Psychological Disorders and Mental Health

Defining Mental Illness

Mental illness is defined by the DSM as patterns of behavior or experience that cause distress, impair day-to-day functioning, or increase the risk of harm. However, this definition is not perfect, as some maladaptive behaviors may not be classified as mental illnesses, and some individuals may be considered mentally ill without clearly meeting these criteria.

• Maladaptive Behavior: Actions that interfere with daily life or pose risks.

• Distress: Emotional suffering is a key component.

• Impairment: Difficulty functioning in social, occupational, or other important areas.

Historical Conceptions of Mental Illness

Views on mental illness have evolved significantly over time, from supernatural explanations to medical models.

• Demonic Model: In the Middle Ages, odd behaviors were attributed to evil spirits, leading to exorcisms and witch hunts.

• Medical Model: During the Renaissance, mental illness was seen as a physical disorder requiring treatment, often in asylums with practices like bloodletting and snake pits.

• Moral Treatment: Reformers such as Phillippe Pinel and Dorothea Dix advocated for humane treatment, allowing patients more freedom and dignity, though effective treatments were still lacking.

Modern Era and Deinstitutionalization

The development of antipsychotic medications, such as chlorpromazine (Thorazine), in the 1950s led to deinstitutionalization, releasing patients from hospitals. However, lack of community support resulted in mixed outcomes.

• Chlorpromazine: Moderately decreased symptoms of schizophrenia and similar disorders.

• Deinstitutionalization: Shift from asylums to community-based care, but often resulted in inadequate support.

Diagnosis and Classification

DSM-5 and the Biopsychosocial Model

The DSM-5 is the official classification system for mental disorders, providing diagnostic criteria and decision rules. It emphasizes ruling out medical or substance-related causes and adopts a biopsychosocial approach.

• Biological Factors: Brain chemistry, genetics, neurodevelopment, physical health.

• Psychological Factors: Cognitive patterns, emotional regulation, personality, coping skills.

• Social Factors: Environment, culture, family dynamics, socioeconomic status.

Explosion of Diagnoses

The number of diagnoses in the DSM has increased dramatically, raising concerns about over-treatment and the influence of the insurance industry.

Culture and Mental Disorders

Culture-Bound Syndromes

Certain mental disorders are influenced by cultural context, while others (e.g., schizophrenia, alcoholism, psychopathy) appear universal.

• Malocchio: Italian syndrome involving headaches, fatigue, anxiety, and bad luck caused by envy.

• Calor do corpo/nervos: Portuguese syndrome involving fatigue, anxiety, and gastrointestinal issues attributed to bodily imbalance.

• Taijin Kyofusho (TKS): Japanese form of social anxiety, characterized by fear of offending others, reflecting collectivist cultural values.

Major Psychological Disorders

Anxiety-Related Disorders

Anxiety disorders are characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety. They include generalized anxiety disorder, panic disorder, specific phobias, OCD, and PTSD.

• Generalized Anxiety Disorder: Continual feelings of worry, tension, and irritability about many areas.

• Panic Disorder: Repeated, unexpected panic attacks and persistent concern about future attacks.

• Phobias: Unrealistic fear of specific situations, activities, or objects.

• Obsessive-Compulsive Disorder: Intrusive obsessions and ritualistic compulsions to reduce distress.

Mood Disorders

Mood disorders include depression and bipolar disorder, affecting nearly 10% of adults in Canada and the US. Depression is more common among women and those living in poverty, with genetic and environmental risk factors.

• Major Depression: Periods of sadness, hopelessness, social withdrawal, and cognitive/physical sluggishness.

• Bipolar Disorder: Extreme shifts in mood, motivation, and energy, with periods of depression and mania.

Schizophrenia

Schizophrenia involves significant breaks from reality, lack of integration of thoughts and emotions, and problems with attention and memory. Symptoms are classified as positive (hallucinations, delusions) and negative (absence of adaptive behavior).

• Brain Structure: Larger ventricles, loss of brain tissue, differences in hippocampus and amygdala.

• Brain Activity: Reduced activity in frontal lobes and emotion/memory regions.

• Neurotransmitters: Dopamine overactivity linked to positive symptoms; glutamate underactivity may play a role.

• Environmental Causes: Extreme stress, low SES, minority status, prenatal environment, cannabis use.

Personality Disorders

Personality disorders are characterized by unusual patterns of behavior that are maladaptive, distressing, and resistant to change. They are grouped into three clusters:

• Cluster A: Odd or eccentric behavior (e.g., paranoid personality, schizoid).

• Cluster B: Dramatic, emotional, and erratic behavior (e.g., antisocial, narcissistic).

• Cluster C: Anxious, fearful, and inhibited behavior (e.g., avoidant personality disorder).

Borderline Personality Disorder

Marked by intense emotional swings, unstable sense of self, impulsivity, and difficult social relationships. Often rooted in emotional insecurity and early adverse experiences.

Antisocial Personality Disorder (APD) and Psychopathy

APD involves a profound lack of empathy, disregard for others' rights, and resistance to treatment. Psychopathy is characterized by extreme antisocial traits, glibness, lack of remorse, impulsivity, and brain differences such as amygdala abnormalities and frontal lobe impairments.

Uncommon Psychiatric Syndromes

• Capgras's Syndrome: Belief that a close person has been replaced by an exact double.

• Ekbom's Syndrome: Delusions of infestation.

• Munchausen Syndrome: Persistent fabrication of medical symptoms, leading to unnecessary treatment.

Mental Illness and the Justice System

Insanity Defense and NCRMD

The insanity defense (NCRMD: Not criminally responsible by reason of mental disorder) is a legal concept, not a psychological one. Criminal guilt requires both actus reus (the guilty action) and mens rea (the guilty mind). Mental illness can negate mens rea.

• NCRMD Test (Canadian Criminal Code S. 16): No person is criminally responsible for an act committed while suffering from a mental disorder that rendered them incapable of appreciating the nature and quality of the act or knowing it was wrong.

• Possible Outcomes: Absolute discharge, conditional discharge, or detention in a hospital, depending on risk and treatment needs.

Myths and Realities of NCRMD

• Myth: Frequently used and successful.

• Reality: Used in only 1% of felony cases, fails 75% of the time.

• Myth: Loophole for the guilty.

• Reality: Most NCR defendants spend their sentence in jail or hospital.

• Myth: Mentally ill are extremely dangerous.

• Reality: Most NCR cases are non-violent.

• Myth: Quick release.

• Reality: NCR individuals are committed longer than if found guilty.

Mental Health in the Correctional System

Mental illness is significantly more common in prison than in the general population. Incarceration often worsens mental health due to harsh conditions, lack of services, and overuse of segregation.

• Prevalence: ~70% of federally incarcerated individuals report mental health symptoms.

• Segregation: 22% of inmates placed in segregation; 42%+ of segregated inmates had a mental health alert.

• Effects: Hallucinations, cognitive disabilities, insomnia, self-harm, paranoia, suicidal tendencies, and neurological changes.

Case Studies: Impact of Solitary Confinement

• Kalief Browder: Held in solitary for 700+ days, never fully recovered from trauma.

• Edward Snowshoe: Spent 162 days in solitary, died by suicide.

• Ashley Smith: Four years in isolation, committed suicide.

Getting Involved

Organizations such as the John Howard Society, Fred Victor, Elizabeth Fry Society, AMHO, CMHA, and CAMH work to support individuals with mental illness and promote meaningful change.