Overview of Mental Illness
Mental illness seems to be a growing problem in societies all around the world. Until the mid-twentieth century a large proportion of people who were classified as mentally ill and admitted to mental hospitals were actually suffering from physical ailments like epilepsy and brain tumors. Today researchers are learning about the biological origins of many mental illnesses such as schizophrenia, autism and alcoholism. The mental disorders that cause severe social problems are the most extreme forms of mental illness, like the ones that threaten the social order such as a sociopath who becomes a serial killer. The number of individual in society with these disorders is small, but they constitute a serious social problem because they are so violent and irrational.
A more widespread social problem is severely mental ill individuals who cannot care for themselves without special attention. These individuals include people who are mentally ill and chemically addicted, and are likely to be indigent and homeless. Mental ill individuals experience a variety of symptoms such as unimaginable fear, uncontrollable hallucinations, panic, crushing sadness, wild elation, and mood swings. For society as a whole, their illness presents a range of social problems: stress in family life, heavy demands on health-care institutions, moral and ethical problems, the cost of treatment to society, etc (Kornblum, 2001). It is said that the mentally ill suffer twice: They suffer from the illness itself, and also from rejection or the stigma that comes with being diagnosed from illness, as if their illness was their own fault.
Statistics of Mental Illness
The most common forms of mental problem in the United States are panic attacks and phobias. Phobias include severe fears such as fear of going outside, fear of heights, or enclosed spaces. It is estimated that about 20 million Americans suffer from panic attacks or phobias in any given year. Another 18 million Americans suffer from other mental illnesses, such as depression, including manic, major, or minor depression. Alcoholism is also classified as a mental illness, and has been diagnosed in approximately 14 million people. A problematic group of mentally ill individuals are substance abusers with a mental illness like schizophrenia that live in urban areas.
This constitutes about 6 million Americans. These people are referred to as mentally ill chemical abusers (MICA) (Kornblum). A general problem with mental illness is the social impact of deinstitutionalization, or discharging patients from mental hospitals directly into the community without the intermediate steps like group housing, or assisted living. Some of these patients may not be able to function like normal members in society. This can cause conflict and consequences to both the patient and the people they come into contact with.
Statistics say that there are about 350 million mentally ill individuals in the world. Approximately 80 percent of the worlds 350 million mentally disabled people live in developing nations. Depression is extremely common in elderly individuals, which is usually worsened by isolation and chronic pain (i.e. arthritis). About 3% of seniors suffer from major depression, but many more may suffer from milder forms of depression. This often leads to more disability and increased mortality. Although late-life depression is treatable, most older people with clinical depression do not receive adequate treatment. Those who do recover from depression have improved physical and social functioning.
Approximately one out of every four Americans suffers from some form of mental disorder in a given year. About 3.5 million Americans suffer from severe mental illnesses like schizophrenia and manic-depressive illness. At least 40 percent of mentally ill people do not seek help or are not being treated, while many wander the streets homeless (Kornblum).
This table shows the prevalence and cost of some of the more common types of mental illness in the United States of America.
Mental illness: The numbers
Prevalence Schizophrenia: About 1% of the population Major depression: Lifetime occurrence – 10% – 25% of women, 5% – 12% of men. Bipolar disorder (manic depression): Lifetime occurrence – 1% – 2% of the population. Panic Disorder: Lifetime occurrence – about 1% of males, 2% of females. Obsessive-compulsive disorders: Lifetime occurrence – about 2.5% of the population.
Cost Mental disorders, other than alcohol and substance abuse, cost U.S. society more than $204.4 billion annually. About $91 billion of that amount (based on 1994 figures) is for direct health care costs; the rest includes social services, disability payments and the expense of lost productivity. Estimates for the annual costs of some specific mental disorders:Major depression: $43.7 billion Anxiety disorders: $65.0 billion Schizophrenia: $44.9 billionOther: $52.7
SOURCE: NIMH, Diagnostic and Statistical Manual of Mental Disorders (4th edition), Journal of Clinical Psychiatry, Institute for Behavior and Health, and Substance Abuse and Mental Health Services Administration (SAMHSA) Statistics Source Book
This information is useful in helping to draw a picture of just how much of the population in America is affected by mental illnesses. This information also shows how much mental disorders cost society and where the money is being spent in the area of mental disorders.
Epidemiological estimates have changed over time because of changes in the definitions and diagnosis of mental health and mental illness. In the early 1950s, the rates of mental illness estimated by epidemiologists were much higher than those of today. One study, for example, found 81.5 percent of the population of Manhattan, New York, to have had signs and symptoms of mental distress (Satcher, 2001). Because of this, the researchers of this study concluded that mental illness was widespread.
However, other studies began to find lower rates when they used more restrictive definitions that reflected more contemporary views about mental illness. As a result of studies like this one, researchers used a “more recent line of epidemiological research” (Satcher) that only identified people as mentally ill if they had a “cluster” of signs and symptoms that, when taken together, impaired people’s ability to function, as appose to classifying anyone with general signs and symptoms as being mentally ill.
With the development and advancements in medicine, the symptoms that accompany many mental illnesses go unnoticed by the general population or community. This leads some to believe that mental illness has gone down in the years. The surgeon general states in chapter 2 of his latest report on mental health “By 1978, the President’s Commission on Mental Health (1978) concluded conservatively that the annual prevalence of specific mental disorders in the United States was about 15 percent. This figure comports with recent estimates of the extent of mental illness in the population. Even as this figure has become more sharply delineated, the older and larger estimates underscore the magnitude of mental distress in the population…”. Statistically mental illness seems to remain the same now as it did in the past.
History of Mental Illness
Mental illness has been around almost since the beginning of mankind. Most of the disorders that humans have today were around since the very beginning. Such disorders like Schizophrenia, anxiety and mood disorders, etc. where found in many people and have been documented throughout history as things such as evil spirits, or a bad mother. Bipolar disorder (manic depression) was a disorder Mark Twain was said to have symptoms of.
The dividing line between normal and abnormal behavior is often determined by the social context or culture of the individual in which a particular behavior occurs, or the individual observing the behavior. An example of this would be a traditional Hindu in India. Certain dietary restrictions are followed as part of the mourning process. It would be a serious breach of social norms if an Indian widow ate fish, meat, onions, garlic, or any other “hot” foods within six months of her husband’s death. If an outsider that didn’t know any better were to observe this behavior, he or she may believe that the woman was crazy or had something wrong with her. In a similar way, hearing “voices” or talking to “spirits” is accepted in some cultures, but would be evidence of serious disturbance in the United States (Hockenbury, 1998). Sometimes unconventiality is labeled as crazy when one is just creatively challenging conventialism or going against the norm.
Treatment for mental illness in any form has existed along side mental illness as far back as early and medieval ages. If a person were “possessed” by a demon, he or she would be “exercised” by a shaman, medicine doctor, or burned at the stake for being a witch. If a “doctor” thought an individual were possessed in the 16th century because they heard voices, he would “trephine” or bore a hole in their skull to allow the evil demon to escape. Other historical treatments for mental illness were being put into a “circulating swing” that involved swinging patients around, or if a person were having a seizure or they would twitch they would be put into a “tranquilizing chair” in the early 1800’s which would restrain and sedate unmanageable patients. “Medical treatments for psychological disorders actually predate modern psychotherapy by hundreds of years.
In past centuries patients were whirled, soothed, drenched, restrained, thrown into institutions, and isolated-all in an attempt to alleviate symptoms of psychological disorders. Today such ‘treatments’ seem cruel, inhumane, and useless” (Hockenbury). These early treatments were based on the limited medical knowledge and technology of the time. Some of these early efforts to treat psychological disorders eventually evolved into treatments that are used today, but for the most part, it wasn’t until the nineteenth century that modern technology and “unconventional” thinking discovered the actual causes of mental illness, although there were hints of some causes not being linked to the “supernatural” as far back as St. Thomas Aquinas in the late 1200’s. But it was not until the twentieth century that effective biomedical therapies were developed to treat the symptoms of mental disorders.
In the 1600’s physiologists were becoming interested in the human brain and its relation to behavior. By the early 1700’s it was discovered that damage to one side of the brain produced a loss of function in the opposite side of the body. By the early 1800’s the debate was over different brain areas controlling different parts of the body and behavioral functions. These scientific methods would later be applied to issues of human behavior and thinking, and were crucial to the development of the field of psychology. These findings made the world think much differently to the causes of mental illnesses and their origins.
Costs of Mental Illness
A current aspect of mental illness is the cost of it to the patients, to the community, for the services, etc. According to the SAMHA Office of Applied Studies mental disorders cost society about $204.4 billion (1994). In 1990 mental illnesses cost the U.S. $150 billion annually. $67 billion of this is for direct health care costs, such as hospitalization, nurses, doctors, nursing homes, medication, etc. The other $83 billion includes social services, disability and social security payments, and the expense of lost productivity. In 1994 these costs jumped to $91.7 billion (44.9 %) for the total economic societal costs of mental illness that were due to the costs of treatment and other direct costs for medical care. The rest of the total costs were morbidity and mortality costs, that is, the costs associated with loss of productivity due to illness (43.2 %) and with premature death (8.1 %) (SAMHSA, 2001).
Morbidity Costs include lost or reduced productivity, and is measured by the estimated lifetime effect on current income. Mortality Costs are discounted (at 6%) lifetime productivity losses for people who died as a result of a mental disorder. The cost is the number of deaths multiplied by the expected value of future earnings, with gender and age taken into account. Other Related Costs included those associated with crime and incarceration, social welfare administration, and family care giving.
The cost of mental disorders is a growing concern for many mostly because it seems to be rising from year to year. The average cost of mental illness has gone up more than 25% from 1990-1994. Health insurance rarely covers mental illness as fully as it covers physical illness, which is a huge obstacle to treatment because new drugs can cost up to 100 times as much as the old ones. These shortcomings affect an audience far beyond mentally ill patients and their families. Untreated mental illness has been a factor in countless episodes of public violence, including a July 1998 shooting which resulted in the death of two police officers at the U.S. Capitol, and the death in early 1999 of a young woman pushed in front of a New York City subway train (Brink, 1999).
Direct costs correspond to spending for treatment and rehabilitation nationwide. When economists calculate the costs of an illness, they also strive to identify indirect costs. Indirect costs can be defined in different ways, such as lost productivity at the workplace, school, and home due to premature death or disability. The indirect costs of mental illness were estimated in 1990 at $78.6 billion (SAMHSA). More than 80 percent of these costs stemmed from disability rather than death because mortality from mental disorders is relatively low.
The cost associated with mental illness also draws concern to many due to the fact that many taxpayers and government officials are uneducated about mental illness, and do not know where the money is going and how it is spent. Due to many common stereotypes, many people believe that people with mental disorders are severely debilitated, and cannot function in society. This is a significant misconception! As the result of better medications and treatments, mental illnesses can be covered up and lay dormant for great periods of time. When politicians decide to cut budgets for mental illnesses, this is one of the first areas in which patients suffer. Providers like Medicare and Medicaid are forced to cover less money for medications, directly effecting individuals with mental illnesses.
The general public is not educated enough to understand the full circle in which tax dollars take in the area of mental disorders, and when the money just isn’t there patient suffer exponentially, which in turn makes the community suffer. The community suffers in many ways: increased homelessness, increased number of individuals on welfare or other state benefit systems, increased number of mortality including homicide and suicide, along with the overall declination of citizen attitudes in neighborhoods and communities.
All this brings about a sort of cyclictic affect on the community and individuals that are mentally ill. The cost associated with mental illness is high–the government cuts budgets for mental illness–the community and mentally ill suffer, and need to be helped–money needs to be put back into services and medications for mentally ill–donations, sponsors, subsidies, etc. are given and the government is asked for money.
Stigma Associated with Mental Illness
Another current issue of mental illness is the stigma that is associated with it. The definition of stigma is a “mark of disgrace or discredit” (Merriam-Webster, 2000). Stigma is a belief or prejudice that is sometimes associated with mental illness. “Stigma is not just the use of the wrong word or action. Stigma is about disrespect. It is the use of negative labels to identify a person living with mental illness. Stigma is a barrier and discourages individuals and their families from getting the help they need due to the fear of being discriminated against.
“We all have an idea of what someone with a mental illness is like, however most of our views and interpretations of mental illness have been distorted through the media. Media, especially television, has done much to create and sustain a distorted view of mental illness. Characters are usually portrayed as aggressive, dangerous and unpredictable — 70% of the television characters with a mental illness are violent. Mental illness has not received the sensitive media coverage that other illnesses have been given.
We are surrounded by stereotypes; popular movies about mentally ill killers, news coverage of tragedies caused by mentally ill people, violence by mentally ill people, casual use of terms like “psycho” or “crazy”, jokes about mental illness, the insanity defense and news coverage of homelessness which is typically attributed to mental illness. These representations distort the public’s view and reinforce inaccuracies about mental illness” (CMHA, 2001).
An estimated 50 million Americans experience a mental disorder in any given year and only one-forth of them actually receives mental health and other services”(KEN, 2001). Stigma results in inadequate insurance coverage for mental health services due to individuals with mental illness not coming forward with their problems, or insurance companies not acknowledging them as having an illness. Often times when mental illness is thought about it is thought of as being a horrible thing or occurring in a horrible person.
People with mental illness are thought to have a very low intelligence, when in actuality, many individuals with mental illness, schizophrenia especially, happen to be extremely intelligent individuals. Many of which are above average in intelligence. A general term or category of “crazy” or “insane” will be labeled to individuals with mental illness. Complex illnesses such as schizophrenia, bipolar disorder, borderline personality disorder, etc. cannot be classified as just “crazy”. Each of these disorders are very different from each other and need specialized attention and treatment.
In general stigma is a type of negative label that is given to individuals with mental illnesses. Stigma results in fear, mistrust, and violence against people living with mental illness, and can result in families and friends turning their backs on people with mental illness. Stigma keeps people from getting needed mental health services. This stigma or label can totally impair a person’s life, goals, career, and family. Stigma is more or less an ignorance of a specified subject. This lack of knowledge of a single subject or a single person can cause devastating repercussions within the area of mental health, mental health funding, mental health communities, services, activities, advancement, etc.
Some things that can be done to combat stigma are: Bringing mental illness into the open and learning to think about it like other illnesses or conditions (such as heart disease, asthma, diabetes), educating the community to overcome attitudes based on misconceptions, promoting mental health by nourishing healthy attitudes through early childhood and adult life, and learning ways to deal with trauma in relationships, situations and events.
Other ways such as encouraging research into mental illness to assist understanding of how these illnesses affect people and how they can be prevented, assisting friends and relatives with a mental illness to obtain care and treatment, talking about mental illness openly with everyone you meet (it is surprising how many people are affected by mental illness, or that of a loved one, but have been too afraid of rejection to discuss it openly), providing high quality support and treatment services which enable people with a mental illness to participate fully in all aspects of community life, and eliminating discrimination in every area of life – including employment, education and the provision of goods, services and facilities, are also good ways in which to stop the stigma associated with mental illness. The Disability Discrimination Act of 1992 makes it unlawful to discriminate against someone because of a disability, including mental illness. The Act also protects the relatives, friends, careers and co-workers of people with a mental illness against discrimination.
Mental Illness Treatments
Another aspect of mental illness is the treatment that mentally ill individuals may go through. Ever since people were mentally ill they have been treated as anything but human. They were ostracized and treated as outcasts of society by their own family, friends, neighbors and community. Mentally ill people were said to be possessed by demons, the product of sin, the punishment for their parents’ sin, and everything in-between. If others thought that the individual was able to be cured, they would undergo harsh treatments such as skull trepanning, seclusion, seances, religious rituals, being dunked into water, profuse spinning, and so on.
Today these treatments seem not only obsolete, but ridiculous, not to mention unethical. We think that with today’s technological advancements and medical achievements such means of treating the mentally ill have been exhausted. The truth of the matter is that many of these treatments are still used by many institutions. Such treatments as electro-shock/electro-convulsive therapy, seclusion/isolation, and sedation are still considered reasonable treatments by most institutions and caregivers. The problem with the treatments of mental illness is that some treatments are very expensive, and not always covered (or covered enough) by benefit programs.
Treatments such as medication are sometimes misused by the patients, not taken by them, or even sold illegally. Other treatments such as electro-shock/electro-convulsive therapy seem unethical by many, while others say the therapy doesn’t work at all. Patients who undergo this therapy sometimes end up worse off them before they started. This can be a major burden to society because of wasted cost on the patients that show no result in shock treatment. Other methods such as seclusion of a patient merely hide the problem of mental illness and doesn’t effectively treat or help the patient at all.
“Science has greatly expanded our understanding and treatment of severe mental illnesses. Once forgotten in the back wards of mental institutions, individuals with brain disorders have a real chance at reclaiming full, productive lives, but only if they have access to the treatments, services, and programs so vital to recovery” (NAMI).
Future of Mental Illness
What is most likely to occur in the immediate future is one of two things. The first is there may be an increase in mental illness due to such factors as increase of drug and alcohol abuse, violence, and suppression of symptoms due to medication. Mental disorders may also increase due to more technological advancements (e.g. computer revolution). With the introduction of more obsession/fixations/crazes, more disorders may occur. Road rage was never considered to be a disorder until motor vehicles were invented and later classified in the Diagnostic and Statistical Manual (DSM IV).
The other outcome that may be possible is that with the development and understanding of the human genome and the genome project, genetically predisposed mental illnesses could be eradicated from existence, reducing the number of disorders and illnesses dramatically. Both of these outcomes seem to be not only plausible, but imminent in the next decade due to both increasing technological and medical advancements and increased unhealthy living.
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