoid and schizotypal personality disorders; types that have described as "dramatic" or "emotional", such as antisocial, borderline, histrionic or narcissistic personality disorders; and those sometimes classed as fear-related, such as anxious-avoidant, dependent, or obsessive-compulsive personality disorders. The personality disorders, in general, are defined as emerging in childhood, or at least by adolescence or early adulthood.

Eating disorder

Eating disorder: These disorders involve disproportionate concern in matters of food and weight.[29] Categories of disorder in this area include anorexia nervosa, bulimia nervosa, exercise bulimia or binge eating disorder.[30]

Sleep disorder

Sleep disorder: These conditions are associated with disruption to normal sleep patterns. A common sleep disorder is insomnia, which is described as difficulty falling and/or staying asleep.

Sexuality related

Sexual disorders and gender dysphoria: These disorders include dyspareunia and various kinds of paraphilia (sexual arousal to objects, situations, or individuals that are considered abnormal or harmful to the person or others).

Other

Impulse control disorder: People who are abnormally unable to resist certain urges or impulses that could be harmful to themselves or others, may be classified as having an impulse control disorder, and disorders such as kleptomania (stealing) or pyromania (fire-setting). Various behavioral addictions, such as gambling addiction, may be classed as a disorder. Obsessive-compulsive disorder can sometimes involve an inability to resist certain acts but is classed separately as being primarily an anxiety disorder.

Substance use disorder: This disorder refers to the use of drugs (legal or illegal, including alcohol) that persists despite significant problems or harm related to its use. Substance dependence and substance abuse fall under this umbrella category in the DSM. Substance use disorder may be due to a pattern of compulsive and repetitive use of a drug that results in tolerance to its effects and withdrawal symptoms when use is reduced or stopped.

Dissociative disorder: People who suffer severe disturbances of their self-identity, memory, and general awareness of themselves and their surroundings may be classified as having these types of disorders, including depersonalization disorder or dissociative identity disorder (which was previously referred to as multiple personality disorder or "split personality").

Cognitive disorder: These affect cognitive abilities, including learning and memory. This category includes delirium and mild and major neurocognitive disorder (previously termed dementia).

Developmental disorder: These disorders initially occur in childhood. Some examples include autism spectrum disorders, oppositional defiant disorder and conduct disorder, and attention deficit hyperactivity disorder (ADHD), which may continue into adulthood. Conduct disorder, if continuing into adulthood, may be diagnosed as antisocial personality disorder (dissocial personality disorder in the ICD). Popularist labels such as psychopath (or sociopath) do not appear in the DSM or ICD but are linked by some to these diagnoses.

Somatoform disorders may be diagnosed when there are problems that appear to originate in the body that are thought to be manifestations of a mental disorder. This includes somatization disorder and conversion disorder. There are also disorders of how a person perceives their body, such as body dysmorphic disorder. Neurasthenia is an old diagnosis involving somatic complaints as well as fatigue and low spirits/depression, which is officially recognized by the ICD-10 but no longer by the DSM-IV.

Factitious disorders, such as Munchausen syndrome, are diagnosed where symptoms are thought to be experienced (deliberately produced) and/or reported (feigned) for personal gain.

There are attempts to introduce a category of relational disorder, where the diagnosis is of a relationship rather than on any one individual in that relationship. The relationship may be between children and their parents, between couples, or others. There already exists, under the category of psychosis, a diagnosis of shared psychotic disorder where two or more individuals share a particular delusion because of their close relationship with each other.

There are a number of uncommon psychiatric syndromes, which are often named after the person who first described them, such as Capgras syndrome, De Clerambault syndrome, Othello syndrome, Ganser syndrome, Cotard delusion, and Ekbom syndrome, and additional disorders such as the Couvade syndrome and Geschwind syndrome.[31]

Various new types of mental disorder diagnosis are occasionally proposed for consideration by the official committees of the diagnostic manuals.

Risk factors

The predominant view is that genetic, psychological, and environmental factors all contribute to the development or progression of mental disorders. Different risk factors may be present at different ages, with risk occurring as early as during prenatal period.[32]

Genetics

A number of psychiatric disorders are linked to a family history (including depression, narcissistic personality disorder[33] and anxiety).[34] Twin studies have also revealed a very high heritability for many mental disorders (especially autism and schizophrenia). Although researchers have been looking for decades for clear linkages between genetics and mental disorders, that work has not yielded specific genetic biomarkers yet that might lead to better diagnosis and better treatments.

Environment

Environmental factors increase the likelihood of mental disorder. During the prenatal stage, factors like unwanted pregnancy, lack of adaptation to pregnancy, or substance abuse during pregnancy increase the risk of developing a mental disorder.[32] Maternal stress and birth complications including prematurity and infections have also been implicated in increasing susceptibility for mental illness.[35] Infants neglected or not provided optimal nutrition also have a higher risk of developing cognitive impairment.[32] Nutrition generally plays a role in mental disorders.[23]

Social influences have also been found to be important, including abuse, neglect, bullying, social stress, traumatic events, and other negative or overwhelming life experiences.[36] Aspects of the wider community have also been implicated,[37] including employment problems, socioeconomic inequality, lack of social cohesion, problems linked to migration, and features of particular societies and cultures. The specific risks and pathways to particular disorders are less clear, however.

In schizophrenia and psychosis, risk factors include migration and discrimination, childhood trauma, bereavement, or separation in families, abuse of drugs, and urbanicity.[37]

In anxiety, risk factors may include parenting factors including parental rejection, lack of parental warmth, high hostility, harsh discipline, high maternal negative affect, anxious child rearing, modeling of dysfunctional and drug-abusing behavior, and child abuse (emotional, physical and sexual).[38] Adults with work to life imbalance are at higher risk for developing anxiety.[32]

For bipolar disorder, stress (such as childhood adversity) is not a specific cause, but does place genetically and biologically vulnerable individuals at risk for a more severe course of illness.

The internet has been shown to have an adverse environmental impact on mental health, particularly with regard to users' suicidal thoughts, predisposition to depression and anxiety, and loneliness.[39]

Drug use

Mental disorders are associated with drug use including: cannabis, alcohol, and caffeine. For psychosis and schizophrenia, usage of a number of drugs has been associated with development of the disorder, including cannabis, cocaine, and amphetamines.

Adolescents are at increased risk for tobacco, alcohol and drug use. At this age, the use of substances could be detrimental to the development of the brain and place them at higher risk of developing a mental disorder.[32]

Chronic disease

People living with chronic conditions like HIV and diabetes are at higher risk for developing a mental disorder since they experience significant stress, which places them at risk for developing anxiety and depression. Conditions like heart disease, stroke, respiratory conditions, cancer and arthritis increase the risk of developing a mental disorder when compared to the general population.[40]

Personality traits

Risk factors for mental illness include a propensity for high neuroticism[41] or "emotional instability." In anxiety, risk factors may include temperament and attitudes (for example, pessimism).[34]

Prevention

It is obvious that prevention of mental disorders is desirable, and various efforts have been undertaken to address such a possibility.[42]

Parenting may affect the child's mental health, and evidence suggests that helping parents to be more effective with their children can address mental health needs.[43]

Management

Services for mental disorders are based in psychiatric hospitals or in the community, and assessments are carried out by mental health professionals such as psychiatrists, psychologists, psychiatric nurses and clinical social workers, using various methods such as psychometric tests but often relying on observation and questioning. Treatments are provided by various mental health professionals. Psychotherapy and psychiatric medication are two major treatment options. Other treatments include lifestyle changes, social interventions, peer support, and self-help. In a minority of cases, there might be involuntary detention or treatment.

"Haus Tornow am See" (former manor house), Germany from 1912 is today separated into a special education school and a hotel with integrated work/job- and rehabilitation-training for people with mental disorders

Treatment and support for mental disorders is provided in psychiatric hospitals, clinics or a range of community mental health services. In some countries services are increasingly based on a recovery approach, intended to support individual's personal journey to gain the kind of life they want.

There are a range of different types of treatment and what is most suitable depends on the disorder and the individual. In a minority of cases, individuals may be treated against their will, which can cause particular difficulties depending on how it is carried out and perceived.

Lifestyle

Lifestyle strategies, including exercise, quitting smoking, and dietary changes appear to be of benefit.[44] Supportive measures are often used, including peer support, self-help groups for mental health, supported housing, or supported employment (including social firms).

Medication

A major option for many mental disorders is psychiatric medication, or pharmacotherapy. There are several main groups of pharmaceutical drugs used in the treatment of mental illness.

Antidepressants are used for the treatment of clinical depression, as well as often for anxiety and a range of other disorders. Anxiolytics (including sedatives) are used for anxiety disorders and related problems such as insomnia. Mood stabilizers are used primarily in bipolar disorder. Antipsychotics are used for psychotic disorders, notably for schizophrenia. Stimulants are commonly used, notably for ADHD.[45]

There is considerable overlap in the disorders for which these drugs are actually indicated. There can be problems with adverse effects of medication and adherence to them, and there is also criticism of pharmaceutical marketing and professional conflicts of interest. However, these medications in combination with non-pharmacological methods, such as cognitive behavioral therapy (CBT), are generally considered to be the most effective treatment for mental disorders.

Therapy

A major option for many mental disorders is psychotherapy. There are several main types. Cognitive behavioral therapy (CBT) is widely used and is based on modifying the patterns of thought and behavior associated with a particular disorder. Other psychotherapy include dialectic behavioral therapy (DBT) and interpersonal psychotherapy (IPT). Psychoanalysis, addressing underlying psychic conflicts and defenses, has been a dominant school of psychotherapy and is still in use. Systemic therapy or family therapy is sometimes used, addressing a network of significant others as well as an individual.

There are a number of specific therapies used for particular disorders, which may be offshoots or hybrids of the above types. Mental health professionals often employ an eclectic or integrative approach. Some psychotherapies are based on a humanistic approach. In addition, there are peer support roles where personal experience of similar issues is the primary source of expertise.

Psychoeducation programs may provide people with the information to understand and manage their problems. Creative therapies are sometimes used, including music therapy, art therapy, or drama therapy.

Other

Reasonable accommodations (adjustments and supports) might be put in place to help an individual cope and succeed in environments despite potential disability related to mental health problems. This could include an emotional support animal or specifically trained psychiatric service dog.

Electroconvulsive therapy (ECT) is sometimes used in severe cases when other interventions for severe intractable depression have failed. ECT is usually indicated for treatment resistant depression, severe vegetative symptoms, psychotic depression, intense suicidal ideation, depression during pregnancy, and catonia. Psychosurgery is considered experimental but is advocated by some neurologists in certain rare cases.[46]

Demographics

Mental disorders are common. Evidence from the WHO suggests that nearly half of the world's population is affected by mental illness with an impact on their self-esteem, relationships and ability to function in everyday life.

Children and young adults

Mental health and stability is a very important factor in a person's everyday life. The human brain develops many skills at an early age including social skills, behavioral skills, and one's way of thinking. Learning how to interact with others and how to focus on certain subjects are essential lessons to learn at a young age. Having a mental illness at a younger age is different from having one in adulthood, since children's brains are still developing and they are learning the necessary skills and habits to succeed in everyday life.

The most common mental illnesses in children include, but are not limited to anxiety disorder, as well as depression in older children and teens. Mental illness affects not only the person themselves but the people around them. Friends and family also play an important role in the child's mental health stability and treatment.[47]

The homeless population

Mental illness is thought to be extremely prevalent among homeless populations, though access to proper diagnoses is limited. Studies have shown that PTSD and learned helplessness are very much present among homeless individuals and families, and it has been suggested that "homelessness itself is a risk factor for emotional disorder."[48]

Society and culture

Different societies or cultures, even different individuals in a subculture, can disagree as to what constitutes optimal versus pathological biological and psychological functioning. Research has demonstrated that cultures vary in the relative importance placed on, for example, happiness, autonomy, or social relationships for pleasure. Likewise, the fact that a behavior pattern is valued, accepted, encouraged, or even statistically normative in a culture does not necessarily mean that it is conducive to optimal psychological functioning.

Cultural bias

People in all cultures find some behaviors bizarre or even incomprehensible. But just what they feel is bizarre or incomprehensible is ambiguous and subjective.[49] These differences in determination can become highly contentious. The process by which conditions and difficulties come to be defined and treated as medical conditions and problems, and thus come under the authority of doctors and other health professionals, is known as medicalization or pathologization.

Mental health is a socially constructed and socially defined concept; that is, different societies, groups, cultures, institutions, and professions have very different ways of conceptualizing its nature and causes, determining what is mentally healthy, and deciding what interventions, if any, are appropriate.[50] Thus, different professionals will have different cultural, class, political, and religious backgrounds, which will impact the methodology applied during treatment. For example, on the context of deaf mental health care, it is necessary for professionals to have cultural competency of deaf and hard of hearing people and to understand how to properly rely on trained, qualified, and certified interpreters when working with culturally Deaf clients.

Current diagnostic guidelines, namely the DSM and to some extent the ICD, have been criticized as having a fundamentally Euro-American outlook. Opponents argue that even when diagnostic criteria are used across different cultures, it does not mean that the underlying constructs have validity within those cultures, as even reliable application can prove only consistency, not legitimacy. Western bias is ironically illustrated in the introduction of cultural factors to the DSM-IV: Disorders or concepts from non-Western or non-mainstream cultures are described as "culture-bound," whereas standard psychiatric diagnoses are given no cultural qualification.

Clinical conceptions of mental illness also overlap with personal and cultural values in the domain of morality, so much so that it can be argued that separating the two is impossible without fundamentally redefining the essence of being a particular person in a society.

Religious considerations

Religious, spiritual, or transpersonal experiences and beliefs meet many criteria of delusional or psychotic disorders. There is a similarity between mental disorders, such as schizophrenia which is characterized by a difficulty in recognizing reality, regulating emotional responses, and thinking in a clear and logical manner, and religious or spiritual experiences. A belief or experience can sometimes be shown to produce distress or disability—the ordinary standard for judging mental disorders.[51]

In the past, mental disorders were attributed to demonic possession, and exorcism techniques were developed to treat the patients. With greater scientific understanding, and the development of psychiatry, possession by demons and evil spirits became treated with increasing skepticism. However, in recent times there has been an increase in interest on the phenomenon of spiritual distress related to spiritual possession or influences, with consequent concern for appropriate care and treatment.[52]

Not all spiritual or religious experiences should be classified as mental disorders. In fact, religion and spirituality can have a positive impact on mental health, alleviating mental disorders by providing a connection to something bigger than oneself, community, guidelines for a healthy life, and a greater sense of self-empowerment.[53]

Mental health professionals recognize the importance of competency in religious diversity and spirituality. They are also partaking in cultural training to better understand which interventions work best for different groups of people. The American Psychological Association explicitly states that religion must be respected, and education in spiritual and religious matters is also required by the American Psychiatric Association.[54]

Laws and policies

Three-quarters of countries around the world have mental health legislation. Compulsory admission to mental health facilities (also known as involuntary commitment) is a controversial topic. It can impinge on personal liberty and the right to choose, and carry the risk of abuse for political, social, and other reasons; yet it can potentially prevent harm to self and others, and assist some people in attaining their right to healthcare when they may be unable to decide in their own interests.[55]

The World Health Organization reports that in many instances national mental health legislation takes away the rights of persons with mental disorders rather than protecting rights, and is often outdated.[55] In 1991, the United Nations adopted the Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, which established minimum human rights standards of practice in the mental health field. In 2006, the UN formally agreed the Convention on the Rights of Persons with Disabilities to protect and enhance the rights and opportunities of disabled people, including those with psychosocial disabilities.[56]

The term insanity, sometimes used colloquially as a synonym for mental illness, is often used technically as a legal term. The insanity defense may be used in a criminal trial.

Stigma

There is stigma attached to mental illness. A stigma is defined as “a mark of disgrace associated with a particular circumstance, quality, or person.” For example, there is the assumption that everyone with a mental problem, no matter how mild or severe, is automatically considered destructive, or criminal, and unattractive.[57] This is a widespread problem with serious impacts on those suffering mental disorders: "Powerful and pervasive, stigma prevents people from acknowledging their own mental health problems, much less disclosing them to others."[15]

Along with social stigmas, individuals with a mental illness can develop a self-stigma. A self-stigma is when the affected individual does not come forward about their feelings in fear of being judged. These self-stigmas can deter the individual from seeking help and treatment.[58] Family caregivers of individuals with mental disorders may also suffer discrimination or face stigma.

Addressing and eliminating the social stigma and perceived stigma attached to mental illness has been recognized as crucial to education and awareness surrounding mental health issues. Efforts are being undertaken worldwide to eliminate the stigma of mental illness. For example, in the United Kingdom, the Royal College of Psychiatrists leads a campaign for better mental health care, including reducing stigma,[59] In the United States, there are many entities that focus on removing the stigma surround mental illness, such as The Manic Monologues,[60] and National Alliance on Mental Illness (NAMI), founded in 1979 to represent and advocate for those struggling with mental health issues, which helps to educate about mental illnesses and health issues, while also working to eliminate stigma attached to these disorders.[61]

Media

Media coverage of mental illness comprises predominantly negative and pejorative depictions, for example, of incompetence, violence, or criminality, with far less coverage of positive issues such as the accomplishments of those suffering mental disorders.[62] Such negative depictions, including in children's cartoons, contribute to stigma and negative attitudes in the public and in those with mental health problems themselves. More sensitive or serious cinematic portrayals have increased in prevalence in recent years.

In the United States, the Carter Center created fellowships for journalists in South Africa, the U.S., and other countries, to enable reporters to research and write stories on mental health topics. Former US First Lady Rosalynn Carter began the fellowships not only to train reporters in how to sensitively and accurately discuss mental health and mental illness, but also to increase the number of stories on these topics in the news media.[63]

Violence

The general public hold a strong stereotype of dangerousness and desire for social distance from individuals described as mentally ill.[64] A US national survey found that a higher percentage of people rate individuals described as displaying the characteristics of a mental disorder as "likely to do something violent to others," compared to the percentage of people who are rating individuals described as being "troubled."[65]

Despite public or media opinion, national studies have indicated that severe mental illness does not independently predict future violent behavior, on average, and is not a leading cause of violence in society. The majority of people with serious mental illness are never violent. In fact, findings consistently indicate that it is many times more likely that people diagnosed with a serious mental illness living in the community will be the victims rather than the perpetrators of violence.[66]

However, there are some specific diagnoses, such as childhood conduct disorder or adult antisocial personality disorder or psychopathy, which are defined by, or are inherently associated with, conduct problems and violence. The mediating factors of violent acts, however, are most consistently found to be mainly socio-demographic and socio-economic factors such as being young, male, of lower socioeconomic status and, in particular, substance abuse (including alcoholism).[66]

High-profile cases have led to fears that serious crimes, such as homicide, have increased due to deinstitutionalization, but the evidence does not support this conclusion.[67] Violence that does occur in relation to mental disorder (against the mentally ill or by the mentally ill) typically occurs in the context of complex social interactions, often in a family setting rather than between strangers.[68]

Mental health

Main article: Mental health

The state of mental health is generally understood to be a state of well-being, with the ability to cope with the stresses of life, and function as a productive member of society. Cultural differences, subjective assessments, and competing professional theories all affect how one defines mental health. Mental health is distinguished from mental disorders, which are disorders or diseases that affect an individual's mood, thinking, and behavior.

In general terms, mental health involves the successful performance of mental functions resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and cope with adversity. As defined by the World Health Organization (WHO): "Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community."[69] The WHO emphasizes that mental health is not just the absence of mental disorders, noting that its constitution states that "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."[69]

It has been suggested that mental health and mental illness are related, but distinct dimensions: one continuum indicates the presence or absence of mental health, the other the presence or absence of mental illness.[70] Thus, people with optimal mental health can also have a mental illness, and people who have no mental illness can also have poor mental health.

Notes

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References

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. American Psychiatric Publishing, 2013. ISBN 978-0890425558
  • Barlow, David H., Vincent Mark Durand, and Stefan G. Hofmann. Abnormal Psychology: An integrative approach. Cengage Learning, 2017. ISBN 978-1305950443
  • Beers, Clifford Whittingham. A Mind That Found Itself. Kessinger Publishing, LLC, 2010. ISBN 978-1169262980
  • Black, Jeremy, and Anthony Green. Gods, Demons and Symbols of Ancient Mesopotamia: An Illustrated Dictionary. University of Texas Press, 1992. ISBN 978-0292707948
  • Bolton, Derek. What is Mental Disorder?: An Essay in Philosophy, Science, and Values. Oxford University Press, 2008. ISBN 978-0198565925
  • Clarke, Isabel (ed.). Psychosis and Spirituality: Consolidating the New Paradigm. Wiley, 2010. ISBN 978-0470683477
  • Enoch, David, Basant K. Puri, and Hadrian Ball. Uncommon Psychiatric Syndromes. Routledge, 2020. ISBN 978-1498787956
  • Nemet-Nejat, Karen Rhea. Daily Life in Ancient Mesopotamia. Greenwood, 1998. ISBN 978-0313294976
  • O’Connell, Mary Ellen, Thomas Boat, and Kenneth E. Warner. Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. National Academies Press, 2009. ISBN 978-0309126748
  • Office of the Surgeon General. Mental Health: A Report of the Surgeon General. Department of Health and Human Services, 1999. ISBN 978-0160503009
  • Richards, P. Scott. Handbook of Psychotherapy and Religious Diversity. American Psychological Association, 2014. ISBN 978-1433817359
  • Torrey, E. Fuller. Out of the Shadows: Confronting America's Mental Illness Crisis. Wiley, 1998. ISBN 978-0471245322
  • Weare, Katherine. Promoting Mental, Emotional and Social Health: A Whole School Approach. Routledge, 2000. ISBN 978-0415168762
  • Wenzel, Amy E. The SAGE Encyclopedia of Abnormal and Clinical Psychology. SAGE Publications, Inc., 2017. ISBN 978-1483365831
  • World Health Organization. WHO Resource Book on Mental Health, Human Rights and Legislation. World Health Organization, 2005. ISBN 978-9241562829

External links

All links retrieved June 4, 2021.


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