Understanding mental illnesses
* BAKANG ABIOT KGAODI | Friday July 9, 2010 00:00
To many, the mention of the term mental paints a grim picture of an uncontrollable, non-sociable and paranoid individual. Although the above description may be characteristic in some psychological disorders (most notably those with a psychotic component) , it is important to note that it falls short in that it does not cater for a vast majority of illnesses categorised as psychological disorders. The Minister of Health Rev Dr Seakgosing highlighted the importance of education in the success in medical treatment of these disorders at the recent opening of Sbrana Psychiatric Hospital in Lobatse.
What are psychological disorders?Psychological disorders are abnormal behaviour that affects or is manifested in a person's brain , and can affect the way the person thinks , behaves and interacts with people. The behaviour is usually deviant, maladaptive or personally distressful over a long period of time. The affected individual manifests atypical behaviour that negatively deviates from what is considered normal and acceptable in a culture. The condition normally interferes with the patient's ability to function effectively and may lead to abnormal and unrelenting sadness. Social and Environmental conditions are important in determining which behaviours are considered normal and which are abnormal (L A King , The science of Psychology 2008).
Causes:There is no one globally accepted approach to causation of Psychological disorders. Instead there are several models that are generally agreed and considered plausible as approaches to causes of Psychological disorders. These include functional impairments that may result from disturbance of one or more of biological function, psychodynamic adaptation, learned behaviour and socio-cultural conditions. Biologic function: Attributes psychological disorders to organic, internal causes. They may be secondary to identifiable physical illness or caused by biochemical disturbances of the brain such as neurotransmitter dysfunction, nutritional deficiencies or toxic agents. Genetic predisposition also plays a major role in the manifestation of psychological disorders.
In short cholinergic deficiency is usually present in some dementias, adrenergic and/or dopaminergic imbalance is important in some psychoses, serotonergic mechanisms are thought to be involved affective disorders and anxiety disorders. This approach forms the basis of medical treatment of abnormal behaviour.
Psychodynamic adaptation: Involves a healthy balancing of intrapsychic motivations. This maladaptation involves intrapsychic aberrations or unconscious conflicts that produce anxiety. Treatment is usually psychotherapeutic.
Learned behaviour: Plays a an important part in the pathogenetic mechanism in most, if not all , psychological behaviour. This approach takes into consideration the effects of positive reinforcement that follows a particular pattern of behavior, an example of which are somatisation disorders, where the patient may have learnt that they only get attention by being sick. This approach is also widely accepted as one of the principal causative factors for personality disorders (Current Medical Diagnosis and Treatment Guidelines 2004).
Socio-cultural conditions: Vitally important in mental balance of the individual. It places more emphasis on the larger social context in which a person lives, including socioeconomic status, gender, ethnicity and culture. Gender is associated with the prevalence of some psychological disorders, for example women are more prone to developing anxiety and depression whereas males are more prone to aggressive behaviour (British Journal Of Psychiatry 2000; 177:117).Other models include the humanistic approach, trait perspectives and biopsychosocial approach.
Types:* Anxiety Disorders: manifest as diffuse, vague and unpleasant feeling of fear and dread, and is accompanied by motor tension, hyperactivity and apprehensive thoughts. The anxiety is usually disproportionate to real danger the individual is facing. They are further divided into;
* generalised anxiety disorder:- marked by persistent anxiety that lasts for more than 6 months. The individual suffering from the condition is usually unable to specify reasons for the anxiety.
*panic disorder:- marked by a sudden onset of intense apprehension, and is often accompanied by agoraphobia (fear of open spaces).
*phobic disorders:- manifest as irrational and persistent fear of a particular object or situation e.g snakes, insects, closed spaces, heights etc.
*obsessive-compulsive disorder:- ritualistic behaviour to prevent possible anxiety. There is a repetitive actions with the common compulsions being excessive checking, cleaning and counting.
*post-traumatic stress disorder:- occurs after exposure to a traumatic situation for instance a war, vehicle accident, severe abuse and natural disasters. It usually accompanied by flashbacks, restricted feeling of emotion, excessive arousal resulting in an exaggerated startle response and insomnia (Baldwin & Birtwistle, Encyclopedia of visual medicine: An Atlas of Depression 2002).
*Affective/mood disorders: these manifest as a prolonged change in the mood. The mood disturbance may include cognitive, behavioural and physical symptoms. There are generally two types of affective disorders. These are ;
*depressive disorder:- key features are low mood, reduced energy and a loss of interest and enjoyment. These symptoms are usually coupled with reduced self-confidence, anorexia (loss of appetite) and sleep disturbances (Baldwin & Birtwistle, Encyclopedia of visual medicine: An Atlas of Depression 2002).
*bipolar disorder:- This is an affective disorder that usually has a manic and depressive component with a change from one state to another .
*Dissociative disorders: there is an increasing feeling of disconnection from immediate experience. In this class are found dissociative amnesia and fugue which manifests as memory loss and assumption of a new identity. Herein is also found dissociative identity disorder or multiple personality disorder, with its characteristic 2 or more distinct personalities.
*Schizophrenia : This is the condition most people usually associate with mental illness. It involves a loss of grasp on the difference between imagination and reality.
It manifests in both positive and negative symptoms, with the latter including hallucinations which may be visual, auditory and even tactile ( seen, heard and felt), delusions and in some cases catatonia. The negative symptoms include a loss in expressing emotion, and difficulty speech. The types include paranoid schizophrenia and disorganized schizophrenia (L A King, The science of Psychology 2008).
l Personality disorders: manifest in chronic maladaptive behavioural patterns. These are grouped into odd/eccentric which includes paranoid and schizoid behavioral patterns, dramatic/emotionally problematic and the avoidant categories.
The dramatic/emotionally problematic cluster encompasses individuals with a vast majority of symptoms ranging from attention seekers to individuals with an unrealistic sense of self-importance. The last category includes avoidant, dependent, passive-aggressive and obsessive-compulsive personality disorders (Mario Maj et. al., WPA series Evidence and experience in Psychiatry 2005)
Other disorders such as anorexia and bulimia nervosa are widely regarded as psychological disorders, though other authors and professionals alike, regard them as eating disorders. These may be an indication of low self-esteem, low self concept and may result from peer-pressure.
It is important to realise that everyone can fall victim to any of the many psychological disorders and as such it is important to recognize when it may be time to seek medical attention. It is equally important to desist from labeling those suffering from mental illnesses and instead provide a support structure on which they can rely to progress to greater heights in both their medical and social lives.
*Bakang Abiot Kgaodi is a medical student at the University Of Botswana School of Medicine.