1. An introduction to key mental health disorders, and the history of mental illness and treatment in America Psychology Information Sourced from mentalhealth.gov

2. A mental illness is a condition that impacts a person's thinking, feeling or mood and may affect his or her ability to relate to others and function on a daily basis. Each person will have different experiences, even people with the same diagnosis. Recovery, including meaningful roles in social life, school and work, is possible, especially when you start treatment early and play a strong role in your own recovery process. A mental health condition isn’t the result of one event. Research suggests multiple, interlinking causes. Genetics, environment and lifestyle combine to influence whether someone develops a mental health condition. A stressful job or home life makes some people more susceptible, as do traumatic life events like being the victim of a crime. Biochemical processes and circuits as well as basic brain structure may play a role too. From National Alliance on Mental Illness

3. Anxiety Behavioral Eating Mental Health and Substance Use Mood Disorders Personality Disorders Psychotic Disorders Suicidal Behavior

4. People with anxiety disorders respond to certain objects or situations with fear and dread. They have physical reactions to those objects, such as a rapid heartbeat and sweating. An anxiety disorder is diagnosed if a person: Has an inappropriate response to a situation Cannot control the response Has an altered way of life due to the anxiety Anxiety disorders include: Obsessive Compulsive Disorder Panic Disorder Phobias Post Traumatic Stress Disorder (PTSD) Anxiety: a medical condition marked by intense apprehension or fear of real or imagined danger

5. Behavioral disorders involve a pattern of disruptive behaviors in children that last for at least 6 months and cause problems in school, at home and in social situations. Nearly everyone shows some of these behaviors at times, but behavior disorders are more serious. Behavioral disorders may involve: Inattention Hyperactivity Impulsivity Defiant behavior drug use criminal activity Behavioral Disorders include: Attention Deficit Hyperactivity Disorder (ADHD)

6. Eating disorders involve extreme emotions, attitudes, and behaviors involving weight and food. The most common eating disorders include: Anorexia Nervosa Binge Eating Bulimia

7. Mental health problems and substance use disorders sometimes occur together. This is because: Certain illegal drugs can cause people with an addiction to experience one or more symptoms of a mental health problem Mental health problems can sometimes lead to alcohol or drug use, as some people with a mental health problem may misuse these substances as a form of self-medication Mental and substance use disorders share some underlying causes, including changes in brain composition, genetic vulnerabilities, and early exposure to stress or trauma

8. More than one in four adults living with serious mental health problems also has a substance use problem. Substance use problems occur more frequently with certain mental health problems, including: Depression Anxiety disorders Schizophrenia Personality disorders

9. Can refer to substance use or substance dependence. Symptoms of substance use disorders may include: Behavioral changes, such as: Drop in attendance and performance at work or school Frequently getting into trouble (fights, accidents, illegal activities) Using substances in physically hazardous situations such as while driving or operating a machine Engaging in secretive or suspicious behaviors Changes in appetite or sleep patterns Unexplained change in personality or attitude Sudden mood swings, irritability, or angry outbursts Periods of unusual hyperactivity, agitation, or giddiness Lacking of motivation Appearing fearful, anxious, or paranoid, with no reason

10. Physical changes, such as: Bloodshot eyes and abnormally sized pupils Sudden weight loss or weight gain Deterioration of physical appearance Unusual smells on breath, body, or clothing Tremors, slurred speech, or impaired coordination Social changes, such as: Sudden change in friends, favorite hangouts, and hobbies Legal problems related to substance use Unexplained need for money or financial problems Using substances even though it causes problems in relationships

11. Recovering from Mental Health Problems and Substance Use Someone with a mental health problem and substance use disorder must treat both issues. Treatment for both mental health problems and substance use disorders may include rehabilitation, medications, support groups, and talk therapy.

12. These disorders, also called affective disorders, may involve: Feeling sad all the time Losing interest in important parts of life Fluctuating between extreme happiness and extreme sadness The most common mood disorders are: Depression Bipolar Disorder Seasonal Affective Disorder (SAD) Self-harm

13. People with personality disorders experience patterns of behavior, feelings, and thinking that can: Interfere with a person’s life Create problems at work and school Cause issues in personal and social relationships Personality disorders include: Antisocial Personality Disorder Borderline Personality Disorder

14. Antisocial personality disorder is a mental health condition in which a person has a long-term pattern of manipulating, exploiting, or violating the rights of others. This behavior is often criminal. Causes Cause of antisocial personality disorder is unknown. Genetic factors and environmental factors, such as child abuse, are believed to contribute to the development of this condition. People with an antisocial or alcoholic parent are at increased risk. Far more men than women are affected. The condition is common among people who are in prison. Fire-setting and cruelty to animals during childhood are linked to the development of antisocial personality. Some doctors believe that psychopathic personality (psychopathy) is the same disorder. Others believe that psychopathic personality is a similar but more severe disorder.

15. Symptoms A person with antisocial personality disorder may: Be able to act witty and charming Be good at flattery and manipulating other people's emotions Break the law repeatedly Disregard the safety of self and others Have problems with substance abuse Lie, steal, and fight often Not show guilt or remorse Often be angry or arrogant

16. Borderline personality disorder (BPD) is a mental health condition in which a person has long-term patterns of unstable or turbulent emotions. These inner experiences often result in impulsive actions and chaotic relationships with other people. Causes Cause of borderline personality disorder is unknown. Genetic, family, and social factors are thought to play roles. Risk factors for BPD include: Abandonment in childhood or adolescence Disrupted family life Poor communication in the family Sexual, physical, or emotional abuse This personality disorder tends to occur more often in women and among hospitalized psychiatric patients.

17. Symptoms Persons with BPD are often uncertain about their identity. As a result, their interests and values can change rapidly. They also tend to view things in terms of extremes, such as either all good or all bad. Their views of other people can change quickly. A person who is looked up to one day may be looked down on the next day. These suddenly shifting feelings often lead to intense and unstable relationships. Other symptoms of BPD include: Intense fear of being abandoned Cannot tolerate being alone Frequent feelings of emptiness and boredom Frequent displays of inappropriate anger Impulsiveness, such as with substance abuse or sexual relationships Repeated crises and acts of self-injury, such as wrist cutting or overdosing

18. Possible Complications Depression Drug abuse Problems with work, family, and social relationships Suicide attempts and actual suicide When to Contact a Medical Professional See your health care provider if you or someone you know has symptoms of borderline personality disorder. It is especially important to seek help right away if you or someone you know is having thoughts of suicide.

19. Exams and Tests BPD is diagnosed based on a psychological evaluation that assesses the history and severity of the symptoms. Treatment Individual talk therapy may successfully treat BPD. In addition, group therapy can sometimes be helpful. Medications have less of a role in the treatment of BPD. But in some cases, they can improve mood swings and treat depression or other disorders that may occur with this condition. Outlook (Prognosis) Outlook of treatment depends on how severe the condition is and whether the person is willing to accept help. With long-term talk therapy, the person often gradually improves.

20. People with psychotic disorders lose contact with reality and experience a range of extreme symptoms that usually includes: Hallucinations—hearing or seeing things that are not real, such as voices Delusions—believing things that are not true However, these symptoms can occur in people with other health problems, including bipolar disorder, dementia, substance abuse disorders, or brain tumors. Psychotic disorders include: Schizophrenia (to be addressed in a subsequent presentation – Chief Bromden)

21. Suicide causes immeasurable pain, suffering, and loss to individuals, families, and communities nationwide. On average, 112 Americans die by suicide each day. Suicide is the second leading cause of death among 15-24 year olds and more than 9.4 million adults in the United States had serious thoughts of suicide within the past 12 months. But suicide is preventable, so it's important to know what to do. For more information, go to www.sprc.org Get Help If you or someone you know needs help, call the National Suicide Prevention Lifeline at 1.800.273.TALK (8255). Trained crisis workers are available to talk 24 hours a day, 7 days a week. If you think someone is in immediate danger, do not leave him or her alone—stay there and call 911.

22. If someone you know is showing one or more of the following behaviors, he or she may be thinking about suicide. Don’t ignore these warning signs. Get help immediately. Talking about wanting to die or to kill oneself Looking for a way to kill oneself Talking about feeling hopeless or having no reason to live Talking about feeling trapped or in unbearable pain Talking about being a burden to others Increasing the use of alcohol or drugs Acting anxious or agitated; behaving recklessly Sleeping too little or too much Withdrawing or feeling isolated Showing rage or talking about seeking revenge Displaying extreme mood swings

23. Get Help If you or someone you know needs help, call the National Suicide Prevention Lifeline at 1.800.273.TALK (8255). Trained crisis workers are available to talk 24 hours a day, 7 days a week. If you think someone is in immediate danger, do not leave him or her alone— stay there and call 911. Tell a trusted adult Teacher, Advisor, Coach, Administration Member, Counselor, et cetera Your safety and well being matter to us. You matter to us. Your friends matter to us.

24. Source Material: www.pbs.org/wgbh/amex/nash/timeline/index.htm

25. The Greek physician Hippocrates (400 BCE) treats mental disorders as diseases to be understood in terms of disturbed physiology Mental Disorders are not angry gods or demonic possession Previously believed by Egyptian, Indian, Greek, and Roman cultures, evidenced by writings. Greek medical treatments: quiet, occupation, and the use of drugs such as the purgative hellebore. Family members care for most people with mental illness in ancient times.

26. In Europe, mentally ill mostly allowed freedom, as long as not dangerous In some places, however, treated as witches, as inhabited by demons Some religious orders care for mentally ill Muslim Arabs establish asylums in 8 th Century, attempt scientific study First European facility specifically for people with mental illness, established in Valencia, Spain, in 1407

27. Europeans begin to isolate people who are mentally ill from the rest of society Placed in asylums and dungeons with vagrants, delinquents, people who are homeless, and people with handicaps or mental retardation. Persons seen as insane begin to be treated inhumanely, chained to walls or kept in dungeons Minimal to non-existent “patient rights”

28. Concern about treatment of mentally ill grows, leads to occasional reforms After the French Revolution, French physician Phillippe Pinel takes over the Bicêtre Insane Asylum Forbids the use of chains and shackles He removes patients from dungeons, provides them with sunny rooms, and also allows them to exercise on the grounds. Yet in other places, mistreatment persists.

29. United States reformer Dorothea Dix discovers the state of living conditions for the mentally ill people (men and women) of Massachusetts: Jailed with criminals Jailed together (all ages and sexes) Denied clothing Left in darkness and without heat No bathroom access Many are chained Many are beaten – behavioral, order, or abuse Over a 40-year period, she crusades on behalf of the mentally ill and succeeds in establishing 32 state hospitals as asylums for the mentally ill Tours Europe in 1854-56 Convinces Pope Pius IX to examine cruelty and inhumane treatment of people who are or are deemed mentally ill

30. German psychiatrist Emil Kraepelin studies mental illness from a scientific perspective Distinguishes different mental disorders Symptoms, Onset, Diagnosis, Prognosis, Treatment Options Some later research will disprove some of his findings Known for fundamental distinction between manic- depressive psychosis and schizophrenia This distinction holds today

31. Expectations for hospitals for the mentally ill in United States prove untrue and unreached Goal: Humane treatment, Attempt to cure the sick (if possible) Severe overcrowding is a huge problem Custodial needs supersede patient support and treatment Inhumane and unsanitary conditions persist Original conditions of low staff-patient ratio and humane treatment are replaced by overwhelmed staff and warehouse conditions New York World reporter, Nellie Bly, gets self admitted to Blackwell’s Island and writes exposé on conditions there, resulting in more funding

32. In 1887, intrepid reporter Nellie Bly pretended she was insane and got herself committed, all to help improve conditions in a New York City mental institution. “The insane asylum on Blackwell’s Island is a human rat-trap. It is easy to get in, but once there it is impossible to get out.” Ten day experience Two days after article is published – massive increase in state funding for Mental Institutions

33. Exceeded her worst expectations. Foreign women, completely sane, who were committed simply because they couldn’t make themselves understood. “oblivious doctors” and “coarse, massive” orderlies who “choked, beat and harassed” patients, and “expectorated tobacco juice about on the floor in a manner more skillful than charming.” Rancid food, dirty linens, no warm clothing and ice-cold baths that were like a precursor to water boarding. Bly described the latter: “My teeth chattered and my limbs were goose-fleshed and blue with cold. Suddenly I got, one after the other, three buckets of water over my head – ice- cold water, too – into my eyes, my ears, my nose and my mouth. I think I experienced the sensation of a drowning person as they dragged me, gasping, shivering and quaking, from the tub. For once I did look insane.” And worst of all, there was the endless, enforced isolation: “What, excepting torture, would produce insanity quicker than this treatment?... Take a perfectly sane and healthy woman, shut her up and make her sit from 6 a.m. to 8 p.m. on straight-back benches, do not allow her to talk or move during these hours, give her no reading and let her know nothing of the world or its doings, give her bad food and harsh treatment, and see how long it will take to make her insane. Two months would make her a mental and physical wreck.”

34. Era of psychoanalysis—the “talking cure” Carl Jung and Sigmund Freud Freud treated wide variety of patients, but most people with psychosis still given custodial care in institutions

35. Clifford Beers publishes his autobiography, A Mind that Found Itself, describing his dehumanizing experiences in a Connecticut mental institution Becomes a call to action Calls for reform, founds National Committee for Mental Hygiene—an education and advocacy group This group later becomes the National Mental Health Association

36. Drugs, electro-convulsive therapy, and surgery are used to treat people with schizophrenia and others with persistent mental illnesses. Some are infected with malaria; others are treated with repeated insulin-induced comas. Others have parts of their brain removed or altered surgically, an operation called a lobotomy, which is performed widely over the next two decades to treat schizophrenia, intractable depression, severe anxiety, and obsessions.

37. Schizophrenia is treated by inducing convulsions, first induced by the injection of camphor, a technique developed by psychiatrist Ladislaus Joseph von Meduna in Budapest. In 1938 doctors run electric current through the brain - - the beginning of electro-shock therapy -- to induce the convulsions, but the process proves more successful in treating depression than schizophrenia.

38. Philadelphia State Hospital

42. Conscientious objectors during World War II serving as attendants in state hospitals helped publicize the plight of the mentally ill and fought to improve conditions for the patients.

43. In 1946, President Harry Truman signs National Mental Health Act, which later establishes the National Institute of Mental Health (1949) In 1949, Australian psychiatrist, J. F. J. Cade introduces use of lithium to treat psychosis. Later this becomes a very useful drug in treating bi-polar disorder.

44. A series of successful anti-psychotic drugs are introduced that do not cure psychosis but control its symptoms. anti-psychotics, the major class of drug used to treat psychosis, is discovered in France in 1952 and is named chlorpromazine (Thorazine). Studies show that 70 percent of patients with schizophrenia clearly improve on anti-psychotic drugs, but there are severe side effects – seen in OFOTCN Hospitalization Numbers England and Wales – 7,000 in 1850; 120,000 in 1930, and 150,000 in 1954 United States – 560,000 in 1955 New Therapy – Behavior Therapy Belief that people can be conditioned and/or trained to overcome phobias and/or anxieties

45. Counter Culture Movement Ken Kesey’s novel, One Flew Over the Cuckoo’s Nest Author Biography Presentation to Follow LSD and VA Hospital Psychiatric Ward Janitorial Work Film – 1975 – Five Academy Awards – Best Adapted Screenplay, Best Director, Best Actor, Best Actress, Best Picture

46. Deinstitutionalization: number of institutionalized mentally ill people in the US drops from 560,000 to 130,000 by 1980. Deinstitutionalization possible because anti-psychotic drugs control symptoms, but long-term institutionalized people need ongoing mental health treatment and an array of social services that are not uniformly available. Inadequate housing, support programs, and follow up care Results: homelessness, “revolving door syndrome,” prison intake increases, concern in the community about discharged patients

47. Community Mental Health Centers Construction Act passes, providing federal money to develop a network of community mental health centers. Belief that former patients will seek out support services, and volunteer for additional treatment as needed and at own discretion Note that this occurs after deinstitutionalization was well underway.

48. National Alliance for the Mentally Ill founded— provides support, advocacy, research for people with serious psychiatric illness. An estimated one-third of all people who homeless are considered seriously mentally ill, the vast majority of them suffering from schizophrenia.

49. Advocacy groups gain traction – starting in 1986: form the National Alliance for Research on Schizophrenia and Depression. Seek improved treatments and cures for schizophrenia and depression Becomes largest non-government, donor-supported organization that distributes funds for brain disorder research. New generation of anti-psychotic drugs introduced— clozapine, etc. Drugs appear to be more effective and have fewer side effects

50. Survey of American jails finds that 7% of inmates (100,000) are seriously mentally ill Most of these individuals receive little, if any, treatment Over a quarter of them are held without charges, often awaiting a bed in a psychiatric hospital.