Mental illness

Mental Illness (or emotional disability, cognitive dysfunction) is a broad generic label for a category of illnesses that may include affective or emotional instability, behavioral dysregulation, and/or cognitive dysfunction or impairment. Specific illnesses known as mental illnesses include major depression, generalized anxiety disorder, bipolar disorder, schizophrenia, and attention deficit hyperactivity disorder, to name a few. Mental illness can be of biological (e.g., anatomical, chemical, or genetic) or psychological (e.g., trauma or conflict) origin. It can impact one’s ability to work or go to school and contribute to problems in relationships. Other generic names for mental illness include "mental disorder", "psychological or psychiatric disorder", "abnormal psychology", "emotional problem", or "behavior problem". The term insanity, often used colloquially as a synonym for mental illness, is used technically as a legal term.

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

The most popular explanations for mental illness, currently, are biological explanations; that is, a person with a mental illness may have a difference in brain structure or function or in neurochemistry, through either genetic or environmental vulnerabilities (such as in utero alcohol exposure). For example, many people diagnosed with schizophrenia have been shown to have enlarged ventricles and reduced grey matter in the brain. Additionally, some argue that neurotransmitter imbalance may cause mental illnesses. Finally, many genetic studies or twin studies have shown strong evidence that mental illnesses such as bipolar disorder (manic depression) and schizophrenia can be inherited.

While biological explanations are the most popular explanations for mental illness, psychological explanations are also offered. Psychological theorists suggest that individual conflict, crisis, stress, or trauma may lead to the development of mental illness, especially in vulnerable individuals. For example, a child who witnesses the homicide of a parent may develop depression, anxiety, or post-traumatic stress disorder.

Finally, social theorists suggest that mental illness may be caused by significant events in, or the conditions of, one’s environment. For example, there may be higher incidences of mental illness in areas that are involved in civil or military actions or that have recently suffered a major natural or man-made disaster. Areas that also suffer from endemic poverty, transience, and few resources and supports are also suggested to have higher rates of mental illness than more affluent or stable areas.

There are likely multiple causes of mental illness. There has been a focus on the neurotransmitters dopamine, norepinephrine, and serotonin. Each disorder is likely to have its own etiology, or causation. Treatment options include psychiatric medication, psychotherapy, lifestyle adjustments, other supportive measures or a combination of these. Sufferers typically seek treatment only when psychiatric symptoms make it very difficult to function, but early treatment - when symptoms are mild or moderate - will generally lead to a better long-term outcome. As with many physical diseases, the diagnostic process is complex and requires the careful skills of a gifted medical detective. Diagnosis remains a subjective - albeit increasingly evidence-based and scientific - art that includes careful and detailed assessment of patient histories and current and past symptoms.

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

Regarding the major psychiatric disorders (e.g. bipolar disorder, schizophrenia, major depression, obsessive-compulsive disorder) the nature versus nurture debate has generally been settled. The answer is "both". The major psychiatric disorders all show strong evidence of heritability. Using genograms, genetic studies and observing identical twins, one or both of whom had mental illness and who were reared apart (to control for environment), psychiatric researchers have shown high rates of heritability (significantly higher than for the population at large) for most mental illnesses, with bipolar disorder showing the highest inheritance and therefore strongest biological component.

A small minority of individuals question whether mental illness is "real." This view is promoted by Scientologists and the anti-psychiatry movement.

Prevalence
According to the 2003 report of the U.S. President's New Freedom Commission on Mental Health, major mental illness, including clinical depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder, when compared with all other diseases (such as cancer and heart disease), is the most common cause of disability in the United States. Additionally, according to National Alliance for the Mentally Ill (NAMI), an American advocacy organisation which accepts funding from the pharmaceutical industry, 23% of North American adults will suffer from a clinically diagnosable mental illness in a given year, but less than half of them will suffer symptoms severe enough to disrupt their daily functioning. Approximately 9% to 13% of children under the age of 18 experience serious emotional disturbance with substantial functional impairment; 5% to 9% have serious emotional disturbance with extreme functional impairment due to a mental illness. It is suggested that many of these young people will recover from their illnesses before reaching adulthood, and go on to lead normal lives uncomplicated by illness.

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

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


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

Controversy
Psychiatry remains somewhat controversial to some people. For example, over thirty years ago homosexuality was considered a mental disorder in American psychiatry (see DSM-II); at the same time, the American psychiatry establishment was also leading the way in refusing to pathologise homosexuality any more and has since argued against such practices as trying to turn gay people straight through therapy. It can be argued that what psychiatry used to consider disorder or illness was likely the result of cultural norms or bias and this perception varies over time and place, but this is true of all illnesses.

Contemporary psychiatry, however, is said to be guided by evidence-based medicine. Thus, it has becoming much more scientific and much less speculative than it once was. However, some diagnoses remain controversial. For instance, whilst a person with transsexualism who is not suffering as a result would probably not be considered to be mentally ill, a person who is suffering from a belief that they are trapped in the wrong body may be considered to have gender dysphoria. Nevertheless, dysfunction or subjective distress are required before such a diagnosis can be made.

As mentioned above, neurochemical studies have revealed abnormalities in neurotransmitter functioning among individuals with certain psychiatric diagnoses. Also, structural or neuroanatomical differences among brains of people with schizophrenia have been detected via neuroimaging. Some mental disorders, such as schizophrenia, are known to be hereditary and possible links between certain genes and particular mental disorders have been found.

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

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

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

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

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

Other arguments against psychiatry include the view that electroconvulsive therapy damages the person. It remains controversial even if it can be life-saving in many circumstances. Long-term institutionalization, for mental illness rarely occurs now, but hospitalization for acute psychiatric illness still does. Hospitalization is usually very short (some would argue too short to effectively stabilize the patient) due to the realities imposed by managed care.

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

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

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

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

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

Crime is not a symptom of mental illness; however, movies often portray murderers as being mentally ill. This makes a villain more emotional, interesting, and dramatic.

Treatment
Medicine has been unable to cure mental illness. Many conditions, like schizophrenia, bipolar disorder, and depression, can be treated with medication, however. The function of the psychiatrist is to provide support, therapy and, if necessary, medications to address the symptoms, the patient's suffering. When medications are used, the psychiatrist and the patient are responsible for monitoring and managing the prescription of these medications and their effects.

Some mental conditions can be "cured" insofar as symptoms go away, whether with medication or support, but the underlying vulnerability remains. Some mental conditions can be "cured" insofar as the patient no longer suffers significantly (like exposure and response for certain phobias). With chronic mental disorders, the chances of the symptoms recurring will be affected by the number of episodes the patient has had in the past, the effectiveness of the treatment, as well as external factors.

Since mental illness is frequently a physical illness manifesting through and exacerbated by behavior, most people with mental illness also benefit from psychotherapy, either from a psychiatrist or some other qualified clinician, like a social worker or psychologist. The most basic treatment involves identifying maladaptive, self-destructive, or inappropriate behaviors and finding ways, with the patient, of coping with, eliminating, or altering those behaviors to promote overall mental health.

Often individuals with serious mental illness will engage in several different treatment modalities, all with specific goals. For example, a patient with chronic schizophrenia may be involved in treatment with a psychiatrist for medication, and he or she may also be engaged in psychotherapy to help manage their life-long condition, as well being engaged in case management (sometimes referred to as "service coordination") or a day treatment, vocational, psychosocial rehabilitation program, or assertive community treatment program to help move them towards a more productive and independent role in the community.

Patient Advocacy
Patient advocacy organizations have been helpful in changing the stereotype of psychiatric illness. These stereotypes are typically made by individuals or groups who know little or nothing about psychiatric illness and mistakenly believe that these illnesses reflects a lack of willpower by the individual. It is important to emphasize that these illnesses are not a sign of personal weakness. In fact, the truth is that most psychiatric patients have endured more pain than those that do not have these illnesses will ever experience. A case could be made that these individuals are in fact quite strong, even when compromised by symptoms. Moreover, most individuals would like to be productive and high-functioning. Thus, patient advocacy organizations try to reverse the stereotype problem by educating the public, fighting stigma, supporting local, state and national legislation that is helpful to individuals with psychiatric disorders, encouraging those with illnesses to seek treatment and to instill hope in those afflicted so that they can continue on the path toward recovery, wellness and a fulfilling and meaningful life.

Books

 * One Flew Over The Cuckoo's Nest by Ken Kesey
 * Woman on the Edge of Time by Marge Piercy
 * The Catcher in the Rye by J. D. Salinger
 * The Curious Incident of the Dog in the Night-time by Mark Haddon
 * The Bell Jar by Sylvia Plath
 * Of Mice and Men by John Steinbeck
 * Girl, Interrupted by Susanna Kaysen
 * The Green Mile by Stephen King
 * She's Come Undone by Wally Lamb
 * Effie's Burning by Valerie Windsor

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

See List of films featuring mental illness.

Television
Many popular television shows feature characters with mental illness. Oftentimes these portrayals are inaccurate and reinforce existing stereotypes, thereby increasing stigma associated with mental illness. Common ways that television shows can generate misunderstanding and fear are by depicting the mentally ill as medically noncompliant, violent, and/or intellectually challenged. However, in recent years certain organizations have begun to advocate for accurate portrayals of mental illness in the media, and certain television shows have been applauded by mental health organizations for helping to dispel myths of mental illness. In 2005, the shows Huff, Monk, Scrubs and ER all won Voice Awards from the Substance Abuse and Mental Health Services Administration for their positive portrayal of people with mental illness. Neal Baer, executive producer of ER and Law & Order: Special Victims Unit also won a lifetime achievement award for his work in incorporating mental health issues into these two shows.

See List of Television Shows Featuring Mental Illness.

WikiBooks

 * Dysfunction section of the Neuroscience Book

Government sites

 * MentalHealthCommission.gov - 'Interim Report of the President's New Freedom Commission on Mental Health' (United States)
 * NIMH.NIH.gov - 'Working to improve mental health through biomedical research on mind, brain, and behavior', National Institute of Mental Health (United States)
 * NIMHE.org.uk - 'Responsible for supporting the implementation of positive change in mental health and mental health services', National Institute for Mental Health (United Kingdom)
 * NIMHE.org.uk - 'Joined up knowledge sharing for mental health service improvement', NIMH (UK)

History and professional specialties

 * CaSlater.freeservers.com - 'From Idiocy to Intellectual Impairment - 1000AD-2000AD: A history of people who have been described over the years as fools and intellectually impaired, mentally retarded and developmentally delayed, mentally handicapped and learning disabled' Catherine Slater, M.A.
 * EricDigests.org - 'Mental Health Counseling: Identity and Distinctiveness'
 * EricDigests.org - 'Mental Health and the Adult Refugee: The Role of the ESL Teacher'
 * EricDigests.org - 'Mental Health Counseling Assessment: Broadening One's Understanding of the Client and the Clients Presenting Concerns'
 * OhioU.edu - 'The History of Mental Illness' Ohio University, The Ridges
 * Plato.stanford.edu - 'Mental Illness', Stanford Encyclopedia of Philosophy

Media coverage

 * PublicIntegrity.org - 'Pushing Prescriptions: Drug Lobby Second to None: How the pharmaceutical industry gets its way in Washington', M. Asif Ismail (July 7, 2005)

Compiled mental health news and resources

 * NAMI.org - 'In The News', National Alliance for the Mentally Ill (NAMI California)
 * PsychCentral.com - 'Dr. Grohol's Psych Central Mental Health Symptoms, Treatments and Resources'
 * SeeMeScotland.org - 'Latest News and Events' (Scotland)

Online support groups

 * Psych Central - 'Psych Central's Self-Help Support Forums'
 * - 'India's Voice on Mental Health'

Stories of Recovery from Mental Illness

 * Recovery Stories - From MemoryWiki.