Mental illness: Definitions, Causes, and Treatments - Essay Example

Running Head: Mental illness: Definitions, Causes and treatments Mental Illness By _________________ Mental Health and Mental Ill Health If we start analysing mental health in the light of cultural context, we would come to realise that it is the influence of 'culture' that distinguishes between mental health and mental ill health. Rapee Ronald highlights the cultural factor, as "According to the cultural factor, people are considered abnormal if their behaviour violates the unwritten rules of society". (Ronald, 2001, p8.4) An example is the crying of a 2-year old child, which is considered quite acceptable. However, the same phenomena repeated by a man would seem quite strange. The reason is our society high expectations, which explains why a behaviour defined as abnormal in one culture may be considered normal in another. Mental health when collides with certain emotional and behavioural disorders, refers to mental illness, which can be defined in several different ways depending upon their classification. Classification refers to identifying subtypes and categories of mental disorders. These categories are identified by particular signs and symptoms. The process of assigning a label to a mental disorder based on the signs and symptoms is referred to as diagnosis. (Ronald, 1999, p8.7) Cultural perspectives in Britain indicate that it is often misunderstood that Black people have something that looks like 'schizophrenia' but isn't. Studies have indeed suggested that Afro-Caribbean 'schizophrenics' have a shorter illness with a better outcome. This has led to the proposition that what is often mistaken for schizophrenia among Afro-Caribbeans is actually an acute psychotic reaction that is, madness brought on as a psychological reaction to unpleasant life events (Lewis et al. 1990). This approach to explaining high rates of psychosis among Afro-Caribbeans involves, thereby, admitting that social events can cause the types of behaviour which psychiatrists call 'psychosis'. This is what is so adamantly denied by the medical model. Nevertheless, this psychiatric anathema is deployed when it comes to explaining why so many Black people go, or are labelled, as 'mad'. Another explanation for all these diagnostic errors is that professionals don't understand what is normal and abnormal in other cultures. This is probably true. This approach, however, suspends another basic tenet of the medical model: that 'schizophrenia' is a biogenetic illness and has nothing to do with breaking cultural norms. What is being suggested is that what is considered 'insane' for White people may be 'normal' for Black people. This can come dangerously close to suggesting that 'Black culture' is not just difficult to understand but actually breeds 'mental illness'. The collective version of the selective migration theory blamed the cultures of the countries of origin for the high rates of 'schizophrenia'. (Bentall et al, 2004, p. 173) Schizophrenia Schizophrenia has been recognised for over 100 years as a form of severe mental illness, which starts as a mild mental disorder in late adolescence or early adulthood. Extensive biological research searching for a unique diagnostic marker has failed to yield a means of diagnosing the illness from a medical test. Accordingly, clinicians remain wholly dependent on the observation of clinical symptom clusters to diagnose the disorder. Since schizophrenia may represent a complex syndrome with diverse etiological bases and disorder outcomes, the identification of specific symptom clusters is vital in the understanding of the nature of the disorder. (Csernansky, 2002, p. 29) Diagnosis According to DSM-IV, for a person to be diagnosed with Schizophrenia, they must show two or more of the following symptoms: 1) Delusions, 2) Hallucinations, 3) Disorganised speech, 4) grossly disorganised behaviour, 5) negative symptoms such as flat mood, lack of motivation. In addition, the person must show a decrease in his/her usual functioning. (Rapee, 2001, p8.20) Symptoms Basic or primary symptoms that directly reflect the illness process include hallucinations, disturbances of association, and melancholia. Accessory, or secondary, symptoms are those that may or may not be observed in any given patient. In schizophrenia, accessory symptoms include thought disorder; affect disturbance, cognitive deficits, and avolition. (Arieti, 1974) Observations by the early diagnostic clinicians and more recent scientific analysis of symptom presentation suggest that multiple replicable groupings of symptoms can be found in schizophrenia. These include: 1) positive symptoms such as hallucinations and delusions, 2) thought-disorder features demonstrated by impairments in thought process, 3) negative symptoms typified by the absence of behaviours (e.g., emotional affect) common in unaffected individuals, and 4) other symptoms found in schizophrenia but also common in other major psychiatric disorders (e.g., depression). (Warner, 2000, p. 54) Symptoms - positive or negative Schizophrenia is a heterogeneous disorder with symptoms that often vary over the course of the illness. These symptoms, where the person shows certain excesses such as unusual thoughts and perceptions are referred to as positive symptoms of schizophrenia. People with schizophrenia may also show several psychomotor signs, such as unusual grimaces, odd movements and odd postures. People with schizophrenia may also report several other symptoms, such as withdrawal from other people, difficulty in interpersonal relationships, poor social skills and impairments in self-care and grooming. Such behavioural deficits are negative symptoms of schizophrenia. (Rapee, 2001, p8.20) Hallucinations are another characteristic symptom of acute schizophrenia. Auditory hallucinations are the most common, occurring in nearly 50% of all patients (Cutting, 1990, p. 34). Several categories of auditory hallucinations include voices speaking thoughts aloud, voices arguing, and voices commenting on the patient. DSM-IV emphasizes the diagnostic importance of some forms of auditory hallucinations e, g, a voice that provides a running commentary on the patient's thoughts or behavior. (Warner, 2000, p. 67) Schizophrenia Theoretical Cause One of the most widely accepted theories of the cause of schizophrenia is the Dopamine Theory. According to this theory, most of the symptoms of schizophrenia are the result of having excessive levels of dopamine, especially in the mesolimbic pathways of the brain. (Carson & Sanislow, 1993) According to Carlsson (1978), "several sources support this theory. First many of the drugs that are used to treat schizophrenia seem to work primarily by blocking certain dopamine receptors in the brain". (Carlsson, 1978) Second, certain drugs that have been found to increase levels of dopamine in the brain also produce symptoms that are very similar to those found in schizophrenia. However there are other factors beside theoretical causes like social model, medical model etc. Treatment The clinical course of schizophrenia typically involves a recurring pattern of acute psychotic episodes, during which the patient experiences significant worsening of positive symptoms, including delusions, hallucinations, thought disorganization, and catatonia. Loss of social, occupational, and personal interests is an important, and potentially devastating, aspect of the illness. Harding (1987) enumerated as many as ten different factors that may cause the patient to withdraw into isolation dominated by negative symptoms, some of them being the psychic suffering due to the recurrence of positive symptoms, the loss of hope and self-esteem, the presence of guilt feelings for previous psychotic behaviour, the threat evoked by social situations, and the effects of institutionalization, including the stigma of being diagnosed as schizophrenic. (Alanen & Leinonen, 1997, p. 105) The treatment of schizophrenia in a way that genuinely combines psychological and biological approaches as based on the illness models. Clearly, the most common method of treating schizophrenia is neuroleptic medication, more or less combined with rehabilitative measures. (Alanen & Leinonen, 1997, p. 111) Because of the limitations of medications, therapists often try to treat schizophrenia using psychological interventions. In some cases psychological treatment has been directly aimed at reducing the positive symptoms of schizophrenia into negative ones. However by combining psychological therapies with drug therapy is a successful method of treating schizophrenia. Social Model of Schizophrenia According to a study in London, the most endorsed causal model of schizophrenia was Unusual or traumatic experiences or the failure to negotiate some critical stage of emotional development, followed by social pressures. (Bentall et al, 2004, p. 134) Social model refers to address the implicit assumptions of disorder like schizophrenia, which accounts a permanent and unchanging binary opposition between the interests and experiences of people. Since the initial development of social models in the 1970s, social ideas have become a crucially important explanatory tool for those people who have some mental illness. Social model explanations of disability represents a different way of explaining disabled people's oppression from previous medicalised accounts, because for the first time they have suggested that many of the problems disabled people face are caused not by their impairments, but rather because society is organised in a way that does not take their needs into account. On this interpretation, the social model approach is a profoundly optimistic one, because it recognises that to achieve change requires that we expect the best of people in acting in ways that challenge existing oppressive practice. (Tregaskis, 2004, p. 23) Social Model Vs. Medical Model Social model thinking thus requires that we analyse the problem of those people who have some kind of mental illness in new ways that avoid a blaming approach. The trouble with this explanation was that it was really pessimistic. It seemed to offer disabled people no hope of greater social inclusion unless they could change themselves by getting rid of their impairments. The big difference that social model ideas have made is that they restate the problem in a different way. So, instead of saying, 'What a shame you can't get into this building because you can't walk up the steps', a social model approach would say 'Actually, you can't get into this building because it has been poorly designed'. The social model view is that disability caused by human factors, like a building being poorly designed, or an organisational promotions policy that puts disabled employees at a disadvantage compared to their non-disabled colleagues. Thus disability is not a characteristic of individual people with impairments, but is a term used to describe all the extra difficulties that people with impairments face because society is not organised in ways that take their needs into account. As such, the social model definition of disability is potentially a more positive tool for change than the individual medical model approach, because it suggests that disability could be eradicated if society was organised in ways that took the needs of all its citizens into account. (Tregaskis, 2003, p. 25) Hardings (1987), a well-known researcher in schizophrenia reported prognostic findings after analysing the 20- to 25-year outcome of patients who had participated in an extensive rehabilitation programme in Vermont, in the 1950s. Of the schizophrenic patients, most of whom had been in hospital for long periods and who were retrospectively found to meet the DSM-III diagnostic criteria 68% had no psychotic symptoms at the time of the follow-up, and most were coping moderately well psychosocially. (Alanen & Leinonen, 1997, p. 37) The lessons learnt from the study refers to those individuals who despite having severe schizophrenic illness recover faster than those who have mild schizophrenia due to the reason that every individual reacts to the illness in a different manner. The reason is every individual intakes different treatments and course therapies. That is what mental illness is all about. References & Bibliography Alanen O. Yrjo & Leinonen Lijsa Sirkka, (1997) Schizophrenia: Its Origins and Need-Adapted Treatment: Karnac Books: London. Arieti S. (1974) Interpretation of Schizophrenia. 2nd ed. New York: Basic Books Bentall P. Richard, Mosher R. Loren & Read John, (2004) Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia: Brunner-Routledge: New York. Carlsson, A. (1978). Antipsychotic drugs, neurotransmitters and schizophrenia. American Journal of Psychiatry, 135, 164-73 Carson R.C, & Sanislow C. A. III. (1993) The Schizophrenias. In P. B Sutker & H. E. Adams Comprehensive Handbook of Psychology. New York: Platinum Press Cutting J. (1990) The Right Cerebral Hemisphere and Psychiatric Disorders. Oxford: Oxford University Press. Csernansky G. John (2002) Schizophrenia: A New Guide for Clinicians: Marcel Dekker: New York. Lewis, G. et al. (1990). Are British psychiatrists racist In British Journal of Psychiatry 157:410- 15. Rapee, M. Ronald, (2001) Abnormal Psychology In Psychological Science: An Introduction. Tregaskis Claire, (2004) Constructions of Disability: Researching the Interface between Disabled and Non-Disabled People: Routledge: New York. Warner Richard, (2000) The Environment of Schizophrenia: Innovations in Practice, Policy, and Communications: Brunner-Routledge: London. Read More