Understanding Mental Disorders

What is a Mental Disorder/Mental Illness?

"Mental Illness - a disorder of one or more of the functions of the mind (such as emotion, perception, memory or thought), which causes suffering to the patient or others."

Oxford Concise Medical Dictionary

When people talk about 'mental illnesses', they are generally talking about illnesses that are psychological in nature, rather than physical.

Today, health-care professionals do not often use the term mental illness, because it implies that people are mentally ill for the same reasons that they are physically ill. The term 'illness' implies that mental illness is caused by physical factors. This is not necessarily true. Many mental disorders may have a physical cause, (for example, depression caused by a chemical imbalance), but many mental disorders have a psychological cause (for example, depression caused by the death of a loved one). Some physical illnesses may even have a psychological cause (for example, eczema caused by stress). So the distinction between what is psychological and what is physical is not clear. As such, some health-care professionals prefer to use the term mental disorder as it is a more neutral term.

Another reason some health-care professionals prefer the term mental disorder rather than mental illness is because it does not imply that the person is 'sick'! There are many stereotypes about people who have a mental disorder – all of them negative – and sadly it is because of these misperceptions that many people find it really difficult to seek the help of a psychologist or other professional. There is also the (false) idea that only 'crazy people' or 'sinners' need to see psychologists and counsellors. The result is that many, many people do not get the help they need. 

Misperceptions About Mental Disorders

The most common misperceptions are:

Myth: "Mentally disturbed people can always be recognised by their consistently deviant, abnormal behaviour."

Reality: Mentally disturbed people are not always distinguishable from others on the basis of consistently unusual behaviour. Even in an outpatient clinic or a psychiatric ward, distinguishing patients from staff on the basis of behaviour alone is often difficult. There are two main reasons for this difficulty. First, as already noted, no sharp dividing line usually exists between 'normal' and 'abnormal' behaviours. Rather, the spectrum of behaviours is continuous, ranging from abnormal to normal. Depending on the situational context and the perspective of the person judging the behaviour, many behaviours could be considered either normal or deviant. Second, even when people are suffering from some form of emotional disturbance, it may not always be detectable in their behaviour.

Myth: "The mentally disturbed have inherited their disorders. If one member of a family has an emotional breakdown, other members will probably suffer a similar fate."

Reality: The belief that insanity runs in certain families has caused misery and undue anxiety for many people. Although the data are far from conclusive, heredity does not seem to play a major role in most mental disorder - except for some cases of schizophrenia and depression, certain types of mental retardation, and the bipolar disorders. Evidence suggests that, even though heredity may predispose an individual to certain disorders, environmental factors are extremely important. When many family members suffer from mental disorders, a stress-producing environment is usually acting on the family predisposition. If the environment is benign, however, or if predisposed individuals modify a stressful environment, psychopathology may never occur.

Myth: "The mentally disturbed person can never be cured and will never be able to function normally or hold a job in the community."

Reality: This erroneous belief has caused great distress to many people who have, at some time, been labelled mentally ill. Former mental patients have endured social discrimination and have been denied employment because of the public perception that 'once insane, always insane'. Unfortunately this myth may keep former mental patients - or those currently experiencing emotional problems - from seeking help. Although most people don't hesitate to consult a doctor, dentist or lawyer for help, many who need mental health services are fearful and anxious about the social stigma attached to being labelled 'mentally ill'.

Nearly three-quarters of clients who are hospitalised with severe disorders will improve and go on to lead productive lives. Many recovered mental patients make excellent employees, and employers frequently report that they outperform other workers in attendance and punctuality. Some famous examples of persons who have recovered from mental disorders are President Abraham Lincoln, philosopher William James, Senator Thomas Eagleton, singer Rosemary Clooney, actress Patty Duke and golfer Bert Yancy.

Myth: "People become mentally disturbed because they are weak-willed. To avoid emotional disorders or cure oneself of them, one need only exercise willpower."

Reality: These statements show that the speaker does not understand the nature of mental disorders.

Needing help to resolve difficulties does not indicate a lack of willpower. In fact, recognising one's own need for help may be a sign of strength rather than a sign of weakness. Many problems stem from situations that are not under the individual's immediate control, such as the death of a loved one or the loss of a job. Other problems stem from lifelong patterns of faulty learning; it is naive to expect that a simple exercise of will would override years of experience. Very often the disorder is the result of biological causes, such as a chemical imbalance. All the will in the world will not correct the imbalance – only ‘chemicals’ in the form of medication or nutrition can do this.

Myth: "Mental illness is always a deficit and the sufferer can never contribute anything of worth until cured."

Reality: Many persons who suffered from mental illness were never 'cured', but they nevertheless made great contributions to humanity.

Ernest Hemingway,one of the greatest writers of our time, who won the Nobel Prize for literature in 1954, suffered from lifelong depressions, alcoholism and was frequently hospitalised. In 1961 he put a shotgun into his mouth and killed himself.

The famous Dutch painter Vincent van Gogh produced great works of art despite the fact that he was severely disturbed. Not only did he lead an unhappy and tortured life, he frequently heard voices, cut off a piece of his left ear as a gift to a prostitute and finally committed suicide.

Others like Pablo Picasso and Edgar Allan Poe contributed major works to humanity while seriously disturbed. The point of these examples is not to illustrate that madness and genius go hand in hand, but that many people who are less severely disturbed can continue to lead productive and worthwhile lives. Because people suffer from psychological problems does not mean that their ideas and contributions are less worthy of consideration.

Myth: "The mentally disturbed person is unstable and potentially dangerous."

Reality: This misconception has been perpetuated by the mass media. Many murderers on television are labelled "psychopaths" and the news media concentrate on the occasional mental patient who kills. However, the thousands of mental patients who do not commit crimes, do not harm others, and do not get into trouble with the law are not news. An important study of the issue does not support the notion that mental patients are seriously dangerous (Rabkin, 1979). Unfortunately, the myth persists.

What is a Nervous Breakdown?

The term 'nervous breakdown' is not an official medical term, nor is it a psychiatric diagnosis. In reality there is no such thing as anervous breakdown. It is a term used by lay people – without really knowing what they are talking about! Different people use it to describe different things, but generally you will find that they describe:

• An anxiety disorder;
• Depression;
• An inability to cope with life/situation.

What Causes a Mental Disorder?

Unfortunately in most cases of mental disorder, we cannot say exactly what caused the disorder. It could be a number of factors. Mental disorders are complex phenomena and trying to find a cause is not easy. It is not as simple as being able to say X caused Y. Generally the thinking today is that it is not just one factor that causes a mental disorder, but a number of factors working together.

This explanation is called the Diathesis–Stress Model/theory and is commonly accepted to be the most comprehensive explanation of the cause of mental disorders.

Diathesis-Stress Model

The Diathesis–Stress Model is a psychological theory that explains behaviour and mental disorders as the result of both biological and genetic vulnerability and stress from life experiences.

The model assumes that the onset of a certain disorder may result from a combination of one's biological disposition towards the given disorder and stressful events that bring about the onset of such a disorder.

In the Diathesis–Stress Model, a biological or genetic vulnerability or predisposition (diathesis) interacts with the environment and life events (stressors) to precipitate (trigger) behaviours or psychological disorders. The behaviour or mental disorder is then maintained by a number of other factors. Let me explain these terms.

Predisposing Factors

The word predispose means to make susceptible to…or inclined to…

So predisposing factors are factors that make an individual vulnerable to a mental disorder. They do not cause the disorder. They just make that individual more likely to have a disorder if the precipitating factors come into play.

Predisposing factors include:

• Genetic factors

For example genes that you inherit/are born with. Research has shown that genetic factors do predispose people to developing mental illness. With most disorders, the closer the genetic relationship to a person with a mental disorder, the more likely one is to also have the disorder. Remember genes alone do not cause a disorder.

• Organic/biological/physiological factors

These include neurotransmitters (chemicals in the brain), hormones and the central nervous system (brain and spinal cord).

If anything goes wrong with any of these elements of the body it can make the individual vulnerable to a mental disorder.

• Early psycho-social factors

This includes the individual’s early social and emotional experiences. For example, how their parents communicated and behaved towards them, relationships with others etc. These early experiences influence the individual’s personality and self-esteem development. Negative early experiences may result in the development of poor self-esteem, which makes an individual more vulnerable to developing a mental disorder when faced with stress. The individual’s culture can even play a role here.

Precipitating Factors

The word 'precipitate' means to hurry, urge on…or hasten occurrence of…

So precipitating factors are factors that trigger off the predisposing factors, to result in the mental disorder that the individual was already vulnerable to.

Precipitating factors are stressful events in the individual’s life. Remember different individuals experience events in different ways. The event in itself may be neither good nor bad, but the individual will interpret it as stressful.

Generally any kind of change in a person’s life – large or small, desirable or undesirable - causes stress. An accumulation of small changes can be just as powerful as one major change.

So the predisposing factors and the precipitating factors work together and result in the mental disorder. The predisposing vulnerability factors are triggered when stressful events overwhelm the person’s ability to cope.

Maintaining Factors

Sometimes there are factors that maintain the disorder. In other words, sometimes certain factors perpetuate the problem. For example, a lack of support, a lack of social and coping skills or the stressor, which triggered off the predisposing factors, continues to worsen.

Mediating Factors

There may however be mediating factors that actually serve as buffers between the predisposing and precipitating factors. These would be things such as the individual’s social support system. These mediating factors may actually help to prevent the disorder, or make it at least less severe.

So to sum up: An individual with a mental disorder is not crazy, weak or sinful. They are not 'problem people'. They are rather 'people with a problem', because of a complex set of factors working together.

Diathesis-Stress Model: Summarised

The Diathesis-Stress Model says that predisposing factors and precipitating factors influence each other and result in the disorder, which is then maintained by various other factors. An example of the possible causes of a mental disorder is shown below:

1. Long-Term, Predisposing Factors

A. Heredity

B. Childhood Circumstances

    1. Parenting style

    2. Parental communication

    3. Emotional insecurity and dependence

C. Cumulative stress over time

 2. Biological Factors

A. Chemical imbalances in the central nervous system

B. Medical conditions that can cause disorders

 3.  Short-Term, Precipitating (Triggering) Factors

A. Stressors that precipitate the disorder

      1. Significant personal loss

      2. Significant life change

      3. Stimulants and recreational drugs

B. Conditioning

C. Other mental disorders

4.  Maintaining Causes

1. 1. Negative self-talk

   2. Mistaken beliefs

   3. Withheld feelings

   4. Lack of assertiveness 

   5. Lack of self-nurturing skills

   6. Stimulants and other dietary factors

   7. High-stress lifestyle

   8. Lack of meaning or sense of purpose

The Diathesis-Stress Model: Illustrated (The Idiots’ Guide)

The Diathesis–Stress Model says that a mental disorder is caused by a biological or genetic vulnerability (or predisposition), which interacts with the environment and life events (stressors) to precipitate (trigger) behaviours or psychological disorders. The behaviour or mental disorder is then maintained by a number of other factors.

It works like this…..

Imagine that I have an ordinary glass, some sand, a few pebbles and a bottle of water: 
The glass shows us how susceptible you are to a mental disorder.
The sand represents your body and the genes you have inherited.
The pebbles represent different stressful events in your life. 
The water represents your thinking and behaviour – for example, your negative thinking.

Let’s say that right now, the glass is empty. This would mean that you have no susceptibility to a mental disorder.

Let’s say that you fill the glass up with just a little bit with the sand - these are the genes that you have inherited - and that makes you just a little bit more susceptible.

Now let’s say you have a few really stressful events occur in your life. Pop a pebble into the glass to represent the abuse you had from your father while you were a child. Pop another pebble into the glass to represent the death of your grandmother, the only person you felt really close to. Pop another pebble into the glass to represent the breakup of your relationship. Put in yet another pebble to represent the stress you are experiencing at school or at work.

All these pebbles in the glass make you much more susceptible.

Now pour in some water to represent the negative way you are thinking about your situation.

You can see where this is going… your glass is filling up.

Well, maybe if your susceptibility is low enough you still won’t get a mental disorder, but we can imagine what would happen if you keep filling up the glass. Maybe your genetic susceptibility is a little higher, maybe you have more stressful events occurring in your life. At some point, the glass will overflow and that is when you show the symptoms of a mental disorder.

It works in the same way for all kinds of mental disorders, but everyone is different, so their glasses will be full of different things as well.  It is not just one thing on its own, but a combination of things.

This is true too for emptying the glass and reducing the susceptibility.

Every person is different and what works for one person in terms of prevention and treatment may not necessarily work for you. This is because your given vulnerability may cause you to react differently to another person who perhaps experiences the same environmental conditions, but who did not start out with the same vulnerability you did.

When it comes to treatment it is often useful to ask not only “What do I do about it now that it’s here?”, but “Why is it there?” and “How did it get there in the first place?”

How do we Treat Mental Disorders?

Doctors and therapists face the difficult challenge of trying to treat different individuals with the same particular problem. The difficulty lies in the fact that different individuals are just that…different! One individual with depression may respond positively to a treatment, while another individual also with depression may respond negatively to the same treatment. Why does this happen?

The answer to this is that no one individual develops a mental disorder for exactly the same reasons as another individual, so treatment cannot be exactly the same.

The Diathesis–Stress Model is useful in the treatment of mental disorders because it helps us understand that mental disorders are complex and that the treatment approach needs to be equally complex.

According to the Diathesis–Stress Model, any intervention should address the predisposing and precipitating factors as well as try to increase the mediating factors and decrease the maintaining factors. This usually requires the help of professionals.

Thus a treatment approach may include all or many of the following:

Please Note: This is not intended to be a comprehensive list of all available treatments, but merely a guide to illustrate possible treatment approaches according to the Diathesis-Stress model.