Mental disorder
Mental disorder | |
---|---|
Other names | Mental breakdown, mental disability, mental disease, mental health condition, mental illness, nervous breakdown, psychiatric disability, psychiatric disorder, psychological disability, psychological disorder psychotic disorders, substance use disorders |
Causes | Genetic and environmental factors |
Treatment | Psychotherapy and medications |
Medication | Antidepressants, antipsychotics, anxiolytics, mood stabilizers, stimulants |
Frequency | 18% per year (United States)[5] |
A mental disorder, also referred to as a mental illness,
The
In 2019, common mental disorders around the globe include:
Definition
The definition and classification of mental disorders are key issues for researchers as well as service providers and those who may be diagnosed. For a mental state to be classified as a disorder, it generally needs to cause dysfunction.[15] Most international clinical documents use the term mental "disorder", while "illness" is also common. It has been noted that using the term "mental" (i.e., of the mind) is not necessarily meant to imply separateness from the brain or body.
According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (
DSM-IV predicates the definition with caveats, stating that, as in the case with many medical terms, mental disorder "lacks a consistent operational definition that covers all situations", noting that different levels of abstraction can be used for medical definitions, including pathology, symptomology, deviance from a normal range, or etiology, and that the same is true for mental disorders, so that sometimes one type of definition is appropriate and sometimes another, depending on the situation.[17]
In 2013, the American Psychiatric Association (APA) redefined mental disorders in the DSM-5 as "a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning."[18] The final draft of ICD-11 contains a very similar definition.[19]
The terms "mental breakdown" or "nervous breakdown" may be used by the general population to mean a mental disorder.[20] The terms "nervous breakdown" and "mental breakdown" have not been formally defined through a medical diagnostic system such as the DSM-5 or ICD-10 and are nearly absent from scientific literature regarding mental illness.[21][22] Although "nervous breakdown" is not rigorously defined, surveys of laypersons suggest that the term refers to a specific acute time-limited reactive disorder involving symptoms such as anxiety or depression, usually precipitated by external stressors.[21] Many health experts today refer to a nervous breakdown as a mental health crisis.[23]
Nervous illness
In addition to the concept of mental disorder, some people have argued for a return to the old-fashioned concept of nervous illness. In How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown (2013), Edward Shorter, a professor of psychiatry and the history of medicine, says:
About half of them are depressed. Or at least that is the diagnosis that they got when they were put on antidepressants. ... They go to work but they are unhappy and uncomfortable; they are somewhat anxious; they are tired; they have various physical pains—and they tend to obsess about the whole business. There is a term for what they have, and it is a good old-fashioned term that has gone out of use. They have nerves or a nervous illness. It is an illness not just of mind or brain, but a disorder of the entire body. ... We have a package here of five symptoms—mild depression, some anxiety, fatigue, somatic pains, and obsessive thinking. ... We have had nervous illness for centuries. When you are too nervous to function ... it is a nervous breakdown. But that term has vanished from medicine, although not from the way we speak.... The nervous patients of yesteryear are the depressives of today. That is the bad news.... There is a deeper illness that drives depression and the symptoms of mood. We can call this deeper illness something else, or invent a neologism, but we need to get the discussion off depression and onto this deeper disorder in the brain and body. That is the point.
— Edward Shorter, Faculty of Medicine, the University of Toronto[24]
In eliminating the nervous breakdown, psychiatry has come close to having its own nervous breakdown.
— David Healy, MD, FRCPsych, Professor of Psychiatry, University of Cardiff, Wales[25]
Nerves stand at the core of common mental illness, no matter how much we try to forget them.
— Peter J. Tyrer, FMedSci, Professor of Community Psychiatry, Imperial College, London[26]
"Nervous breakdown" is a pseudo-medical term to describe a wealth of stress-related feelings and they are often made worse by the belief that there is a real phenomenon called "nervous breakdown".
— Richard E. Vatz, co-author of explication of views of Thomas Szasz in "Thomas Szasz: Primary Values and Major Contentions"[page needed]
Classifications
There are currently two widely established systems that classify mental disorders:
- ICD-11 Chapter 06: Mental, behavioural or neurodevelopmental disorders, part of the International Classification of Diseases produced by the WHO (in effect since 1 January 2022).[27]
- Diagnostic and Statistical Manual of Mental Disorders (DSM-5) produced by the APA since 1952.
Both of these list categories of disorder and provide standardized criteria for diagnosis. They have deliberately converged their codes in recent revisions so that the manuals are often broadly comparable, although significant differences remain. Other classification schemes may be used in non-western cultures, for example, the
Unlike the DSM and ICD, some approaches are not based on identifying distinct categories of disorder using
In the scientific and academic literature on the definition or classification of mental disorder, one extreme argues that it is entirely a matter of value judgements (including of what is
The DSM and ICD approach remains under attack both because of the implied causality model[32] and because some researchers believe it better to aim at underlying brain differences which can precede symptoms by many years.[33]
Dimensional models
The high degree of comorbidity between disorders in categorical models such as the DSM and ICD have led some to propose dimensional models. Studying comorbidity between disorders have demonstrated two latent (unobserved) factors or dimensions in the structure of mental disorders that are thought to possibly reflect etiological processes. These two dimensions reflect a distinction between internalizing disorders, such as mood or anxiety symptoms, and externalizing disorders such as behavioral or substance use symptoms.[34] A single general factor of psychopathology, similar to the g factor for intelligence, has been empirically supported. The p factor model supports the internalizing-externalizing distinction, but also supports the formation of a third dimension of thought disorders such as schizophrenia.[35] Biological evidence also supports the validity of the internalizing-externalizing structure of mental disorders, with twin and adoption studies supporting heritable factors for externalizing and internalizing disorders.[36][37][38] A leading dimensional model is the Hierarchical Taxonomy of Psychopathology.
Disorders
There are many different categories of mental disorder, and many different facets of human behavior and personality that can become disordered.[39][40][41][42]
Anxiety disorder
An anxiety disorder is
Mood disorder
Other affective (emotion/mood) processes can also become disordered. Mood disorder involving unusually intense and sustained sadness, melancholia, or despair is known as
Psychotic disorder
Patterns of belief, language use and perception of reality can become dysregulated (e.g.,
Personality disorder
Eating disorder
An eating disorder is a serious mental health condition that involves an unhealthy relationship with food and body image. They can cause severe physical and psychological problems.[47] Eating disorders involve disproportionate concern in matters of food and weight.[40] Categories of disorder in this area include anorexia nervosa, bulimia nervosa, exercise bulimia or binge eating disorder.[48][49]
Sleep disorder
Sleep disorders are associated with disruption to normal
Narcolepsy is a condition of extreme tendencies to fall asleep whenever and wherever. People with narcolepsy feel refreshed after their random sleep, but eventually get sleepy again. Narcolepsy diagnosis requires an overnight stay at a sleep center for analysis, during which doctors ask for a detailed sleep history and sleep records. Doctors also use actigraphs and polysomnography.[50] Doctors will do a multiple sleep latency test, which measures how long it takes a person to fall asleep.[50]
Sleep apnea, when breathing repeatedly stops and starts during sleep, can be a serious sleep disorder. Three types of sleep apnea include obstructive sleep apnea, central sleep apnea, and complex sleep apnea.[51] Sleep apnea can be diagnosed at home or with polysomnography at a sleep center. An ear, nose, and throat doctor may further help with the sleeping habits.
Sexual disorders include dyspareunia and various kinds of paraphilia (sexual arousal to objects, situations, or individuals that are considered abnormal or harmful to the person or others).
Other
Cognitive disorder: These affect cognitive abilities, including learning and memory. This category includes delirium and mild and major neurocognitive disorder (previously termed dementia).
Somatoform disorders may be diagnosed when there are problems that appear to originate in the body that are thought to be manifestations of a mental disorder. This includes somatization disorder and conversion disorder. There are also disorders of how a person perceives their body, such as body dysmorphic disorder. Neurasthenia is an old diagnosis involving somatic complaints as well as fatigue and low spirits/depression, which is officially recognized by the ICD-10 but no longer by the DSM-IV.[52][non-primary source needed]
Factitious disorders are diagnosed where symptoms are thought to be reported for personal gain. Symptoms are often deliberately produced or feigned, and may relate to either symptoms in the individual or in someone close to them, particularly people they care for.
There are attempts to introduce a category of
There are a number of uncommon psychiatric
Signs and symptoms
Course
The onset of psychiatric disorders usually occurs from childhood to early adulthood.[54] Impulse-control disorders and a few anxiety disorders tend to appear in childhood. Some other anxiety disorders, substance disorders, and mood disorders emerge later in the mid-teens.[55] Symptoms of schizophrenia typically manifest from late adolescence to early twenties.[56]
The likely course and outcome of mental disorders vary and are dependent on numerous factors related to the disorder itself, the individual as a whole, and the social environment. Some disorders may last a brief period of time, while others may be long-term in nature.
All disorders can have a varied course. Long-term international studies of schizophrenia have found that over a half of individuals recover in terms of symptoms, and around a fifth to a third in terms of symptoms and functioning, with many requiring no medication. While some have serious difficulties and support needs for many years, "late" recovery is still plausible. The World Health Organization (WHO) concluded that the long-term studies' findings converged with others in "relieving patients, carers and clinicians of the chronicity paradigm which dominated thinking throughout much of the 20th century."[57][non-primary source needed][58]
A follow-up study by Tohen and coworkers revealed that around half of people initially diagnosed with bipolar disorder achieve symptomatic recovery (no longer meeting criteria for the diagnosis) within six weeks, and nearly all achieve it within two years, with nearly half regaining their prior occupational and residential status in that period. Less than half go on to experience a new episode of mania or major depression within the next two years.[59][non-primary source needed]
Disability
Disorder | Disability-adjusted life years[60] |
---|---|
Major depressive disorder | 65.5 million |
Alcohol-use disorder | 23.7 million |
Schizophrenia | 16.8 million |
Bipolar disorder | 14.4 million |
Other drug-use disorders | 8.4 million |
Panic disorder | 7.0 million |
Obsessive–compulsive disorder | 5.1 million |
Primary insomnia | 3.6 million |
Post-traumatic stress disorder | 3.5 million |
Some disorders may be very limited in their functional effects, while others may involve substantial disability and support needs. In this context, the terms psychiatric disability and psychological disability are sometimes used instead of mental disorder.
It is also the case that, while often being characterized in purely negative terms, some mental traits or states labeled as psychiatric disabilities can also involve above-average creativity, non-conformity, goal-striving, meticulousness, or empathy.[62] In addition, the public perception of the level of disability associated with mental disorders can change.[63]
Nevertheless, internationally, people report equal or greater disability from commonly occurring mental conditions than from commonly occurring physical conditions, particularly in their social roles and personal relationships. The proportion with access to professional help for mental disorders is far lower, however, even among those assessed as having a severe psychiatric disability.[64] Disability in this context may or may not involve such things as:
- Basic activities of daily living. Including looking after the self (health care, grooming, dressing, shopping, cooking etc.) or looking after accommodation (chores, DIY tasks, etc.)
- communication skills, ability to form relationships and sustain them, ability to leave the home or mix in crowds or particular settings
- Occupational functioning. Ability to acquire an employment and hold it, cognitive and social skills required for the job, dealing with workplace culture, or studying as a student.
In terms of total
Suicide, which is often attributed to some underlying mental disorder, is a leading cause of death among teenagers and adults under 35.[66][67] There are an estimated 10 to 20 million non-fatal attempted suicides every year worldwide.[68]
Risk factors
The predominant view as of 2018[update] is that genetic, psychological, and environmental factors all contribute to the development or progression of mental disorders.[69] Different risk factors may be present at different ages, with risk occurring as early as during prenatal period.[70]
Genetics
A number of psychiatric disorders are linked to a family history (including depression, narcissistic personality disorder[71][72] and anxiety).[73] Twin studies have also revealed a very high heritability for many mental disorders (especially autism and schizophrenia).[74] Although researchers have been looking for decades for clear linkages between genetics and mental disorders, that work has not yielded specific genetic biomarkers yet that might lead to better diagnosis and better treatments.[75]
Statistical research looking at eleven disorders found widespread assortative mating between people with mental illness. That means that individuals with one of these disorders were two to three times more likely than the general population to have a partner with a mental disorder. Sometimes people seemed to have preferred partners with the same mental illness. Thus, people with schizophrenia or ADHD are seven times more likely to have affected partners with the same disorder. This is even more pronounced for people with Autism spectrum disorders who are 10 times more likely to have a spouse with the same disorder.[76]
Environment
During the prenatal stage, factors like unwanted pregnancy, lack of adaptation to pregnancy or substance use during pregnancy increases the risk of developing a mental disorder.[70] Maternal stress and birth complications including prematurity and infections have also been implicated in increasing susceptibility for mental illness.[77] Infants neglected or not provided optimal nutrition have a higher risk of developing cognitive impairment.[70]
Social influences have also been found to be important,
Nutrition also plays a role in mental disorders.[10][80]
In schizophrenia and psychosis, risk factors include migration and discrimination, childhood trauma, bereavement or separation in families, recreational use of drugs,[81] and urbanicity.[79]
In anxiety, risk factors may include parenting factors including parental rejection, lack of parental warmth, high hostility, harsh discipline, high maternal negative affect, anxious childrearing, modelling of dysfunctional and drug-abusing behavior, and child abuse (emotional, physical and sexual).[82] Adults with imbalance work to life are at higher risk for developing anxiety.[70]
For bipolar disorder, stress (such as childhood adversity) is not a specific cause, but does place genetically and biologically vulnerable individuals at risk for a more severe course of illness.[83]
Drug use
Mental disorders are associated with drug use including:
Chronic disease
People living with chronic conditions like HIV and diabetes are at higher risk of developing a mental disorder. People living with diabetes experience significant stress from the biological impact of the disease, which places them at risk for developing anxiety and depression. Diabetic patients also have to deal with emotional stress trying to manage the disease. Conditions like heart disease, stroke, respiratory conditions, cancer, and arthritis increase the risk of developing a mental disorder when compared to the general population.[90]
Personality traits
Risk factors for mental illness include a propensity for high neuroticism[91][92] or "emotional instability". In anxiety, risk factors may include temperament and attitudes (e.g. pessimism).[73]
Causal models
Mental disorders can arise from multiple sources, and in many cases there is no single accepted or consistent cause currently established. An eclectic or pluralistic mix of models may be used to explain particular disorders.[92][93] The primary paradigm of contemporary mainstream Western psychiatry is said to be the biopsychosocial model which incorporates biological, psychological and social factors, although this may not always be applied in practice.
Diagnosis
Psychiatrists seek to provide a
Routine diagnostic practice in mental health services typically involves an interview known as a
Time and budgetary constraints often limit practicing psychiatrists from conducting more thorough diagnostic evaluations.
More structured approaches are being increasingly used to measure levels of mental illness.
- HoNOS is the most widely used measure in English mental health services, being used by at least 61 trusts.[99] In HoNOS a score of 0–4 is given for each of 12 factors, based on functional living capacity.[100] Research has been supportive of HoNOS,[101] although some questions have been asked about whether it provides adequate coverage of the range and complexity of mental illness problems, and whether the fact that often only 3 of the 12 scales vary over time gives enough subtlety to accurately measure outcomes of treatment.[102]
Criticism
Since the 1980s, Paula Caplan has been concerned about the subjectivity of psychiatric diagnosis, and people being arbitrarily "slapped with a psychiatric label." Caplan says because psychiatric diagnosis is unregulated, doctors are not required to spend much time interviewing patients or to seek a second opinion. The Diagnostic and Statistical Manual of Mental Disorders can lead a psychiatrist to focus on narrow checklists of symptoms, with little consideration of what is actually causing the person's problems. So, according to Caplan, getting a psychiatric diagnosis and label often stands in the way of recovery.[103][unreliable medical source]
In 2013, psychiatrist
Gary Greenberg, a psychoanalyst, in his book "the Book of Woe", argues that mental illness is really about suffering and how the DSM creates diagnostic labels to categorize people's suffering.[107] Indeed, the psychiatrist Thomas Szasz, in his book "the Medicalization of Everyday Life", also argues that what is psychiatric illness, is not always biological in nature (i.e. social problems, poverty, etc.), and may even be a part of the human condition.[108]
Potential routine use of MRI/fMRI in diagnosis
in 2018 the
- "have a sensitivity of at least 80% for detecting a particular psychiatric disorder"
- should "have a specificity of at least 80% for distinguishing this disorder from other psychiatric or medical disorders"
- "should be reliable, reproducible, and ideally be noninvasive, simple to perform, and inexpensive"
- proposed biomarkers should be verified by 2 independent studies each by a different investigator and different population samples and published in a peer-reviewed journal.
The review concluded that although neuroimaging diagnosis may technically be feasible, very large studies are needed to evaluate specific biomarkers which were not available.[109]
Prevention
The 2004 WHO report "Prevention of Mental Disorders" stated that "Prevention of these disorders is obviously one of the most effective ways to reduce the [disease] burden."[110] The 2011 European Psychiatric Association (EPA) guidance on prevention of mental disorders states "There is considerable evidence that various psychiatric conditions can be prevented through the implementation of effective evidence-based interventions."[111] A 2011
Parenting may affect the child's mental health, and evidence suggests that helping parents to be more effective with their children can address mental health needs.[114][115][116]
Universal prevention (aimed at a population that has no increased risk for developing a mental disorder, such as school programs or mass media campaigns) need very high numbers of people to show effect (sometimes known as the "power" problem). Approaches to overcome this are (1) focus on high-incidence groups (e.g. by targeting groups with high risk factors), (2) use multiple interventions to achieve greater, and thus more statistically valid, effects, (3) use cumulative meta-analyses of many trials, and (4) run very large trials.[117][118]
Management
Treatment and support for mental disorders are provided in
There is a range of different types of treatment and what is most suitable depends on the disorder and the individual. Many things have been found to help at least some people, and a placebo effect may play a role in any intervention or medication. In a minority of cases, individuals may be treated against their will, which can cause particular difficulties depending on how it is carried out and perceived. Compulsory treatment while in the community versus non-compulsory treatment does not appear to make much of a difference except by maybe decreasing victimization.[119]
Lifestyle
Lifestyle strategies, including dietary changes, exercise and quitting smoking may be of benefit.[13][80][120]
Therapy
There is also a wide range of
A major option for many mental disorders is psychotherapy. There are several main types. Cognitive behavioral therapy (CBT) is widely used and is based on modifying the patterns of thought and behavior associated with a particular disorder. Other psychotherapies include dialectic behavioral therapy (DBT) and interpersonal psychotherapy (IPT). Psychoanalysis, addressing underlying psychic conflicts and defenses, has been a dominant school of psychotherapy and is still in use. Systemic therapy or family therapy is sometimes used, addressing a network of significant others as well as an individual.
Some psychotherapies are based on a
Medication
A major option for many mental disorders is
Despite the different conventional names of the drug groups, there may be considerable overlap in the disorders for which they are actually indicated, and there may also be
Other
Epidemiology
Mental disorders are common. Worldwide, more than one in three people in most countries report sufficient criteria for at least one at some point in their life.[130] In the United States, 46% qualify for a mental illness at some point.[131] An ongoing survey indicates that anxiety disorders are the most common in all but one country, followed by mood disorders in all but two countries, while substance disorders and impulse-control disorders were consistently less prevalent.[132] Rates varied by region.[133]
A review of anxiety disorder surveys in different countries found average lifetime prevalence estimates of 16.6%, with women having higher rates on average.[134] A review of mood disorder surveys in different countries found lifetime rates of 6.7% for major depressive disorder (higher in some studies, and in women) and 0.8% for Bipolar I disorder.[135]
In the United States the frequency of disorder is: anxiety disorder (28.8%), mood disorder (20.8%), impulse-control disorder (24.8%) or substance use disorder (14.6%).[131][136][137]
A 2004 cross-Europe study found that approximately one in four people reported meeting criteria at some point in their life for at least one of the DSM-IV disorders assessed, which included mood disorders (13.9%), anxiety disorders (13.6%), or alcohol disorder (5.2%). Approximately one in ten met the criteria within a 12-month period. Women and younger people of either gender showed more cases of the disorder.[138] A 2005 review of surveys in 16 European countries found that 27% of adult Europeans are affected by at least one mental disorder in a 12-month period.[139]
An international review of studies on the prevalence of schizophrenia found an average (median) figure of 0.4% for lifetime prevalence; it was consistently lower in poorer countries.[140]
Studies of the prevalence of personality disorders (PDs) have been fewer and smaller-scale, but one broad Norwegian survey found a five-year prevalence of almost 1 in 7 (13.4%). Rates for specific disorders ranged from 0.8% to 2.8%, differing across countries, and by gender, educational level and other factors.[141] A US survey that incidentally screened for personality disorder found a rate of 14.79%.[142]
Approximately 7% of a preschool pediatric sample were given a psychiatric diagnosis in one clinical study, and approximately 10% of 1- and 2-year-olds receiving developmental screening have been assessed as having significant emotional/behavioral problems based on parent and pediatrician reports.[143]
While rates of psychological disorders are often the same for men and women, women tend to have a higher rate of depression. Each year 73 million women are affected by major depression, and suicide is ranked 7th as the cause of death for women between the ages of 20–59. Depressive disorders account for close to 41.9% of the psychiatric disabilities among women compared to 29.3% among men.[144]
History
Ancient civilizations
Ancient civilizations described and treated a number of mental disorders. Mental illnesses were well known in ancient
Europe
Middle Ages
Conceptions of madness in the Middle Ages in Christian Europe were a mixture of the divine, diabolical, magical and humoral, and transcendental.[147] In the early modern period, some people with mental disorders may have been victims of the witch-hunts. While not every witch and sorcerer accused were mentally ill, all mentally ill were considered to be witches or sorcerers.[148] Many terms for mental disorders that found their way into everyday use first became popular in the 16th and 17th centuries.
Eighteenth century
By the end of the 17th century and into the Enlightenment, madness was increasingly seen as an organic physical phenomenon with no connection to the soul or moral responsibility. Asylum care was often harsh and treated people like wild animals, but towards the end of the 18th century a moral treatment movement gradually developed. Clear descriptions of some syndromes may be rare before the 19th century.
Nineteenth century
Industrialization and population growth led to a massive expansion of the number and size of insane asylums in every Western country in the 19th century. Numerous different classification schemes and diagnostic terms were developed by different authorities, and the term psychiatry was coined (1808), though medical superintendents were still known as alienists.
Twentieth century
The turn of the 20th century saw the development of psychoanalysis, which would later come to the fore, along with Kraepelin's classification scheme. Asylum "inmates" were increasingly referred to as "patients", and asylums were renamed as hospitals.
Europe and the United States
Early in the 20th century in the United States, a
Electroconvulsive therapy, insulin shock therapy,
Advances in
Africa and Nigeria
Most Africans view mental disturbances as external
The WHO estimated that fewer than 10% of mentally ill Nigerians have access to a psychiatrist or health worker, because there is a low ratio of mental-health specialists available in a country of 200 million people. WHO estimates that the number of mentally ill Nigerians ranges from 40 million to 60 million. Disorders such as depression, anxiety, schizophrenia, personality disorder, old age-related disorder, and substance-abuse disorder are common in Nigeria, as in other countries in Africa.[152]
Nigeria is still nowhere near being equipped to solve prevailing mental health challenges. With little scientific research carried out, coupled with insufficient mental-health hospitals in the country, traditional healers provide specialized psychotherapy care to those that require their services and pharmacotherapy[153][154]
Society and culture
Different societies or cultures, even different individuals in a subculture, can disagree as to what constitutes optimal versus pathological biological and psychological functioning. Research has demonstrated that cultures vary in the relative importance placed on, for example, happiness, autonomy, or social relationships for pleasure. Likewise, the fact that a behavior pattern is valued, accepted, encouraged, or even statistically normative in a culture does not necessarily mean that it is conducive to optimal psychological functioning.
People in all cultures find some behaviors bizarre or even incomprehensible. But just what they feel is bizarre or incomprehensible is ambiguous and subjective.[155] These differences in determination can become highly contentious. The process by which conditions and difficulties come to be defined and treated as medical conditions and problems, and thus come under the authority of doctors and other health professionals, is known as medicalization or pathologization.
Mental illness in the Latin American community
There is a perception in
Latin Americans from the US are slightly more likely to have a mental health disorder than first-generation Latin American immigrants, although differences between ethnic groups were found to disappear after adjustment for place of birth.[157]
From 2015 to 2018, rates of serious mental illness in young adult Latin Americans increased by 60%, from 4% to 6.4%. The prevalence of major depressive episodes in young and adult Latin Americans increased from 8.4% to 11.3%. More than a third of Latin Americans reported more than one bad mental health day in the last three months.[158] The rate of suicide among Latin Americans was about half the rate of non-Latin American white Americans in 2018, and this was the second-leading cause of death among Latin Americans ages 15 to 34.[159] However, Latin American suicide rates rose steadily after 2020 in relation to the COVID-19 pandemic, even as the national rate declined.[160][161]
Family relations are an integral part of the Latin American community. Some research has shown that Latin Americans are more likely rely on family bonds, or familismo, as a source of therapy while struggling with mental health issues. Because Latin Americans have a high rate of religiosity, and because there is less stigma associated with religion than with psychiatric services,[162] religion may play a more important therapeutic role for the mentally ill in Latin American communities. However, research has also suggested that religion may also play a role in stigmatizing mental illness in Latin American communities, which can discourage community members from seeking professional help.[163]
Religion
Religious, spiritual, or transpersonal experiences and beliefs meet many criteria of delusional or psychotic disorders.[164][165] A belief or experience can sometimes be shown to produce distress or disability—the ordinary standard for judging mental disorders.[166] There is a link between religion and schizophrenia,[167] a complex mental disorder characterized by a difficulty in recognizing reality, regulating emotional responses, and thinking in a clear and logical manner. Those with schizophrenia commonly report some type of religious delusion,[167][168][169] and religion itself may be a trigger for schizophrenia.[170]
Movements
Controversy has often surrounded psychiatry, and the term
The
Alternatively, a movement for global mental health has emerged, defined as 'the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide'.[178]
Cultural bias
Diagnostic guidelines of the 2000s, namely the DSM and to some extent the ICD, have been criticized as having a fundamentally Euro-American outlook. Opponents argue that even when diagnostic criteria are used across different cultures, it does not mean that the underlying constructs have validity within those cultures, as even reliable application can prove only consistency, not legitimacy.
Cross-cultural psychiatrist Arthur Kleinman contends that the Western bias is ironically illustrated in the introduction of cultural factors to the DSM-IV. Disorders or concepts from non-Western or non-mainstream cultures are described as "culture-bound", whereas standard psychiatric diagnoses are given no cultural qualification whatsoever, revealing to Kleinman an underlying assumption that Western cultural phenomena are universal.[181] Kleinman's negative view towards the culture-bound syndrome is largely shared by other cross-cultural critics. Common responses included both disappointment over the large number of documented non-Western mental disorders still left out and frustration that even those included are often misinterpreted or misrepresented.[182]
Many mainstream psychiatrists are dissatisfied with the new culture-bound diagnoses, although for partly different reasons. Robert Spitzer, a lead architect of the
Clinical conceptions of mental illness also overlap with
Such approaches, along with cross-cultural and "
Laws and policies
Three-quarters of countries around the world have mental health legislation. Compulsory admission to mental health facilities (also known as involuntary commitment) is a controversial topic. It can impinge on personal liberty and the right to choose, and carry the risk of abuse for political, social, and other reasons; yet it can potentially prevent harm to self and others, and assist some people in attaining their right to healthcare when they may be unable to decide in their own interests.[191] Because of this it is a concern of medical ethics.
All human rights oriented mental health laws require proof of the presence of a mental disorder as defined by internationally accepted standards, but the type and severity of disorder that counts can vary in different jurisdictions. The two most often used grounds for involuntary admission are said to be serious likelihood of immediate or imminent danger to self or others, and the need for treatment. Applications for someone to be involuntarily admitted usually come from a mental health practitioner, a family member, a close relative, or a guardian. Human-rights-oriented laws usually stipulate that independent medical practitioners or other accredited mental health practitioners must examine the patient separately and that there should be regular, time-bound review by an independent review body.[191] The individual should also have personal access to independent advocacy.
For involuntary treatment to be administered (by force if necessary), it should be shown that an individual lacks the mental capacity for informed consent (i.e. to understand treatment information and its implications, and therefore be able to make an informed choice to either accept or refuse). Legal challenges in some areas have resulted in supreme court decisions that a person does not have to agree with a psychiatrist's characterization of the issues as constituting an "illness", nor agree with a psychiatrist's conviction in medication, but only recognize the issues and the information about treatment options.[192]
Proxy consent (also known as
The World Health Organization reports that in many instances national mental health legislation takes away the rights of persons with mental disorders rather than protecting rights, and is often outdated.[191] In 1991, the United Nations adopted the Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, which established minimum human rights standards of practice in the mental health field. In 2006, the UN formally agreed the Convention on the Rights of Persons with Disabilities to protect and enhance the rights and opportunities of disabled people, including those with psychiatric disabilities.[194]
The term
Perception and discrimination
Stigma
The social stigma associated with mental disorders is a widespread problem. The US Surgeon General stated in 1999 that: "Powerful and pervasive, stigma prevents people from acknowledging their own mental health problems, much less disclosing them to others."[195] Additionally, researcher Wulf Rössler in 2016, in his article, "The Stigma of Mental Disorders" stated
"For millennia, society did not treat persons suffering from depression, autism, schizophrenia and other mental illnesses much better than slaves or criminals: they were imprisoned, tortured or killed".[196]
In the United States, racial and ethnic minorities are more likely to experience mental health disorders often due to low socioeconomic status, and discrimination.[197][198][199] In Taiwan, those with mental disorders are subject to general public's misperception that the root causes of the mental disorders are "over-thinking", "having a lot of time and nothing better to do", "stagnant", "not serious in life", "not paying enough attention to the real life affairs", "mentally weak", "refusing to be resilient", "turning back to perfectionistic strivings", "not bravery" and so forth.[200]
Efforts are being undertaken worldwide to eliminate the stigma of mental illness,[204] although the methods and outcomes used have sometimes been criticized.[205]
Media and general public
Media coverage of mental illness comprises predominantly negative and pejorative depictions, for example, of incompetence, violence or criminality, with far less coverage of positive issues such as accomplishments or human rights issues.[206][207][208] Such negative depictions, including in children's cartoons, are thought to contribute to stigma and negative attitudes in the public and in those with mental health problems themselves, although more sensitive or serious cinematic portrayals have increased in prevalence.[209][210]
In the United States, the Carter Center has created fellowships for journalists in South Africa, the U.S., and Romania, to enable reporters to research and write stories on mental health topics.[211] Former US First Lady Rosalynn Carter began the fellowships not only to train reporters in how to sensitively and accurately discuss mental health and mental illness, but also to increase the number of stories on these topics in the news media.[212][213] There is also a World Mental Health Day, which in the United States and Canada falls within a Mental Illness Awareness Week.
The general public have been found to hold a strong stereotype of dangerousness and desire for social distance from individuals described as mentally ill.[214] A US national survey found that a higher percentage of people rate individuals described as displaying the characteristics of a mental disorder as "likely to do something violent to others", compared to the percentage of people who are rating individuals described as being troubled.[215] In the article, "Discrimination Against People with a Mental Health Diagnosis: Qualitative Analysis of Reported Experiences," an individual who has a mental disorder, revealed that, "If people don't know me and don't know about the problems, they'll talk to me quite happily. Once they've seen the problems or someone's told them about me, they tend to be a bit more wary."[216] In addition, in the article,"Stigma and its Impact on Help-Seeking for Mental Disorders: What Do We Know?" by George Schomerus and Matthias Angermeyer, it is affirmed that "Family doctors and psychiatrists have more pessimistic views about the outcomes for mental illnesses than the general public (Jorm et al.,1999), and mental health professionals hold more negative stereotypes about mentally ill patients, but, reassuringly, they are less accepting of restrictions towards them."[217]
Recent depictions in media have included leading characters successfully living with and managing a mental illness, including in bipolar disorder in Homeland (2011) and post-traumatic stress disorder in Iron Man 3 (2013).[218][219][original research?]
Violence
Despite public or media opinion, national studies have indicated that severe mental illness does not independently predict future violent behavior, on average, and is not a leading cause of violence in society. There is a statistical association with various factors that do relate to violence (in anyone), such as substance use and various personal, social, and economic factors.[220] A 2015 review found that in the United States, about 4% of violence is attributable to people diagnosed with mental illness,[221] and a 2014 study found that 7.5% of crimes committed by mentally ill people were directly related to the symptoms of their mental illness.[222] The majority of people with serious mental illness are never violent.[223]
In fact, findings consistently indicate that it is many times more likely that people diagnosed with a serious mental illness living in the community will be the victims rather than the perpetrators of violence.[224][225] In a study of individuals diagnosed with "severe mental illness" living in a US inner-city area, a quarter were found to have been victims of at least one violent crime over the course of a year, a proportion eleven times higher than the inner-city average, and higher in every category of crime including violent assaults and theft.[226] People with a diagnosis may find it more difficult to secure prosecutions, however, due in part to prejudice and being seen as less credible.[227]
However, there are some specific diagnoses, such as childhood conduct disorder or adult antisocial personality disorder or
High-profile cases have led to fears that serious crimes, such as homicide, have increased due to deinstitutionalization, but the evidence does not support this conclusion.[229][230] Violence that does occur in relation to mental disorder (against the mentally ill or by the mentally ill) typically occurs in the context of complex social interactions, often in a family setting rather than between strangers.[231] It is also an issue in health care settings[232] and the wider community.[233]
Mental health
The recognition and understanding of mental health conditions have changed over time and across cultures and there are still variations in definition, assessment, and classification, although standard guideline criteria are widely used. In many cases, there appears to be a continuum between mental health and mental illness, making diagnosis complex.[41]: 39 According to the World Health Organization, over a third of people in most countries report problems at some time in their life which meet the criteria for diagnosis of one or more of the common types of mental disorder.[130] Corey M Keyes has created a two continua model of mental illness and health which holds that both are related, but distinct dimensions: one continuum indicates the presence or absence of mental health, the other the presence or absence of mental illness.[234] For example, people with optimal mental health can also have a mental illness, and people who have no mental illness can also have poor mental health.[235]
Other animals
The risk of anthropomorphism is often raised concerning such comparisons, and assessment of non-human animals cannot incorporate evidence from linguistic communication. However, available evidence may range from nonverbal behaviors—including physiological responses and homologous facial displays and acoustic utterances—to neurochemical studies. It is pointed out that human psychiatric classification is often based on statistical description and judgment of behaviors (especially when speech or language is impaired) and that the use of verbal self-report is itself problematic and unreliable.[236][238]
Psychopathology has generally been traced, at least in captivity, to adverse rearing conditions such as early separation of infants from mothers; early sensory deprivation; and extended periods of
Laboratory researchers sometimes try to develop
See also
- 50 Signs of Mental Illness
- List of mental disorders
- Mental illness portrayed in media
- Mental disorders in film
- Mental illness in fiction
- Mental illness in American prisons[globalize]
- Parity of esteem
- Psychological evaluation
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Further reading
- Atkinson J (2006). Private and Public Protection: Civil Mental Health Legislation. Edinburgh: Dunedin Academic Press. OCLC 475785132.
- Fried Y, Agassi J (1976). Paranoia: A Study in Diagnosis. Boston Studies in the Philosophy of Science. Vol. 50. Springer Dordrecht. ISSN 2214-7942.[publisher missing]
- Fried Y, Agassi J (1983). Psychiatry as Medicine. The Hague: Nijhoff. LCCN 83004224.
- Hicks JW (2005). ISBN 9780300106572.
- Hockenbury D, Hockenbury S (2004). Discovering Psychology. Worth Publishers. ISBN 978-0-7167-5704-7.
- PMID 27631043.
- ISBN 0-19-280267-4. Archived from the originalon 18 March 2022.
- Radden J (20 February 2019). Mental Disorder (Illness).
- Weller MP, Eysenck M, eds. (1992). The Scientific Basis of Psychiatry (2nd ed.). London: W. B. Saunders. ISBN 0702014486.
- World Health Organization (2018). Management of physical health conditions in adults with severe mental disorders (PDF). Department of Mental Health and Substance Abuse. Geneva. ISBN 978-92-4-155038-3. Archived from the original (Guidelines) on 12 November 2020.)
{{cite book}}
: CS1 maint: location missing publisher (link - Wiencke M (2006). "Schizophrenie als Ergebnis von Wechselwirkungen: Georg Simmels Individualitätskonzept in der Klinischen Psychologie". In Kim D (ed.). Georg Simmel in Translation: Interdisciplinary Border-Crossings in Culture and Modernity. Cambridge: Cambridge Scholars Press. pp. 123–55. ISBN 978-1-84718-060-5.
External links
- Overcoming Mental Health Stigma in the Latino Community – Consult QD clevelandclinic.org
- National Institute of Mental Health
- International Committee of Women Leaders on Mental Health Archived 30 October 2008 at the Wayback Machine
Library resources about Mental illness |