Mental Health and Illness
Overview of Approaches, Definitions,
Perspectives
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Continuous or discrete?
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Continuous model:
Mental Health
Mental Illness
+++++++++++++++++++++++++++++
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.
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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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Mentally
Healthy
Mentally Ill
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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.
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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?
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?
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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
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 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.
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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.
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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.
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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
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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
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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.
13
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 a
very wealthy person who shoplifts is likely to be
seen as “sick.”
 Why?
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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.
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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.
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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
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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
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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?
No one really knows. Research so far is
inconclusive.
 Research is being carried out from diverse
perspectives:
 Psychological
 Biological
 Sociological
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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 (early development,
cognitive styles, personal identity)
Perspectives
 Psychoanalytical—early developmental influences,
such as child abuse/neglect, quality of parenting
 Cognitive-behavioral/behavioral—how ways of
thinking affect behavior, social learning
 Phenomenological/existential—focus on choice,
responsibility, meaning
 Family dynamics—focus on family roles,
communication patterns
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Possible biological causation:
Factors examined by researchers:
 Genetics
 Neurochemisty
 Viral causation
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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
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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
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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
 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
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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
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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
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