MENTAL ILLNESSES: AN OVERVIEW
Revised October 20, 1999
When people hear the phrase “mental illness,” they
often conjure up the images of a person tortured by the demons only he or she
sees, or by the voices no one else hears.
Or they may think of a benign, foolish person who, like Jimmy Stewart’s
character in the film Harvey, talks to nonexistent friends.
This is the knowledge of mental illnesses that most of
us have acquired from movies and literature.
Films and books trying to create dramatic effect often rely on the
extraordinary symptoms of psychotic illnesses like schizophrenia, or they draw
on outmoded descriptions of mental illnesses that evolved during a time when no one had any
idea what caused them. Few who have seen
these characterizations ever realize that people with even the most severe
mental illnesses actually are in touch with reality most of the time.
In fact, most mental illnesses do not have
hallucinations as symptoms. For example,
people who have obsessive compulsive disorder, or a phobia, do not have
hallucinations or delusions. Most people
with depression aren’t so seriously ill that they act on bizarre sensory
perceptions or thought processes. The
unrelenting hopelessness, helplessness, and suicidal thoughts of depression may
be hard to comprehend, but these are real, painful emotions, not hallucinations
or delusions. Similarly, the despair
brought on by alcoholism or drug abuse
does not involve hallucinations or delusions.
These widespread assumptions about mental illnesses
overlook the important reality that most people suffering from mental illnesses
can effectively return to normal, productive lives if they receive appropriate
treatment. Depending on the illness, 60
to 95% of those suffering from these illnesses will improve with
treatment. Psychiatrists and other
mental health professionals can offer their patients a wide variety of
effective treatments.
Today, it is well established that mental illnesses
are brain disorders--that is that they are biologically based medical
problems in the same sense that epilepsy is a brain disorder in need of medical
treatment. Mental illnesses are not
caused by bad character, poor child-rearing, or an individual’s behavior.
Mental illnesses are disorders of the brain that disrupt
a person’s thinking, feeling, moods, and ability to relate to others. Just as diabetes is a disorder of the
pancreas, mental illnesses are brain disorders that often result in a
diminished capacity for coping with the ordinary demands of life.
Anyone, no matter what age, economic status, race, or
religion can develop a mental illness.
During any one-year period, up to 50 million Americans--more than
22%--have a clearly diagnosable mental disorder involving a degree of
incapacity that interferes with employment, attendance at school, or daily
life. Five million Americans suffer from
a serious, chronic brain disorder of the types described in this brochure. It is vital that Americans know this and know
that help is available, because:
t Some 8 to 14 million Americans experience depression
each year. As many as one in five
Americans will have at least one episode of major depression during their
lifetime.
t Some 2 million Americans have schizophrenic disorders, and 300,000 new cases occur each year.
t About 12
million children under age 18 suffer from mental disorders such as autism,
depression, and hyperactivity.
t 15.4 million
American adults and 4.6 million adolescents experience serious alcohol-related
problems, and another 12.5 million suffer from drug abuse or dependence.
t 20% of the
ailments for which Americans seek a doctor’s care are related to anxiety
disorders, such as panic attacks, that interfere with their ability to live
normal lives.
t Suicide is
the third leading cause of death for people between the ages of 15 and 24.
t Nearly
one-fourth of the elderly who are labeled as senile actually have some form of
mental illness that could be effectively treated.
Many Go Untreated
People often do not recognize mental illnesses for
what they are. About 27% of people
seeking medical care for physical problems actually suffer from a mental
disorder or emotional illness.
Mental illnesses and substance abuse disorders afflict
both men and women. Studies by the U.S.
Alcohol, Drug Abuse, and Mental Health Administration indicate that men are
more likely to suffer from drug and alcohol abuse and personality disorders,
whereas women are at a higher risk of suffering from depression and anxiety
disorders.
The personal and social costs that result from
untreated mental disorders are considerable--similar to those for heart disease
and cancer. According to estimates by
the Substance Abuse and Mental Health Services Administration Institute of
Medicine the direct costs for support and medical treatment of mental illnesses
total $55.4 billion a year, the direct costs of substance abuse disorders, come
to $11.4 billion a year; and indirect costs such as lost employment, reduced
productivity, criminal activity, vehicular accidents, and social welfare
programs increase the total cost of mental and substance abuse disorders to
more than $273 billion a year.
Emotional and mental disorders can be treated or
controlled, but only 20% (one in five) of persons who have these disorders seek
help, and even fewer of the children suffering from severe mental illnesses
(only 4 to 15%) receive appropriate treatment.
This unfortunate reality is further complicated by the fact that most
health insurance policies provide limited mental health and substance abuse coverage,
if any.
Medications relieve the acute symptoms of
schizophrenia in 80% of cases, but only about half of all people with
schizophrenia seek treatment. Fewer than
one-fourth of those with anxiety disorders seek treatment, even though
psychotherapy, behavior therapy, and some medications effectively treat these
illnesses. Fewer than one-third of those
with depressive disorders seek treatment.
Yet, with therapy, 80 to 95% of the people afflicted with these diseases
can get better.
Advances in Diagnosis and Treatment
Researchers have made tremendous progress in
pinpointing the physical and psychological origins of mental illnesses and
substance abuse disorders.
t Scientists
are now certain that some disorders are caused by imbalances in neurotransmitters. Neurotransmitters are the chemicals in the
brain that carry messages between nerve cells.
Studies have linked abnormal levels of these neurotransmitters with
depression and schizophrenia.
t A special
technology called positron emission tomography (PET) has allowed psychiatric
medical researchers to “watch” the living brain’s functioning. Researchers have used PET to show that the
brains of people with schizophrenia do not metabolize the sugar called glucose
in the same way as the brains of healthy people. PET also helps physicians determine if a
person suffers from schizophrenia or the manic phase of bipolar disorder, which can have similar
symptoms.
t The
introduction of lithium carbonate, a
drug used in treating bipolar disorder,
has led to an estimated annual savings of
$8 billion in treatment costs and lost productivity associated with
bipolar disorder.
t Medications
are helpful in treating and preventing panic attacks among patients with severe
anxiety disorders. Studies also indicate
that panic disorders could be caused by some underlying physical, biochemical
imbalance.
t Studies of
psychotherapy by the National Institute of Mental Health have shown it to be
very effective in treating mild-to-moderate depression.
t Scientists
are beginning to understand the biochemical reactions in the brain that induce
the severe craving experienced by cocaine users. Using this knowledge, medications are being
developed to break the cycle of cocaine craving and use.
Although these findings require continued research,
they offer hope that many mental disorders may one day be prevented.
Depression
The term depression can be confusing, because
it is often used to describe a very normal emotion that passes quickly. Everyone feels “blue” or sad
occasionally. But if that emotion
continues for long periods, and if it is accompanied by feelings of guilt and
hopelessness, it could be an indication of major depression, an illness in need of
treatment. The persistence and severity
of such feelings distinguishes the mental disorder of major depression from
normal mood changes.
Because the outward behavior of a depressed person
often seems relatively normal and rarely disrupts the lives of others to the
extent of some other serious mental illnesses, major depression is often
misdiagnosed or not diagnosed at all.
However, it is estimated that one out of every five women and one in
fifteen men will suffer from major depression in their lifetime. Almost one-fifth of all Americans can expect
to experience clinical depression at some point in their life. On any given day, 4% of the American
population has symptoms of clinical depression. Depression is the most commonly diagnosed emotional problem.
People with serious depression say they feel their lives
are pointless, or hopeless. They feel
slowed down, “burned out,” and useless.
Some even lack the energy to move or to eat. They doubt their own abilities and often look
on sleep as an escape from life. Many
think about suicide, a form of escape from which there is obviously no return.
Other symptoms that characterize depression are
sleeplessness, loss of self-esteem, inability to feel pleasure in formerly
interesting activities, loss of sexual drive, social withdrawal, apathy, and
fatigue.
Most likely there is not one single cause of major
depression. Depression can be a response
to stress from a job change, loss of a loved one, even pressures of everyday
living. Sometimes it just happens, with
no identifiable external cause.
Scientific studies of the brain indicate a chemical dysfunction among
depressed patients, and genetics are also thought to play a role. Depression can be debilitating, but it is not
insurmountable. Many types of treatment
are available and with treatment, people with depression can recover and lead
full lives.
Some people suffer from bipolar disorder, an
illness in which a person’s mood may swing from depression to an abnormal
elation or mania that is characterized by hyperactivity, scattered ideas,
distractibility, and recklessness.
Three million Americans suffer from bipolar disorder. After accurate diagnosis, people with bipolar
disorder can be successfully treated with medication in 80 to 90% of all
cases. Most people with bipolar disorder
respond remarkably well to medications which even out the disorder’s terrible
highs and lows. Supportive counseling
and psychosocial therapies have also proven helpful.
Psychiatrists have a number of effective treatments
for major depression and bipolar ---usually involving a combination of
psychotherapy and medications.
Psychotherapy addresses specific emotional responses that contribute to
the illness. The discovery of such
emotional triggers allows people to change their environment or their emotional
reactions to it, thereby alleviating the symptoms. Today, psychiatrists have a full range
of medications that they use to augment
psychotherapy.
Almost all patients with major depression or bipolar
disorder respond to psychotherapy, medication, or a combination of these treatments. Some patients with depression cannot take
antidepressant medications, however, or may experience a depression so profound
that it resists medication. Others may
be at immediate risk of suicide, and with these patients the medications may
not act quickly enough. Fortunately
psychiatrists can help these patients with electroconvulsive therapy (ECT), a
safe and effective treatment for some serious mental disorders. In this treatment, the patient receives a
short-acting general anesthetic and a muscle relaxant followed by a painless
electric current administered for less than a second through contacts placed on
the head. Many patients report
significant improvement in their mood after only a few ECT treatments.
Anxiety Disorders
Fear is a safety valve that helps us recognize and
avoid danger. It increases our reflex
responses and sharpens awareness. But
when a person’s fear becomes an irrational, pervasive terror or a nagging worry
or dread that interferes with daily life, he or she may have some form of
anxiety disorder.
Anxiety disorders affect about 30 million Americans,
including 11% of the population with serious anxiety symptoms related to a
physical illness. In fact, anxiety is
thought to contribute to or cause 20% of all medical conditions among Americans
seeking general health care, and accounts for about one-third of all patient
visits to doctors.
There are many different expressions of excessive
anxiety. Phobic disorders, for example,
are irrational, terrifying fears about a specific object, social situations or
public places. Psychiatrists divide
phobic disorders into several different classifications, most notably
specific phobias, social phobias, and agoraphobia.
Specific phobias are relatively common among Americans.
As this category’s name implies, people with specific phobia generally
have irrational fear of specific objects.
If the feared object rarely appears in the person’s life, the phobia may
not create serious disability. If the
object is common, however, the resulting disability can be severe. The most common specific phobia in the
general population is fear of animals--particularly dogs, snakes, insects and
mice. Other specific phobias are
claustrophobia (fear of enclosed spaces) and acrophobia (fear of heights). Most specific phobias develop during
childhood and eventually disappear, but those that persist into adulthood
rarely go away without treatment.
Social phobia
is the irrational fear and avoidance of being in a situation in which a
person’s activities can be watched by others.
In a sense, it is a form of “performance anxiety,” but a social phobia
causes symptoms that go well beyond the normal nervousness before an onstage
appearance. People with social phobias
intensely fear being watched or humiliated while doing something--such as
signing a personal check, drinking a cup of coffee, buttoning a coat, or eating
a meal--in front of others. Many
patients have a generalized form of social phobia, in which they fear and avoid
most interactions with other people.
This makes it difficult for them to go to work or school, or to
socialize at all. Social phobias occur
equally among men and women, generally developing after puberty and peaking
after age 30. A person can suffer from
one or a cluster of social phobias.
Derived from the Greek, agoraphobia literally
means “fear of the marketplace.” This
disorder, which afflicts twice as many women as men, is the most serious of the
phobic disorders. It causes its victims
to fear being alone in any place or situation from which they think escape
would be difficult or help unavailable if they were incapacitated. People with agoraphobia avoid streets,
crowded stores, churches, theaters, and other crowded places. Normal activities are restricted by this
avoidance, and people with the disorder often become so disabled they literally
will not leave their homes. If people
with agoraphobia do venture into phobic situations, they do so only with great
distress or when accompanied by a friend or family member.
Most people with agoraphobia develop the disorder
after first suffering a series of one or more spontaneous panic attacks. The attacks seem to occur randomly and
without warning, making it impossible for the person to predict what situations
will trigger the reaction. The
unpredictability of the panic attacks “trains” the victims to anticipate future
panic attacks and, therefore, to fear any situation in which an attack may
occur. As a result, they avoid going
into any place or situation where previous panic attacks occurred. Agoraphobia victims also may develop
depression, fatigue, tension, alcohol or drug abuse problems, and obsessive
disorders.
These conditions are treatable with psychotherapy and
with medication. Psychiatrists and other
mental health professionals use desensitization techniques to help people with
phobic disorders. They teach deep muscle
relaxation techniques and work to understand what provoked the anxiety. The relaxation techniques help patients to
quell or manage their fear. As the sessions
progress, the object or situation that provokes the fear no longer has its hold
on the person.
While Panic disorder often accompanies phobias
such as agoraphobia, it can occur alone.
Two to five percent of Americans suffer from panic disorder. People with panic disorder feel sudden,
intense apprehension, fear, or terror that can be accompanied by heart
palpitations, chest pain, choking or smothering sensations, dizziness, hot and
cold flashes, trembling, and faintness.
These “panic attacks,” which are the disorder’s main feature, usually
begin during adolescence or early adult life.
Many people experience panic disorder’s symptoms at some time in their
lives as a “panic attack,” in episodes that are limited to a single brief
period and that may be connected to stressful life events. But psychiatrists diagnose panic disorder
when the condition has become chronic, meaning the individual has experienced
four or more panic attacks in a four-week period.
Panic disorder seems to run in families, and this
suggests some genetic inheritability or predisposition. Biological theories point to possible
physical defects in the autonomic nervous system. Chemical or hormonal imbalances, drugs or
alcohol, and stress or other situational events can bring on a panic
attack. Seventy-five to 95 percent of
those treated show significant improvement.
Unfortunately, only about one quarter of those who suffer from this
disorder ever seek appropriate treatment.
People with generalized anxiety disorder
experience unrealistic or excessive anxiety and worry about life
circumstances. For example, they may
feel anxious about financial matters when there’s plenty of money in the bank
and their debts are paid. Or they may
be constantly preoccupied about the
welfare of a child who is safe at school.
People with generalized anxiety disorder may have stretches of time when
they’re not consumed by these worries, but they are anxious most of the
time. Persons with this disorder often
feel “shaky,” reporting that they feel “keyed up” or “on edge” and that they
sometimes “go blank” because of the tension they feel. They often also have mild depression.
The behaviors that are a part of obsessive-compulsive
disorder (OCD) include obsessions (which are recurring, persistent, and
involuntary thoughts or images) that often occur with compulsions (repetitive,
ritualistic behaviors--such as hand washing or lock checking--which a person
performs according to certain “rules”).
The individual doesn’t get pleasure from such behavior and, in fact,
recognizes that it is excessive and has no real purpose. Without effective treatment, people with OCD
“can’t help” their ritualistic behavior and will become very anxious if it is
interrupted. OCD will affect nearly one
out of every 40 people in America at some point in their lives. Often beginning in adolescence or early
adulthood, the obsessive and compulsive behaviors frequently become
chronic. Heredity appears to be a strong
factor. If you have OCD, there is a 25%
chance that one of your immediate family members will also have this
disease. Scientific evidence indicates
that OCD results from a chemical imbalance in the brain.
Years ago, psychoanalysts believed that anxiety
disorders were the result of a traumatic experience in childhood that had been
consciously forgotten but surfaced as a reaction to a feared object or
stressful life situation. However today,
increasing evidence supports the theory that these disorders arise at least
partly from imbalances in the brain’s chemistry. Several forms of medication, psychotherapy,
and behavior modification programs are highly effective in treating anxiety
disorders, because all of these treatments modify the brain’s chemistry. Research continues into the causes and the
most effective therapies for anxiety disorders..
Schizophrenia
Like depression, schizophrenia afflicts people of all
ages, races, and economic levels. It
affects up to 2 million Americans during
any given year. Its symptoms frighten
patients and their loved ones, and those with the disorder may begin to feel
isolated.
The term schizophrenia refers to a group of disorders
that have common characteristics, though their causes may differ. The hallmark of schizophrenia is a distorted
thought pattern. The thoughts of people
with schizophrenia often seem to dart from subject to subject, often in an
illogical way. Patients may think others
are watching or plotting against them.
Often, they lose their self-esteem or withdraw from those close to them.
The disease often affects the five senses. Persons suffering from schizophrenia
sometimes hear nonexistent sounds, voices, or music or see nonexistent
images. Because their perceptions do not
fit with reality, they react inappropriately to the world. Schizophrenia also affects the emotions. Patients react in an inappropriate manner, or
without any visible emotion at all.
Though the symptoms of schizophrenia can appear
suddenly during times of great stress, schizophrenia most often develops
gradually, and close friends or family might not initially notice the change in
personality as the illness begins to take hold.
Theories about the causes of schizophrenia abound, but
research has not yet pinpointed what causes the disease. In recent years, laboratory findings have
strongly suggested that schizophrenia is passed on genetically from generation
to generation. Scientist have theorized
that the disease may be triggered, in some people with this inherited
predisposition, by another illness that changes the body’s chemistry, a highly
stressful situation in life, or a combination of these. Some think disturbances in brain chemistry or
the hormonal system contribute to the disease’s development. Some studies have found abnormal levels of
some chemicals in the blood and urine of people with schizophrenia. One study has suggested that the alignment of
cells in a particular area of the brain goes awry before birth. Recent studies suggest that some aspect of
the brain’s development during childhood has gone awry. Today, schizophrenia cannot be cured, but it
can be controlled. Thanks to new
treatments, many people with schizophrenia are able to work, live with their
families, and enjoy friends. Very few are
ever violent or behave in unacceptable ways.
But, like a person with diabetes, the person with schizophrenia probably
will have to be under medical care for the rest of his or her life.
Researchers have found a number of antipsychotic
medications that aid in the treatment of schizophrenia. Of course, these drugs should be used only
under the close supervision of a psychiatrist.
Additionally, psychotherapy can offer understanding,
reassurance, and careful insights and suggestions for handling the emotional
aspects of the disorder. A change in the
patient’s living and working environment can reduce stressful situations. A combination of treatments should be
tailored to the individual patient’s needs.
Substance Abuse
Substance abuse should be a part of any discussion
about mental illnesses. Substance
abuse--the misuse of alcohol, cigarettes, and both illegal and legal drugs--is
by far the predominant cause of premature and preventable illness, disability,
and death in our society. According to
the National Institute of Mental Health, nearly 17% of the U.S. population 18
years old and over will fulfill criteria for alcohol or drug abuse in their
lifetime. When the effects on the
families of abusers and people close to those injured or killed by intoxicated
drivers are considered, such abuse affects untold millions more.
Whereas abuse of and/or dependence on substances may
in their own right bring suffering and physical sickness that require
psychiatric medical treatment, they often accompany other seemingly unrelated
mental illnesses as well.
Many people who struggle with mental illnesses also
struggle with alcohol or drug habits that may have begun in their mistaken
belief that they could use the substance to “medicate” the painful feelings
that accompany their mental illness.
This belief is mistaken because substance abuse only adds to the
suffering, bringing its own mental and physical anguish. Here, too, psychiatrists can offer hope with
a number of effective treatment programs that can reach the substance abuser
and his or her family.
Conclusion
People who experience mental disorders such as those
described here do not have to suffer without help. By consulting a psychiatrist, they can make a
positive step toward controlling the condition that interferes with their life. If you, a friend, or family member is
experiencing symptoms of mental illness, contact the psychiatric or medical
society in your area, contact a local mental health center, or ask your general
physician for names of psychiatrists.
Don’t be afraid to ask for help. It’s a sign of strength.
Sources: American Psychiatric Association and NAMI
brochures
For more information - contact:
ALLIANCE FOR THE MENTALLY ILL
NAMI OF GREATER CHICAGO
1536 West Chicago Avenue
Chicago, IL 60622
Phone: 312-563-0445 Fax: 312-563-0467