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

WHY WANT DEFINITION OF MENTAL ILLNESS?

• DISTINGUISH FROM NORMAL

• INDICATE NEED FOR MENTAL HEALTH TREATMENT

• WHAT CONDITIONS SHOULD BE REIMBURSED?

• DETERMINE CRIMINAL LIABILITY - PUNISH OR TREAT?

DSM-IV DEFINITION (1)

• “MENTAL DISORDER IS A CLINICALLY SIGNIFICANT BEHAVIORAL OR PSYCHOLOGICAL PATTERN THAT IS ASSOCIATED WITH PRESENT DISTRESS OR DISABILITY.”

DISTRESS OR DISABILITY

• MUST HAVE EITHER DISTRESS (MENTAL PAIN) OR DISABILITY (LOSS OF FUNCTIONING)

• EITHER MUST REALLY BOTHER PEOPLE - E.G. THINK LEFT STOVE ON

• OR HAVE NEGATIVE IMPACT ON THEIR LIVES - E.G. ASPD

DSM (2)

• “IN ADDITION, THIS PATTERN MUST NOT BE MERELY AN EXPECTABLE AND CULTURALLY SANCTIONED RESPONSE TO A PARTICULAR EVENT, FOR EXAMPLE, THE DEATH OF A LOVED ONE.”

NOT EXPECTABLE RESPONSE

• BEREAVEMENT EXCLUSION

• SYMPTOMS ARE NORMAL

• ROMANTIC BREAKUPS

• SOLDIER ENTERING COMBAT

• SYMPTOMS THEMSELVES ARE NOT SUFFICIENT

• MUST KNOW CONTEXT

DSM (3)

• “WHATEVER ITS ORIGINAL CAUSE, IT MUST CURRENTLY BE A BEHAVIORAL, PSYCHOLOGICAL, OR BIOLOGICAL DYSFUNCTION IN THE INDIVIDUAL.”

INTERNAL DYSFUNCTION

• SOME PSYCHOLOGICAL SYSTEM (MOOD, FEAR, THOUGHT, EMOTION, ETC.) IS NOT FUNCTIONING APPROPRIATELY - SOMETHING HAS GONE WRONG

• MANY CAUSES – BIOLOGICAL, PSYCH., SOCIAL – OF M.I.

DSM (4)

• “NEITHER DEVIANT BEHAVIOR (E.G. POLITICAL, RELIGIOUS, OR SEXUAL) NOR CONFLICTS BETWEEN THE INDIVIDUAL AND SOCIETY ARE MENTAL DISORDERS UNLESS THE DEVIANCE OR CONFLICT IS A SYMPTOM OF A DYSFUNCTION IN THE INDIVIDUAL.”

MENTAL DISORDER IS NOT DEVIANCE

• DEVIANCE IS VIOLATION OF MORAL STANDARDS OR SOCIAL NORMS - BAD BEHAVIOR

• PEOPLE WHO DRINK TOO MUCH, TAKE WRONG KIND OF DRUGS, OR STEAL, CHEAT, AND LIE NEED NOT BE MENTALLY ILL

• DEVIANCE IS A CHOICE

DEVIANCE OR M.I.?

• ONLY MENTAL DISORDER WHEN SOME MECHANISM IS UNABLE TO FUNCTION AS IT IS SUPPOSED TO

• ALCOHOLIC OR ADDICT WHO CAN’T STOP DRINKING OR TAKING DRUGS

• NOT JUST DEFIANCE OF RULES

• VERY DIFFICULT TO DISTINGUISH

SUMMARY

• MENTAL DISORDER IS HARMFUL INTERNAL DYSFUNCTION

• CAUSES CAN BE PSYCHOLOGICAL, BIOLOGICAL, OR SOCIAL

• DISTINGUISH FROM EXPECTABLE RESPONSES TO STRESSORS AND FROM SOCIAL DEVIANCE

MAJOR PROBLEM

• DSM DEFINITION OF MENTAL DISORDER IS GOOD

• DSM AND SURVEYS BASED ON IT DO NOT APPLY THE DEFINITION IN PRACTICE

• VIEW ALL SYMPTOMS AS INDICATING DISORDER

PSYCHOSES

• MOST SEVERE KIND OF M.I.

• SCHIZOPHRENIA

• BI-POLAR (MANIC DEPRESSION)

SCHIZOPHRENIA

• PERHAPS MOST IMPORTANT MENTAL ILLNESS

• CREATES STEREOTYPE OF MENTAL ILLNESS - CRAZY, NUTS, BIZARRE

IMPORTANCE

• MOST ADMISSIONS AND RESIDENTS OF PUBLIC MENTAL HOSPITALS

• CHRONICITY AND SEVERITY MEAN COSTLY AND DIFFICULT TO TREAT

• PUBLIC POLICY - HOMELESSNESS, NOTORIOUS CRIMES

• TREMENDOUS FAMILY BURDEN

SYMPTOMS

• THOUGHT DISORDER

• POSITIVE SYMPTOMS

• THOUGHT INSERTION AND BROADCAST

• LOOSE ASSOCIATION

• HALLUCINATIONS - AUDITORY

• DELUSIONS - PARANOIA, GRANDIOSITY