Transcript conceptions of mental illness

CONCEPTIONS OF MENTAL
ILLNESS
• HOW VIEWS OF MENTAL ILLNESS
HAVE CHANGED OVER TIME
• CURRENT CONCEPTIONS OF
MENTAL ILLNESS
• WHERE DRAW THE LINE BETWEEN
MENTAL ILLNESS AND NORMALITY?
PRE-20TH CENTURY
• MENTAL ILLNESS IS UNIVERSAL
• MENTAL ILLNESS LIMITED TO SMALL
NUMBER OF MOST SERIOUS
CONDITIONS
• MENTALLY ILL HIGHLY STIGMATIZED
CAUSES
• NOT MUCH KNOWN
• SUPERNATURAL
• BRAIN DISEASE
EARLY TREATMENT
• PRE-19TH CENTURY – FAMILY
RESPONSIBILITY OR LEFT TO FEND
FOR SELVES
• NO OUTPATIENT TREATMENT
• 19TH CENTURY - SHUT AWAY IN
INSTITUTIONS
PRE-20TH CENTURY
• LIMITED TO SMALL NUMBER OF
SEVERE CONDITIONS
• MENTALLY ILL BIZARRE AND
DIFFERENT
• CAUSES UNKNOWN
• INSTITUTIONALIZED
CURRENT CONCEPTIONS
• BEGAN WITH DSM-III (1980) - NOW
NEARLY 400 CONDITIONS
• NOT JUST MOST SEVERE
CONDITIONS BUT MANY DIFFERENT
CONDITIONS
M.I. WIDESPREAD
• NO LONGER SEEN AS UNUSUAL BUT
MANY PEOPLE AFFECTED BY THEM
• 50 PERCENT OF POPULATION OVER
LIFETIME; 20 PERCENT IN ANY GIVEN
YEAR
NORMALIZATION
• MENTALLY ILL NOT SEEN AS
DIFFERENT FROM NORMAL
• MENTALLY ILL NOT CERTAIN KIND
OF PERSON BUT NORMAL PERSON
WITH PARTICULAR DISEASE
MEDICALIZATION
• NORMAL PEOPLE HAVE MEDICAL
CONDITION
• MENTAL ILLNESSES VIEWED AS
BRAIN DISEASES
• GENETICS AND BRAIN CHEMISTRY
AT FAULT
• TREATED BY PROFESSIONALS
TREATMENT
Psychotropic Prescribing in USA
(IMS - S Units)
10000000
9000000
8000000
7000000
6000000
5000000
4000000
3000000
2000000
1000000
0
Antidepressant
Antipsychotic
1990 1992 1994 1996 1998 2000 2001
TREATMENT
• SSRI - SELECTIVE SEROTONIN
REUPTAKE INHIBITORS - “ANTIDEPRESSANTS”
• HUGE INCREASE IN DRUG
TREATMENT - 60 MILLION SCRIPTS
• 3 OF 7 MOST PRESCRIBED DRUGS
THERAPEUTIC CULTURE
•
•
•
•
MANY BEHAVIORS MEDICALIZED
MENTAL ILLNESS IS COMMON
MENTALLY ILL NOT DIFFERENT
MORE PEOPLE IN TREATMENT AND
MORE MENTAL HEALTH PROFS.
• OUTPATIENT FAR MORE THAN
INPATIENT
RATES OF TREATMENT
2500
2000
1970
1980
1990
2000
1500
1000
500
0
ALL
IN
OUT
M.H. PROFS. 1980-2000
social
work
school psy
clin psych
1980
1990
2000
psychiatry
100,000
90,000
80,000
70,000
60,000
50,000
40,000
30,000
20,000
10,000
0
SUMMARY OF TRENDS
• FROM ONLY SERIOUS TO MANY
CONDITIONS
• FROM RARE TO WIDESPREAD
• FROM STIGMATIZED TO
MEDICALIZED
• FROM UNKNOWN CAUSES TO
PRESUMED BIOLOGICAL
SUMMARY OF TRENDS
• FROM INSTITUTIONS TO OUTPATIENT
THERAPY AND DRUGS
• FROM SEGREGATION TO PART OF
CULTURE
WHERE DRAW THE LINE?
• ARE TOO MANY CONDITIONS
MEDICALIZED NOW?
• HOW CAN WE SEPARATE WHAT’S M.I.
FROM WHAT’S NORMAL?
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