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