Mental illness

See also: Mental health

See also: Mentally healthy mind

Mental illness is a disease of the brain and mind. The afflictions prevent a person from functioning to varying extents. They are sometimes treatable with medications or drug therapy as well as psychotherapy and behavior therapy and other methods. Studying mental illness is a relatively new area for science because it was only a few hundred years ago when the dominant view was that people acting abnormally were possessed by demons. But this has been replaced by what is termed a medical model of mental illness which sees it as a potentially treatable illness rather than a supernatural phenomenon.

Overview

Generally, psychologists and biochemists and other scientists look at four key areas in assessing mental illness:

• Thinking or thought processes
• Mood or affects, that is, how someone feels, whether they're depressed, angry, fearful.
• Behavior, such as violence, compulsive behaviors such as gambling or drug abuse
• Physical signs such as joint pain, sweating, headaches and such.

(CC) Photo: Csaba Segesvári
Scientists can measure brain waves using instruments like this one, but assessing mental illness remains a difficult task. They study healthy students to try to develop benchmarks as well as conduct experiments.

Psychologists use a variety of intellectual criteria to try to diagnose mental illness, but determinations are not always exact, and some symptoms overlap with others. But the general criteria are these:

• Normative criterion. This is when a person does things which most people don't do; they think differently, act differently, behave differently. This doesn't mean they're necessarily mentally ill, but it can be a sign pointing in this direction. And it depends on the society which has the norms; for example, in the United States of America it's a norm of driving to use the right-hand side of the road; if a person drives on the left hand side, it's abnormal (and possibly fatal). But in United Kingdom it's normal to drive on the left.

• Subjective criterion. When a person feels abnormal or different or unwell or ill. This is a self-assessment.

• Maladaptive behavior. When a person does things or behaves in ways which don't help them survive or succeed in life, to varying extents.

• Behavior which is hard to explain or justify. A person walking down a busy city sidewalk singing loud may have some kind of mental problem or they may be practicing for an audition; in the latter case, there's a reason for the behavior which doesn't suggest mental illness.

According to the Diagnostic and Statistical Manual of the American Psychological Association, a mental illness is defined as:

A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g. painful symptoms) or disability (i.e. impairment in one or more areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.

Specific diseases

Here are several general categories of mental illness which encompass many diseases. Some patients have symptoms from several of these syndromes, and there can be considerable overlap.

Schizophrenia

Schizophrenia is a mental illness marked by a break from reality, which is characterized by such symptoms as: delusions, hallucinations, disorganized speech (in which a person can make nonsense sounds, interspersed with seemingly sensible speech), and behavior which is seen as extremely disorganized or catatonic (marked by immobility, lack of awareness, or not talking). It is a serious illness which can be life threatening, and possibly harmful to others, particularly if a person becomes violent or suicidal. It strikes about 1 in every 10,000 persons, and symptoms usually become more pronounced when during the late teens and early twenties, with symptoms become more full-blown when a person is in their middle to late twenties, with males generally showing signs somewhat earlier than females (although there have been cases when schizophrenia has been diagnosed in children or young teenagers, but research in this area is not definitive.) Sometimes it's marked by what's termed a flat effect, meaning a person doesn't show any signs of emotions or emotionality. Other symptoms include alosia (dull blocked thoughts) as well as avolition (showing no signs of motivation or interest in doing things.) People with this affliction have trouble in school, keeping a job, and have difficulties managing relationships with others, such as love affiliations with significant others. What causes it? It's uncertain, but some analyses suggest problems with brain chemistry and even malformed areas of the brain; there have been studies suggesting that too much criticism of a person may be a factor. Medication

Depression

Depression is extended sadness, that is, a sadness that lasts for days or even weeks, which doesn't go away. It's characterized by marked disinterest in activities in life or anhedonia, as well as difficulties in sleeping, excessive sleeping, feelings of worthlessness, excessive guilt, as well as trouble concentrating and focusing. Sometimes there is weight gain or weight loss or other changes in appetite, as well as repeated thoughts of death or suicide. Speculation about possible causes of depression include models from biology, particularly it may be the result of certain chemicals in the brain. In addition, possible causes include psychological, such as an experience of loss, such as losing one's beloved or having a close friend fall prey to disease or else moves away.

What causes depression? Scientists continue to explore several areas of investigation:

• The Object relations theory of depression, posited by psychologist Melanie Klein, suggested it was caused by an incomplete or unsuccessful process of child development in which there was too much guilt, shame, or problems regarding self-worth.

• Attachment theory suggests that depression may be related to a disrupted bonding process, in which an infant may have been abandoned (or when a caregiver shifts), and for some reason or other, doesn't learn to cope, and develops feelings of helplessness.

• A related perspective is termed learned helplessness in which experiences growing up, as a child, taught a person that striving and trying doesn't make sense, and may have been distinguished by lessons or events which suggested that the chances of success were impossible and that the odds were insurmountable.

Treatments, in many situations, are effective, and include:

• Medications such as Prozac and Paxil which are often sufficient in themselves to bring sufficient relief from the symptoms.

• Psychotherapy in either group or individual situations, sometimes in conjunction with medication, sometimes without.

• Some reports suggest physical activity and regular physical exercise will help keep the symptoms away.

Bipolar disorder

Bipolar disorder is marked by extreme mood shifts from mania to depression, and also has been termed manic-depression. The mania phase has a mood of elation, sometimes irritability, with a decreased need for sleep, racing thoughts, and sometimes an extreme need and pressure to talk, with boosted levels of energy and possibly excessive engagement in pleasurable activities (such as gambling, spending sprees, or sexual excursions. These episodes can be very disruptive and can be intensified by stress. But then the mood can shift to a mood of dour depression, sometimes within the span of an hour, and is marked by being tired, lack of interest, and the other signs of depression.

Scientists speculate that the cause of bipolar disorder is rooted in chemistry. Treatments are with drugs such as mood stabilizers, including Lithium and Depakote.

Anxiety

Anxiety is marked by stress, excessive worry, and nervousness. There are different types:

• Generalized anxiety disorder is anxiety manifest in different ways throughout a person's life.

• Posttraumatic stress disorder, which is when an extremely traumatic event or episode (such as being in a war and returning home) or being the victim of a violent attack, can have lasting repercussions after the event is over.

• Paranoia is extreme fear with the general sense that other people are out to get you. Generally, it's an irrational fear, provoked perhaps by perceptions that are misinterpreted or exaggerated, and a person suffers a delusion that another person or organization intends harm when it's not the case.

• Obsessive-compulsive disorder also known as OCD are compulsions, usually anxiety-based, such as excessive and repeated hand-washing to prevent an irrational fear of germs. It's marked by compulsive thoughts and behaviors.

• Panic attack is a "discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within ten minutes:

• palpitations
• sweating or trembling or shaking
• shortness of breath, feeling of choking, chest pain
• nausea, dizziness, light-headedness
• fear of losing control or going crazy or dying
• numbness, tingling, chills, hot flashes

There are specific types of anxiety as well, such as a fear of heights acrophobia, crowds (including packed elevators or even driving in dense traffic) called agorophobia, closed spaces such as closets or crowded subway cars or claustrophobia, night or nyctophobia, germ contamination or mysophobia, or animals or specific animals or zoophobia. One listing suggests there are several hundred types of specific anxieties (with a specific word for each type.)

There is research speculating into what causes certain panic disorders:

• Biopsychosocial approach (proposed by David Barlow) suggests its' an overreactive fear response within the brain under stress.
• Cognitive model by Beck, Emery, Greenberg (1985) sees it as a vicious cycle in which initial misattribution of normal body sensations cause increased fear, which in turn exacerbates the initial bodily symptoms even further. Drugs can be given to aid relaxation, such as tricyclics which are antidepressant medications, and benzodiazapines as well.

Anxiety has been treated using various behavior therapys, such as Rogerian therapy, which utilizes the principle of cognitive dissonance proposed by psychologist Leon Festinger. The idea is that the mind can not have two entirely different ideas at the same time; if it tries to have two opposing ideas at once, this creates a kind of dissonance or disharmony, which is like mental motivation to somehow resolve the conflict. Accordingly, if a person is afraid of bees, for example, he or she can't keep the idea of a bee crawling on the skin and the idea of relaxing by a waterfall in the head at the same time. The person will either be highly tense or relaxed but can't have both reactions at the same time, since one response has to give. Accordingly, in Rogerian therapy, a therapist will ask a patient to create a list of anxiety-producing thoughts ranked from least scary to most scary (example: least scary: the word "bee" in a magazine" slightly more scary: bee buzzing near a window ... scariest: getting stung by 27 bees) and then, with a stepwise procedure beginning with the least scary thought, try to get a patient to think that thought while staying relaxed.

In psychotherapy, a general course of counseling is to try to turn what if thinking, into so what thinking, and to help patients understand the difference between rational and irrational fears.

Other areas

Scientists are learning more about how the brain works, including its internal wiring or circuitry, and studying how brain chemistry interacts with tissue and how it processes ideas. By applying magnetic resonance imaging with statistical analysis, it's possible to use noninvasive techniques to measure sections of the brain in terms of volume and mass in an emerging rapidly-changing discipline called brain morphometry, and perhaps new findings will bring new understanding to the wide range of mental illnesses, as well as new and more effective treatments.