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
• 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 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.”
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
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 FAMILY BURDEN
SYMPTOMS
• THOUGHT DISORDER
• POSITIVE SYMPTOMS
• THOUGHT INSERTION AND BROADCAST
• LOOSE ASSOCIATION
• HALLUCINATIONS - AUDITORY
• DELUSIONS - PARANOIA, GRANDIOSITY
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
A BEAUTIFUL MIND
• JOHN NASH
