James Hicks, M.D., 50 SIGNS OF MENTAL ILLNESS (Yale University Press)

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Introduction

This book will teach you what you need to know about mental illness, whether you have been diagnosed with a mental illness, have untreated problems, or care about someone who may be mentally ill. The book is organized alphabetically by symptom so that you can look up the specific symptoms that concern you. In each section you will learn how the symptom presents itself in various illnesses.

The symptoms of psychiatric illness frequently overlap and are easily misdiagnosed. For example, if you have bipolar illness, or manic depression, you will see, on average, at least three physicians over an eight-year period before you receive a correct diagnosis and proper treatment. If you feel anxious all the time, you may have depression, phobia, obsessive-compulsive disorder, panic disorder, a drug or alcohol problem, or any number of other underlying illnesses. This book will inform you about the possibilities and help you and your physician or therapist to make the correct diagnosis in your case.

In selecting topics, I have tried to use terms that are commonly used and easily recognized, even if their medical meanings are not widely known. The extensive index will help you find detailed discussions of specific illnesses, medications, and symptoms. Each topic includes multiple italicized references to other related topics. For example, when you read about psychosis, you will also be referred to delusions, hallucinations, and nonsense.

Many of us are initially reluctant to seek help from a professional. This book will help answer your questions and guide you to treatment, if treatment is needed. Moreover, each section suggests ways to cope with your specific concerns.

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Everyone Experiences Mental Health Problems

Nearly one of every three of us experiences psychiatric symptoms each year. These range from the relatively minor, such as a short period of anxiety or grief during times of stress, to the severely disabling and painful. Nearly half of us have a family member or a close friend with serious mental illness. One common illness, depression, is the major cause of medical disability in the United States. Mental illness can kill: rates of suicide are as high as one in five in bipolar illness, one in six in depression, and one in ten in schizophrenia. Though poorly understood by most people, mental illness clearly rivals any other area of medicine in its widespread and serious impact on people's lives.

Fortunately, mental illness has been coming out of the closet in the past decade. The respected television journalist Mike Wallace has talked about his experiences with severe depression. The actor Margot Kidder has candidly discussed her recurrent bouts of manic psychosis and her recovery with medication. The best-selling author Stephen King has written about his struggles with alcohol and drug abuse. The Oscar-winning box office hits A Beautiful Mind and Shine dramatize the real-life stories of talented individuals who developed schizophrenia or similar mental illnesses. In 1999, the surgeon general of the United States issued a national report on mental health and illness, bringing the symptoms and treatment of psychiatric illness to the attention of physicians, public health workers, politicians, and the general public.

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What Causes Mental Illness?

Scientists do not know exactly what causes mental illness. Like cancer, mental illness can strike anyone and has a variety of causes. Scientists are certain that genetic vulnerability plays a role in many mental illnesses, since the risk of becoming ill is greater if you have a close relative who suffers from depression, bipolar illness, schizophrenia, anxiety, or alcoholism, among others. However, no specific gene has yet been isolated that causes any of these illnesses. Even identical twins (who have identical genetic makeup) do not always develop the same mental illnesses.

Everyone agrees that stress plays a role in most mental illness. Even if you have a genetic vulnerability, the illness might not develop unless something disturbs your equilibrium. The loss of an important relationship-for example, through divorce-is one of the most serious stresses to the mind. You may become sick after experiencing extraordinary dangers. On the other hand, serious illness can arise seemingly out of the blue, without any obvious stress or loss. You may have always thought of yourself as a confident and happy person until, over the course of a month or two, you find yourself feeling inexplicably hopeless and sad, confused and suspicious, or unable to sleep and concentrate.

Scientists are also uncertain about which physical changes in the brain lead to psychiatric symptoms. They have studied brain volume, hormone levels, blood flow, and other physiological data without finding conclusive answers. We know that abnormal proteins cause plaques in the brains of people who suffer from Alzheimer's dementia, but no smoking gun has been found for depression, schizophrenia, or other major illnesses. The medications that treat mental illness have complex effects on certain molecules in the brain, particularly those involved in the communication between brain cells. Scientists speculate that abnormal levels of these molecules may cause the underlying illness. This is why psychiatrists often talk about a "chemical imbalance" in the brain. Eventually it may be possible to connect specific genes to specific molecules to specific illnesses and, ultimately, to specific treatments. But the brain is a very complex organ, and scientists are far from achieving this goal. Scientific breakthroughs have been rare in other illnesses, such as diabetes and angina, even though the organs involved-in these cases, the pancreas and the heart-are considerably simpler than the brain.

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Mental Health Problems Are Treatable

Effective treatments exist for most mental health problems. Some problems respond very well to psychotherapy, in which a skilled clinician talks to you and helps you to change your feelings, choices, and behaviors. For several decades medications have been available for successfully treating illnesses such as depression, anxiety, bipolar illness, and schizophrenia. Antidepressant medications are prescribed more widely in the United States than any other class of medication, with the exception of antibiotics. They are among the most effective of medications, with at least two-thirds of sufferers responding within weeks to the first antidepressant prescribed. Similar rates of improvement are seen in the treatment of other mental illnesses.

Why do our feelings, our thoughts, and our behaviors improve with medication? Most of us like to think of our minds as independent of our body and of the effects of medication. In fact, what we call the mind is inseparable from the physical functioning of the brain. Our ability to think, to perceive the outside world, and to experience emotions derives from the continuous cellular growth, electrical transmission, and movement of molecules within our brain. Even our memories are physically "stored" in the cellular structure of our brain. Like any other part of the body, the brain can sometimes experience stress. When that happens (and it does happen to all of us at one time or another), then either rest, the attention of friends and family, religious faith, or the passage of time-or a combination of these-can lead to recovery. On the other hand, the brain, like all other organs, can sometimes become sick to the extent that it will not get better without medical treatment.

Most of us now understand that there are medical explanations and treatments for many of our emotional pains and worries. Americans make more than twenty-six million visits to a psychiatrist each year. But most of us first turn to our primary care physicians, if we turn to anyone. Unfortunately, half of us who experience mental health problems do not seek treatment at all. And physicians often misdiagnose and undertreat the psychiatric symptoms that we bring to their attention.

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Signs, Symptoms, Syndromes, and Disorders

The fifty topics that follow cover the full range of psychiatric disturbances. Most of them are what physicians refer to as signs and symptoms. A symptom is a medical complaint that you bring to the attention of your physician, such as chest pains or feeling sad. A sign is an abnormal finding by the physician, which you may or may not be aware of, such as high blood pressure or rapid speech.

A few of the fifty topics belong to a broader category, which physicians refer to as syndromes. A syndrome is a collection of signs and symptoms that typically occur together but which may be seen in several different illnesses. For example, pneumonia is a syndrome that typically includes cough, breathing difficulty, and fever but can be caused by several different germs. In this book mania and psychosis are syndromes made up of a number of signs and symptoms, most of which are also discussed as separate topics. Mania and psychosis can occur in several different illnesses, though they are most often associated with bipolar disorder and schizophrenia, respectively. Depression can refer to both a symptom and a syndrome (when sadness is combined with changes in energy, sleep, and appetite).

Psychiatrists have classified the wide range of mental disturbances into several specific disorders that are listed in the textbook Diagnostic and Statistical Manual of Mental Disorders (or DSM; see "Additional Sources of Information"). None of these disorders can be diagnosed exclusively on the basis of laboratory tests or other physical findings, so psychiatrists have reached a consensus, based on clinical experience and research, on the signs and symptoms that are required to make a specific diagnosis. Most of these illnesses have been well described and reliably diagnosed for decades, if not centuries. The disorders that psychiatrists diagnose and treat can be grouped into several major categories:

  • Adjustment disorders (temporary emotional reactions to stress).
  • Anxiety disorders (phobias, panic attacks, and disabling worries).
  • Depression (which affects mood, sleep, appetite, sexual desire, and energy level).
  • Bipolar disorder, formerly known as manic-depressive illness (periods of depression alternating with elevated mood and hyperactivity).
  • Schizophrenia (hallucinations, delusions, and disorganized thinking).
  • Obsessive-compulsive disorder (intrusive thoughts and repetitive behaviors).
  • Post-traumatic stress disorders (reactions to life-threatening events).
  • Personality disorders (persistent and extreme character styles that often lead to problems in relating to others).
  • Drug and alcohol disorders (intoxication, addiction, and withdrawal).
  • Physical complaints and worries (can reflect psychological difficulties).
  • Sexual disorders (performance problems and unwanted urges and preoccupations).
  • Autism, mental retardation, hyperactivity, and other learning disorders emerging in childhood.
  • Dementia and delirium (memory loss and confusion, most common in the elderly).

You should keep in mind when reading this book that there is a wide range of variation in what can be considered normal. Even something as seemingly disturbed as hearing voices when no one is around may be normal in certain circumstances. We have a wide range of temperaments, cultural backgrounds, beliefs, experiences, and idiosyncrasies, and the world would be a boring place if this were not so. So when you read about personality disorders, you should be aware that shyness, impulsiveness, empathy, grandiosity, moodiness, and other traits exist on a spectrum. We all have these traits to some extent. Likewise, we all experience sadness, joy, and nervousness from time to time. We each get stressed-out, and sometimes we each make bad decisions. One goal of this book is to show the extent to which many of these experiences can be normal. You should resist the temptation to diagnosis yourself just because you once felt jealous or lost your temper, for example. Another goal of this book is to demonstrate how normal even the oddest behaviors can seem once you understand the underlying illness.

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What Treatments Are Available for Mental Illness?

If you experience mental health problems, you should consult a professional at some point. Many mental health problems can worsen if left untreated, or they can occur again in the future. And there may be physical causes of your symptoms that only a physician can uncover. This book will help you to recognize your symptoms and communicate to your physician about them. It also provides valuable information about the benefits and side effects of available medications, which your physician may not discuss with you in depth. In some cases, you will learn that psychotherapy may be more appropriate than medication.

A psychiatrist is a medical doctor who specializes in the assessment and treatment of mental illnesses. Psychiatrists have an M.D. or a D.O. degree and are licensed to practice and prescribe as a physician. Fellowship training and board certification are signs of additional expertise or qualification. A psychiatrist is able to perform a medical examination, order tests, assess for signs and symptoms of mental illness, make a diagnosis, prescribe medication, perform psychotherapy, or make a referral to a qualified therapist. If you have a serious, chronic, or difficult-to-treat mental illness, then you should certainly see a psychiatrist.

General medical doctors are also able to make a psychiatric diagnosis and prescribe psychiatric medications. However, they have less experience than psychiatrists in working with mental illness. If you have mild to moderate problems with anxiety, depression, alcoholism, or nicotine addiction, then your regular doctor may be able to provide adequate treatment. A general doctor does not provide psychotherapy.

Psychologists and social workers can be licensed to provide psychotherapy. Some psychologists have a Ph.D. or Psy.D. degree and are referred to as doctors, though they are not medical doctors. They often have greater expertise than psychiatrists in providing specific types of psychotherapy and in administering psychological tests that assist in diagnosis. They can assess for signs and symptoms of mental illness and make a diagnosis. They can refer you to a psychiatrist for further medical workup or to see if you might benefit from medication. Social workers have a master's degree and can provide psychotherapy or more general counseling and support.

There are many types of psychotherapy, or talk therapy, that may help you feel better, either as a sole treatment or in combination with medication. The types of therapy that are generally most effective are those that use cognitive-behavioral techniques aimed at changing your habits and modifying attitudes that can cause or perpetuate your symptoms. These techniques are particularly helpful in the treatment of anxiety disorders. When you are in a personal crisis, you may benefit from counseling that helps you to problem-solve and improve your relationships with others. Couple therapy and family therapy focus on problems that have developed between people who care about each other. Relapse-prevention therapy is the treatment of choice for addiction, often supplemented with participation in a self-help group.

Psychodynamic therapies, which evolved out of the theories of Freud and his successors, try to explore your unconscious motivations and link your current patterns of behavior to past experiences. This may increase anxiety and other symptoms, at least initially, and has not been proven to be effective in the treatment of most serious mental illnesses. However, if your symptoms are mild, you may find a deeper exploration of your motivations and relationship patterns to be enlightening and enriching. Over time, psychodynamic therapy may help you to alter your personal patterns of behavior and long-standing ways of thinking that bother you.

All forms of psychotherapy share some basic features. You will receive information about psychological disturbances and the significance of your experiences. You will be reassured and feel more confident as a result of understanding the symptoms that have troubled you. You will have a safe and confidential relationship with a professional and be able to say things that you might not be able to share with anyone else. You will be given guidance and suggestions on how to understand and resolve your problems. You will feel glad that you took a positive step toward helping yourself feel better.

You may be able to find some of these features in a deep discussion with a parent, best friend, or religious leader. But mental health professionals are much more experienced with psychiatric symptoms and solutions and can provide you with more specific information. They can also take a fresh and objective look at your problems.

There are several types of medications for mental illness, often referred to as psychotropics. You may not need psychiatric medication in order to feel better. Whether you do depends on the type of problem you are having, the severity of your symptoms, and your willingness to devote time and energy to psychotherapy instead. Psychiatric medications are generally as effective, and often safer, than medications used for other medical conditions, like heart disease and diabetes. Medications never control your thoughts or alter your personality. Rather, they restore your ability to think clearly and to feel like yourself again. Medications and their potential side effects are described in detail, especially at the end of the chapters on depression, anxiety, psychosis, mania, hyperactivity, memory loss, sleep problems, and physical complaints and pain.

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A Note About Sources of Information

The chapters that follow present specific figures for the prevalence of mental illnesses and response rates to various treatments, among other data. These numbers are derived from research studies and are easily found in most psychiatric textbooks. Much of what we know about the prevalence of mental illness in the general community derives from studies such as the Epidemiological Catchment Area Study conducted in the 1980s and the National Comorbidity Survey of the early 1990s.

If you are interested in further detailed information about mental health and illness, you may wish to refer to the comprehensive psychiatric textbooks listed in the appendix "Recommended Resources." The appendix also lists emergency hotlines, respected organizations, informative Web sites, and books about particular illnesses.

 

This excerpt may not be reproduced without written permission from the publishers.
Fifty Signs of Mental Illness: A Guide to Understanding Mental Health
Yale University Press / New Haven and London
Copyright © 2005 by James Whitney Hicks

Return to Table of Contents > Next Topic: Anger

Everyone Experiences Mental Health Problems

What Causes Mental Illness?

Mental Health Problems Are Treatable

Signs, Symptoms, Syndromes, and Disorders

What Treatments Are Available for Mental Illness?

A Note About Sources of Information

 


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