By special request, Mental Health Tuesday explores the question: "What is Mental Illness?"
A recent news story stating that half of all Americans will experience mental illness at some point in their lives prompted the question addressed on today's show. The news story drew its information from a book entitled What is Mental Illness? by Richard J. McNally and published last January. McNally is an advisor to the American Psychiatric Association's Diagnostic and Statistical Manual, Fifth Edition, the day-to-day practical guide on the definition of mental illness, scheduled for publication in 2013. McNally is a critic of the overuse of psychiatric diagnoses, and also defends a careful approach of describing disorders by patterns of observable symptoms.
The following is a quote from the current edition of the Diagnostic and Statistical Manual (DSM-IV-TR) under the heading Definition of Mental Disorder:
"Although this volume is titled Diagnostic and Statistical Manual of Mental Disorders, the term mental disorder unfortunately implies a distinction between "mental" disorders and "physical" disorders that is a reductionistic anachronism of mind/body dualism. A compelling literature documents that there is much "physical" in the "mental" disorders much "mental" in the "physical" disorders. The problem raised by the term "mental" disorders has been much clearer than its solution, and, unfortunately, the term persists in the title of DSM-IV because we have not found an appropriate substitute."
"Moreover, although this manual provides a classification of mental disorders, it must be admitted that no definition adequately specifies precise boundaries for the concept of "mental disorder." The concept of mental disorder, like many other concepts in medicine and science, lacks a consistent operational definition that covers all situations. All medical conditions are defined on various levels of abstraction - for example, structural pathology (e.g., ulcerative colitis), symptom presentation (e.g., migraine), deviance from a physiological norm (e.g., hypertension), and etiology (e.g., pneumococcal pneumonia). Mental disorders have also been defined by a variety of concepts (e.g., distress, dyscontrol, disadvantage, disability, inflexibility, irrationality, syndrome pattern, etiology, and statistical deviation). Each is a useful indicator for a mental disorder, but none is equivalent to the concept, and different situations call for different definitions."
Some points from today's show include:
1. There is no clear difference between the mind and the body (which includes the brain), or, said, another way, there is considerable overlap in all disorders, though some emphasize one presentation or the other. For example, a recent survey in the State of Washington found the following diagnoses within their sample:
31% physical illness only
21% mental illness and substance use disorder
14% mental and physical illness
13% mental and physical illness and substance use disorder
11% physical illness and substance use disorder
5% mental illness only
5% substance use disorder only
2. The risk of developing a given mental disorder is small. However, when you add them all together, as in the study that prompted this episode, the numbers do support the notion that lifetime risk of mental illness is about 50%. However, most of these mental illnesses are mild, transient, and end with full recovery.
3. Diagnosis cannot be made by reading a book. To recognize schizophrenia, for example, a clinician needs to see a lot of people with schizophrenia. The DSM offers an imperfect description of the disorder that is necessarily less than the experience of interviewing people with schizophrenia. The description grew out of that experience, but is not equal to it. That is why clinicians must not only study the book, but must have clinical residencies and internships before they practice on their own.
A link to the proposed revisions of the DSM (DSM-5), can be found here:
http://www.dsm5.org/Pages/Default.aspx
The Amazon link to What is Mental Illness? by Richard J. McNally can be found here:
http://www.amazon.com/What-Mental-Illness-Richard-McNally/dp/0674046498
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Sunday, January 1, 2012
Monday, December 5, 2011
Show Notes for December 6, 2011: Personality Disorders
From the U.S. National Library of Medicine - The World's Largest Medical Library
Personality disorders are a group of psychiatric conditions in which a person's long-term (chronic) behaviors, emotions, and thoughts are very different from their culture's expectations and cause serious problems with relationships and work.
Causes, incidence, and risk factors
The causes of personality disorders are unknown. However, many genetic and environmental factors are thought to play a role.
Mental health professionals categorize these disorders into the following types:
Symptoms
Symptoms vary widely depending on the type of personality disorder.
In general, personality disorders involve feelings, thoughts, and behaviors that do not adapt to a wide range of settings.
These patterns usually begin in adolescence and may lead to problems in social and work situations.
The severity of these conditions ranges from mild to severe.
Signs and tests
Personality disorders are diagnosed based on a psychological evaluation and the history and severity of the symptoms.
Treatment
At first, people with these disorders usually do not seek treatment on their own. They tend to seek help once their behavior has caused severe problems in their relationships or work, or when they are diagnosed with another psychiatric problem, such as a mood or substance abuse disorder.
Although personality disorders take time to treat, there is increasing evidence that certain forms of talk therapy can help many people. In some cases, medications can be a useful addition to therapy.
Expectations (prognosis)
The outlook varies. Some personality disorders go away during middle age without any treatment, while others only improve slowly throughout life, even with treatment.
Complications
- Problems with relationships
- Problems with career
- Other psychiatric disorders
Calling your health care provider
Call for an appointment with your health care provider or mental health professional if you or someone close to you has symptoms of a personality disorder.
References
- Blais MA, Smallwood P, Groves JE, Rivas-Vazquez RA. Personality and personality disorders. In: Stern TA, Rosenbaum JF, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 39.
- Review Date: 11/14/2010.Reviewed by: Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Tuesday, November 1, 2011
Show Notes for November 1, 2011: Some of the Latest Findings from Positive Psychology
Positive Psychology is the scientific study of the strengths and virtues that enable individuals and communities to thrive. In his keynote address to the Second World Congress on Positive Psychology this past summer, Dr. Martin Seligman stated that the notion that we are driven by the past is "a profound error about human nature" made by most schools of psychology. Rather, he sees human beings as being "drawn into the future" by meaningful goals.
More about Positive Psychology can be found at the following links:
Positive Psychology Center of the University of Pennsylvania
Authentic Happiness
A Recording of Dr. Martin Seligman's Keynote Address on Shrink Rap Radio
A Recording of Dr. Ed Diener's Keynote Address on Shrink Rap Radio
Dr. Martin Seligman on Positive Psychology from a 2004 presentation:
More about Positive Psychology can be found at the following links:
Positive Psychology Center of the University of Pennsylvania
Authentic Happiness
A Recording of Dr. Martin Seligman's Keynote Address on Shrink Rap Radio
A Recording of Dr. Ed Diener's Keynote Address on Shrink Rap Radio
Dr. Martin Seligman on Positive Psychology from a 2004 presentation:
Monday, October 3, 2011
Show Notes for October 4, 2011: How to Successfully Reach Your Goals
A fast Google search turns up a variety of psychologists writing things like "5 steps to reach your goals" or "7 steps to reach your goals." Clearly, people want to reach their goals!
In this blog, I want to take a different approach. I'm going to assume that failure to reach a goal may not be a problem with the person, but with the goal. I'm going to assume that people generally know how to set and reach goals. People do this all the time. Maybe when people fail to reach their goals, its because of a problem with the goal.
Here's what I mean: To be motivated to reach a goal, it either has to mean something to you, or be the means to an end that means something to you. If you want to reach your goals, you first have to figure out what is really important to you. You have to determine your top values.
After that, look at your goals. Do your goals really reflect your values. If you are like most people, you will find that the goals you reach are the ones that really reflect your values. One of three possibilities will emerge for each of your goals:
1) You will see the connection between the goal and the value and discover new motivation to reach the goal.
2) You will discover the goal does not reflect your values, at which time you may discard the goal.
3) You will discover values that you are doing nothing about, at which time you may set new goals.
A colleague of mine, Dr. Robert Hutzell, created a workbook to guide people through this process. It is not a quick-fix, follow 5, or 7, steps-approach, but it is one way to help people figure out what they really want to do in life. The workbook is now out of print, so he has made an electronic version of it available for free:
A Workbook to Increase Your Meaningful and Purposeful Goals by R. R. Hutzell, Ph.D. and Mary D. Eggert, Ph.D. (2009 PDF version).
I hope you enjoy it!
Thursday, September 8, 2011
Monday, August 1, 2011
Show Notes for August 2, 2011: Psychology and Heat
HOT UNDER THE COLLAR: Psychology and Heat
As multiple heat records have been set throughout the country this summer, and almost everyone you talk to mentions the heat, it seems like a good time to review what is known about the effects of heat on human behavior.
One thing to keep in mind is that heat is at least partly subjective. A string of 90-degree days in Chicago prompts the city to open cooling centers for the underprivileged while the evening news reports on heat related deaths. The same string of 90-degree days in southern Texas, on the other hand, would be normal and expected. A string of 110-degree days in Austin, however, is something to talk about!
While studies on the effects of heat are somewhat mixed, there are a few things that do stand out:
Hotter-than-expected temperatures are associated with more aggression. Some of the earliest studies in social psychology looked at crime rates, especially violent crime rates, and found a stable correlation with temperature. These studies have been replicated several times and the findings hold up. Smaller studies find that people even blow their car horns more and gesture more from vehicles when the temperatures are hot.
Depression has been found to increase with hotter temperatures along with the number of suicide attempts. According to national averages, the months of April through June are the times of greatest suicide risk, though at our center we received a low number of emergency calls in June, while the number has been steadily increasing as the heat wave has persisted.
Heat waves appear to be associated with greater alcohol and drug abuse. Popping open a cold beer on a hot day may seem like a good idea, but alcohol is one of the worst things you can drink in the heat. Alcohol absorbs moisture, and it is a diuretic. So, alcohol places people at higher risk for dehydration.
One interesting set of studies is exploring the effect that temperature may have on perceptions of human closeness. The warmer the temperature -- within normal and expected limits -- the more a person's choice of words reflects feelings of closeness to others, while the cooler the temperature, the more abstract and remote a person's vocabulary becomes. This has been studied with small changes in room temperature, as well as on a smaller scale by giving a person either a warm or cold drink to hold. Its highly speculative, of course, but when one considers the more communal cultures that have developed close to the equator versus the more individual cultures that have developed far from the equator, one wonders if the temperature influenced the way the culture developed.
When high heat is accompanied by high humidity, especially when people don't have air conditioning, sleep becomes more of a problem. A number of factors are associated with high heat and humidity, all of which could also be related to sleep. These include poorer concentration, irritability, and sleepiness during the day.
So what can you do to minimize the effects of the heat?
For one thing, take a look at the cultures that have already adapted to warmer temperatures. People closer to the equator often take a siesta or a nap during the hottest part of the day. This is offset by fewer hours of sleep at night and by workdays that stretch longer into the evening when temperatures are cooler.
Drink more water and less alcohol. Be aware of the signs of dehydration.
Spend as much time as you can out of the heat, preferably in cool buildings with air conditioning.
Keep an extra eye on your kids and check in on the elderly. Heat tends to affect the very young and the very old the most. Also, talk to your doctor about any heat related effects of your medications.
Practice patience. If you are feeling tired and irritable in the heat, chances are everyone else is, too!
Monday, July 4, 2011
Show Notes for July 5, 2011: Delusional Disorder and other Psychoses
Today's topic is Delusional Disorder, and, if time, other rare psychotic conditions. For more information on Delusional Disorder, please see this Psychology Today article.
Definition:
Definition:
Delusional disorder refers to a condition associated with one or more nonbizarre delusions of thinking—such as expressing beliefs that occur in real life such as being poisoned, being stalked, being loved or deceived, or having an illness, provided no other symptoms of schizophrenia are exhibited.
Delusions may seem believable at face value, and patients may appear normal as long as an outsider does not touch upon their delusional themes. Mood episodes are relatively brief compared with the total duration of the delusional periods. Also, these delusions are not due to a medical condition or substance abuse.
Themes of delusions may fall into the following types: erotomanic type (patient believes that a person, usually of higher social standing, is in love with the individual); grandiose type (patient believes that he has some great but unrecognized talent or insight, a special identity, knowledge, power, self-worth, or special relationship with someone famous or with God); jealous type (patient believes his partner has been unfaithful); persecutory type (patient believes he is being cheated, spied on, drugged, followed, slandered, or somehow mistreated); somatic type (patient believes he is experiencing physical sensations or bodily dysfunctions—such as foul odors or insects crawling on or under the skin—or is suffering from a general medical condition or defect); mixed type (characteristics of more than one of the above types, but no one theme dominates); or unspecified type (patient's delusions do not fall in described categories).
Delusions may seem believable at face value, and patients may appear normal as long as an outsider does not touch upon their delusional themes. Mood episodes are relatively brief compared with the total duration of the delusional periods. Also, these delusions are not due to a medical condition or substance abuse.
Themes of delusions may fall into the following types: erotomanic type (patient believes that a person, usually of higher social standing, is in love with the individual); grandiose type (patient believes that he has some great but unrecognized talent or insight, a special identity, knowledge, power, self-worth, or special relationship with someone famous or with God); jealous type (patient believes his partner has been unfaithful); persecutory type (patient believes he is being cheated, spied on, drugged, followed, slandered, or somehow mistreated); somatic type (patient believes he is experiencing physical sensations or bodily dysfunctions—such as foul odors or insects crawling on or under the skin—or is suffering from a general medical condition or defect); mixed type (characteristics of more than one of the above types, but no one theme dominates); or unspecified type (patient's delusions do not fall in described categories).
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