Mental Health and Illness
Overview of Approaches, Definitions, Perspectives
Continuous or discrete?
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Continuous model:
Mental Health
Mental Illness
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Healthy>>>>Adjustment reaction>>>>Neurosis>>>>Psychosis
We all have differing degrees of mental health at different times in our lives. Most
people aren’t at the extremes but fall somewhere in the middle.
Anyone can become mentally ill, given the right circumstances.
Discrete model
Some people are mentally healthy; others have specific mental
disorders.
 “Decision trees” can distinguish who has a specific mental
disease and who doesn’t.
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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.
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What is mental illness?
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Is it a disease, like diabetes or smallpox?
Is it a form of deviant behavior—like being rebellious, choosing
to dress differently, being extremely religious, being extremely
creative?
The Medical Model and Concepts of Disease
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“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 examinations.
Once disease is diagnosed, doctor generally knows:
 Its cause
 How disease is likely to run its course
 What most appropriate treatment is
Are mental illnesses like other diseases?
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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 problems.
Perspective of DSM
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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.
DSM
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Strength: useful tool for practitioners, insurers, courts, agencies, since it
allows for communication, offers consistent set of definitions.
Limitation: However, it is purely descriptive, doesn’t indicate causes,
offers limited information about expected course of the disease, doesn’t
suggest appropriate treatment.
Major DSM-IV categories
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Disorders usually first diagnosed in infancy, childhood, or adolescence
Delirium, dementia, amnestic, and other cognitive disorders
Mental disorders due to a general medical condition not elsewhere classified
Substance-related disorders
Schizophrenia and other psychotic disorders
Mood disorders
Anxiety disorders
Somatoform disorders
Factitious disorders
Dissociative disorders
Sexual and gender identity disorders
Eating disorders
Sleep disorders
Impulse-control disorders not elsewhere classified
Adjustment disorders
Personality disorders
Other conditions that may be the focus of clinical attention
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, don’t behave appropriately.
 Individuals who become labeled as mentally ill are those not
powerful enough to resist such labels.
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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
individuals.
 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 one’s 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 labels—e.g.,
poor person who shoplifts is more likely to be considered “bad,” whereas
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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
determined—by 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 treatment—if 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.
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How can mental illness be measured?
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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
communities:
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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 population
Comorbidity: occurrence of more than one disease in the same individual
Terms (continued):
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Prevalence: How often the disease occurs
 Point prevalence: percentage of population affected with an
illness at any given point in time
 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), 1981
2nd in USA: National Comorbidity Study (NCS) 1990’s
 Also a number of studies of prevalence and types of mental
illness in other cultures
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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
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What causes mental illness?
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No one really knows. Research so far is inconclusive.
Research is being carried out from diverse perspectives:
 Psychological
 Biological
 Sociological
Biological, developmental, or social?
Since human beings are both biological and social animals, it
doesn’t 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
behavior.
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Possible psychological/ developmental
causation:
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Psychological research into causes of mental illness examines individual personality
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(early development, cognitive styles, personal identity)
Perspectives
 Psychoanal ytical—earl y developmental influences, such as child abuse/neglect,
quality of parenting
 Cognitive-behavioral/behavioral—how wa ys of thinking affect behavior, social
learning
 Phenomenological/existential—focus on choice, responsibility, meaning
 Family d ynamics—focus 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
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Poverty
Poor living conditions
Dangerous neighborhoods
Overwhelming role responsibilities
Negative life events—stress and coping
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Natural disasters
Unemployment
Adjusting to new environments and roles
Environmental/social causation (continued):
Another factor examined by researchers:
 Labeling
 Social control—how mental health diagnosis and treatment acts as an
agent of social control
 Relationship between social attitudes toward mental illness and the
course of mental disorders—effects of stigma, discrimination, and
social exclusion
Environmental/social causation (continued):
Collective mobilization
 Notion that society produces disabilities by how it:
 Defines persons with impairments
 Limits access to community facilities and employment
 Discriminates against them
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Impairments can become either a major aspect or minor aspect of a
person’s identity, depending on how society and government respond to
persons with impairments
Disease or problem in living?
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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.
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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 deviant—mad
or bad.
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Value of the disease model
Disease model attempts to be objective and universal, avoiding
value judgments about behaviors.
 Psychiatrists attempt to separate out symptoms from cultural
content (e.g., schizophrenia).
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DSM Decision Tree: Mood Disorders