TWO TOPICS DEFINITION OF MENTAL ILLNESS NATURE OF SCHIZOPHRENIA

WHY WANT DEFINITION OF MENTAL ILLNESS? DISTINGUISH FROM NORMAL INDICATE NEED FOR MENTAL HEALTH TREATMENT WHAT CONDITIONS SHOULD BE REIMBURSED? DETERMINE CRIMINAL LIABILITY - PUNISH OR TREAT?

DSM-IV DEFINITION (1) “MENTAL DISORDER IS A CLINICALLY SIGNIFICANT BEHAVIORAL OR PSYCHOLOGICAL PATTERN THAT IS ASSOCIATED WITH PRESENT DISTRESS OR DISABILITY.”

DISTRESS OR DISABILITY MUST HAVE EITHER DISTRESS (MENTAL PAIN) OR DISABILITY (LOSS OF FUNCTIONING) EITHER MUST REALLY BOTHER PEOPLE - E.G. THINK LEFT STOVE ON OR HAVE NEGATIVE IMPACT ON THEIR LIVES - E.G. SCHIZOPHRENIA

DSM (2) “IN ADDITION, THIS PATTERN MUST NOT BE MERELY AN EXPECTABLE AND CULTURALLY SANCTIONED RESPONSE TO A PARTICULAR EVENT, FOR EXAMPLE, THE DEATH OF A LOVED ONE.”

NOT EXPECTABLE RESPONSE BEREAVEMENT EXCLUSION SYMPTOMS ARE NORMAL ROMANTIC BREAKUPS SOLDIER ENTERING COMBAT MUST KNOW CONTEXT

DSM (3) “WHATEVER ITS ORIGINAL CAUSE, IT MUST CURRENTLY BE A BEHAVIORAL, PSYCHOLOGICAL, OR BIOLOGICAL DYSFUNCTION IN THE INDIVIDUAL.”

INTERNAL DYSFUNCTION SOME PSYCHOLOGICAL SYSTEM (MOOD, FEAR, THOUGHT, EMOTION, ETC.) IS NOT FUNCTIONING PROPERLY - SOMETHING IS WRONG WRONG CONTEXT OR TOO SEVERE OR TOO ENDURING MANY CAUSES – BIOLOGICAL, PSYCH., SOCIAL – OF M.I.

DSM (4) “NEITHER DEVIANT BEHAVIOR (E.G. POLITICAL, RELIGIOUS, OR SEXUAL) NOR CONFLICTS BETWEEN THE INDIVIDUAL AND SOCIETY ARE MENTAL DISORDERS UNLESS THE DEVIANCE OR CONFLICT IS A SYMPTOM OF A DYSFUNCTION IN THE INDIVIDUAL.”

DEVIANCE OR M.I.? ONLY MENTAL DISORDER WHEN SOME MECHANISM IS UNABLE TO FUNCTION AS IT IS SUPPOSED TO ALCOHOLIC OR ADDICT WHO CAN’T STOP DRINKING OR TAKING DRUGS NOT JUST DEFIANCE OF RULES VERY DIFFICULT TO DISTINGUISH

SUMMARY MENTAL DISORDER IS HARMFUL INTERNAL DYSFUNCTION CAUSES CAN BE PSYCHOLOGICAL, BIOLOGICAL, OR SOCIAL DISTINGUISH FROM EXPECTABLE RESPONSES TO STRESSORS AND FROM SOCIAL DEVIANCE

PSYCHOSES MOST SEVERE KIND OF M.I. SCHIZOPHRENIA BI-POLAR (MANIC DEPRESSION)

SCHIZOPHRENIA PERHAPS MOST IMPORTANT MENTAL ILLNESS CREATES STEREOTYPE OF MENTAL ILLNESS - CRAZY, NUTS, BIZARRE

IMPORTANCE MOST ADMISSIONS AND RESIDENTS OF PUBLIC MENTAL HOSPITALS SEVERITY AND CHRONICITY MEAN COSTLY AND DIFFICULT TO TREAT PUBLIC POLICY - HOMELESSNESS, NOTORIOUS CRIMES TREMENDOUS PERSONAL AND FAMILY BURDEN

A BEAUTIFUL MIND JOHN NASH

SYMPTOMS THOUGHT DISORDER

POSITIVE SYMPTOMS THOUGHT INSERTION AND BROADCAST LOOSE ASSOCIATION HALLUCINATIONS DELUSIONS – PARANOIA, GRANDIOSITY

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NEGATIVE SYMPTOMS FLAT AFFECT LACK OF PLEASURE - ANHEDONIA ISOLATION

DISABILITIES POOR SOCIAL, FAMILY, AND WORK RELATIONSHIPS SIDE EFFECTS OF MEDICATION VIOLENCE WHEN IN PSYCHOTIC STATE SOCIAL STIGMA

CAUSES USED TO THINK BAD FAMILIES WERE CAUSE (SCHIZOPHRENOGENIC MOTHER) NOW THOUGHT TO BE BRAIN DISORDER WITH GENETIC OR BIOLOGICAL CAUSE ABOUT 1% PREVALENCE IN WIDE VARIETY OF TIMES AND PLACES

CORRELATES LOW SOCIAL CLASS CAUSE OR CONSEQUENCE? NO SEX DIFFERENCES NO ETHNIC DIFFERENCES NO INTELLIGENCE DIFFERENCES EARLY ONSET YEARS ALMOST ALL NOT MARRIED

PROGNOSIS (COURSE) USED TO THINK DEGENERATIVE NOW THOUGHT TO BE VARIABLE 1/3 CHRONIC; 1/3 EPISODIC; 1/3 RECOVER HIGH RATE OF SUICIDE - 10%

TREATMENT USED TO BE LONG STAYS IN MENTAL HOSPITALS NOW BRIEF, EPISODIC HOSPITAL STAYS ALONG WITH COMMUNITY TREATMENT (OR NEGLECT) MEDICATION SINCE 1950’S PHENOTHIAZINES AND CLOZAPINE

TREATMENT MEDICATION DOESN’T CURE, BUT CONTAINS - BUT MUST TAKE IT PSYCHOSOCIAL TREATMENTS - SOCIAL AND JOB SKILLS, HOUSING PSYCHOTHERAPY LESS CRITICAL HARDEST TO TREAT - MICA (MENTALLY ILL CHEMICAL ABUSERS)

MAJOR PROBLEMS INADEQUATE FUNDING FOR TREATMENT MANY DON’T ADMIT THAT THEY ARE ILL - STOP TAKING MEDICATIONS WHEN GET IN TROUBLE PUT IN JAILS AND PRISONS