MENTAL ILLNESS

Anne Nicole M. Cordero

NATURE OF MENTAL ILLNESS

Nearly all forms of disruptive or disapproved behavior were once believed to stem from demonic possessions. Immortality and wanton lifestyle 18th century - lunatics or the insane beaten, publicly displayed, or put away in asylums It was believed that the insane were irreparably damaged and permanently impaired (Mumford, 1983)

NATURE OF MENTAL ILLNESS

Mid-twentieth century advent of psychotherapeutic drugs; physicians and others associated with institutions for the mentally ill began treating their patients more humanely. The medical model emerged as the dominant explanation and treatment strategy. Organic causes Highly effective drug therapies replaced confinement. A decline occurred in the number of patients housed in mental hospitals, and this resulted in the ability to successfully treat them in a community setting (Mumford, 1983).

DEFINITION OF MENTAL ILLNESS

CULTURAL DEFINITIONS
Societies share particular historical traditions, challenges, opportunities and stresses that provide a common experience. These experiences create a distinctive context that influences how basic psychological processes are expressed within a given culture (NIMH 1999a). Culture - affects conceptions of behavior & the definition of mental illness Cultural relativism cross-cultural variation in the social construction of reality

CULTURAL DEFINITIONS
Manifestations of mental disorder are socially and culturally constructed. U.S. & other developed countries persons who hallucinate Rural Laos unprovoked assaultive or destructive behavior, social isolation, selfendangerment due to neglect or selfdestructive acts, nonviolent but disruptive or inappropriate behavior, and inability to do productive work; rarely hallucinations

CULTURAL DEFINITIONS
Dobu of the South Pacific those who are not distrustful and constantly vigilant Some mental disorders and responses to mental disorders are culture-bound. Japan overwhelming sense of obligation & dependence. Shinkeishitsu (nervous temperament) involves hypersensitivity, perfectionism, social withdrawal or total discomfort in unfamiliar surroundings (Increasing Signs of Stress, 1983:67).

CULTURAL DEFINITIONS
Treatment methods reflect cultural differences as well. Japan aimed at getting patients back to work Naikan (introspection) directed meditation program where the therapist urges those in treatment to focus on their ingratitude toward the sacrifices of important persons in their life. The therapist then instructs that the only escape from mental anguish is to plunge oneself into acts of service.

Syndrome

Culture Malaysia, Laos, Papua New Guinea, Puerto Rico, Navajos Latin America

Symptoms Brooding, followed by violent behavior, persecutory ideas, amnesia, exhaustion. (more men) Uncontrollable shouting, crying, trembling, heat in the chest rising to the head, verbal or physical aggression, seizures, fainting. Nightmares, weakness, feelings of danger, loss of appetite, fainting, dizziness, hallucinations, loss of consciousness, sense of suffocation. Sudden & intense anxiety that the penis/vulva &nipples will recede into body and cause death. Hypersensitivity to sudden fright, trancelike behavior (middle-aged women)

Amok

Ataque de nervios Ghost sickness

Native Americans

Koro Latah

Malaysia, China, Thailand East Asia

Susto

Mexico, Central America

Appetite & sleep disturbances, sadness, loss of motivation, low self-worth, following a frightening event. Sufferers believe their soul has left their body.
Intense fear that ones body displeases, embarrasses or is offensive to others.

Taijin kyofusho

Japan

SOCIAL DEFINITONS
The definition of mental illness is based upon (1) value judgments made by mental health professionals (2) normative expectations & reactions of society (3) differing beliefs about the causes of mental illness (Clinard & Meier 1998; Mechanic, 1968).

SOCIAL DEFINITIONS
Value Judgments. Diagnostic decisions are often influenced by prior experience with the symptoms or an idealized view as to what constitutes normal behavior (Clinard & Meier 1998: 414). The individuals emotional state, physical illnesses, stressful life events, and social and occupational functioning may also be taken into account when evaluating his/her mental health (Atkinson et al., 1996).

SOCIAL DEFINITONS
Normative Expectations, Societal Reactions,

and Labeling.
Mental illness as a departure from normative guidelines or expectations for behavior Normative violations Societal reactions and labeling produce new social roles Norms, violation of norms, societal reaction, and subsequent processes of societal labeling

SOCIAL DEFINITIONS
Beliefs about Mental Illness. Mental illness is differentially perceived across cultures and forms of social organization. Mental illness is either viewed as a behavior that can be controlled by the afflicted person or viewed as beyond the will of the individual to control. These conflicting views often shape how groups define and treat mentally ill behavior (Schnittker et al., 2000).

MEDICAL DEFINITION
Mental illness results from some genetic abnormality or inherited vulnerability. Medical Model mental disorders are comparable to physical disorders, requiring medical diagnoses & treatment. The Diagnostic and Statistical Manual (1994) of he American Psychological Association (DSM-IV) provide standard criteria for the diagnosis and treatment of specific mental health disorders.

MEDICAL DEFINITION
Classifications: Organic disorders (Alzheimers disease, senile psychosis, and paresis) originate from physiological difficulties & organic causes Functional disorders include several related disorders whose underlying causes are less well known Psychoses Neuroses

Traditional Classification of Mental Disorders

Schizophrenia Psychotic disorder

Manic-depressive behavior
Anxiety reaction Functional disorder Mental Disorder Organic disorder Neurotic disorder ObsessiveCompulsive behavior Depressive reaction Character disorder Psychophysiologic disorder

Adapted from Thio

Main Diagnostic Categories (DSM-IV)

1. Disorders usually first diagnosed in infancy, childhood or adolescence 2. Delirium, dementia, amnesic, & other cognitive disorders; mental disorders due to a general medical condition 3. Substance abuse disorders 4. Schizophrenic disorders 5. Mood disorders 6. Anxiety disorders 7. Somatoform Disorders

Main Diagnostic Categories (DSM-IV)

8. Dissociative disorders 9. Sexual & Gender Identity disorders 10. Factitious disorders 11. Eating disorders 12. Sleep disorders 13. Impulse-control disorders 14. Personality disorders 15. Adjustment and 16. other disorders

MEDICAL DEFINITON
Some of the most common and well-known functional disorders: Depression Bipolar Disorder Personality Disorders Schizophrenia Anxiety Disorders

Depression
Unipolar (major) depression serious mood disorder; distinguished from normal depressive moods The APA considers depression abnormal only when it is out of proportion to the event and continues past the point at which most people begin to recover (Atkinson et al., 1996:524). Marked by cognitive, motivational, and physical symptoms.

Depression
Some of the symptoms include: Dissatisfaction and anxiety Changes in appetite, sleep & psychomotor functions Loss of interest & energy Feelings of guilt Thoughts of death Diminished concentration

Bipolar Disorder
Also known as manic-depression Differs from unipolar depression (depression only) Pronounced mood swings from depression to uncontrolled mania Manic behavior: recognized by elevated mood, increased psychomotor activity, racing thought processes, experience a sense of omnipotence, pronounced lack of judgment about the consequences of their actions

Personality Disorders
Characterized by long-standing patterns of maladaptive behavior that constitute immature and inappropriate ways of coping with stress or solving problems (Atkinson et al., 1996:513). Express manipulative behavior, disorganized and unstable mood or behavior, and thought disturbances. Often co-occur with other mental disorders, most commonly mood disorders.

Schizophrenia
Most chronic, severe, and disabling of the mental disorders. Most common type of psychosis Involves alteration in thought, perception, and consciousness; little foundation in reality Hallucination a perception of something external that is not actually present. Delusion to believe in something that is contrary to reality

Schizophrenia
Withdrawal from social interaction and inability to perform tasks Changes in personal conduct difficulty concentrating, anxious, frightened, little concern for appearance or personal hygiene; often apathetic, totally abandon goals and values that were once important to them Positive symptoms Negative symptoms

Schizophrenia
Positive Symptoms Reflects an excess of normal functions Suspiciousness and delusional behavior Negative Symptoms Loss or decrease in normal functioning including flat affect or lack of emotion Loss of motivation or initiative Loss of energy Inability to experience pleasure

Anxiety Disorders
Include: panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and phobias Symptoms of anxiety and avoidance behavior an anxiety behavior may be said to exist if the anxiety experienced is disproportionate to the circumstance, is difficult for the individual to control, or interferes with normal functioning (U.S. Department of Health and Human Services, 1999a:Chapter 7).

Anxiety Disorders
May stem from very specific situations or objects [phobia] Characterized by:
Excessive worrying Restlessness Tension Feeling of fear or dread Rapid heart rate Lightheadedness/dizziness Perspiration Cold hands/feet Shortness of breath

SOCIAL FACTORS IN MENTAL DISORDER

Social Class/Status
People from lower classes are more likely than those from other classes to become mentally ill. Explanations: Social Causation lower-class people are more prone to mental disorder because they are more likely to experience social stress; to suffer from psychic frailty;, infectious diseases, & neurological impairments; lack quality medical equipment, coping ability & social support Low social status cause mental illness

Social Class
Social selection or Drift suggests that mentally ill people from higher social classes drift downward into the lower-class neighborhood, helping to increase the rate in that neighborhood Lower-class position is a consequence of mental illness among formerly highstatus people

Sex
Men and women in the general population are equally likely to have some form of mental disorder. Studies on specific types of disorder indicate a gender difference. Bipolar depression; Schizophrenia WHO men have more problems related to alcohol, drug abuse and anti-social behavior, while women suffer more from anxiety, depression and eating disorders

Sex
Women greater risk for developing posttraumatic stress disorder (PTSD) Twice as likely to experience unipolar depression How can we account for this gender difference? Gender roles Female role relatively restrictive & oppressive Male role liberating

Age
Mental disorders are more common among adults aged 18 to 54. Young adults experience some of the highest rates of mental illness. Depressive disorders and schizophrenia are usually in the early to mid-twenties. Increase of major depression among younger individuals.

Age
Youth
1 in 10 children has a mental disorder. 13% are affected by an anxiety disorder. 10% of children and adolescents ages 9 to 17 are affected by disruptive disorders (ADD & conduct disorder). Schizophrenic disorders are thought to be extremely rare in children.

Age
Elderly
At a greater risk for some mental disorders than young people (65 & up). 25% have a mental disorder. Approximately 15% of this group is afflicted with depression. 236 elderly people per 100,000 suffer from mental illness 93 per 100,000 for those aged 45 to 64, the next younger group

Race and Ethnicity

Like gender, race and ethnicity have not been consistently found to be related to mental illness in general. Higher rates minorities compared to whites?
Discrimination, poverty, cultural conflict

No significant difference
Minorities group identification, group solidarity,

social network

Race and Ethnicity

Specific Disorders: Somatization more common among African Americans than among white Americans African Americans more likely to have phobias & schizophrenia but less likely to have depressive disorders Native Americans extremely high rates of mental illnesses including disruptive behavior, substance abuse disorders, & comorbid disorders (compared to whites).

Race and Ethnicity

Adult Mexican immigrants lower compared to Mexican Americans Adult Puerto Ricans living on the island lower depression compared to Puerto Rican living on the mainland Latino youth (compared to white youth) more anxiety-related & delinquency problem behavior, depression, and drug use 26% older Hispanic American are depressed (related to physical health) 5.5% depression not related to physical health

Urban Environment
Higher rates of mental disorders in urban areas than in rural areas. The urban environment produces a lot of mental problems because it generates an abundance of physical and social stresses. Severe depression prevalent among rural and small-town dwellers acting-out disorder

Cultural Forces
The rate of mental disorder is generally higher in modern industrial societies than in traditional agricultural societies. Why? Modern societies have to fend for themselves Traditional societies readily available relatives & friends Types of mental disorder also vary from one culture to another.

Cultural Forces
Susto (Latin America) the pathological fear that their souls have left their bodies. Latah (Malaysia) hyperstartle syndrome; makes the victim scream, swear, or gesture for a prolonged period when startled by something like a loud noise or snake. Anorexia Nervosa (U.S.) extreme fear of weight gain; rarely/never found in third worl societies Belief of people

Cultural Forces
The symptoms of a given mental disorder may vary from one culture to another. Depression: more likely to show itself in somatic or physical symptoms in developing countries than in the U.S. & other Western societies. OCD: the compulsion to perform a task in a repetitive manner
In the U.S. people usually wash their hands over & over In Bali uncontrollable urge to collect information about people

Marital Status
Being married is associated with good mental health & low incidence of mental illness. The divorced or separated, the widowed or the never married often exhibit the poorest mental health. The Midtown Manhattan Study Men married, lowest rates of mental illness; single; divorced Women single, lowest rates; married; divorced

LABELING, SOCIETAL REACTION, AND SOCIAL ROLES

Labeling, Societal Reaction, & Social Roles

Labeling Approach (Merton) self-fulfilling prophecy The process of labeling a person as mentally ill results in the very behavior that portends mental illness. The person is being viewed as what he/she is labeled. When a negative label is assigned to an individual, their behaviors are interpreted as being consistent with that label.

Popular Myths
The mentally ill are popularly believed to be extremely weird. Mental illness is commonly regarded as hopeless, as essentially incurable. There is a sharp, clear distinction between mentally ill and mentally healthy. The mentally ill are often portrayed in the news media, movies, and television programs as crazed, violent people. Midwinter depression/ Seasonal Affective Disorder (SAD)

The Myth of Mental Illness

Thomas Szasz (1974) views mental illness as a myth Society labels individuals as mentally ill because their behavior is morally or otherwise unacceptable to the group. Mental illness is a response to such behavior. game-playing model of human behavior The mentally ill & psychiatrists act out certain behaviors socially defined by their roles,

The Myth of Mental Illness

5 reasons why psychiatrists make diagnoses: 1. Scientific 2. Professional 3. Legal 4. Political-economic 5. Personal

The Mentally Ill Role

Thomas Scheff (1966) Societal Labeling and Role-playing model Mental illness, or the symptoms of mental illness, is seen as residual rule-breaking or residual deviance any nonconforming, disruptive behavior that is not otherwise defined as criminal. Steroetypes and other cultural expectations of the mentally ill help labeled persons play the role of a mentally ill person.

The Mentally Ill Role

Three propositions: 1. labeled deviants may be rewarded for playing the stereotyped deviant role 2. labeled deviants are punished when they attempt to return to conventional roles 3. in the crisis occurring when a residual rule-breaker is publicly labeled, the deviant is highly suggestible, and may accept the proffered role of the insane as the only alternative

Being Sane in Insane Places

D.L. Rosenhan (1973) & Erving Goffman (1961) Provide analyses of the role of institutionalized mental patients and of how they are treated by the hospital staff. diagnosis betrays little about the patient but much about the environment in which an observer finds him Patients who are easily managed, who submit to hospital routines, and who follow staff directives are labeled as mentally healthy; patients who are not submissive & compliant are viewed as mentally ill.

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