Mental Illness

I

Introduction

Mental Illness, disorder characterized by disturbances in a person’s thoughts, emotions, or behavior. The term mental illness can refer to a wide variety of disorders, ranging from those that cause mild distress to those that severely impair a person’s ability to function. Mental health professionals sometimes use the terms psychiatric disorder or psychopathology to refer to mental illness.

II

The Experience of Mental Illness

Severe mental illness almost always alters a person’s life dramatically. People with severe mental illnesses experience disturbing symptoms that can make it difficult to hold a job, go to school, relate to others, or cope with ordinary life demands. Some individuals require hospitalization because they become unable to care for themselves or because they are at risk of committing suicide.

The symptoms of mental illness can be very distressing. People who develop schizophrenia may hear voices inside their head that say nasty things about them or command them to act in strange or unpredictable ways. Or they may be paralyzed by paranoia—the deep conviction that everyone, including their closest family members, wants to injure or destroy them. People with major depression may feel that nothing brings pleasure and that life is so dreary and unhappy that it is better to be dead. People with panic disorder may experience heart palpitations, rapid breathing, and anxiety so extreme that they may not be able to leave home. People who experience episodes of mania may engage in reckless sexual behavior or may spend money indiscriminately, acts that later cause them to feel guilt, shame, and desperation.

Other mental illnesses, while not always debilitating, create certain problems in living. People with personality disorders may experience loneliness and isolation because their personality style interferes with social relations. People with an eating disorder may become so preoccupied with their weight and appearance that they force themselves to vomit or refuse to eat. Individuals who develop post-traumatic stress disorder may become angry easily, experience disturbing memories, and have trouble concentrating.

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Experiences of mental illness often differ depending on one’s culture or social group, sometimes greatly so. For example, in most of the non-Western world, people with depression complain principally of physical ailments, such as lack of energy, poor sleep, loss of appetite, and various kinds of physical pain. Indeed, even in North America these complaints are commonplace. But in the United States and other Western societies, depressed people and mental health professionals who treat them tend to emphasize psychological problems, such as feelings of sadness, worthlessness, and despair. The experience of schizophrenia also differs by culture. In India, one-third of new cases of schizophrenia involve catatonia, a behavioral condition in which a person maintains a bizarre statuelike pose for hours or days. This condition is rare in Europe and North America.

With appropriate treatment, most people can recover from mental illness and return to normal life. Even those with persistent, long-term mental illnesses can usually learn to manage their symptoms and live productive lives.

III

Attitudes Toward Mental Illness

In most societies mental illness carries a substantial stigma, or mark of shame. The mentally ill are often blamed for bringing on their own illnesses, and others may see them as victims of bad fate, religious and moral transgression, or witchcraft. Such stigma may keep families from acknowledging that a family member is ill. Some families may hide or overprotect a member with mental illness—keeping the person from receiving potentially effective care—or they may reject the person from the family. When magnified from individuals to a whole society, such attitudes lead to underfunding of mental health services and terribly inadequate care. In much of the world, even today, the mentally ill are chained, caged, or hospitalized in filthy, brutal institutions. Yet attitudes toward mental illness have improved in many areas, especially owing to health education and advocacy for the mentally ill.

IV

Social and Economic Costs

Mental illness creates enormous social and economic costs. Depression, for example, affects some 500 million people in the world and results in more time lost to disability than such chronic diseases as diabetes mellitus and arthritis. Estimating the economic cost of mental illness is complex because there are direct costs (actual medical expenditures), indirect costs (the cost to individuals and society due to reduced or lost productivity, for example), and support costs (time lost to care of family members with mental illnesses). One study estimated that in 1985 the economic costs of mental illness in the United States totaled $103.7 billion. Of this, treatment and support costs totaled $42.5 billion, which represented 11.5 percent of the total cost of care for all illnesses.

Another method of estimating the cost of mental illness to society measures the impact of premature deaths and disablements. Research by the World Health Organization and the World Bank estimated that in 1990, among the world’s population aged 15 to 44 years, depression accounted for more than 10 percent of the total burden attributable to all diseases. Two other illnesses, bipolar disorder and schizophrenia, accounted for another 6 percent of the burden. This research has helped governments recognize that mental illnesses constitute a far greater challenge to public health systems than previously realized.

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