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Mental Health and Illness

Overview of Approaches, Definitions,


Continuous or discrete?

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 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 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

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 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


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

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
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

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, dont behave
Individuals who become labeled as
mentally ill are those not powerful enough
to resist such labels.


Mental illness as deviant

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

Assumptions behind bad or

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

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


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


Terms useful in assessment of

mental illness in communities:

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):

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) 1990s
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


What causes mental illness?

No one really knows. Research so far is
Research is being carried out from diverse


Biological, developmental, or
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 behavior.


Possible psychological/
developmental causation:

Psychological research into causes of mental illness examines

individual personality (early development, cognitive styles,
personal identity)
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


Possible biological causation:

Factors examined by researchers:
Viral causation


Possible environmental/social
Factors examined by researchers:
Chronic strains in the environment

Poor living conditions
Dangerous neighborhoods
Overwhelming role responsibilities

Negative life eventsstress and coping

Natural disasters
Adjusting to new environments and roles


Environmental/social causation
Another factor examined by researchers:
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
Collective mobilization
Notion that society produces disabilities by how it:
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

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

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


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.,


DSM Decision Tree: Mood Disorders