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 - 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
20th CENTURY VIEWS
• FIRST PSYCHIATRIC MANUAL AT
BEGINNING OF 20TH CENTURY – 19 OF
20 CONDITIONS PSYCHOTIC
• DSM NOW - NEARLY 400 DIFFERENT
MENTAL ILLNESSES
• TREMENDOUS BROADENING OF
CONDITIONS VIEWED AS MENTAL
ILLNESSES
EXPANSION OF M.I.
• SIGMUND FREUD
• EVERYONE TO SOME EXTENT IS M.I.
• IDEAS BEGAN TO EXPAND THROUGH
THE CULTURE - MOVIES, BOOKS,
PROFESSIONS
RESPONSE
• OUTPATIENT TREATMENT IN
COMMUNITY
• PSYCHOTHERAPY
• FOR MOST PART, LIMITED TO ELITE
CURRENT CONCEPTIONS
• BEGAN WITH DSM-III (1980)
• 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
• TREATED BY PROFESSIONALS
BIOLOGICAL CAUSES
• MENTAL ILLNESSES VIEWED AS
BRAIN DISEASES
• GENETICS AND BRAIN CHEMISTRY
AT FAULT
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
RISING NUMBERS OF PEOPLE IN
TREATMENT AND OF MENTAL
HEALTH PROFESSIONALS
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 TO 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