Post on 20-Dec-2015
CONCEPTIONS OF MENTAL ILLNESS
• HOW VIEWS OF MENTAL ILLNESS HAVE CHANGED OVER TIME
• CURRENT CONCEPTIONS OF MENTAL ILLNESS
• WHERE DRAW THE LINE BETWEEN MENTAL ILLNESS AND NORMALITY?
PRE-20TH CENTURY
• MENTAL ILLNESS IS UNIVERSAL
• MENTAL ILLNESS LIMITED TO SMALL NUMBER OF MOST SERIOUS CONDITIONS
• MENTALLY ILL HIGHLY STIGMATIZED
CAUSES
• NOT MUCH KNOWN
• SUPERNATURAL
• BRAIN DISEASE
EARLY TREATMENT
• PRE-19TH CENTURY – FAMILY RESPONSIBILITY OR LEFT TO FEND FOR SELVES
• NO OUTPATIENT TREATMENT
• 19TH CENTURY - SHUT AWAY IN INSTITUTIONS
PRE-20TH CENTURY
• LIMITED TO SMALL NUMBER OF SEVERE CONDITIONS
• MENTALLY ILL BIZARRE AND DIFFERENT
• CAUSES UNKNOWN
• INSTITUTIONALIZED
CURRENT CONCEPTIONS
• BEGAN WITH DSM-III (1980) - NOW NEARLY 400 CONDITIONS
• NOT JUST MOST SEVERE CONDITIONS BUT MANY DIFFERENT CONDITIONS
M.I. WIDESPREAD
• NO LONGER SEEN AS UNUSUAL BUT MANY PEOPLE AFFECTED BY THEM
• 50 PERCENT OF POPULATION OVER LIFETIME; 20 PERCENT IN ANY GIVEN YEAR
NORMALIZATION
• MENTALLY ILL NOT SEEN AS DIFFERENT FROM NORMAL
• MENTALLY ILL NOT CERTAIN KIND OF PERSON BUT NORMAL PERSON WITH PARTICULAR DISEASE
MEDICALIZATION
• NORMAL PEOPLE HAVE MEDICAL CONDITION
• MENTAL ILLNESSES VIEWED AS BRAIN DISEASES
• GENETICS AND BRAIN CHEMISTRY AT FAULT
• TREATED BY PROFESSIONALS
TREATMENT
Psychotropic Prescribing in USA (IMS - S Units)
0100000020000003000000400000050000006000000700000080000009000000
10000000
1990 1992 1994 1996 1998 2000 2001
AntidepressantAntipsychotic
TREATMENT
• SSRI - SELECTIVE SEROTONIN REUPTAKE INHIBITORS - “ANTI-DEPRESSANTS”
• HUGE INCREASE IN DRUG TREATMENT - 60 MILLION SCRIPTS
• 3 OF 7 MOST PRESCRIBED DRUGS
THERAPEUTIC CULTURE
• MANY BEHAVIORS MEDICALIZED
• MENTAL ILLNESS IS COMMON
• MENTALLY ILL NOT DIFFERENT
• MORE PEOPLE IN TREATMENT AND MORE MENTAL HEALTH PROFS.
• OUTPATIENT FAR MORE THAN INPATIENT
RATES OF TREATMENT
0
500
1000
1500
2000
2500
ALL IN OUT
1970198019902000
010,00020,00030,00040,00050,00060,00070,00080,00090,000
100,000
psyc
hiat
ry
clin
psy
ch
scho
ol p
sy
soci
alw
ork
198019902000
M.H. PROFS. 1980-2000
SUMMARY OF TRENDS
• FROM ONLY SERIOUS TO MANY CONDITIONS
• FROM RARE TO WIDESPREAD
• FROM STIGMATIZED TO MEDICALIZED
• FROM UNKNOWN CAUSES TO PRESUMED BIOLOGICAL
SUMMARY OF TRENDS
• FROM INSTITUTIONS TO OUTPATIENT THERAPY AND DRUGS
• FROM SEGREGATION TO PART OF CULTURE
WHERE DRAW THE LINE?
• ARE TOO MANY CONDITIONS MEDICALIZED NOW?
• HOW CAN WE SEPARATE WHAT’S M.I. FROM WHAT’S NORMAL?
SOPRANOS
• BEHAVIORS VIEWED AS DISEASES
• CHANGE OVER TIME FROM ROWDY TO SICK
• CONFLICT WITH MUCH LAY CULTURE
• RISE OF M.H. PROFESSIONALS
• TREATMENT NOT PUNISHMENT