Over the course of civilization, mental illness has been explained in either natural or supernatural terms. In ancient Greece the physician Hippocrates viewed abnormal behavior as the result of bodily processes such as disease or an imbalance in bodily fluids. He recommended rest, exercise, and dietary change. In the Middle Ages, however, abnormal behavior was considered a result of demonic possession. Treatments included exorcism, flogging, or torture to drive the evil spirits from the body.
Psychiatry
Mental disorders seriously affect an individual's ability to function and to lead a happy and productive life. Such disorders take many shapes and forms and often appear as exaggerations of situations commonly experienced by psychologically healthy individuals. For example, healthy people sometimes feel depressed, frightened, envious, or angry. Such feelings are symptoms of a mental disorder only when they are continuous, excessive, and lead to self-destructive behavior (see Mental Illness). Psychiatry is the medical specialty that is concerned with the diagnosis, treatment, and prevention of mental disorders. Trained psychiatrists are doctors who have completed a residency in psychiatry. They diagnose mental illness through clinical interviews and psychological tests and by examining the patient's history. They also study the causes of mental illness and the effectiveness of different treatment procedures. Like psychiatrists, clinical psychologists diagnose and treat mental illness. They are not physicians, however, and cannot prescribe or administer drugs.
The psychiatric interview is a basic diagnostic technique. In such an interview, the psychiatrist leads the patient into a discussion about the patient's life and feelings. By communicating an accepting and nonjudgmental attitude, the therapist lessens the patient's anxiety about discussing embarrassing or negative facts. In classical psychoanalysis, the patient lies on a couch and attempts to free-associate about events and dreams. Free association is an uncensored verbal or written expression of all the content of consciousness. In addition to the psychiatric interview, the patient may also be given intelligence and personality tests. These are usually administered by a clinical psychologist. In some intelligence tests, scales are used to compare verbal and motor abilities of people in specific age groups. The patient's intelligence quotient (IQ) is the measure of overall performance within the individual's age group. Personality tests consist of either objective personality tests, also called personality inventories, or projective personality tests.
Mental
Illness: Abnormal behavior or disturbing feelings, thoughts, or actions
that interfere with everyday functioning constitutes mental illness. The
definition of abnormal behavior may depend on the culture and on societal
values. Persons with an impaired ability to meet daily responsibilities,
however, are likely to be regarded in most societies as exhibiting abnormal
behavior.
A specific abnormal behavior is referred to as a symptom. Several symptoms
are usually found in combination and are collectively referred to as a
syndrome. Most currently recognized mental disorders are syndromes. Current
evidence suggests that between 16 percent and 25 percent of the population
of the United States suffer from some form of mental illness.
There
are more than 250 mental disorders that have been classified into different
types or groups. In the United States the most widely used system of classification
is that found in the third edition of 'Diagnostic and Statistical Manual
of Mental Disorders', a book published in 1980 by the American Psychiatric
Association.
Anxiety disorders cause a person to experience tension, fear, and feelings
of danger. In some cases the anxiety is associated with a specific object
or situation; it is then referred to as a phobia.
Psychotic disorders include dysfunctions in which a person's adaptive
functioning and contact with reality are significantly impaired. Schizophrenia
is the most prominent of these disorders and is characterized by severe
distortion of thoughts, perceptions, and feelings.
Affective disorders refer to disturbances of mood. Depression is the most
common of these.
Personality disorders are enduring manners of relating to the social environment
that are maladaptive and lead to personal maladjustment or distress. An
example is antisocial personality disorder, marked by a lifelong pattern
of reckless, aggressive, and illegal behavior.
Substance use disorders are linked to chemical dependence or abuse of
substances such as alcohol, drugs, or tobacco.
Somatoform disorders are those involving bodily malfunctions such as breathing
difficulties or pains that have no apparent physical cause. The most common
of these disorders is hypochondriasis, or a constant fear of disease.
Dissociative disorders involve the splitting of a person's psychological
functions such as memory, control of motion, or knowledge of identity
from the rest of the personality. An example is psychogenic amnesia, in
which a person forgets past experiences. The amnesia may result from an
organic brain disorder, but the problem can also appear in the absence
of any physical impairment.
Psychosexual disorders include a number of sexual dysfunctions in which
psychological factors play a major role. One example, sexual deviance,
involves sexual attraction to socially censured objects, persons, or modes
of behavior.
Adjustment disorders refer to reactions that develop in response to a
specific environmental event. Factors such as the death of a relative,
marital difficulties, or the loss of a job may temporarily precipitate
symptoms such as depression or anxiety.
Organic mental disorders are dysfunctions in which organic, or physical,
impairment is present. Such impairment is usually detected by physical
examination or laboratory testing. Dementia, for example, is a loss of
intellectual abilities and adaptive functioning. It may result from a
disease or injury or may reflect an aging process in which there has been
atrophy of the brain.
Disorders with onset of infancy, childhood, or adolescence. There is also
a large group of dysfunctions that first become evident before adulthood.
Two examples are mental retardation and infantile autism. A child with
the latter disorder shows a marked lack of response to others and grossly
impaired language and communication skills.
The
cause, or etiology, of mental illness can vary greatly from one disorder
to another. Some disorders can be traced to specific physical conditions;
these are referred to as organic disorders. Other disorders are called
functional disorders because they have no known organic cause. Environmental
and interpersonal factors are also believed to play a major role in many
forms of mental illness. For the vast majority of disorders, however,
the cause is unknown.
Biological factors. Several biological factors have been linked to the
development of mental disorders. Genetic influences play a role in depression,
schizophrenia, and alcoholism: children of parents with one of these disorders
are more likely to develop the disorder than are children of unimpaired
parents. Biochemical factors are also linked to certain disorders. Several
neurohumors (chemicals affecting the functioning of the brain) have been
associated with specific disorders such as schizophrenia and depression.
Medications that reduce the symptoms of these disorders are thought to
influence the biochemical balance in the brain and possibly restore it
to normal.
Psychosocial and environmental factors. Psychosocial factors refer to
interpersonal events that may give rise to abnormal behavior later in
life. According to the psychoanalytic view, childhood conflicts may be
the cause of later symptoms. According to the behavioral view, parents
may teach or transmit specific problems to their children. Stressful events
can also be linked to mental disorders. For example, post-traumatic stress
disorder may result from exposure to high-level stress such as a war or
natural disaster. The symptoms may include a reexperiencing of the event,
difficulty in falling asleep, inability to concentrate, depression, and
anxiety.
Diagnosis
is the process of identifying which specific type of disorder a person
has. It requires a careful assessment of the person's functioning, usually
accomplished through an extensive interview in which the patient is questioned
about the presence, severity, and duration of various symptoms. On the
basis of this assessment, the diagnostician may identify one or more mental
disorders. The diagnosis, investigation, and treatment of mental disorders
is the concern of three major professions: psychiatry, clinical psychology,
and social work. A psychiatrist has a doctorate of medicine (M.D.) and
training in diagnosis, psychotherapy, and the use of medications to alter
abnormal behavior (see Psychiatry). A clinical psychologist holds a doctorate
of philosophy (Ph.D.) and is trained in the diagnosis of abnormal behavior
and the administration of psychotherapeutic techniques. Social workers
hold a master's degree and often assist in the treatment of families with
mental-health problems. After diagnosis, the patient may undergo treatment.
Most treatment is administered on an outpatient basis: the patient lives
at home and comes to a clinic only for treatment. Persons with severe
dysfunctions, however, often are inpatients and live in hospital settings.
For some severely disturbed patients, special living conditions may be
required. Halfway houses, for example, provide community-based living
arrangements with conditions similar to those in a home or apartment but
with staff members who oversee treatment. There are a large number of
treatments available. The purpose of all of them is to reduce the symptoms
of the disorder and to increase the person's adaptive functioning in everyday
life. Psychosocial treatments. The most widely applied treatment for mental
disorders is some form of psychotherapy, which relies on interpersonal
or psychological procedures to alter the way a person thinks, feels, or
behaves. This is accomplished primarily by talking with the therapist.
Some researchers estimate that there are more than 400 different forms
of psychotherapy. Biological treatments. Biological treatments directly
alter bodily processes. Medication is the most common biological treatment.
Tranquilizers and sedatives may be prescribed to reduce anxiety and distress.
Antidepressants are sometimes used to treat affective disorders. Stimulants,
which speed up bodily processes, have been used for depression and, ironically,
overactivity in children. Antipsychotic drugs are used to reduce excitement,
confusion, thought disorders, and hallucinations. Use of these medications
has permitted many patients to return to the community rather than remain
in institutions.
Another biological treatment is electroconvulsive treatment (ECT), in
which small amounts of electrical current are applied to the brain. ECT
has been used to reduce the symptoms of depression. With the development
of increasingly effective medications, today ECT is less frequently used
for affective disorders. Psychosurgery is a biological treatment in which
various nerve centers in the brain are surgically severed, rendering the
patient more docile. Because such surgery is irreversible and usually
develops no new adaptive behaviors, it is rarely used.
Psychosis
Disorder involving personality disorganization and inability to deal with reality; manifests in a variety of ways mental illness
Psychosomatic disorders
Diseases thought to be caused, at least in part, by emotional factors are known as psychosomatic disorders. The term comes from the Greek psyche, meaning "spirit" or "soul," and soma, meaning "body" and refers to the effect of the mind on the body's health. Other terms used to describe psychosomatic disorders are psychophysiologic disorders, psychogenic diseases, and organ neuroses. In psychosomatic disorders, repeated emotional stress can cause dysfunction or structural damage in the body's tissues, organs, and organ systems by chronically stimulating the involuntary nervous system and the glands of internal secretion. This process is in contrast to disorders caused by bacterial or viral infections. A headache, for example, can stem from a common cold or from muscle tension caused by stress. The headache of a cold disappears when the infection is gone, but headaches from continued emotional stress may be self-perpetuating. Tightened muscles in the neck, shoulders, and back increase the person's stress, which in turn increases tension in the muscles, which increases stress setting up a vicious cycle. Chronic tension headaches often progress to chronic back pain, which can become disabling.
Neurotic personalities and neurotic characters
A compulsive person is a neurotic who spends an inordinate amount of energy in keeping things clean and orderly, which symbolizes the effort to keep the id impulses under control. In contrast, the anxiety neurotic has few defenses and is upset by everything. Suggestible and easily frightened, the anxiety hysteric often shrinks from new experiences. Some patients transform their anxieties into physical complaints, resulting in hypochondria an obsessive and unwarranted concern about personal health. Other patients translate their anxieties into fears that have little or no basis in fact, called phobias. In addition to the neurotic personalities, in which anxiety is the chief symptom, there are also neurotic characters. Whereas the neurotic personality experiences too much anxiety and guilt, the neurotic character experiences too little. The psychopathic person can inflict pain and suffering with little guilt or remorse. Because neurotic characters do not suffer anxiety, they are less likely to come for treatment and are more difficult to treat. They tend to feel that it is the world, not themselves, that has the problems.
