Before mental illness can be defined, the idea of illness must be understood more completely. As medicine is becoming increasingly driven by technologic advances, the concept of disease has supplanted the concept of illness. Medicine is driven by a need for objective evidence and elimination of subjective experience. Subjective data, although they can help inform our knowledge of diseases, are by their very nature experienced only through the one subject, rather than witnessed with a community, and therefore, they are inherently unreliable.
In contrast, major advances came from objective, experimental methods to various diseases and their treatments.With the price of healthcare skyrocketing, making healthcare dollars less and less available to treat a disease, simple economic necessity dictates that we put money into things that yield results. With a finite number of dollars, cash is therefore spent on diseases that can be defined and cured.
Humans, however, are more than simply their diseases. To be human would be to experience the disease in a unique way that other humans cannot experience. To become human with a disease would be to are afflicted by a disease. Having an illness is a subjective experience that might be easily dismissed as less important compared to objective facts from the disease.
In treating individual patients, doctors address both disease and illness; one piece of that treatment may be the elimination or charge of the disease. Healing, on the other hand, requires more than just the removal of disease; it takes an understanding from the person's knowledge about the disease in the type of their illness and the removal of that as well.
Mental illness can be complicated to define, as it is generally based on the subjective connection with those struggling with it. Fortunately, the field of psychiatry has experienced technologic advances, and the amounts of effective psychiatric therapies available to treat mental illness have exploded in the past 10 years.
Unfortunately, even though scientific theories have continued to succeed our understanding of possible underlying causes, virtually no clinically useful objective evidence remains to validate the condition concept. This is why mental illness is really devastating to individuals suffering from it and stays so stigmatized by people who little understand it.
Consider the different feelings felt by a patient who sees his / her internist for a variety of physical complaints that all of the testing is negative and he or she is left languishing in the helpless idea that his / her complaints are "all in his / her head," whereas someone visiting the psychiatrist with similar variety of complaints is provided with a medical explanation of his or her illness and feels reassured that it's "not all in his / her head."
Webster's dictionary defines mental illness like a "disease of the mind," illustrating the struggle to identify boundaries between disease versus illness and mind versus body. This type of distinction has its own utility but results in the shame and stigmatization that exists for all those struggling with mental illness.
Mental illness is better thought of in the less pejorative sense of being a disease, if merely for that fact that it brings aid and luxury to those who are suffering from it. Certainly enough biological evidence exists to argue strongly for this definition even if no clinical testing exists.
What defines the "menu" of symptoms is not just having the listing of symptoms outlined in each disorder, but rather showing the impact that those symptoms have on one's life in terms of distress and disability. It is that universal inclusion criteria (combined with the universal exclusion criteria of "not due to a medical problem or toxic reaction") that define the boundaries between normal variant, mentally ill, and physically ill.
Defining the differences between your normal and pathologic serves to prevent the subjectivity that can occur when defining illness of thought, emotions, or behavior. Any condition defined in the DSMIV- TR is recognized as a mental illness or disorder.
Many terms are thrown about today in popular culture that are utilized to distinguish between types of mental illnesses. Such terms include, but are not restricted to, behavior disorder, brain disorder, minimal brain dysfunction, nervous breakdown, neurosis, psychosis, panic attacks, depression, schizophrenia, personality disorder, character disorder, major mental illness, minor mental illness, and "biologically based condition." Many of these terms have more than one meaning based on who defines them. These terms may be defined by the next:
First, in popular culture and media, mental illness is based on the idea that one is either "crazy" or otherwise. Terms for example "insane," "deranged," "demented," "mentally ill," "psychotic," and "schizophrenic" are generally associated with some appalling violent or criminal act that seems to lack any understandable motive that can be discovered by either law enforcement or even the press. In this case, "crazy" substitutes for that lack of apparent motive.
Regardless of how many times the argument is made that the mentally ill are no more violent than society at large, the press never stops from mentioning when someone is mentally ill after being arrested for any heinous criminal act. A few of these terms, for example schizophrenia, do have specific psychiatric definitions that are the main DSM-IV-TR.
Some include legal terms (such as insanity) that only the courts can determine. The media and popular culture, however, define all in pejorative terms that carry clear moral connotations. It is such definitions that lead patients to prevent a psychiatrist's office for fear of being labeled crazy or mentally ill.
Second, political, legal, or economic definitions of mental illness are meant to protect people from arbitrary actions by virtue of their illness. This is when the terms biologically based, behavior disorder, and insanity derive. Due to the broad reach of behavior making up the definitions of mental illness where no validated biological tests exist, the potential for abuse in our social system is rife.
Consequently, legal and political definitions were instituted to protect individuals and organizations from that potential abuse. To protect individuals, the definition of biologically based was established in order to force insurers to pay for their treatment. Included in this are such DSM-IV-TR disorders as schizophrenia, major depressive disorder, and bipolar disorder. Alternatively, behavior disorders aren't considered biologically based from the insurers' perspective and thus would be the responsibility of the baby and therefore are not susceptible to third-party payment.
Insanity is a strictly legal definition that only the courts can determine. It may be informed by the fact that an individual is suffering from a mental illness, but that is just part of the equation. One are affected from schizophrenia but rob a supermarket for purely financial reasons. He or she is not judged insane; although in the point of view of psychiatry, he or she has a mental illness, and from the perspective from the popular press, that person can be called "crazy."
Definitions that interest scientists and clinicians the most are from the third type, specific operational criteria trying to codify mental and behavioral phenomena in a pattern that has a specific etiology (cause), diagnostic symptom list (pattern), and prognosis (result). The history of attempting to classify and understand mental illness is really as long since the history of medicine itself.
Distinctions between biologically based, psychologically based, and socially based are relevant only in as far as attempts are made to understand each individual, biological, psychological, and social element that adopts causing each disorder. This does not mean that psychiatry is without its arbitrary distinctions.
A distinction can be created between major mental illnesses and personality disorders, classified as Axis I and Axis II diagnoses in the DSM-IV-TR. The two axes separate major mental illnesses or states that can wax and wane as time passes and treatment and personality disorders, or traits, that are generally considered to be enduring and unresponsive to biological therapies. States change. Traits endure.
This distinction is one from the "useful fictions" that inform our knowledge of behavior in general and mental illness more specifically. The line between state and trait is extremely gray but has allowed psychiatry to focus historically and also to set limits on what can be accurately defined and treated. In the past, personality disorders were considered not changeable and never treatable.
As science has advanced, however, there has been a discovery that certain elements of personality do change with time and are improved with treatment. Insurers and also the courts, however, still make such distinctions, because this is what is generally meant by the distinction between biologically based versus behavior disorder or mentally ill versus personality disordered.
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Note: This article was sent to us by: Elaine Brenten at 02102011
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