A term generally referred to as mental illness is used to describe a diseases or condition affecting the brain which affects the way a person thinks, behaves, feels and his/her relation to others and surroundings. A person suffering from this condition would often be unable to cope with life’s daily routines and demands.
Mental illness covers a wide scope of generic label for different types of emotional or cognitive dysfunction. Illnesses falling within this category include schizophrenia, major depression, bipolar disorder, generalized anxiety, to name a few. Current opinion in psychology traces its origin as either psychological or biological in nature. Biological causes points to the anatomical, chemical or genetic makeup of a person as the mental-illness-causing factor. Trauma or severe conflict could bring or contribute to psychological dysfunction.
Other terms used interchangeably for mental illness are: “mental disorder”, “psychiatric or psychological disorder”, “and behavior problem”, “emotional problem”, “abnormal psychology”. But “insanity” is the most commonly used term for mental illness, and it is also the term used for legal purposes.
The subject of mental illness was usually surrounded with mystery and fear in the past. However, present day understanding and even the ability to offer effective treatments to patients suffering from this disorder, have tremendously progressed. And yet, lack of information or disinformation regarding the illness had stood in the way of individuals needing this kind of help.
Mental illness is a common occurrence, and much more the milder conditions. The American Psychiatric Association has stated that: “one fifth of Americans suffer from a diagnosable mental disorder during any given year. One fifth of school-age children are also affected by these conditions. Severe and persistent mental illness is less common, but still afflicts 3 percent of the population” (See “Let’s Talk Facts About What is Mental Illness?”).
Despite high prevalence of mental illness, about only half of people with mental illness seek professional help. Mental illness may be perceived as less real compared to physical illness, leading to less support in the part of policy makers and insurance companies to pay for treatment. Parents too, may receive blame for causing mental illness in their children. A more common public reaction to people with mental illness is to shun them, live as far as possible from them, or avoid working and socializing with them. All these factors combined do not help the person with mental illness; thereby much is desired in alleviating this problem which permeates all levels of society.
Mental illness does not occur in isolation. It is common to all countries and its effects are felt everywhere. It is estimated that even in established market economies, mental illness ranks towards the burden of disease and by 2020, it is predicted that depression will be the second highest contributor to the disease burden globally. The possibility of developing some illnesses such as Alzheimer’s, only increases with age. A person, who doesn’t suffer any mental illness now, may suffer it in the future.
What then is a mentally healthy person? A person who has mental health simply means he or she does not have any mental illness. The person is able to cope with the ordinary and extraordinary relationship that comes along his path. It is has been said that mental health is the invisible man of health problems. Mental health is as important as physical health for a person’s well being (See “Mental Health”).
II. Reasons for Occurrence:
The occurrence of mental illness can be caused by different factors or a combination of these several factors. Different explanations are offered by different schools of thought, such as biological, psychological or social explanations for causing mental illness. Current theories however, have mostly acknowledged that all three contribute in varying amounts to a person’s mental ill-health. Many psychiatric diseases can be classified as syndromes, or the association of several clinically recognizable features that do not always have a single cause.
A. Biological Factor
The currently most popular explanation for mental illness is biological explanations. It believes that a person suffering from mental illness may exhibit a difference in brain structure or function or in neurochemistry, either through genetic or environmental vulnerabilities. Research findings for example, have shown that people with schizophrenia have enlarged ventricles and reduced gray matter in the brain. In addition, other studies have also found that imbalance in neurotransmitters could also play a factor in causing mental illness. Studies have focused on the neurotransmitters dopamine, nor epinephrine, and serotonin. If these chemicals are out of balance or may not be working properly, messages sent to the brain may not be sent correctly leading to symptoms of mental illness.
Problems in mental conditions may also be caused by injury to certain areas of the brain.
Moreover, many genetic studies have showed strong evidence that mental illness can be inherited, such as in the cases of schizophrenia and bipolar disorder. Many mental illnesses have been found to run in a family, which suggests that people with a mentally ill family member are more likely to develop mental illness as well. Experts link mental illness to abnormalities in many genes, and not just one. It is possible that a person who has inherited a susceptibility to this illness may not develop the illness. The occurrence of mental illness comes from the interaction of multiple genes and other factors such as stress, traumatic event, or abuse, which can trigger an illness in a person who has inherited genes susceptible to it.
Brain damage and the development of mental illness had also been found to have been caused by certain infections. For instance, a condition known as pediatric autoimmune neuropsychiatric disorder (PANDA) has been closely associated with the Streptococcus bacteria, linked to the development of certain mental illnesses in children.
Prenatal damage caused by disruption of early fetal brain development such as loss of oxygen to the brain, may be a factor in the development certain mental illness. Other factors such as poor nutrition and exposure to toxins could also be responsible or contributory to insanity.
B. Psychological Factor
Psychological explanations suggest that individual conflict, stress, crises, or traumatic experiences could trigger mental illness in especially vulnerable individuals. The early loss of a significant person/s such as a parent; neglect; and the lack of ability to relate to others may be other factors (See “Mental Health: Causes of Mental Illness”).
C. Social / Environmental Factor
Social theorists suggest that mental illness may be caused by the conditions of the person’s environment. For example, there has been significant finding of higher incidences of psychological disorder in areas where people have suffered a major natural or man-made disaster. People involved in civil or military actions have also shown higher occurrences of this illness. Areas that are more affluent or stable may have lesser probability of mental illness compared to places that suffer from endemic poverty, few resources and support.
In so far as major psychiatric disorders are concerned, the nature versus nurture debate has generally been settled. It has been widely accepted that both play an important role in the sufferer’s life.
It is has been known though, that mental illness is NOT caused by: weakness of character or personality, or sinful behavior (although stress arising from guilt may cause psychological disorder).
Psychiatric disorders may differ from one individual to another. Degree may range from mild, severe, or anything in between. Symptoms can also vary even in one person over time — from severe to complete remission and back. Such incidence or “flare-ups” may be triggered by stress or other factors.
Symptoms usually vary and every person with mental illness is different from one another. Arizona NAMI had developed a list of several warning signs of mental illness. The presence of a single symptom does not necessarily indicate mental illness but a severe symptom or multiple signs are strong indication for a need to seek medical evaluation.
Arizona NAMI had developed a list of warning signs of mental illness. These are the following:
· Changes in cognitive functioning: hallucinations, delusions, inability to concentrate
· Extreme changes in the person’s mood: extreme sadness or thinking, or extreme excitement or euphoria with no relation to events or circumstances, pessimism, expression of hopelessness, loss of vitality in once pleasurable activities, suicidal talks or thoughts
· Behavioral Changes such as: inappropriate laughter, friendlessness or abnormal self-involvement, sitting and doing nothing, being hostile from once being pleasant, indifference or lack of attention towards highly important situations, unable to express joy, inability to continue in worthwhile activities, excessive fears or suspicions, inappropriate words or language structure or statements, frequent attempts change geographic location such as frequent moves or hitchhiking trips, bizarre behavior like skipping or strange posturing, unusual sensitivity to sound, light or clothing, among others
· Physical changes also occur: the person would either exhibit hyperactivity or inactivity or would run from each extreme symptoms, personal care and hygiene visibly deteriorates, unexplained gain or loss of weight, and or too much sleeping or unable to sleep
As of now, there is no reliable way to predict what the course of the illness may be. Symptoms displayed may change from year to year. And even if the diagnosis may be the same among two patients, symptoms may be different from one person to another. Other disease such as hypothyroidism, brain tumor, and multiple sclerosis had also been found to cause mental illness in some cases (See “Symptoms of Mental Illness”).
A common misconception regarding mentally ill person is for them to be perceived as violent. The vast number of individuals suffering from mental illness is not violent. It is a fact that a majority of violent acts were conducted by persons who are not mentally ill. The reverse is more commonly true, they are victims rather than perpetrators of violence and more inclined to harm themselves than hurt other people.
IV. Categories of Mental Illnesses & Disorders
Mental illnesses in the United States have been categorized into groups according to their common symptoms found in the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association.
Here are samples of different categories and some its disorders:
Developmental disorders and developmental disabilities
autism, mental retardation
Memory disorders and Cognitive disorders
Mental disorders caused by general medical condition
AIDS- related psychosis
Mental disorders due to a general medical condition
Psychotic disorders and schizophrenia
Manic-depressive disorder, clinical depression
General anxiety disorder
Dissociative identity disorder
Sexual and gender identity disorders
Sexual and gender identity disorders
Impulse-control disorders not elsewhere classified
Impulse-control disorder not elsewhere classified
Narcissistic personality disorder
Other conditions that may be a focus of clinical attention
Other conditions that may be a focus of clinical attention
V. Available Treatment
In the recent past, prevalent perception on some severe mental disorders was dismal, and is considered to be marked by lifelong deterioration. Schizophrenia, for example, was seen by health professionals as having a downhill course. Emil Kraepelin, a leading psychiatrist in the beginning of 20th century, judged schizophrenia as hopeless that he named the disorder as “dementia praecox” or premature dementia. His writings had painted a negative concept of severe mental illness, followed by others influenced by his perceptions which were written in textbooks for decades. A turnabout in attitudes came, more as a result of the consumer movement and self-help activities. It produced a more positive attitude and self-perception, backed by recent scientific research, which supported a more optimistic view of the possibility of recovery (See “Mental Health: A Report of the Surgeon General”).
Different options for treatment may include psychiatric medication, psychotherapy, other supportive measures, and may even require lifestyle adjustments or a combination of these. It has often observed that individuals who suffer from this illness seek treatment only when symptoms have become severe to function normally. However, early treatment is best and most effective when symptoms are still mild or moderate.
The diagnostic process is complex and largely subjective. It requires the careful skills of a gifted medical detective, making careful and detailed assessment of patient histories and current and past symptoms.
A number of treatment procedures for mental illness can be categorized as either somatic or psychotherapeutic. Treatment under somatic category includes the administration of drugs and electro convulsion in therapy. Psychotherapeutic treatments on the other hand incorporate individual, group, or family and even marital psychotherapy. Behavior therapy modification such as relaxation training or exposure therapy is also included. Most professional opinion would suggest that the major treatment of mental health disorders should involve both drugs and psychotherapy in order to achieve effective treatment, instead of either method used alone.
Professionals involve in the treatment of mental health does not fall on psychiatrists alone but includes clinical psychologists social workers, nurses, and some pastoral counselors. The majority of mental health care professionals practice psychotherapy in addressing persons with mental disorder.
There are has also been keen interest in developing the method of involving clients and their caregivers in the aspect of treatment for mental illness. Tensions may arise at the initial implementation of patient-family involvement. There are various bases on the influences on this approach such as the idea that treatment comes as a response to recognition of mental illness as having psychological and social dimensions, and the first-hand experience from clients. Goal of treatment is to enable the person to make appropriate choices and have control over their daily lives. Treatment of mental health problems are no longer exclusively confined within the walls of psychiatric hospitals and other institutions.
It is recognized that there are social dimensions to psychiatric treatment as well as psychiatric dimensions to the social pathology of mental illness. The coordination between patients and their caregivers is particularly important in trying to coordinate treatment and support which covers health and social care. But how collaboration and coordination will be taken is subject to different interpretations by different professionals. Medical practitioners might interpret collaboration as taking place with co professionals while nonmedical practitioners would take it to mean coordination with nonprofessionals. Collaboration must be defined clearly; otherwise confusion would come in its implementation. Success has been found in the treatment of patients with schizophrenia upon the coordination between health and social care, the roles of families and wider social networks. In order to satisfy the needs of patients, it is imperative to go beyond medical symptoms but must also recognize that such patients have a variety of needs that must also be met (C. Truman. “The Autonomy of Professionals and the Involvement of Patients and Families”).
Some Methods Used for treatment of Mental Illness:
Ø Drug Therapy: A number of psychoactive drugs have been developed which had been used by psychiatrists and other medical doctors. Such drugs are often categorized according to the disorder in which they are primarily prescribed. Antidepressants for example, are used for the treatment of depression. The most widely used class of antidepressants is the selective serotonin reuptake inhibitors. Other antipsychotic drugs are chlorpromazine, haloperidol and thiothixene, found to be effective in treating schizophrenia. Clonazepam and diazepam are used to treat anxiety disorders such as panic disorders and phobias. Bipolar disorders had been treated with lithium, carbamazepine and valproate to stabilize erratic moods.
Ø Electroconvulsive Therapy: Electrodes are attached to the head and a series of electrical shockers are administered to the brain to induce seizures in this type of therapy. This has been used in treating severe depression among patients. Temporary memory loss may be experienced by the patient but unlike media’s portrayal, electroconvulsive therapy is safe and rarely causes complications. The treatment is complimented by the use of anesthetics and muscle relaxants to reduce risks.
Ø Psychotherapeutic Treatments: There had been significant progress in the field of psychotherapeutic treatments. Sometimes referred to as “talk therapy”, it works on the assumption that every person possess within himself the cure for his own suffering and that such cure can be facilitated through trusting, and supportive relationship with the psychotherapist. The presence of an emphatic and accepting atmosphere helps the person to identify the source of his problems and creates steps in dealing with them. Awareness and insight often result in a change in attitude and behavior that helps a person to live a fuller, more meaningful, and satisfying life. Its application can be used in a wide range of conditions. Psychotherapy may also be useful even in persons without mental disorders in coping problems such as bereavement, employment difficulties, or chronic illness in the family. Variations are group psychotherapy, family, and couple’s therapy. Mental health professionals using this method practice within these five types of psychotherapy namely: cognitive therapy, psychoanalysis, behavior therapy, psychodynamic psychotherapy, or interpersonal therapy.
Ø Hypnosis and Hypnotherapy: Hypnosis is the induction of an altered state of consciousness, while hypnotherapy involves psychotherapeutic intervention within the hypnotic state. It has been found effective in lowering anxiety and tension, such as in the case of cancer patients undergoing depression in addition to physical pain.
VI. Types of Mental Health Care Professionals
Ø Psychiatrist: a medical doctor who received four years of psychiatric training after finishing medical school. A psychiatrist is allowed to prescribe drugs and admit sufferers to the hospital. Others incorporate psychotherapy, while others only prescribe drugs, and many practice both.
Ø Psychologist: These are professionals who have received a doctorate but not a medical degree. A number have postdoctoral training, and are mostly trained to administer psychological tests that are helpful in diagnosis. Although some conduct psychotherapy, it is limited in the sense that it is not allowed to perform physical examinations, prescribe or administer drugs, or admit people to the hospital for treatment.
Ø Psychiatric Social Worker: Is a professional who has received specialized training in certain aspects of psychotherapy applied in family or marital therapy, or individual psychotherapy. Others have a master’s degree while some have doctorates as well. They too, cannot perform physical examination or prescribe drugs but they are often useful with the social service systems in the state.
Ø Psychiatric Nurse: A professional or registered nurse who is trained to practice psychotherapy independently in some states. They may prescribe drugs under the supervision of a doctor.
Ø Psychoanalyst: Can either be a psychiatrist, psychologist, or social worker who had undergone years of training in the practice of psychoanalysis. Clients are subjected to several sessions a week in order to identify unconscious patterns of thought, feeling, and behavior which affect the person. Psychoanalysts who are also psychiatrists are legally allowed to prescribe drugs and admit people to hospitals.
(See “Treatment of Mental Illness”)
VII. Other Issues: Employment
A mentally healthy person is able to function normally and integrate into the society with which he belongs. An important aspect of society is the workforce, and a major determinant of mental well-being is being able to be a part and cope with its demands. Exclusion creates deprivation of wealth, confidence, and may lead to further isolation and bring detriment to mental health. Despite the progress that has been made in laws and policies which focuses on the rights of mentally ill persons, research findings show considerable discrimination due to prejudicial attitudes from employers and workmates which are being experienced by sufferers of mental illness. This shows that legislation remains inadequate to abate these prejudicial attitudes. There are various attitudes and structural barriers which prevent individuals with mental disabilities from becoming full participants in a competitive work place. Employer attitudes play a key role in the success of the legislation passed against discrimination to extend assistance to disabled people and convey acceptance into occupational life. Other studies have shown that employers had been found to give poor support for equity and workplace accommodations for mentally disabled persons (N Vilchinsky, L Findler, “Attitudes toward Israel’s Equal Rights for People with Disabilities Law: A Multiperspective Approach”). It has been found further that there is a low level of compliance with legislative requirements (B Heijbel et al. “Employer, Insurance, and Health System Response to Long-term sick leave in the Public Sector: Policy Implications”). Discrimination and harassment against people with mental disorders are the second most common basis for charges in the United States under the Americans with Disabilities Act (TL Scheid. “Employment of Individuals with Mental Disabilities: Business Response to the ADA’s Challenge”). While it is imperative that employees or prospective employees disclose that they have a mental disorder which would limit their capacity to work, disclosure however, remains a dilemma for employees since it might lead to undermine employability, jeopardize career advancement or dismissal from work. As of now, there had been no conclusive way of disclosure without suffering from the stigma attached to it or to ensure security of workplace accommodations. It is a common practice today that such individuals withhold psychiatric information to avoid discrimination (B Schulze, MC Angermeyer. “Subjective Experience of Stigma”).
It should be emphasized that there are benefits that should be considered if psychiatric disability will be disclosed such as eligibility for protection against discrimination under antidiscrimination legislation, have access to accommodations such as flexible hours and support from a job coach, and a number of psychological benefits like reduced stress brought by ongoing concealment. But risk factors are not eliminated such as decreased chances of employment, missing a promotion, losing a job, become subject of social stigma of disrespect and harassment from coworkers, and more mental health risks resulting from stress and distress (Dr. H. Stuart. “Mental Illness and Employment Discrimination”).
It has been suggested that supported employment as a base for vocational intervention for people with psychiatric evidence be used towards reintegration and achieving normal functioning in society. It emphasizes real-world conditions rather than pre-employment experiences. Two separate studies had been conducted which showed supported employment was more effective over traditional vocational services (Lehman et al. “Improving Employment Outcomes for Persons with Severe Mental Illness”). Supported employment was more cost-effective than traditional stepwise programs since the latter, although would earn similar amounts of income, would be working extensively in sheltered, non-competitive settings. It integrates clinical and rehabilitative services which aid successful integration, such as the education of the medical staff and stressing the importance of giving attention to client preferences and choices throughout the vocational process.
Additional studies had also focused on skill training as a needed supplement to supported employment. Other experiments also showed that individuals with cognitive deficits can learn entry-level job tasks with a method called ‘errorless learning’, relying more on implicit rather than explicit memory thereby compensating for mental deficits. Programs which provided the addition of supported education to supported employment resulted to improved quality and appropriateness of the jobs they held. There were other reports which gave evidence that clients with severe mental illness can become successful workers within the mental health system, primarily because they possess unique experiences and talents which they alone can offer. Cultural, racial and gender-related disparities do remain an important issue. These concerns however, should not cover the fact that most adults with severe mental illness have expressed strong interest in working. Considerations should be made, not only on the client’s goal for competitive employment but on the programs offered and staff attitudes which influence the success of the client’s goal (R Drake, D Becker, G Bond. “Recent Research on Vocational Rehabilitation for Persons with Severe Mental Illness”).
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