WHAT IS MENTAL ILLNESS?

1. WHAT IS MENTAL ILLNESS?

2. TWO TOPICS • DEFINITION OF MENTAL ILLNESS • NATURE OF SCHIZOPHRENIA

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?

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

7. 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. SCHIZOPHRENIA

8. 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.”

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

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

11. INTERNAL DYSFUNCTION • SOME PSYCHOLOGICAL SYSTEM (MOOD, FEAR, THOUGHT, EMOTION, ETC.) IS NOT FUNCTIONING PROPERLY - SOMETHING IS WRONG • WRONG CONTEXT OR TOO SEVERE OR TOO ENDURING • MANY CAUSES – BIOLOGICAL, PSYCH., SOCIAL – OF M.I.

12. 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.”

13. 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

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

15. TYPES OF MENTAL ILLNESS

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

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

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

20. A BEAUTIFUL MIND • JOHN NASH

21. SYMPTOMS • THOUGHT DISORDER

22. POSITIVE SYMPTOMS • THOUGHT INSERTION AND BROADCAST • LOOSE ASSOCIATION • HALLUCINATIONS • DELUSIONS – PARANOIA, GRANDIOSITY

23. Source: www.wheelmeon.org/schizophrenia.jpg1993

24. Source: http://www.wheelmeon.org/schizophrenia.jpg

25. NEGATIVE SYMPTOMS • FLAT AFFECT • LACK OF PLEASURE - ANHEDONIA • ISOLATION

26. DISABILITIES • POOR SOCIAL, FAMILY, AND WORK RELATIONSHIPS • SIDE EFFECTS OF MEDICATION • VIOLENCE WHEN IN PSYCHOTIC STATE • SOCIAL STIGMA

27. CAUSES • USED TO THINK BAD FAMILIES WERE CAUSE (SCHIZOPHRENOGENIC MOTHER) • NOW THOUGHT TO BE BRAIN DISORDER WITH GENETIC OR BIOLOGICAL CAUSE • ABOUT 1% PREVALENCE IN WIDE VARIETY OF TIMES AND PLACES

28. CORRELATES • LOW SOCIAL CLASS • CAUSE OR CONSEQUENCE? • NO SEX DIFFERENCES • NO ETHNIC DIFFERENCES • NO INTELLIGENCE DIFFERENCES • EARLY ONSET - 16-25 YEARS • ALMOST ALL NOT MARRIED

29. PROGNOSIS (COURSE) • USED TO THINK DEGENERATIVE • NOW THOUGHT TO BE VARIABLE • 1/3 CHRONIC; 1/3 EPISODIC; 1/3 RECOVER • HIGH RATE OF SUICIDE - 10%

30. TREATMENT • USED TO BE LONG STAYS IN MENTAL HOSPITALS • NOW BRIEF, EPISODIC HOSPITAL STAYS ALONG WITH COMMUNITY TREATMENT (OR NEGLECT) • MEDICATION SINCE 1950’S • PHENOTHIAZINES AND CLOZAPINE

31. TREATMENT • MEDICATION DOESN’T CURE, BUT CONTAINS - BUT MUST TAKE IT • PSYCHOSOCIAL TREATMENTS - SOCIAL AND JOB SKILLS, HOUSING • PSYCHOTHERAPY LESS CRITICAL • HARDEST TO TREAT - MICA (MENTALLY ILL CHEMICAL ABUSERS)

32. MAJOR PROBLEMS • INADEQUATE FUNDING FOR TREATMENT • MANY DON’T ADMIT THAT THEY ARE ILL - STOP TAKING MEDICATIONS • WHEN GET IN TROUBLE PUT IN JAILS AND PRISONS