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Gale Encyclopedia of Psychology
Mental illness
Author/s: Paula Ford-Martin
Overview
Mental illness is a serious public health problem. According to the World Health Organization
and the Harvard School of Public Health, mental illness accounts for nearly 11 percent of
total worldwide disease burden. (Disease burden is determined by the calculation of DALYs,
or disability-adjusted life years. The DALY statistic measures lost years of healthy life from
death or disability due to a disease.) In countries that are considered "established market
economies" (i.e., United States, Great Britain), mental illness is second only to heart
disease as the most disabling disease category. Unipolar major depression was determined
to be the second leading source of disease burden (after ischemic heart disease) in
established market economies, and the fourth leading cause of disease burden worldwide.
In its Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), a
reference standard for mental health professionals, the American Psychiatric Association
distinguishes 16 different subtypes (or categories) of mental illness. These include:
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Disorders usually first diagnosed in infancy childhood, or adolescence. These
include learning and developmental disorders, mental retardation, and attentiondeficit hyperactivity disorder.
•
Delirium, dementia, amnesia, and other cognitive disorders. These include
dementia related to Alzheimer's disease, head injury, and central nervous system
infection; and substance-induced delirium.
•
Mental disorders due to a general medical condition. Medical/mental conditions
that are not classified in other areas of the DSM-IV are found in this category.
•
Substance-related disorders. Disorders related to alcohol and drug use, abuse,
dependence, and withdrawal are included in this category.
•
Schizophrenia and other psychotic disorders. These include the schizoid
disorders (schizophrenia, schizophreniform, and schizoaffective disorder), delusional
disorder, and psychotic disorders.
•
Mood disorders. Depressive disorders (major, dysthymic) and bipolar disorders are
classified as mood disorders.
•
Anxiety disorders. This classification includes panic disorder, agoraphobia, social
phobia, obsessive-compulsive disorder, posttraumatic stress disorder, and
generalized anxiety disorders, all disorders in which a certain situation or place
triggers excessive fear and/or panic symptoms (i.e., dizziness, racing heart).
•
Somatoform disorders. Somatoform disorders involve clinically significant physical
symptoms that cannot be explained by a medical condition. Somatization disorder,
conversion disorder, pain disorder, hypochondriasis, and body dysmorphic disorder.
•
Factitious disorders. These are disorders in which the individual creates and
complains of symptoms of a non-existent illness in order to assume the role of a
patient (or sick role).
•
Dissociative disorders. These disorders involve a change in memory, identity,
and/or consciousness. They include dissociative amnesia, dissociative fugue,
dissociative identity disorder, and depersonalization disorder.
•
Sexual and gender identity disorders. Disorders of sexual desire, arousal,
performance, and pain are included here, as is gender identity disorder. It should be
noted that the inclusion of gender identity disorder as a mental illness in the DSM-IV
has been a point of some contention among mental health professionals.
•
Eating disorders. Anorexia and bulimia are both eating disorders.
•
Sleep disorders. Insomnia, narcolepsy, hypersomnia, and parasomnias (nightmares
and sleepwalking) are all considered sleep disorders.
•
Impulse-control disorders not elsewhere classified. Includes kleptomania and
pyromania.
•
Adjustment disorders. Adjustment disorders involve an excessive emotional or
behavioral reaction to a stressful event.
•
Personality disorders. These are maladjustments of personality, including
paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic,
avoidant, dependent, and obsessive-compulsive personality disorder (not to be
confused with the anxiety disorder OCD).
Causes and symptoms
The causes of mental illness are not completely understood, but organic, genetic
(hereditary), familial, traumatic life events, and social factors all may play a part in
triggering mental illness. Frequently, it is a combination and interrelationship of several of
these factors. For example, schizophrenia is caused by genetically determined abnormalities
in the structure and chemistry of the brain, but the course and severity of the disease can
be influenced by social factors such as environmental stress and the absence of a family or
peer support system.
In some cases, mental illness is primarily a byproduct of a disease or general medical
condition. For example, central nervous system infections that can occur in advanced AIDS
can cause dementia. Depending on their location and severity, neurological conditions such
as traumatic brain injury, tumor, or infarct (areas of tissue death as a result of loss of blood
supply) can also cause various symptoms of mental illness.
Individuals dealing with traumatic life events (e.g., death of a close friend, experiencing a
natural disaster, witnessing a brutal crime) may experience psychological distress and
difficulty dealing with day-to-day tasks. Because these mental health problems tend to be of
a temporary nature, they aren't termed mental illness. It is important to remember that
prompt and proper treatment of these issues in the form of counseling or other
psychological interventions is critical, as they have the potential to progress into a longterm mental disorder or illness.
Diagnosis and treatment
Patients with symptoms of mental illness should undergo a thorough physical examination
and patient history to rule out an organic or structural cause for the illness. If a neurological
cause for the disorder is suspected, further diagnostic tests (e.g., CT scan, MRI, PET scan,
neuropsychological assessments) are typically required. If a disorder with no organic cause
is suspected, a psychologist or other mental healthcare professional will conduct a patient
interview and administer one or more psychological assessments (also called clinical
inventories, scales, or tests).
Counseling is typically a front-line treatment for mental illness. A number of counseling or
talk therapy approaches exist, including psychotherapy, cognitive therapy, behavioral
therapy, and group therapy. These are sometimes used in conjunction with alternative
therapy approaches such as art or music therapy that use the creative process to promote
patient self-discovery and awareness. A number of mental healthcare professionals are
involved in the treatment of mental illness, including licensed counselors and therapists,
social workers, nurses, psychologists, and psychiatrists.
Psychoactive medication is prescribed for symptom relief in patients with organic and nonorganic mental illness. For mental illnesses that are considered biological in nature, such as
bipolar disorder or schizophrenia, pharmaceutical therapy is considered a primary treatment
approach. In other cases, such as in personality disorder or dissociative disorder,
psychoactive medications are usually considered a secondary, or companion treatment to
psychotherapy.
Many individuals suffering from mental illness choose to treat their illness through regular
attendance in self-help groups, where they can seek advice and counsel from others in
similar circumstances. Some of the most popular self-help organizations (i.e., Alcoholics
Anonymous), are as, if not more, effective than traditional doctor/patient therapy for many
individuals.
In some cases, effectively treating mental illness requires hospitalization of the patient. This
hospitalization, also known as inpatient treatment, is usually employed in situations where a
controlled therapeutic environment is critical for the patient's recovery (e.g., rehabilitation
treatment for alcoholism or other drug addictions), or when there is a risk that the patient
may harm himself (suicide) or others. One popular variation of the inpatient treatment
program, known as milieu therapy, focuses on providing the patient with opportunities to
gain self-confidence and interact with peers in a positive way. Activities that encourage selfdiscovery and empowerment such as art, music, dance, and writing are important
components of this approach.
Further Reading
For Your Information
•
American Psychiatric Association. Diagnostic and Statistical Manual of Mental
Disorders. 4th ed. Washington, DC: American Psychiatric Press, Inc., 1994.
•
Murray, C.L., and A.D. Lopez, eds. The Global Burden of Disease: A comprehensive
assessment of mortality and disability from diseases, injuries, and risk factors in
1990 and projected to 2020. Global Burden of Disease and Injury Series. Cambridge:
Harvard University Press, 1996.
•
Satcher, David. Mental Health: A Report of the Surgeon General. Washington, DC:
Government Printing Office, 1999. [available online at www.surgeongeneral.gov]
Further Information
•
National Institute of Mental Health (NIMH), 6001 Executive Boulevard, Rm. 8184,
MSC 9663, Bethesda, MD 20892-9663; Toll-free:301-443-4279; Fax:301-443-4513;
E-mail: [email protected] Website: http://www.nimh.nih.gov
------------------------------------------------------------------------------Gale Encyclopedia of Psychology, 2nd ed. Gale Group, 2001.
in association with The Gale Group and LookSmart.