WHAT IS MENTAL ILLNESS?

1. WHAT IS MENTAL ILLNESS?

2. 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

3. WHY WANT DEFINITION OF MENTAL ILLNESS? • DISTINGUISH FROM NORMAL • INDICATE NEED FOR MENTAL HEALTH TREATMENT • WHAT CONDITIONS SHOULD BE REIMBURSED? • DETERMINE CRIMINAL LIABILITY - PUNISH OR TREAT?

4. DSM-IV DEFINITION (1) • “MENTAL DISORDER IS A CLINICALLY SIGNIFICANT BEHAVIORAL OR PSYCHOLOGICAL PATTERN THAT IS ASSOCIATED WITH PRESENT DISTRESS OR DISABILITY.”

5. DISTRESS OR DISABILITY • MUST HAVE EITHER DISTRESS (MENTAL PAIN) OR DISABILITY (LOSS OF FUNCTIONING) • EITHER MUST REALLY BOTHER PEOPLE - E.G. THINK LEFT STOVE ON • OR HAVE NEGATIVE IMPACT ON THEIR LIVES - E.G. ASPD

6. DSM (2) • “IN ADDITION, THIS PATTERN MUST NOT BE MERELY AN EXPECTABLE AND CULTURALLY SANCTIONED RESPONSE TO A PARTICULAR EVENT, FOR EXAMPLE, THE DEATH OF A LOVED ONE.”

7. NOT EXPECTABLE RESPONSE • BEREAVEMENT EXCLUSION • SYMPTOMS ARE NORMAL • ROMANTIC BREAKUPS • SOLDIER ENTERING COMBAT • SYMPTOMS THEMSELVES ARE NOT SUFFICIENT • MUST KNOW CONTEXT

8. DSM (3) • “WHATEVER ITS ORIGINAL CAUSE, IT MUST CURRENTLY BE A BEHAVIORAL, PSYCHOLOGICAL, OR BIOLOGICAL DYSFUNCTION IN THE INDIVIDUAL.”

9. INTERNAL DYSFUNCTION • SOME PSYCHOLOGICAL SYSTEM (MOOD, FEAR, THOUGHT, EMOTION, ETC.) IS NOT FUNCTIONING APPROPRIATELY - SOMETHING HAS GONE WRONG • MANY CAUSES – BIOLOGICAL, PSYCH., SOCIAL – OF M.I.

10. DSM (4) • “NEITHER DEVIANT BEHAVIOR (E.G. POLITICAL, RELIGIOUS, OR SEXUAL) NOR CONFLICTS BETWEEN THE INDIVIDUAL AND SOCIETY ARE MENTAL DISORDERS UNLESS THE DEVIANCE OR CONFLICT IS A SYMPTOM OF A DYSFUNCTION IN THE INDIVIDUAL.”

11. MENTAL DISORDER IS NOT DEVIANCE • DEVIANCE IS VIOLATION OF MORAL STANDARDS OR SOCIAL NORMS - BAD BEHAVIOR • PEOPLE WHO DRINK TOO MUCH, TAKE WRONG KIND OF DRUGS, OR STEAL, CHEAT, AND LIE NEED NOT BE MENTALLY ILL • DEVIANCE IS A CHOICE

12. DEVIANCE OR M.I.? • ONLY MENTAL DISORDER WHEN SOME MECHANISM IS UNABLE TO FUNCTION AS IT IS SUPPOSED TO • ALCOHOLIC OR ADDICT WHO CAN’T STOP DRINKING OR TAKING DRUGS • NOT JUST DEFIANCE OF RULES • VERY DIFFICULT TO DISTINGUISH

13. SUMMARY • MENTAL DISORDER IS HARMFUL INTERNAL DYSFUNCTION • CAUSES CAN BE PSYCHOLOGICAL, BIOLOGICAL, OR SOCIAL • DISTINGUISH FROM EXPECTABLE RESPONSES TO STRESSORS AND FROM SOCIAL DEVIANCE

14. MAJOR PROBLEM • DSM DEFINITION OF MENTAL DISORDER IS GOOD • DSM AND SURVEYS BASED ON IT DO NOT APPLY THE DEFINITION IN PRACTICE • VIEW ALL SYMPTOMS AS INDICATING DISORDER

16. TYPES OF MENTAL ILLNESS

17. PSYCHOSES • MOST SEVERE KIND OF M.I. • SCHIZOPHRENIA • BI-POLAR (MANIC DEPRESSION)

18. SCHIZOPHRENIA • PERHAPS MOST IMPORTANT MENTAL ILLNESS • CREATES STEREOTYPE OF MENTAL ILLNESS - CRAZY, NUTS, BIZARRE

20. IMPORTANCE • MOST ADMISSIONS AND RESIDENTS OF PUBLIC MENTAL HOSPITALS • CHRONICITY AND SEVERITY MEAN COSTLY AND DIFFICULT TO TREAT • PUBLIC POLICY - HOMELESSNESS, NOTORIOUS CRIMES • TREMENDOUS FAMILY BURDEN

21. SYMPTOMS • THOUGHT DISORDER • POSITIVE SYMPTOMS • THOUGHT INSERTION AND BROADCAST • LOOSE ASSOCIATION • HALLUCINATIONS - AUDITORY • DELUSIONS - PARANOIA, GRANDIOSITY