Mental illness

Mental illness, any of several diseases of the mind manifesting itself as disordered thoughts or feelings, or behavior which is apparently irrational or which deviates from socially and culturally accepted norms. The modern concept of mental illness rests on 3 foundations. The oldest of these consists of norms of feeling, development, and behavior defined by society and prevailing in a culture at a particular time. One example of an important area bearing on an individual's mental health that is strongly defined by custom and belief is sexuality. Our definition of mental illness also proceeds from rationalism, the idea that a healthy mind is predominantly a logical mind. And we rely upon science, particularly neurophysiology and neurochemistry, for research into the organic causes of mental illness. Though it is widely accepted that many, if not most, mental illnesses are caused or can be treated organically, there are many mental disorders that have no known organic cause but whose symptoms may be masked or alleviated by drugs. Organic disorders include delirium, which may be accompanied by illusions or hallucinations, and dementia, characterized by lapses of one or more of the mental faculties. Delirium can be caused by alcoholism or certain illnesses; dementia often accompanies aging. Schizophrenia, a severe form of psychosis, has recently been associated with chemical imbalances in the brain and there are indications it may be hereditary. Affective disorders, including mania, depression, and manic-depression, are profound disturbances of mood which can be managed to some degree with antidepressants or tranquilizers.

Other forms of mental illness include a variety of anxieties such as obsessive-compulsive behavior or phobias (agoraphobia, or fear of public places, and claustrophobia, or fear of closed places, are examples). There are also dissociative disorders in which a person may suffer a change or loss of identity. These can manifest as one of several kinds of amnesia or as multiple personality disorder, in which a person has more than 1 personality with now one, then the other, being dominant. The underlying causes of these conditions are as yet unknown.

There are also certain kinds of mental illness unique to a particular age group. Children, for example, may be hyperactive or they may be afflicted with autism, a disorder in which the child appears remote, expressionless, and unresponsive. Alzheimer's, a disease of the brain cells that leads to impairment of the mental faculties, attacks people in their 40s and older.

The principal health professionals concerned with diagnosing and treating the mentally ill are psychiatrists and psychologists. Psychiatrists are medical doctors; psychologists are usually Ph.D.s in psychology. Treatment for the mentally ill may include drug therapy, various forms of psychotherapy, or periods of institutionalization. In many cases, a combination of therapies is used. For some patients, psychoanalysis is found useful, while others respond best to behavior modification. In extreme cases, electroshock treatments and even psychosurgery may be necessary, though both are highly controversial forms of treatment which now raise fundamental moral, ethical, and legal questions.

For the most part, society's treatment of the mentally ill has not been a bright page in human history. Mental disorders have been seen as curses and the work of malevolent spirits and the mentally ill, as often as not, were shunned, tormented, or persecuted. Among the Greeks, Hippocrates made a major advance in the 5th century B.C. by offering a rational explanation for mental illness as being due to imbalances in certain bodily fluids. But it would be another 2,000 years before humane and rational treatment of the mentally ill became the accepted standard. It was in the 1700s that Philippe Pinel, a French doctor, and the British merchant William Tuke, introduced modern reforms into mental institutions. Their innovations were taken up by Benjamin Rush in America, and reform of the country's mental institutions was hastened by the writings of Dorothea Dix. Reform was also advanced by the work of Clifford W. Beers, a former mental patient, whose book, A Mind That Found Itself, helped improve public understanding of the problems of the mentally ill. In 1909, he founded the National Committee for Mental Hygiene, which later became the National Association for Mental Health. Simultaneously with institutional reform came medical advances and new forms of treatment and therapy. Toward the end of the 19th century, Emil Kraepelin and Eugen Bleuler classified most mental disorders. Early in the 20th century, Sigmund Freud introduced his psychoanalytic method and his ideas on the structure and development of the mind. Research into various forms of psychotherapy, the development of behaviorist theories, research into the physiology and chemistry of the brain and the nervous system, and the development of psychotropic drugs, have all had a significant effect upon the care and treatment of the mentally ill. But they are still, in many ways, feared, ignored, or discriminated against, and problems of care, treatment, and integration of the mentally ill into society are as urgent as the need for continued medical research.