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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
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of Contents > Next Topic:
Anger
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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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