definitions of mental illness 1

“Defining mental disorders” – a starting point

Defining mental illness is a complex and diverse endeavour, given the many definitions of “healthy” or “sick” condition or behaviour, based on your culture, community and medical perspective.   The following is a medical/academic collection of interpretations to help you build a foundation of understanding, as you start to form  your own definition of mental health and illness – FG2 editors.

A mental disorder or psychiatric disorder is a mental or behavioral pattern that causes distress or disability, and which is not developmentally or socially normative.

Mental disorders are generally defined by a combination of how a person feels, acts, thinks or perceives. This may be associated with particular regions or functions of the brain or rest of the nervous system.

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. According to the World Health Organisation (WHO), over a third of people in most countries report problems at some time in their life which could meet criteria for diagnosis of one or more of the common types of mental disorder.

Mental health conditions may include;
Depression
Anxiety
Eating Disorders
Addiction
Personality Disorders
Bipolar Disorder
Psychosis
Schizophrenia
Self-harm
Struggles with Identity
Suicide

The causes of mental disorders are varied and in some cases unclear, and theories may incorporate findings from a range of fields including biochemistry, metabolic function, DNA and genetics, social work, stress & coping strategy, psychology and psychiatry.

Services can be based in psychiatric hospitals, in medical or psychology practices or in the community, and assessments are carried out by psychiatrists, clinical psychologists, general practitioners and clinical social workers, using various methods but often relying on observation and questioning.

Clinical treatments are provided by various mental health professionals. Psychotherapy and psychiatric medication are two major treatment options, as are social interventions, peer support and self-help.

In a minority of debilitating or harm-threatening cases there might be involuntary detention or involuntary treatment, where legislation allows.

Stigma and discrimination can add to the suffering and disability associated with mental disorders (or with being diagnosed or judged as having a mental disorder), leading to various social movements attempting to increase understanding and challenge social exclusion. Prevention is now appearing in some mental health strategies.  The impact on families is now also being recognized.

The definition and classification of mental disorders is a key issue for researchers as well as service providers and those who may be diagnosed. 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 brain or body.

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 normal) while another proposes that it is or could be entirely objective and scientific (including by reference to statistical norms).

Common hybrid views argue that the concept of mental disorder is objective even if only a “fuzzy prototype” that can never be precisely defined, or conversely that the concept always involves a mixture of scientific facts and subjective value judgments. Although the diagnostic categories are referred to as ‘disorders’, they are presented as medical diseases, but are not validated in the same way as most medical diagnoses.  It is important to recognize that these are human conditions that affect individuals.  There is no ‘one size fits all’ across mental health conditions or in any one specific case.  Sensitivity and flexibility to address one’s environment, social background and metabolic function must be taken into account when observing or assisting any specific person with a potential mental health concern.

Factors & Causes

Mental disorders can arise from multiple sources, and in many cases there is no single accepted or consistent cause currently established for any one mental health condition.

An eclectic or pluralistic mix of models may be used to explain particular disorders. 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.

Biological psychiatry follows a biomedical model where many mental disorders are conceptualized as disorders of brain circuits likely caused by developmental processes shaped by a complex interplay of genetics and experience. A common assumption is that disorders may have resulted from genetic and developmental vulnerabilities, exposed by stress in life,  although there are various views on what causes differences between individuals. Some types of mental disorder may be viewed as primarily neurodevelopmental disorders.

Psychoanalytic theories have continued to evolve alongside cognitive-behavioral and systemic-family approaches. A distinction is sometimes made between a “medical model” or a “social model” of disorder and disability.

Studies have indicated that variation in genes can play an important role in the development of mental disorders, although the reliable identification of connections between specific genes and specific categories of disorder has proven more difficult.

Environmental events have also been implicated. Traumatic brain injury may increase the risk of developing certain mental disorders. There have been some tentative inconsistent links found to certain viral infections,to substance misuse, and to general physical health.

Social influences have been found to be important, including abuse, neglect, bullying, social stress, and other negative or overwhelming life experiences. *STRESS reaction to life experiences is a huge potential factor leading to mental health disorders as it not only impacts the personality, but creates a substantial chemical footprint in one’s metabolism that can trigger anxiety, avoidant and depressive reactions – which furthers cycles of stress, isolation and both physical, emotional and social functioning (FG editorial).

The specific risks and pathways to particular disorders are less clear, however. Aspects of the wider community have also been implicated, including employment problems, socioeconomic inequality, lack of social cohesion, problems linked to migration, and features of particular societies and cultures (and resulting levels of STRESS experience – FG).

Abnormal functioning of neurotransmitter systems has been implicated as symptoms in several mental disorders, including serotonin, norepinephrine, dopamine and glutamate systems. Differences have also been found in the size or activity of certain brain regions in some cases. Psychological mechanisms have also been implicated, such as cognitive (e.g. reasoning) biases, emotional influences, personality dynamics, temperament and coping style.

Correlations of mental disorders with drug use include; cannabis, alcohol and caffeine.

Risk factors for mental illness include genetic inheritance, life experiences and substance intake.

Risk factors involving parenting include parental rejection, lack of parental warmth, high hostility, harsh discipline, high maternal negative affect, parental favouritism, anxious childrearing, modelling of dysfunctional and drug-abusing behaviour, and child abuse (emotional, physical and sexual).

Other risk factors may include family history (e.g. of anxiety), temperament and attitudes (e.g. pessimism). In schizophrenia and psychosis, risk factors include migration and discrimination, childhood trauma, bereavement or separation in families, and abuse of drugs.

Research

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.”

For depressive disorders, research has shown a reduction in incidence of new cases when people participated in interventions, for instance by 22% and 38% in meta-analyses. In a study of patients with sub-threshold depression, those who received minimal-contact psychotherapy had an incidence of a major depressive disorder one year later a third lower (an incidence rate of 12% rather than 18%) than the control group.

Such interventions also save costs.[74] The Netherlands mental health care system provides preventive interventions, such as the Coping with Depression course for people with subthreshold depression. A meta-analysis showed that people who followed this course had a 38% lower incidence of developing a major depressive disorder than the control group.

For anxiety disorders, use of CBT with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes. Other interventions (parental inhibition reduction, behaviourism, parental modelling, problem-solving and communication skills) have also produced significant benefits.  Subthreshold panic disorder sufferers were found to significantly benefit from use of CBT. Use of CBT was found to significantly reduce social anxiety prevalence.

(Note – psychotherapy, such as CBT involves interacting with a councillor and receiving interpersonal attention and support. The combination of support, human interaction that breaks isolation, addresses stigma and fear – and education towards self-awareness, all lowers stress for an individual over time. The ability to endure, overcome and reverse patterns of stress may have benefits intellectually, emotionally, metabolically and socially, thus producing less incidence of symptoms we’ve come to define as mental illness – FG2 Editor)

For psychosis and schizophrenia, usage of a number of drugs has been associated with development of the disorder, including cannabis, cocaine, and amphetamines. Studies have shown reductions in onset through preventative CBT. Another study showed that schizophrenia prevalence in people with a high genetic risk was significantly influenced by the parenting and family environment.

For bipolar, stress (such as childhood adversity or highly conflictual families) is not a diagnostically specific causal agent, but does place genetically and biologically vulnerable individuals at risk for a more pernicious course of illness. There has been considerable debate regarding the causal relationship between usage of cannabis and bipolar disorder.

Further research is needed both on mental health causal factors, and on the effectiveness of prevention programs.

Sources:
Wikipedia 2013 – “Definitions of mental disorders” –  authors in aggregate.  
Family Guide editorial staff (FG).

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