CHANGING CONCEPTIONS OF MENTAL ILLNESS

1. CHANGING CONCEPTIONS OF MENTAL ILLNESS

2. CONCEPTIONS OF MENTAL ILLNESS • HOW VIEWS OF MENTAL ILLNESS HAVE CHANGED OVER TIME • CURRENT CONCEPTIONS OF MENTAL ILLNESS • WHERE DRAW THE LINE BETWEEN MENTAL ILLNESS AND NORMALITY?

3. PRE 20TH CENTURY

4. PRE-20TH CENTURY • MENTAL ILLNESS IS UNIVERSAL • MENTAL ILLNESS LIMITED TO SMALL NUMBER OF MOST SERIOUS CONDITIONS • MENTALLY ILL HIGHLY STIGMATIZED

6. CAUSES • NOT MUCH KNOWN • SUPERNATURAL • BRAIN DISEASE

7. EARLY TREATMENT • PRE-19TH CENTURY - LEFT TO FEND FOR SELVES • NO OUTPATIENT TREATMENT • 19TH CENTURY - SHUT AWAY IN INSTITUTIONS

9. PRE-20TH CENTURY • LIMITED TO SMALL NUMBER OF SEVERE CONDITIONS • MENTALLY ILL BIZARRE AND DIFFERENT • CAUSES UNKNOWN • INSTITUTIONALIZED

10. 1900 - 1980

11. 20th CENTURY VIEWS • FIRST PSYCHIATRIC MANUAL AT BEGINNING OF 20TH CENTURY – 19 OF 20 CONDITIONS PSYCHOTIC • DSM NOW - NEARLY 400 DIFFERENT MENTAL ILLNESSES • TREMENDOUS BROADENING OF CONDITIONS VIEWED AS MENTAL ILLNESSES

12. EXPANSION OF M.I. • SIGMUND FREUD • EVERYONE TO SOME EXTENT IS M.I. • IDEAS BEGAN TO EXPAND THROUGH THE CULTURE - MOVIES, BOOKS, PROFESSIONS

13. RESPONSE • OUTPATIENT TREATMENT IN COMMUNITY • PSYCHOTHERAPY • FOR MOST PART, LIMITED TO ELITE

14. CURRENT CONCEPTIONS

15. CURRENT CONCEPTIONS • BEGAN WITH DSM-III (1980) • NOT JUST MOST SEVERE CONDITIONS BUT MANY DIFFERENT CONDITIONS

17. M.I. WIDESPREAD • NO LONGER SEEN AS UNUSUAL BUT MANY PEOPLE AFFECTED BY THEM • 50 PERCENT OF POPULATION OVER LIFETIME; 20 PERCENT IN ANY GIVEN YEAR

19. NORMALIZATION • MENTALLY ILL NOT SEEN AS DIFFERENT FROM NORMAL • MENTALLY ILL NOT CERTAIN KIND OF PERSON BUT NORMAL PERSON WITH PARTICULAR DISEASE

22. MEDICALIZATION • NORMAL PEOPLE HAVE MEDICAL CONDITION • TREATED BY PROFESSIONALS

24. BIOLOGICAL CAUSES • MENTAL ILLNESSES VIEWED AS BRAIN DISEASES • GENETICS AND BRAIN CHEMISTRY AT FAULT

27. TREATMENT • SSRI - SELECTIVE SEROTONIN REUPTAKE INHIBITORS - “ANTI-DEPRESSANTS” • HUGE INCREASE IN DRUG TREATMENT - 60 MILLION SCRIPTS • 3 OF 7 MOST PRESCRIBED DRUGS

30. THERAPEUTIC CULTURE • MANY BEHAVIORS MEDICALIZED • MENTAL ILLNESS IS COMMON • MENTALLY ILL NOT DIFFERENT • RISING NUMBERS OF PEOPLE IN TREATMENT AND OF MENTAL HEALTH PROFESSIONALS

31. RATES OF TREATMENT

32. M.H. PROFS. 1980-2000

33. SUMMARY OF TRENDS • FROM ONLY SERIOUS TO MANY CONDITIONS • FROM RARE TO WIDESPREAD • FROM STIGMATIZED TO MEDICALIZED • FROM UNKNOWN CAUSES TO PRESUMED BIOLOGICAL

34. SUMMARY OF TRENDS • FROM INSTITUTIONS TO OUTPATIENT THERAPY TO DRUGS • FROM SEGREGATION TO PART OF CULTURE

35. WHERE DRAW THE LINE? • ARE TOO MANY CONDITIONS MEDICALIZED NOW? • HOW CAN WE SEPARATE WHAT’S M.I. FROM WHAT’S NORMAL?

36. SOPRANOS • BEHAVIORS VIEWED AS DISEASES • CHANGE OVER TIME FROM ROWDY TO SICK • CONFLICT WITH MUCH LAY CULTURE • RISE OF M.H. PROFESSIONALS • TREATMENT NOT PUNISHMENT