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Mental Health and Illness


* Mental illness as deviant behavior ... Chronic strains in the ... Public definitions of mental illness Most people who seek treatment for mental ... – PowerPoint PPT presentation

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Title: Mental Health and Illness

Mental Health and Illness
  • Overview of Approaches, Definitions, Perspectives

Continuous or discrete?
  • Continuous model
  • Mental Health Mental Illness
  • HealthygtgtgtgtAdjustment reactiongtgtgtgtNeurosisgtgtgtgtPsy
  • We all have differing degrees of mental health at
    different times in our lives. Most people arent
    at the extremes but fall somewhere in the middle.
  • Anyone can become mentally ill, given the right

Discrete model
  • Some people are mentally healthy others have
    specific mental disorders.
  • Decision trees can distinguish who has a
    specific mental disease and who doesnt.

Mentally Healthy
Mentally Ill
What is mental health?
  • In our society, a mentally healthy person
  • Has self-esteem, self-acceptance
  • Is realizing potential
  • Is able to maintain fulfilling relationships
  • Has a sense of psychological well-being
  • Has sense of autonomy
  • Has sense of competence, mastery, purpose
  • However, other cultures may have different ideas
    about what mental health is.

Who has mental health?
  • We all fall short to some extent.
  • Therefore, advocates of mental health believe
    that a broad range of mental health services
    should be available to general population, not
    just seriously mentally ill.
  • They believe that prevention and education, as
    well as treatment, are important.

What is mental illness?
  • Is it a disease, like diabetes or smallpox?
  • Is it a form of deviant behaviorlike being
    rebellious, choosing to dress differently, being
    extremely religious, being extremely creative?

The Medical Model and Concepts of Disease
  • When distress or inappropriate behavior is
    thought to be a consequence of a bodily
    dysfunction, it is called a disease. Mechanic,
    p. 14.
  • To diagnose diseases in physical medicine,
    doctors perform laboratory tests, do body
    imaging, take medical history, do physical
  • Once disease is diagnosed, doctor generally
  • Its cause
  • How disease is likely to run its course
  • What most appropriate treatment is

Are mental illnesses like other diseases?
  • Mental illnesses cannot be confirmed by objective
    laboratory tests or body imaging.
  • Diagnosis in mental illness does not lead to an
    understanding of cause, of the course of the
    illness, or of the most appropriate treatment.
  • Some (e.g., Thomas Szasz) have argued that mental
    illnesses are not diseases because of the above

Perspective of DSM
  • Mental disorders represent a clinically
    significant behavioral or psychological syndrome
    or pattern that occurs in an individual and that
    is associated with present distress (e.g., a
    painful symptom) or disability.
  • DSM tries to make psychiatric diagnoses more
    similar to medical diagnoses. Sees psychiatric
    symptoms as indicators of disease, not deviance.

  • Strength useful tool for practitioners,
    insurers, courts, agencies, since it allows for
    communication, offers consistent set of
  • Limitation However, it is purely descriptive,
    doesnt indicate causes, offers limited
    information about expected course of the disease,
    doesnt suggest appropriate treatment.

Major DSM-IV categories
  • Anxiety disorders
  • Somatoform disorders
  • Factitious disorders
  • Dissociative disorders
  • Sexual and gender identity disorders
  • Eating disorders
  • Sleep disorders
  • Impulse-control disorders not elsewhere
  • Adjustment disorders
  • Personality disorders
  • Other conditions that may be the focus of
    clinical attention
  • Disorders usually first diagnosed in infancy,
    childhood, or adolescence
  • Delirium, dementia, amnestic, and other cognitive
  • Mental disorders due to a general medical
    condition not elsewhere classified
  • Substance-related disorders
  • Schizophrenia and other psychotic disorders
  • Mood disorders

Sociological perspective
  • Mental disorders are type of deviant behavior,
    not a disease process.
  • Those who are seen as mentally ill are those who
    violate social rules, dont behave appropriately.
  • Individuals who become labeled as mentally ill
    are those not powerful enough to resist such

Mental illness as deviant behavior
  • Researchers who view mental illness as deviant
    behavior usually study processes and rules used
    to define mental illness rather than symptoms in
  • Szasz (1963, 1984)
  • Mental illness is not a disease, since there are
    no physical lesions that indicate it.
  • Calling people mentally ill denies concepts of
    free will and responsibility for ones actions.

Bad or mad?
  • Why do we call some deviant behaviors bad and
    some mad?
  • If there is self-interest involved, we are more
    likely to call the behavior bad.
  • Same behavior, different context, can be assigned
    different labelse.g., poor person who shoplifts
    is more likely to be considered bad, whereas a
    very wealthy person who shoplifts is likely to be
    seen as sick.
  • Why?

Assumptions behind bad or mad
  • Ambivalent ideas
  • Social and behavioral sciences are deterministic,
    assuming that behavior is determinedby prior
    events, social forces, biology
  • At the same time, we assume that individuals can
    distinguish between right and wrong and have
    free will and thus can be held responsible for
    their actions.

Definitions and labeling can be problematic
  • Not so much in voluntary treatmentif an
    individual seeks help from a mental health
    professional, then common goals can be identified
    and pursued.
  • If an individual is forced into treatment, then
    many ethical dilemmas can arise.

How can mental illness be measured?
  • Some researchers (sociologists, public health
    specialists, social workers) prefer to study how
    mental illness develops in communities, rather
    than its manifestations in those who are being
    treated for mental illness.

Terms useful in assessment of mental illness in
  • Epidemiology study of how illness is
    distributed in a population, rates of disease,
    who appears to be susceptible, in an attempt to
    identify causes and discover interventions
    (example of work of John Snow on cholera in
    London in 1854)
  • Morbidity prevalence of diseases in a
  • Comorbidity occurrence of more than one disease
    in the same individual

Terms (continued)
  • Prevalence How often the disease occurs
  • Point prevalence percentage of population
    affected with an illness at any given point in
  • Lifetime prevalence percentage of population
    ever affected with an illness
  • Incidence rate at which new cases appear within
    a given time period

Epidemiological studies of mental illness
  • 1st in USA Epidemiologic Catchment Area (ECA),
  • 2nd in USA National Comorbidity Study (NCS)
  • Also a number of studies of prevalence and types
    of mental illness in other cultures

Cross-cultural studies
  • What is normal in one culture is not necessarily
    normal in another
  • Therefore, measurement in cross-cultural studies
    is a real problem
  • This holds true in cross-national studies and in
    studies of diverse ethnic groups within nations

What causes mental illness?
  • No one really knows. Research so far is
  • Research is being carried out from diverse
  • Psychological
  • Biological
  • Sociological

Biological, developmental, or social?
  • Since human beings are both biological and social
    animals, it doesnt make sense to argue about
    what causes mental illness.
  • Causes are complex, involving some combination of
    biological vulnerability, environmental
    conditions, social stressors, social network and
    supports, psychological orientations, and learned

Possible psychological/ developmental causation
  • Psychological research into causes of mental
    illness examines individual personality (early
    development, cognitive styles, personal identity)
  • Perspectives
  • Psychoanalyticalearly developmental influences,
    such as child abuse/neglect, quality of parenting
  • Cognitive-behavioral/behavioralhow ways of
    thinking affect behavior, social learning
  • Phenomenological/existentialfocus on choice,
    responsibility, meaning
  • Family dynamicsfocus on family roles,
    communication patterns

Possible biological causation
  • Factors examined by researchers
  • Genetics
  • Neurochemisty
  • Viral causation

Possible environmental/social causation
  • Factors examined by researchers
  • Chronic strains in the environment
  • Poverty
  • Poor living conditions
  • Dangerous neighborhoods
  • Overwhelming role responsibilities
  • Negative life eventsstress and coping
  • Natural disasters
  • Unemployment
  • Adjusting to new environments and roles

Environmental/social causation (continued)
  • Another factor examined by researchers
  • Labeling
  • Social controlhow mental health diagnosis and
    treatment acts as an agent of social control
  • Relationship between social attitudes toward
    mental illness and the course of mental
    disorderseffects of stigma, discrimination, and
    social exclusion

Environmental/social causation (continued)
  • Collective mobilization
  • Notion that society produces disabilities by how
  • Defines persons with impairments
  • Limits access to community facilities and
  • Discriminates against them
  • Impairments can become either a major aspect or
    minor aspect of a persons identity, depending on
    how society and government respond to persons
    with impairments

Disease or problem in living?
  • Some problematic behaviors are given the status
    of disease in DSM
  • Alcohol abuse and dependence
  • Drug abuse
  • Conduct disorders in children
  • They may not really fit into the disease model
  • It may be more valid to consider them as problems
    in living

Public definitions of mental illness
  • Most people who seek treatment for mental
    disorders do so because they feel distressed.
  • Some people, however, feel they do not need help
    but are identified by others (e.g., family,
    friends, police, schools, employers). Evaluators
    have to make difficult judgments in such cases.

Role of values
  • Values of evaluator can influence judgments about
    individuals being evaluated. Evaluators notions
    of what is appropriate behavior are shaped by
    their culture and social context.
  • If an evaluator accepts the worldview of his/her
    society, then people with different worldviews
    can be seen as deviantmad or bad.

Value of the disease model
  • Disease model attempts to be objective and
    universal, avoiding value judgments about
  • Psychiatrists attempt to separate out symptoms
    from cultural content (e.g., schizophrenia).

DSM Decision Tree Mood Disorders