|
Let's
Talk Facts About...
MENTAL
ILLNESS
An Overview
When
people hear the phrase "mental illnesses,"
often they will conjure up the images of a person tortured
by the demons only he or she sees, or by the voices
no one else hears. Or they may think of a benign, foolish
person who, like Jimmy Stewart's character in "Harvey,"
talks to nonexistent friends.
This,
of course, is the version of mental illnesses that most
of us have developed from movies and literature. Films
and books trying to create dramatic effect often rely
on the extraordinary symptoms of psychotic illnesses
like schizophrenia, or they draw on outmoded descriptions
of mental illnesses that were evolved during a time
when no one had any idea what caused them. Few who have
seen these characterizations ever realize that people
suffering even from the most severe mental illnesses
actually are in touch with reality as often as they
are disabled by their illnesses.
Moreover,
few mental illnesses have hallucinations as symptoms.
For example, most people suffering from a phobia do
not have hallucinations or delusions, nor do those with
obsessive compulsive disorder. Most people with depression
aren't so seriously ill that they act on bizarre sensory
perceptions or thought processes. The unrelenting hopelessness,
helplessness and suicidal thoughts of depression, the
despair brought by alcoholism or drug abuse, may be
hard to comprehend, but these are real, painful emotions,
not hallucinations or delusions.
These
widespread assumptions about mental illnesses also overlook
one other important reality: as many as eight in ten
people suffering from mental illnesses can effectively
return to normal, productive lives if they receive appropriate
treatment--treatment which is readily available. Psychiatrists
and other mental health professionals can offer their
patients a wide variety of effective treatments.
It
is vital that Americans know that this help is available,
because anyone, no matter what age, economic status
or race, can develop a mental illness.
- During
any one-year period, up to 50 million Americans --
more than 22 percent -- suffer from a clearly diagnosable
mental disorder involving a degree of incapacity that
interferes with employment, attendance at school or
daily life.
- 20
percent of the ailments for which Americans seek a
doctor's care are related to anxiety disorders, such
as panic attacks, that interfere with their ability
to live normal lives.
- Some
8 million to 14 million Americans suffer from depression
each year. As many as one in five Americans will suffer
at least one episode of major depression during their
lifetimes.
- About
12 million children under 18 suffer from mental disorders
such as autism, depression and hyperactivity.
- Two
million Americans suffer from schizophrenic disorders
and 300,000 new cases occur each year.
- 15.4
million American adults and 4.6 million adolescents
experience serious alcohol-related problems, and another
12.5 million suffer from drug abuse or dependence.
- Nearly
one-fourth of the elderly who are labeled as senile
actually suffer some form of mental illness that can
be effectively treated.
- Suicide
is the third leading cause of death for people between
the ages of 15 and 24.
Many
Go Untreated
People suffering from mental illnesses often do not
recognize them for what they are. About 27 percent of
those who seek medical care for physical problems actually
suffer from troubled emotions.
Mental
illnesses and substance abuse afflict both men and women.
Studies by the U.S. Alcohol, Drug Abuse and Mental Health
Administration indicate men are more likely to suffer
from drug and alcohol abuse and personality disorders,
while women are at higher risk of suffering from depression
and anxiety disorders.
The
personal and social costs that result from untreated
mental disorders are considerable--similar to those
for heart disease and cancer. According to estimates
by the Substance Abuse and Mental Health Services Administration
(SAMHSA), Institute of Medicine, the direct costs for
support and medical treatment of mental illnesses total
$55.4 billion a year; the direct costs of substance
abuse disorders come to $11.4 billion a year; and indirect
costs such as lost employment, reduced productivity,
criminal activity, vehicular accidents and social welfare
programs increase the total cost of mental and substance
abuse disorders to more than $273 billion a year.
Emotional
and mental disorders can be treated or controlled, but
only one in five people who have these disorders seek
help, and only four to 15 percent of the children suffering
severe mental illnesses receive appropriate treatment.
This unfortunate reality is further complicated by the
fact that most health insurance policies provide limited
mental health and substance abuse coverage, if any at
all.
Medications
relieve acute symptoms of schizophrenia in 80 percent
of cases, but only about half of all people with schizophrenia
seek treatment. Fewer than one-fourth of those suffering
from anxiety disorders seek treatment, even though psychotherapy,
behavior therapy and some medications effectively treat
these illnesses. Fewer than one-third of those with
depressive disorders seek treatment. Yet, with therapy,
80 to 90 percent of the people suffering from these
diseases can get better.
Advances
in Diagnosis and Treatment
Researchers
have made tremendous progress in pinpointing the physical
and psychological origins of mental illnesses and substance
abuse. Scientists are now certain that some disorders
are caused by imbalances in neurotransmitters, the chemicals
in the brain that carry messages between nerve cells.
Studies have linked abnormal levels of these neurotransmitters
with depression and schizophrenia.
A
special technology called positron emission tomography
(PET) has allowed psychiatric medical researchers to
"watch" the living brain's functioning. Researchers
have used PET to show that the brains of people suffering
from schizophrenia do not metabolize the sugar called
glucose in the same way as the brains of healthy people.
PET also helps physicians determine if a person suffers
from schizophrenia or the manic phase of manic-depressive
illness, which can have similar symptoms.
Refinements
of lithium carbonate, used in treating manic-depressive
(bipolar) disorder, have led to an estimated annual
savings of $8 billion in treatment costs and lost productivity
associated with bipolar disorder.
Medications
are helpful in treating and preventing panic attacks
among patients suffering severe anxiety disorders. Studies
also indicate that panic disorders could be caused by
some underlying physical, biochemical imbalance.
Studies
of psychotherapy by the National Institute of Mental
Health have shown it to be very effective in treating
mild-to-moderate depression.
Scientists
are beginning to understand the biochemical reactions
in the brain that induce the severe craving experienced
by cocaine users. Through this knowledge, new medications
may be developed to break the cycle of cocaine craving
and use. Although these findings require continued research,
they offer hope that many mental disorders may one day
be prevented.
Depression
Depression
is the most commonly diagnosed emotional problem. Almost
one-fourth of all Americans suffer from depression at
some point in life, and four percent of the population
have symptoms of depression at any given time.
The
term "depression" can be confusing, since
it's often used to describe a very normal emotion that
passes quickly. Everyone feels "blue" or sad
occasionally. But if that emotion continues for long
periods, and if it is accompanied by feelings of guilt
and hopelessness, it could be an indication of depression.
The persistence and severity of such emotions distinguishes
the mental disorder of depression from normal mood changes.
People
who suffer serious depression say they feel their lives
are pointless. They feel slowed down, "burned out"
and useless. Some even lack the energy to move or to
eat. They doubt their own abilities and often look on
sleep as an escape from life. Many think about suicide,
a form of escape from which there is obviously no return.
Other
symptoms that characterize depression are sleeplessness,
loss of self-esteem, inability to feel pleasure in formerly
interesting activities, loss of sexual drive, social
withdrawal, apathy and fatigue.
Depression
can be a response to stress from a job change, loss
of a loved one, even pressures of everyday living. Sometimes
it just happens, with no external cause. The problem
can be debilitating, but it is not insurmountable and
no one should have to suffer its symptoms. With treatment,
people with depression can recover and lead full lives.
Some
persons suffer from manic-depressive (bipolar) disorder,
an illness in which sufferers' mood may swing from depression
to an abnormal elation or mania that is characterized
by hyperactivity, scattered ideas, distractibility,
and recklessness. Most people suffering from bipolar
disorder respond remarkably well to the mineral salt
lithium, which seems to even out the disorder's terrible
highs and lows.
Psychiatrists
have a number of effective treatments for depression--usually
involving a combination of psychotherapy and medications.
Psychotherapy, a common form of treatment for depression,
addresses specific emotional responses that contribute
to a person's depression. The discovery of such emotional
triggers allows persons to change their environment
or their emotional reactions to it, thereby alleviating
the symptoms. Psychiatrists have a full range of antidepressant
medications which they often use to augment psychotherapy
for treating depression.
Almost
all depressed patients respond to psychotherapy, medication,
or a combination of these treatments. Some depressed
patients cannot take antidepressant medications, however,
or may experience a depression so profound that it resists
medication. Others may be at immediate risk of suicide,
and with these patients the medications may not act
quickly enough. Fortunately, psychiatrists can help
these patients with electroconvulsive therapy (ECT),
a safe and effective treatment for some serious mental
disorders. In this treatment, the patient receives a
short-acting general anesthetic and a muscle relaxant
followed by a painless electric current administered
for less than a second through contacts placed on the
head. Many patients report significant improvement in
their mood after only a few ECT treatments.
Anxiety
Disorders
Fear
is a safety valve that helps us recognize and avoid
danger. It increases our reflexive responses and sharpens
awareness.
But
when a person's fear becomes an irrational, pervasive
terror or a nagging worry or dread that interferes with
daily life, he or she may be suffering from some form
of anxiety disorder. This affliction affects about 30
million Americans, including 11 percent of the population
who suffer serious anxiety symptoms related to physical
illness. In fact, anxiety is thought to contribute to
or cause 20 percent of all medical conditions among
Americans seeking general health care.
There
are many different expressions of excessive anxiety.
Phobic disorders, for example, are irrational, terrifying
fears about a specific object, social situations or
public places. Psychiatrists divide phobic disorders
into several different classifications, most notably
specific phobias, social phobias and agoraphobia.
Specific
phobias are a relatively common problem among Americans.
As this category's name implies, people suffering from
specific phobia generally have irrational fear of specific
objects. If the feared object rarely appears in the
person's life, the phobia may not create serious disability.
If the object is common, however, the resulting disability
can be severe. The most common specific phobia in the
general population is fear of animals -- particularly
dogs, snakes, insects and mice. Other specific phobias
are claustrophobia (fear of enclosed spaces) and acrophobia
(fear of heights). Most specific phobias develop during
childhood and eventually disappear. But those that persist
into adulthood rarely go away without treatment.
Social
phobia is the irrational fear and avoidance of being
in a situation in which a person's activities can be
watched by others. In a sense, it is a form of "performance
anxiety," but a social phobia causes symptoms that
go well beyond the normal nervousness before an on-stage
appearance. People suffering social phobias intensely
fear being watched or humiliated while doing something--such
as signing a personal check, drinking a cup of coffee,
buttoning a coat or eating a meal--in front of others.
Many patients suffer a generalized form of social phobia,
in which they fear and avoid most interactions with
other people. This makes it difficult for them to go
to work or school, or to socialize at all. Social phobias
occur equally among men and women, generally developing
after puberty and peaking after age 30. A person can
suffer from one or a cluster of social phobias.
Derived
from the Greek, agoraphobia literally means "fear
of the marketplace." This disorder, which afflicts
twice as many women as men, is the most serious of the
phobic disorders. It causes its victims to fear being
alone in any place or situation from which he or she
thinks escape would be difficult or help unavailable
if he or she were incapacitated. People with agoraphobia
avoid streets, crowded stores, churches, theaters and
other crowded places. Normal activities are restricted
by this avoidance, and people with the disorder often
become so disabled they literally will not leave their
homes. If people with agoraphobia do venture into phobic
situations, they do so only with great distress or when
accompanied by a friend or family member.
Most
people with agoraphobia develop the disorder after first
suffering a series of one or more spontaneous panic
attacks. The attacks seem to occur randomly and without
warning, making it impossible for a person to predict
what situations will trigger the reaction. The unpredictability
of the panic attacks "trains'' the victims to anticipate
future panic attacks and, therefore, to fear any situation
in which an attack may occur. As a result, they avoid
going into any place or situation where previous panic
attacks have occurred.
Agoraphobia
victims also may develop depression, fatigue, tension,
alcohol or drug abuse problems and obsessive disorders.
These
conditions are treatable with psychotherapy and with
medication. Psychiatrists and other mental health professionals
use desensitization techniques to help people with phobic
disorders. They teach patients deep muscle relaxation
techniques, and work to understand what provoked the
anxiety. They rely on relaxation techniques to quell
patients' fear. As the sessions progress, the object
or situation that provokes the fear no longer has its
hold on the person.
Panic
disorder, while it often accompanies phobias such as
agoraphobia, can occur alone. People with panic disorder
feel sudden, intense apprehension, fear or terror, that
can be accompanied by heart palpitations, chest pain,
choking or smothering sensations, dizziness, hot and
cold flashes, trembling and faintness. These ``panic
attacks,'' which are the disorder's main feature, usually
begin during adolescence or early adult life. Many people
experience panic disorder's symptoms at some time in
their lives as a "panic attack," in episodes
that are limited to a single brief period and that may
be connected to stressful life events. But psychiatrists
diagnose panic disorder when the condition has become
chronic.
People
with generalized anxiety disorder suffer with unrealistic
or excessive anxiety and worry about life circumstances.
For example, they may feel anxious about financial matters
when there's plenty of money in the bank and their debts
are paid. Or they may be preoccupied constantly about
the welfare of a child who's safe at school. People
with generalized anxiety disorder may have stretches
of time when they're not consumed by these worries,
but they are anxious most of the time. Patients with
this disorder often feel "shaky," reporting
that they feel "keyed up" or "on edge"
and that they sometimes "go blank" because
of the tension they feel. They often suffer also with
mild depression.
The
behaviors that are a part of obsessive-compulsive disorder
include obsessions (which are recurring, persistent
and involuntary thoughts or images) which often occur
with compulsions (repetitive, ritualistic behaviors
-- such as hand washing or lock checking -- which a
person performs according to certain "rules").
The individual doesn't get pleasure from such behavior,
and, in fact, recognizes that it is excessive and has
no real purpose. Still, a person with OCD will claim
they "can't help" their ritualistic behavior,
and will become very anxious if it is interrupted. Often
beginning in adolescence or early adulthood, obsessive
and compulsive behaviors frequently become chronic.
Increasing
evidence supports the theory that the disorders arise
at least partly from imbalances in the brain's chemistry.
Some investigators believe these disorders result from
a traumatic experience in childhood that has been consciously
forgotten, but surfaces as a reaction to a feared object
or stressful life situation, while others believe they
arise from imbalances in brain chemistry. Several forms
of medication and psychotherapy are highly effective
in treating anxiety disorders, and research continues
into their causes.
Schizophrenia
Like
depression, schizophrenia afflicts persons of all ages,
races and economic levels. It effects up to two million
Americans during any given year. Its symptoms frighten
patients and their loved ones, and those with the disorder
may begin to feel isolated as they cope with it.
The
term schizophrenia refers to a group of disorders that
have common characteristics, though their causes may
differ. The hallmark of schizophrenia is a distorted
thought pattern. The thoughts of people with Schizophrenia
often seem to dart from subject to subject, often in
an illogical way. Patients may think others are watching
or plotting against them. Often, they lose their self-esteem
or withdraw from those close to them.
The
disease often affects the five senses. Persons suffering
schizophrenia sometimes hear nonexistent sounds, voices
or music or see nonexistent images. Because their perceptions
do not fit reality, they react inappropriately to the
world. In addition, the illness affects the emotions.
Patients react in an inappropriate manner or without
any visible emotion at all.
Though
the symptoms of schizophrenia can appear suddenly during
times of great stress, schizophrenia most often develops
gradually, and close friends or family might not notice
the change in personality as the illness takes initial
hold.
Theories
about the causes of schizophrenia abound, but research
has not yet pinpointed what causes the disease. In recent
years, laboratory findings have suggested strongly that
schizophrenia is passed on genetically from generation
to generation. Scientist have theorized that the disease
may be triggered, in some people with this inherited
predisposition, by another illness that changes the
body's chemistry, an unhappy or violent childhood, a
highly stressful situation in adult life or a combination
of these. Some think disturbances in brain chemistry
or the hormonal system contribute to the disease's development.
Some studies have found abnormal levels of some chemicals
in the blood and urine of people with schizophrenia.
One study has suggested that the alignment of cells
in a particular area of the brain goes awry before birth.
Schizophrenia
cannot be cured, but it can be controlled. Thanks to
new treatments, most persons with schizophrenia are
able to work, live with their families, and enjoy friends.
Very few are ever violent or behave in unacceptable
ways. But, like a person with diabetes, the person with
schizophrenia probably will have to be under medical
care for the rest of his or her life.
Researchers
have found a number of antipsychotic medications that
aid in the treatment of schizophrenia. Of course, these
drugs should be used only under the close supervision
of a psychiatrist.
Additionally,
psychotherapy can offer understanding, reassurance,
and careful insights and suggestions for handling the
emotional aspects of the disorder. A change in the patient's
living and working environment can reduce stressful
situations. A combination of treatments should be tailored
to the individual patient's needs.
Substance
Abuse
Substance
abuse should be a part of any discussion about mental
illnesses. Substance abuse -- the misuse of alcohol,
cigarettes and both illegal and legal drugs -- is by
far the predominant cause of premature and preventable
illness, disability and death in our society. According
to the National Institute of Mental Health, nearly 17
percent of the U.S. population 18 years old and over
will fulfill criteria for alcohol or drug abuse in their
lifetimes. When the effects on the families of abusers
and people close to those injured or killed by intoxicated
drivers are considered, such abuse affects untold millions
more.
While
abuse of and/or dependence on substances may in their
own right bring suffering and physical sickness that
require psychiatric medical treatment, they often accompany
other seemingly unrelated mental illnesses as well.
Many people who struggle with mental illnesses also
struggle with alcohol or drug habits that may have begun
in their mistaken belief that they can use the substance
to "medicate" the painful feelings that accompany
their mental illness. This belief is mistaken because
substance abuse only adds to the suffering, bringing
its own mental and physical anguish. Here, too, psychiatrists
can offer hope with a number of effective treatment
programs that can reach the substance abuser and his
or her family.
Conclusion
People
who experience emotional disorders such as those described
in this brochure do not have to suffer without help.
By consulting a psychiatrist, they make a positive step
toward controlling and curing the condition that interferes
with their lives. If you, a friend or family member
is suffering with a mental illness, contact the psychiatric
or medical society in your area, a local mental health
center, or ask your general physician for names of a
psychiatrist.
Don't
be afraid to ask for help. It's a sign of strength.
Bibliography
Ablow,
K. Anatomy of A Psychiatric Illness: Healing the Mind
and the Brain. Washington, DC: American Psychiatric
Press, Inc., 1993.
Brown,
George W. and Harris, Tirril O., Eds. Life Events and
Illness. New York: Guilford Press, 1989.
Copeland,
M. The Depression Workbook. New Harbinger, 1992.
Gaw,
A., Ed. Culture, Ethnicity, and Mental Illness. Washington,
DC: American Psychiatric Press, Inc., 1992.
Fink,
Paul and Tasman, Allan, Eds. Stigma and Mental Illness.
Washington, DC: American Psychiatric Press, Inc., 1991.
Lickey,
Marvin and Gordon, Barbara. Medicine and Mental Illness:
Understanding Drug Treatment in Psychiatry. New York,
NY: Freeman and Co., 1991.
McElroy,
E., Ed. Children and Adolescents with Mental Illness:
A Parents Guide. Kensington, MD: Woodbine House, 1988.
Roth,
M. and Kroll, J. The Reality of Mental Illness. New
York, NY: Cambridge University Press, 1986.
Resources
|
