Chapter 8 – Mental Disorder

Mental Disorder

• Mental disorders are to be taken seriously and must be looked into getting a cure for.
• Millions of Americans suffer from bipolar disorder in our society.
• About half of all adult Americans have experienced at least one episode of psychiatric disorder during their lifetime.
• Mild depression is so prevalent that it has been called “the common cold of mental illness” 

Popular Belief

• The mentally ill are believed to be extremely weird.
  
  • most patients are like us, “much more simply human than otherwise”
  • the flamboyant symptoms of hallucinations and delusions are not the most important characteristics of their disorder
  • the less demonstrative symptoms of apathy and inertia constitute the core of schizophrenia.
•  Mental illness is hopeless or incurable
  • the majority (some 70 to 80 percent) of hospitalized mental patients can recover and live normal lives if their treatment has been adequate and received in time.
  • According to studies in the United States and Europe, about half of all schizophrenics spontaneously get better over the course of 20 years, and professional treatment with support from family and friends further makes the recovery easier and faster
• There is a sharp, clear distinction between “mentally ill” and “mentally healthy.”
  • This is not only because the behavior of different individuals ranges by imperceptible degrees from normal to abnormal, but also because an individual may shift at different times to different positions along that range, appearing normal at one time and abnormal at another.
• The mentally ill are mostly crazed or violent, as often portrayed in news media, movies, and television programs.
  • the great majority (about 90 percent) of mental patients are not prone to violence and criminality.
  • They are more likely to engage in behavior harmful to themselves rather than to others.
  • Most significant, they are six or seven times more likely than other citizens to become victims of homicide
• Midwinter depression, which psychiatrists may call SAD (seasonal affective disorder).
  • people assume that we are likely to become depressed in the middle of winter because of its coldness and lack of sunshine.
  • The summer is more likely to give us the blues because we spend less time with our loved ones than we do in the winter.
• Antidepressant drugs such as Prozac, Zoloft, Paxil, and Wellbutrin can cure depression.
  • Research has indeed shown that most (about 75 percent) of the patients who take these drugs recover from their depression. But it is not the drugs themselves that lift the depression in those patients.
  • The patient’s’ belief that the drugs will cure them that gets rid of their depression. 
• Popular belief is that there is an epidemic of autism— characterized by serious problems with language and social bonding—among American children.
  • Broader definition that includes many more children with mild symptoms who would not be considered autistic in the past.

Types of Mental Disorder

• Traditional Classification
  • Organic Disorder is caused by damage to the brain. Brain damage can be originated from a tumor, head injury, viral meningitis, brain syphilis, lead poisoning, deterioration from old age, drug abuse or other acute physical damage.
  • Functional Disorder is caused by psychological and social factors. Those factors can be unpleasant childhood experiences, interpersonal conflict or social stress. Functional disorder can be further divided into three major categories.
    • Three major Functional Disorders categories are:
      • Psychotic Disorder – losing touch with reality
      • Neurotic Disorder- inability to face reality.
      • Personality Disorder – too self-absorbed, unsociable or antisocial.
    • Since functional disorder is divided into three major categories it hold more detail than organic mental disorder. When comparing all three categories psychosis is more serious than neurosis and personality/ character disorder.

Psychosis

• Psychotic Disorder is when you lose touch with reality. With that being said if someone has psychotic disorder they cannot attend school or work or do other things that normal people do. There are many types of psychosis but in our chapter we only discuss two major ones, Schizophrenia and Manic-depressive Disorder.
  • Schizophrenia is the most common type of psychosis. Schizophrenics think and talk in unconventionally, illogical or ambiguous ways. For example, they can say “ My body is a bottle.” They also express emotions inappropriately. When hearing sad news they can express themselves by laughing or crying for happy news. Schizophrenics also withdraw themselves from their surroundings. They could be surrounded by people and  yet be in their own thoughts and become totally unresponsive. When they withdraw themselves it could be because of hallucinations and delusions, where they think they hear voices or they think of themselves as the president.
  • Manic- Depressive Disorder is also known as Bipolar disorder. Those who have bipolar disorder fluctuate between two opposite extremes of mood. One extreme, called mania and the other depression. Mania is characterized by great elation, exuberance, confidence or excitement. When in this mood people are constantly making jokes and laughing. After the mania phase comes the depression which is the complete opposite. At this state the victims feel an overwhelming despair, experience the delusion of worthlessness, and think of committing suicide. At this stage they don’t have the desire to eat, talk and move, they mostly sleep and cry.

Neurosis

• Neurosis is less severe that psychosis. They appear normal and do most of the things that normal people do. For example, staying in job and keeping a job. The only problem is that neurotic symptoms present human beings from being as happy as they want to be. There are various types of neurosis each described by certain syndromes.
  • Anxiety reaction- Many of us experience anxiety which is a form of nervousness. It could be before a test or a speech. However, those examples are not severe. The anxiety that attacks the neurotic is more serious. For example, an employee gets up to leave from work and suddenly they can’t breathe, felt dizzy and thought they were dying. As time passes the panic subsided and the employee felt better and was able to make their way home.
    • Phobia-
      • With anxiety, phobia can play a big part of it. If identified that the victim has fear from a certain object then that indicates they have Phobia. Phobia neurotics may have extreme, unreasonable fear of animals (zoophobia), fear of heights (acrophobia), fear of closed spaces (claustrophobia) etc.
      • Social Phobia- brought on by the presence of other people. The way that neurotics tie in with social phobia is that when one has social phobia cannot speak before an audience, eat in restaurants or write their names when someone else is around.
    • Obsession and Compulsion-
      • Obsession involves some inconvenient idea that keeps interrupting ones train of thought.
      • Compulsion involves ritualistic action that neurotics feel they must perform.
    • Depressive reaction-
      • Is distinguishable from psychotic depression. The milder neurotic depression is identified by the feeling of sadness, dejection and self- deprecation. This can go on for weeks or even months and if it doesn’t then it becomes more psychotic depression.
    • Psychophysiological disorder-
      • Psychophysiological disorder also known as psychosomatic illness.
      • Symptoms range from minor to severe, headaches ulcers, amnesia and paralysis.

Personality Disorder

• Personality disorder is a general category for all sorts of mental disorders that psychiatrist cannot diagnose as either psychotic or neurotic. Also known as character disorder or sociopathic disorder. An individual who is identified with personality disorder has the prominent blatant disregard for society’s rules. One thought of cause is lack of moral development, failure to develop conscience, failure to acquire true compassion or failure to learn how to form meaningful relationship. Example of people who can have personality disorder is con men, dope pushers, pimps, criminals, unprincipled business people, shyster lawyers, quack doctors and crooked politicians.

The DSM-IV Classification

• Over 300 hundred mental disorders can be found in the DSM-IV ( Diagnostic and Statistical Manual Of Mental Disorders, Fourth  Edition).
• In this classification you will be able to find the disorder and a list of symptoms that they have.
• For example, panic disorder is defined as having the following symptoms: shortness of breath or smothering sensations, dizziness, unsteady feelings or faintness, etc.

Social Factors in Mental Disorder

• Studies suggest that mental health is influenced by the following social factors:  
• Social Class: Individuals of lower class are more likely to be mentally ill. The fact that Americans of lower class suffer from psychiatric symptoms has caused two  conflicting ideologies: 
  • Social Causation: This ideology states that individuals of lower class are more likely to suffer from mental disorders because they are more likely to deal with stressors, such as financial burdens, martial difficulties, infectious disease, neurological impairments, lack of proper medical care, lack of social support and coping abilities.  
  • Social Drift: This ideology suggests that those individuals who are of      higher class and do suffer from mental illness, eventually fall on the lower end of the socioeconomic ladder; thus, low class position is in fact a consequence of mental illness.  
• Gender: Sociologists have had difficulty finding what gender is more likely to suffer from mental illness, as some studies suggest that men are more likely, while other studies suggest that women are more likely. However, studies have found that there are differences between men and women.  
  • Women are more likely to suffer from the following mental disorders:
    • Depression
    • Anxiety Attacks
    • Posttraumatic Stress Disorder
  • Explanation: Sociologists suggest that the reason women are more likely to suffer from disorders like depression and anxiety is due to gender roles. Society has conditioned women to be relatively restrictive and oppressed. Women tend to internalize their problems and not be expressive about what they feel; thus, causing problems like depression and anxiety attacks. Also, women have been taught to value emotional connections to others, while men have been taught to be dismissive and emotionally unavailable.   
  • Men are more likely to suffer from the following mental disorders:
    • Antisocial Personality
    • Paranoia  
    • Drug Abuse  
    • Alcohol Abuse
  • Explanation: As opposed to the female role, the male role has conditioned men to be aggressive, expressive, and assertive. Therefore, if a male is frustrated, it is socially acceptable to lash out in anger and express his feelings—which comes across as antisocial and paranoid.
• Young Age: Studies from the 1980’s suggest that senior citizens were more likely to suffer from mental illness, due to their declining health and lack of importance in society. However, newer studies from the 1980’s and 1990’s show that this was in fact not true and that seniors are the least likely of all age groups to suffer from mental illness.
  • According to a national survey published in 1994, individuals between the ages of 25-34 are the most likely to suffer from mental illness.  
  • A study conducted by Cross-National Collaborative Group (1992) found that over the last several decades, the younger generations have a high increase in major depression.
  • Individuals born before 1955 in countries like the United States, Taiwan, Lebanon and New Zealand are three times more likely than their grandparents to suffer from depressive disorders.  
  • 6% of Americans born before 1955 have become severely depressed by age 24.  
  • Explanation: The reason younger individuals are more likely to be depressed is due to changes in modern society. The younger generation is more likely to deal social stressors attributed to financial burden, and family problems like divorce, child abuse, parental differences and children’s needs for love and support.
•  A Social Profile of Depressed Teens
  • There are three types of depression:  
    • Mild Depression: When you feel slightly sad over ordinary, everyday disappointments.  
    • Situational Depression: Being extremely sad due to a tragic event, like the death of a loved one, losing a job or going through a breakup/divorce. This type of depression is heavy but the individual eventually manages to surpass it.  
    • Major Depression: This is the most serious type of depression and it involves a kind of extreme, unexplained, excessive sadness.  
  • 8% of U.S teens suffer from major depression
  • About half of teens will become depressed again after 5 years, even if they have the depression treated the first time around.  
  • In 2003, 40% of American college students said that they felt severely depressed at least once during the year.  
  • Explanation: The problems are likely caused by family problems like parental divorce, child sexual abuse, academic stressors, and difficulty fitting in with peers.
• Race and Ethnicity:
  • Studies suggest that American Blacks, Hispanics and Asians experience more psychiatric distress than whites due to social stressors stemmed from discrimination, poverty and cultural conflict.
  • However, there have been other studies that suggest that there is no difference between minorities and whites. A reason for this may be that minorities are protected by their strong social networks and community integration.  
  • The same explanation can be given for Great Britain’s minorities, Pakistanis and Indians. Even though these minorities are the most isolated, they are the least vulnerable to psychological disorders.  
  • Puerto Ricans and African Americans are more likely than Irish and Jewish Americans to have sociopathic disorders.  
  • African Americans are more likely to show paranoid disorders.  
  • Jewish Americans are more likely to show depressive disorders.
  • Korean Americans are more likely to show depressive symptoms than whites.  
• Urban Environment
  • Surveys in the U.S and Netherlands indicate that individuals in urban environments, particularly in inner cities, show higher rates of depression.
  • This is due to traffic congestions, excessive noise, population density, tenuous social relations, loneliness and lack of social support that individuals from urban areas experience.  
  • Urban residents exhibit higher levels of neurotic and personality disorders, while more severe psychotic conditions like severe depression are more prevalent among rural and small-town residents.  This is due to the fact that small town residents live more restricted lives, as they cannot express frustration and anger amongst their peers.
• PTSD: An Impact of War:
  
  • Posttraumatic Stress Disorder is a mental illness that causes alcohol and drug abuse, emotional numbness, rage, major depression, nightmares and in some cases suicide or homicide.  
  • 20% of military service members return home with symptoms of PTSD.
  • Less than half seek treatment  
  • Mark Waddle, a Navy commander suffered from PTSD. This caused him to sleep with a gun under his pillow, strangle his wife during a nightmare, burst out in range due to loud noise and have severe night sweats. Fortunately, he received proper treatment which included drugs and psychological therapy.  

A Global Perspective on Metal Disorder

• The incidence of mental disorder is generally higher in modern industrial societies such as the United States and France than in traditional agricultural societies such as China and Nigeria. A major reason is the culture of individualism and competitiveness in modern societies, where individuals with personal problems often have to fend for themselves, doing without the relatives and friends who are more readily available to offer support in group-oriented, traditional societies. The United States, being presumably the world’s most individualistic and competitive society, has the world’s highest incidence of mental disorder.
• Some types of mental disorder appear in certain societies but never or rarely in others.
• In Latin America, some people are tormented by susto, the pathological fear that their souls have left their bodies.
• In Malaysia, some people suffer from latah, known in the West as hyper startle syndrome, which makes the victim scream, swear, or gesture for a prolonged period when startled by something like a loud noise or a snake.
• In the United States, some women are afflicted with anorexia nervosa, the extreme fear of weight gain, which is rarely or never found in third world societies.
• The symptoms of a given mental disorder may also mirror the culture in which they take place. Depression is more likely to show itself as a physical illness in developing countries than in the United States and other Western societies. This is because in the culture of developing countries it is shameful to admit to emotional distress.
• In the United States, people suffering from obsessive-compulsive disorder (the compulsion to perform a task repeatedly) usually wash their hands over and over, because concern with cleanliness and health is widely considered important in U.S. culture.
• In Bali, Indonesia, one common symptom of the compulsive disorder is the uncontrollable urge to collect information about people. A Balinese man with the disorder would find out the name of every person who passes by his house, so that he could treat even strangers like friends. This is of great importance in Balinese society, famous for its extreme friendliness to everybody.
• In short, there are some differences between societies in the incidence, types, and symptoms of mental disorder. But there are also similarities. Virtually everywhere, women are more likely than men to suffer from anxiety and depression, men are more likely to have alcohol disorders, and young people are more likely than older ones to have mental disorders.

Perspectives on Mental Disorder

• There are three ways of looking at mental disorders by the medical, psychological and labeling models. The first two are from the positivist perspective and the third is from the constructionist perspective. 
• The Medical Model
  
  • Mental illness is similar to a physical disease and should be treated as a physical disease. Mental illness is impacted from a chemical imbalance of the brain. Mental illness has to be cause by a psychosocial disorder such as emotional conflict or social stress.
• The Psychosocial Model
  • Psychoanalytic Theory- Psychoanalytic theory is from a mental disorder to some unresolved psychic or emotional conflict in the patient.
  • Social Stress Theory-Is a major factor to the development of mental illness.
• The Labeling Model
• Mental illness as a myth- Psychiatrist Thomas Szasz (1974b,1994) has criticized the medical model for assuming that mental illness is a real body disease.
• The impact of Labeling- Sociologist Thomas Scheff (1966) describes mental illness as rule breaking because it has rule violations that society does not define as rule breaking.
• Insanity as Supersanity- British psychiatrist R.D. Lasing )1967) defines mental illness as invalid, unreal and false from other people’s normal experiences.
• Criticisms of the labeling model- Number of sociologist have criticized the labeling model.
• Scheff argue that labeling only victimizes the individual.

 Perspectives on Mental Disorder

• Mental disorders can be viewed from three different perspectives.  These perspectives are through the medical, psychosocial, and labeling models.
• Medical Model
  
  • The Medical Model is derived from the positivist perspective and has been taking over since the 1970s.
  • The positivist perspective means that mental illness is viewed as a “disease with biological origin.
  • From this perspective, whoever treats the mental illness does so using methods such as drugs or surgery.
  • This model uses two forms of evidence in order to prove it’s perspective on mental disorders which are the study of genetically related individuals, and the successful treatment of mental patients with antipsychotic and antidepressant drugs.
  • The evidence found among genetically related individuals stated that if one twin suffers from depression, there is a 78% that the other twin will suffer from depression as well.
  • The drug related form of evidence proved that using drugs to treat mental illness such as depression and schizophrenia, was proven to be relatively effective, which means that the drugs healed the patients in at least two-thirds to three-quarters of mental illness cases.
  • These two forms of evidence, however, are not considered completely accurate because both twins would have the illness no matter what if it was determined by genetics, and drugs would completely fix the mental illness if it were simply a mental disorder caused by chemical imbalance.
• The Psychosocial Model
  • This model is also derived from the positivist perspective, just as the Medical Model.
  • This model contains two theories, which are the psychoanalytic theory, and the social stress theory.
  • The psychoanalytic theory was presented by Sigmund Freud a century ago.
  • This theory describes mental disorder as being brought up by some unresolved psychic or emotional conflict endured by the patient.
  • Freud states that human personalities are made up of 3 parts: the id, the ego, and the superego.
  • The id has a strong desire for pleasure without considering morals.
  • The ego is the more rational and logical personality, and puts limits on what the id can do.
  • The superego is considered the “conscience”.
  • The ego’s goal is to resolve conflict between the animalistic nature of the id, and the conscience, or superego.
  • If the conflict cannot be resolved, this is what brings about mental illness, due to the repression of the conflict.
  • Freud’s suggestion is that the “bringing out” of the conflict will help control the illness.
  • The social stress theory has been studied in regards to mental illness since the 1980s.
  • 20-40 percent of people who experience a life crisis fail to recover from depression or psychiatric illness.
  • It is believed that mental illness can be prevented through proper coping methods including social support, personal skill, and high self esteem.
• The Labeling Model
  
  • This model comes from the constructionist perspective, and mental disorder is not seen as a sickness in this model, but as something labeled by others based on disturbing behavior.
  • Psychiatrist Thomas Szasz stated that those who call mental illness a disease are masking the nature of the behavior by simply calling it a sickness.  
  • Szasz defines mental illness not as a medical condition, but one that develops socially and morally.
  • Thomas Scheff, a sociologist, defines mental illness as “residual rule breaking”, due to the fact that their behavior isn’t bad enough to be defined as law breaking, but it is still considered wrong.
  • Scheff believes that labeling a person as mentally ill is the number one way a person can become a chronic mental patient, being that they are being forced into labeling themselves as mentally ill, which can lead to confusion and anxiety.
  • British psychiatrist R.D Laing views mental illness as a myth, along with the prior names mentioned, but instead accuses other psychiatrists of not believing the mental illnesses experienced by patients are legitimate.   
  • Laing also states that psychiatrists don’t know the nature of space and time, meaning that mentally ill people are “inner-oriented”, which means that have inner experiences that others, including the psychiatrists, cannot see.
  • Laing did not use drugs to treat his mental patients, but instead allowed them to roam freely to experience their “inner-oriented” mental illnesses so that they could be treated accordingly.
  • A large amount of criticism revolves around the Labeling Model from people including John Clausen, Carol Huffine and Walter Grove.
  • The big argument made is that the Labeling Theory simply defines mental illness as a myth, and that there is not enough evidence to state that it is not caused by medical issues.
• Overall, the perspective on mental illness varies.  Some state that it is medically caused, while others state that it is social and environmental.  Although the perspectives are different, all do recognize that some form of mental illness exists, it’s just a matter of why, and how it came about.