Show Notes for January 3, 2012: What is Mental Illness?

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