The Mental Illness Stigma
History of Mental Illness
Mental illness of has been a part of human existence since ancient times although for thousands of years it wasn't recognized as such. In Ancient Egypt, people attributed mental illness and psychosis to things such as demonic possession. In the Medieval Era, signs of mental illness was a possible sign of witchery and was usually punishable by death. In the 19th century psychiatrists became much more informed about the existence of mental illness and no longer attributed it to things like possession. Instead, doctors began listing symptoms of various illnesses and attempting classifications. Over time, the general public gained some understanding that psychotic behaviour was not a result of supernatural causes but this information still didn't prevent stigmas.
Early Recording of MPD/DID
During the French Revolution, the doctor Paracelsus recorded an early,case of a possible multiple personality disorder. The case involved a 21-year-old woman who lived in Stuttgart, Germany. She presented an alter who spoke fluent French and spoke French with a German accent.The Revolution was a time when many people fled France for Germany, so the influence of the French people was obvious in her alter. The French woman was aware of the patient, but this was not mutual. During amnesia, the patient had no knowledge of her actions and was unable to speak or understand French.
Earliest Recording of Paranoid Schizophrenia
James Tilly Matthews is considered to be the first recorded patient with schizophrenia. Living in England, he had been a London tea broker who was committed to Bethlem or Bedlam psychiatric hospital. He was heavily involved in politics and for a three-year period was imprisoned in France until government agents declared him a "lunatic" and freed him. His delusions about political matters, especially those involving espionage, caused his doctors to declare him "insane." Matthews hallucinated and frequently spoke to non-existent people. He believed a group of spies were penetrating his thoughts with an "air loom", a machine that directed rays at him. He even drew the non-existent air loom for his doctors.
His family attempted to have him freed but, as Matthews was considered a danger to the public, he was moved to a private psychiatric hospital called the Fox London's House. There he actually helped to design blueprints to rebuild Bethlam Hospital and some of his ideas were used in the final building. His diagnosis was paranoid schizophrenia.
Sane Vs Insane
In the 20th century, their still remains the incorrect expressions "insane" and "sane." These are not psychiatric terms: they are legal terms and as such are only used in a court of law. Doctors refer to patients who display a break with reality as psychotic. These patients may not necessarily be schizophrenic. They may also suffer from Bipolar Disorder, formerly known as manic-depression. A person in extreme mania exhibits the same symptoms as a paranoid schizophrenic and many patients have been misdiagnosed as schizophrenic before being correctly assessed as having Bipolar Disorder.
The first draft of the DSM-I or the Diagnostic and Statistical Manual for the Treatment and Diagnosis of Mental Disorders was just after WWI, when soldiers returned home with signs of PTSD, or post-trauamtic stress disorder. Since the first publication of the manual, there have been many revisions. Currently the DSM-5 is published and used by doctors worldwide, although not all of its classifications are accepted by the ICD-10, or International Classification of Mental and Behavioral Disorders.
There are 10 major revisions in the DSM-5 including:
- definition and types of schizophrenia
- use of standard number 5 instead of roman numeral V
- change in the definition of bereavement
- classification and definition of autism
- addition of a disorder called disruptive mood disregulation disorder
- discontinued use of the term child/adolescent illnesses/disorders
- information about ADHD
- symptoms of PTSD
- major and mild neurocognitive disorder
- definition of MPD as that of DID or dissociative identity disorder
Critics of the manual state that so many revisions imply it is not an accurate assessment tool. However, psychiatrists state that improvements and new classifications of disorders are the result of ongoing learning and research; a positive sign that psychiatry is constantly evolving.
None of these classifications however prevent public stigma. It is ongoing. Many people who do not suffer from mental health issues learn fictitious information about mental illness from movies and television shows. This media generally portrays the mentally ill as dangerous lunatics, running about on a homicidal spree. Even people who associate with mentally ill persons maintain a certain degree of prejudice. The need for medications often brings with it an uncertainty as to whether the patient is dangerous or competent at his/her work. Lawsuits have been filed by mentally ill persons over several decades for unlawful dismissal, especially when these people are completely functional and are capable of a strong work performance.
Depending on the disorder, prognosis can be very good. Bipolar Disorder for example has a prognosis of approximately 80%, an excellent statistic. The prognosis statistic would be higher, except there are many people whose behavior is regulated through medications but after functioning successfully for a number of weeks or months, these people discontinue their medications without the guidance of a psychiatrist. Symptoms return and their lives become chaotic again.
Schizophrenia is a more complex disorder. Like Bipolar Disorder, its symptoms can be controlled with regular medication. Unlike Bipolar Disorder, sufferers of schizophrenia are seldom able to work full-time, marry or raise families.
Compulsive disorders such as OCD are sometimes controllable with anti-anxiety and other types of medication, but this depends upon the condition.
Cure vs Control
There is no cure for a mental illness or a mood disorder. Using medication and attending ongoing counselling with a therapist is an efficient means of controlling symptoms. Depending upon the disorder, this helps the affected person to maintain a functional, competent lifestyle.
There are disorders that do not respond to medication. DID/MPD for example, doesn't respond to psychotropic medications and the prognosis is generally poor. However, people with the disorder often function very well, holding down jobs and successfully raising families. It is the fictitious portrayal of people with mental illness and disorders that keep the public unaware of the reality of mental illness. This causes stigma and prejudice that is unnecessary and acts as a barrier for people with mental illness in the general community..
- DSM-5 Released: The Big Changes | World of Psychology
The DSM-5 was officially released today. We will be covering it in the weeks to come here on the blog and over at Psych Central Professional in a series of