An Overview of mental health and illnesses
Concept of Mental Health: A mental trait is characterised as abnormal if it causes distress to the individual, persistent over long periods, deviates from the ideals of normal as stated by society and causes significant impairment in functioning. Mental illnesses have been treated with various aspects through history with practices such as bloodletting, feeling for abnormalities in the skull known as phrenology, and even exorcism. The evolution of treating mental health was created over the years with notions of mental well-being being introduced to promote mental health. The mental hygiene movement by Dorothy Dix promoted the need for looking at mental health with equal importance as physical health. The understanding of mental health developed a need for looking at biological influences, such as genes on a person’s likelihood of acquiring a mental illness. However, the onset of a genetically predisposed mental illness is strongly connected to the environmental factors that can trigger the onset of the mental illness.
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With mental health gaining prominence, the American Psychological Association (APA) was formed in 1892, to understand mental health and well-being. The organisation comprises of psychologists and psychiatrists who work towards furthering research on mental health. The APA published the first Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952, three years following the inclusion of mental illnesses in the International Classification of Diseases (ICD). The manual creates a fixed criterion for each mental illness which helps mental health practitioners in diagnosis and understanding of a psychological condition. However, it must be noted that cultural variations for specific disorders must also be taken into account. The treatment of mental health is a combination of therapeutic and medicational treatments. The DSM has been routinely revised by looking at new research and understanding of mental well-being. The present-day publication of the DSM-5 looks at 20 broad classification of disorders under which each has a cluster of disorders within them. The following article looks at five of the classifications, which are the most prominent in terms of diagnosis and awareness.
These compromise of disorders that cause emotional distress in the form of intense fear or anxiousness. A human’s fear response triggers a surge in adrenaline which causes a fight or flight response. In the case of anxiety disorders, these feelings of fear are persistent and repetitive. This can be a result of a specific stimulus (a trigger) or a consistent feeling. The manifestation of the fear can occur in the form of panic attacks which are common with anxiety disorders. Panic attacks are periods of sudden panic which are not limited to anxiety disorders and can sometimes present as a panic disorder. In order for an individual to be diagnosed with an anxiety disorder, it must be noted that the anxiety is not a result of any external substances or comorbid mental condition. The feeling of anxiety and consistent distress must persist for at least six months in order to be diagnosed. Anxiety disorders are a result of genetic factors. However, environmental triggers can play a massive role in the manifestation of anxiety. Bandelow and Michaelis attempt to look at anxiety disorders in the twenty-first century. Their reports suggested that an average of 33% of the population will have an anxiety disorder at some point in their life. The prevalence of anxiety is more common in females in comparison to males which can also be a result of biased reporting as male mental health issues are often overlooked.
The DSM-5 classifies mood disorders into two categories: bipolar and related disorders and depressive disorders. The separation of the two is a result of bipolar disorders being classified as a “bridge” between psychotic and depressive disorders. Bipolar disorders are known to have psychotic episodes as a symptom while being a mood disorder, hence resulting in the separate classification. Mood disorders also present with a bias towards higher rates in females compared to males.
Bipolar and related disorders are classified into Bipolar I and Bipolar II disorders. The variation between the to is noted to be the extent of mania. Bipolar I comprises of Manic episodes accompanied by Major Depression while Bipolar II comprises of Hypomanic episodes accompanied by Major Depression. Manic episodes refer to a condition wherein individuals experience “elevation in mood which can also cause irritability, an extreme surge in energy, uncontrollable or racing thoughts and high-risk behaviours. Hypomanic episodes are milder forms of manic episodes. Under bipolar disorders, the third major classification is cyclothymia which is a condition where individuals present with symptoms similar to bipolar disorder but experience hypomania and depressive symptoms which are not enough to meet the criterion for major depression or mania.
Depressive disorders are characterised by low mood, diminished interest, fatigue, insomnia or hypersomnia, feelings of worthlessness, difficulty in concentrating and decision making and thoughts of death, suicidal tendencies. Depressive disorders are separated from bipolar disorders as all illnesses within the classification present the above-listed symptoms. However, the variation between the illnesses are factors such as duration, aetiology and onset period. Depressive disorders have a high comorbidity rate with anxiety and substance abuse disorders.
Schizophrenia Spectrum and Psychotic Disorders
The disorders in the following category look at variations of Schizophrenic disorders and other disorders which have Psychotic symptoms. Psychosis is impairment in the ability to understand external stimuli such as speech, vision emotions and reality. Schizophrenia spectrum disorders look at variations of schizophrenia which also presents with psychotic symptoms. However, the various forms of the disease create a spectrum. The disorders under the following category are classified based on observing abnormalities in one or more in the five domains, which are delusions, hallucinations, disorganised thinking (speech), abnormal motor behaviour and negative symptoms. In order to understand the classification of disorders, the DSM 5 explains the five domains in detail-
They are defined as having a fixed false personal belief with absolute conviction despite evidence that disprove the belief. These could be of various kinds which include persecutory (inability to recognise reality), grandiose (belief of one’s superiority), jealousy (false belief of others being jealous of individual), erotomania (false belief of other(s) being in love with the individual), and somatic (false belief of one’s body as being abnormal or having changed).
A hallucination is a false response to an absent real stimulus. This could include auditory, visual, tactile, olfactory and gustatory hallucinations. Hallucinations can result in paranoid response to the hallucinations as the individual cannot control the hallucinations.
3.Disorganised Thinking (Speech)
Symptoms of disorganised thinking in the form of speech comprises of the derailment of speech which can lead to incomplete sentences, loss of tangentiality and hence resulting in a disorganised conversation as individual wanders from the original conversation.
4.Abnormal Motor Behaviour
Symptoms include the inability to control one’s motor skills, hence resulting in uncontrolled body movements, remaining in a position for long periods and refusal to perform other actions and sudden loss of muscle tone.
Lack of normal functioning is referred to as negative symptoms. This includes the inability to speak, feel pleasure, movement, socialisation and maintain attention.
Characterised by a disruption or discontinuity in one’s consciousness and memory, dissociative disorders earned their name as individuals with the following condition feel dissociated from their bodies, mind and reality. The onset of the condition is frequently seen to be after a traumatic experience. This is a result of the mind attempting to escape the memories and recollections of the trauma. The two characteristics of the disorder are Depersonalization, which is the detachment from one’s body and mind, and Disassociative Amnesia, which is the inability to recollect information about one’s self. Dissociative Disorders are comorbid with Post-traumatic Stress Disorder as a means of coping with stress from the trauma.
Personality is defined as individual differences in thinking and behaviour. Personality disorders look at abnormalities in thinking and behaviour, which result in deviation from the social and cultural expectations of an individual’s personality. The various personality disorders in the section are classified into three clusters based on their descriptive similarities. The global prevalence of personality disorders is around 10%. The gender variations are not distinct as each personality disorder has a different variation in gender prevalence. This is a result of the lack of gendered stigma around personality disorders when compared to mood and anxiety disorders.
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Awareness and the Promotion of Positive Mental Health
The notion of positive mental health includes traits such as “subjective well-being, perceived self-efficacy, autonomy, competence, and recognition of the ability to realise one’s intellectual and emotional potential. It has also been defined as a state of well-being whereby individuals recognise their abilities, are able to cope with the normal stresses of life, work productively and fruitfully, and make a contribution to their communities.” (Srivatsava, 2011) Understanding abnormalities in mental health helped dissolve superstitions such as demonic possessions and promoted the need to cater to mental health conditions with equivalent status as physical health conditions. The revision of the DSM to accommodate and modify mental illnesses and their means of diagnosis help develop effective treatment methods. The evolution of mental health has resulted in more conversation around mental health and attempts to destigmatise mental illness, therapy, and medical treatment.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). American Psychiatric Publishing Inc.https://doi.org/10.1176/appi.books.9780890425596
Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in clinical neuroscience, 17(3), 327–335.
Patki,S. (2019).Introduction to Abnormal Psychology. Lecture, FLAME University.
Srivastava K. (2011). Positive mental health and its relationship with resilience. Industrial psychiatry journal, 20(2), 75–76. https://doi.org/10.4103/0972-6748.102469