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

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. ASPD

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 SYMPTOMS THEMSELVES ARE NOT SUFFICIENT 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 APPROPRIATELY - SOMETHING HAS GONE WRONG 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.”

MENTAL DISORDER IS NOT DEVIANCE DEVIANCE IS VIOLATION OF MORAL STANDARDS OR SOCIAL NORMS - BAD BEHAVIOR PEOPLE WHO DRINK TOO MUCH, TAKE WRONG KIND OF DRUGS, OR STEAL, CHEAT, AND LIE NEED NOT BE MENTALLY ILL DEVIANCE IS A CHOICE

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

MAJOR PROBLEM DSM DEFINITION OF MENTAL DISORDER IS GOOD DSM AND SURVEYS BASED ON IT DO NOT APPLY THE DEFINITION IN PRACTICE VIEW ALL SYMPTOMS AS INDICATING DISORDER

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 CHRONICITY AND SEVERITY MEAN COSTLY AND DIFFICULT TO TREAT PUBLIC POLICY - HOMELESSNESS, NOTORIOUS CRIMES TREMENDOUS FAMILY BURDEN

SYMPTOMS THOUGHT DISORDER POSITIVE SYMPTOMS THOUGHT INSERTION AND BROADCAST LOOSE ASSOCIATION HALLUCINATIONS - AUDITORY DELUSIONS - PARANOIA, GRANDIOSITY