mental illness exam 1

Mental Health

A state of well-being involving the ability to cope with stress, work productively, and contribute to the community. Definitions may be too ambitious, circular, or dichotomous.

What is "Normal"?

"Normal" is often defined by statistical averages (bell curve), lab test results, and social or cultural norms—each with limitations.

Mental Illness

A condition involving significant disturbance in cognition, emotion, or behavior, often debated as being "real" or a social construct.

Reality of Mental Illness

Controversial; depends on how we define it and who decides its criteria—clinicians, institutions, or society.

American Psychiatric Association (APA) Definition of Mental Illness

A syndrome causing clinically significant disturbance in cognition, emotional regulation, or behavior, reflecting dysfunction in psychological, biological, or developmental processes.

Key Features of APA Definition

Results in subjective distress or functional impairment

Must not be a culturally appropriate response, simple deviance, or political conflict

Not Considered Mental Illness (APA)

Expected or culturally appropriate responses (e.g., grief)

Simple deviance from norms

Personal or political conflict

Problems with Defining Mental Illness

Atheoretical and merely descriptive

Arbitrary health-illness thresholds

Overly broad definitions leading to overdiagnosis

Continuum Model

Mental health and illness exist on a spectrum; distinctions like "mildly ill" vs. "probably well" can be unclear.

Sensitivity vs. Specificity

Tension between identifying all cases (sensitivity) and avoiding false positives (specificity); too much sensitivity leads to overdiagnosis.

Diagnostic Inflation

Expanding diagnostic categories to include normal stress or mild issues, increasing the number of people labeled as mentally ill.

The "Worried Well"

People who are not truly ill but still receive diagnoses or treatment—often due to overly broad definitions.

Political, Value, and Financial Influences

Mental illness diagnoses can be shaped by societal values, politics, or profit motives (e.g., "disease mongering").

Example of Political Diagnosis

Drapetomania - a historical "diagnosis" used to pathologize enslaved people's desire for freedom, showing how psychiatry can be misused.

Resilience and Homeostasis

Humans have natural resilience; our minds and bodies often return to balance (homeostasis) after stress.

When to Diagnose Mental Illness

Only when symptoms are clear-cut, severe, and not resolving on their own.

Healthy Responses to Everyday Problems Instead of rushing to diagnose, it's better to:

Wait it out

Make life changes

Seek social support

Use coping strategies (e.g., hobbies, exercise, prayer, meditation)

Prevalence of Mental Illness (NIMH, 2019)

In 2019, 51.5 million Americans (20.6%) were reported to have a mental illness.

Most Commonly Diagnosed Mental Disorders

Anxiety, depression, bipolar disorder, OCD, panic disorder, and PTSD.

Rising Mental Health Issues in Youth

Depression and anxiety increased by 52% in adolescents (2005-2017)

Increased by 63% in young adults (2009-2017)

Is There a Mental Health Crisis in the U.S.? - YES Arguments

Rising prevalence of diagnoses

Poll data showing concern

Overburdened mental health care systems

Increased "deaths of despair" (e.g., suicide, overdose)

High treatment demand

Is There a Mental Health Crisis in the U.S.? - NO Arguments

Better awareness and education

Reduced stigma

More help-seeking behavior

Improved reporting

Diagnostic inflation (more people being labeled with disorders)

Possible Causes for Increasing Mental Illness Rates

Social media use

Smaller families and changing dynamics

Loss of community and increased isolation

COVID-19 pandemic effects

Political and social polarization

More flexible identities and life paths (leading to stress or uncertainty)

Groups Reporting Higher Mental Health Issues

Adults under 30

Low-income individuals

LGBT+ population

Women (especially with depression)

Women and Mental Health: Why Higher Rates?

Hormonal differences (estrogen vs. testosterone)

Socialized to "act in" (internalize problems)

Less stigma for reporting

Oppression can lead to depression

"Emotional switchboards" (more emotionally attuned or responsive)

Deaths of Despair

Term describing deaths due to suicide, drug overdose, or alcohol-related illness, often linked to poor mental health.

Diagnostic Inflation Increase

in diagnoses due to lowering diagnostic thresholds, expanded criteria, or greater sensitivity, possibly labeling non-clinical problems as disorders.

Help-Seeking Behavior

More individuals today are willing to seek mental health support, due to increased awareness and decreasing stigma.

Impact of Social Media on Mental Health

Linked to increased anxiety, depression, and comparison stress, especially in adolescents and young adults.

COVID-19 and Mental Health

Contributed to rising mental health concerns through isolation, economic stress, health fears, and grief.

Deaths of Despair (Case & Deaton)

Declining U.S. life expectancy due to deaths from suicide, drug overdoses, and alcoholic liver disease, especially among white men without a college degree.

Main Causes of Deaths of Despair

Suicide

Drug overdose

Alcoholic liver disease (ALD)

Economic Causes of Despair

Unemployment and underemployment

Lack of job stability

Disincentives for hiring (e.g., high healthcare costs)

Long-term economic stagnation

Durkheim's Theory of Alienation

Social breakdown and loss of norms (anomie) lead to isolation, family instability, and decreased religious participation—increasing risk of despair.

Other Risk Factors for Deaths of Despair

Chronic pain

Access to means (e.g., drugs, firearms)

Suicide Trends (2011-2022)

Suicide rates rose 16%, with a record high in 2022

Likely underreported

Groups with Highest Suicide Rates

Native Americans

Males

People in rural areas

Groups with Largest Increases in Suicide

People of color

Young people

Suicide Prevention Tools

SAD PERSONS Scale

Safety plans

Drug Overdose Deaths - Current Stats

About 100,000 overdose deaths per year

Death rate increased over 255% in 20 years

Demographics Most Affected by Overdose

Men aged 25-34

Overdoses are primarily driven by opioids

Alcoholic Liver Disease (ALD) Trends (1999-2019)

ALD deaths tripled overall

Increased in all age groups except 85+

7× increase among those aged 24-35

Gender Trends in ALD

ALD death rates increasing faster for women than men

Largest spikes during COVID-19 lockdowns

COVID-19 and Deaths of Despair

Lockdowns worsened isolation and stress, amplifying rates of suicide, overdose, and ALD.

White Men Without College Degrees

This group is disproportionately affected by deaths of despair due to economic and social decline.

Historical Accounts of Madness

Descriptions of mental illness appear in Greek mythology, Biblical texts, and across ancient cultures—often explained as spiritual or moral failings.

Ancient Explanations for Mental Illness

Malevolent spirits

Curses

Punishment for misdeeds

Angry or jealous gods

Culture-Bound Syndromes

Some disorders are unique to specific cultures, but many mental illness symptoms show cross-cultural similarities.

Humoral Theory (Hippocrates)

Mental illness caused by imbalances in bodily fluids (blood, black bile, yellow bile, phlegm).

Rule of Thirds: 1/3 get better, 1/3 stay the same, 1/3 worsen

Treatments: diet, bloodletting, rest, purging

Religious Theories of Mental Illness

Demonic Possession: Treated with exorcism or harsh discipline

Sinful Nature: Seen as punishment for immorality

Charity Hospitals: Provided care, often with a religious mission

Philippe Pinel

Advocated for humane treatment in asylums

Believed causes included heredity, brain damage, stress, life experiences

Promoted moral therapy

Sigmund Freud

Mental illness from unconscious conflicts and inborn drives

Developed psychoanalysis as treatment (talk therapy, dream analysis)

Dorothea Dix

Led reforms for the mentally ill in the U.S., pushing for creation of state mental hospitals.

Clifford Beers & Dr. Adolph Meyer

Founded the Mental Hygiene Movement, promoting prevention, education, and early intervention.

Late 1800s institutions

Mental hospitals became overcrowded and poorly managed.

1900s-1940s Experimental treatments used:

Lobotomy

Electroconvulsive therapy (ECT)

Insulin shock therapy

1950s institutions

Introduction of psychotropic medications like lithium and Thorazine improved symptom management.

1955 institutions

U.S. institutional population peaked at 560,000 individuals.

1960s - Deinstitutionalization Begins Driven by:

New medications

Civil rights concerns

Exposure of abuses in institutions

Push for community-based care

Today: Legacy of Deinstitutionalization

Many with mental illness are homeless or incarcerated

Mental health needs are frequently unmet

National Mental Health Act (1946)

Created the National Institute of Mental Health (NIMH) and laid the groundwork for federal involvement in mental health care.

Community Mental Health Act (1963)

Funded community-based mental health centers, beginning the process of deinstitutionalization.

Controlled Substances Act (1970)

Established a federal drug scheduling system and regulated prescription and use of psychiatric medications.

Anti-Drug Abuse Act (1988)

Increased funding for drug enforcement, emphasizing criminalization over treatment for substance use disorders.

Mental Health Parity and Addiction Equity Act (2008)

Required that insurance coverage for mental health and substance use be equal to physical health coverage (no higher co-pays or limits).

Emergency Commitment

Initiated when someone poses an immediate threat to self or others

Taken by law enforcement to the ER

Must receive a hearing within 15 days

Judicial Commitment

Initiated by an "interested person" (e.g., family member, doctor)

May be based on danger or inability to make sound treatment decisions

Lessard v. Schmidt (1972)

Ruled that people cannot be committed without due process; they have rights similar to criminal defendants (e.g., right to remain silent).

O'Connor v. Donaldson (1975)

You cannot involuntarily commit a person unless they are a danger to themselves or others; mental illness alone is not sufficient.

Wyatt v. Stickney (1971)

Established the right to treatment: committed individuals must receive humane care, adequate staffing, individualized plans, and freedom restrictions must be minimized.

Tarasoff v. Regents of the University of California (1976)

Established the "duty to warn": mental health professionals must break confidentiality if a client poses a serious threat to an identifiable person.