Mental Health and Mental Illness
Although it might seem easy to define mental health as the absence of
mental illness, most experts agree that there is more to being mentally
healthy. The state of being mentally healthy is enviable given the
advantages it affords. For example, mentally healthy adults tend to report
the fewest health-related limitations of their routine activities, the fewest full
or partially missed days of work, and the healthiest social functioning (for
example, low helplessness, clear life goals, high resilience, and high levels
of intimacy in their lives).
What is mental illness?
Mental illness refers to all of the diagnosable mental disorders. Mental
disorders are characterized by abnormalities in thinking, feelings, or
behaviors. Highly common, about 46% of Americans can expect to meet
the formal diagnostic criteria for some form of anxiety, depressive,
behavioral, thought, or substance-abuse disorder during their lifetime.
Some of the most common types of mental illness include anxiety,
depressive, behavioral, and substance-abuse disorders. Examples of
anxiety disorders include phobias, panic disorder, generalized anxiety
disorder (GAD), social anxiety disorder, and obsessive compulsive disorder
(OCD). Anxiety disorders are characterized by excessive worry to the point
of interfering with the sufferer's ability to function. Examples of anxiety
disorders include the following:
Phobias: involve severe, irrational fear of a thing or situation. Examples
of phobias include fear of heights (acrophobia), spiders
(arachnophobia), and of venturing away from home (agoraphobia).
Social anxiety disorder is the fear of being in social situations or feeling
scrutinized, like when speaking in public.
Generalized anxiety disorder (GAD) tends to result in the person either
worrying excessively about many aspects of their life (like about money,
family members, the future) or having a free-floating anxiety that is
otherwise hard to describe. GAD is quite common, affecting about 10%
of the population.
Panic disorder is characterized by recurring episodes of sudden,
severe, debilitating anxiety (panic) attacks that are immobilizing. Those
episodes usually include symptoms like racing heart beat, shortness of
breath, stomach upset, and trouble thinking. In order to be diagnosed
as having panic disorder, the person must also either worry about
having another attack or about what the attack means (for example,
wondering if the symptoms of panic indicate they are having a heart
Behavioral disorders (like attention deficit hyperactivity disorder [ADHD],
oppositional defiant disorder, or conduct disorder) are characterized by
problems conforming to the tenets of acceptable behavior. The most
common behavior disorder is ADHD; this condition includes symptoms of
inattention and/or hyperactivity and impulsivity. While it used to be
considered primarily a disorder of boys, it is now understood to be just as
likely to occur in girls and that it can persist into adulthood in about half of
children with ADHD.
Dementia, including Alzheimer's dementia, is characterized by a problem
with thinking, involving both memory problems and other forms of thinking.
These are also known as cognitive problems and include difficulties with
language or with identifying or recognizing things despite having no
medical cause for these issues such as stroke or a brain tumor.
Depressive disorders involve feelings of sadness that interfere with the
individual's ability to function or, as with adjustment disorder, persist longer
than most people experience in reaction to a particular life stressor.
Examples of depressive disorders include the following:
Major depression involves the sufferer feeling depressed most days
and for most of each day for at least two weeks in a row. Along with
sadness, the individual with major depression experiences a number of
other associated symptoms, like irritability, loss of motivation or interest
in activities they usually enjoy, hopelessness, and increased or
decreased sleep, appetite, and/or weight. The person might also exhibit
thoughts, plans, or attempts to harm themselves. Women with
postpartum depression tend to experience many of the above
symptoms for weeks to months after giving birth.
Dysthymia sufferers experience depression and milder levels of the
symptoms of major depression. In dysthymia, the symptoms are fairly
consistent for more than two years in adults and one year in children
Bipolar disorder, also called manic depression, is a mental illness that is
characterized by severe mood swings, repeated episodes of
depression, and at least one episode of mania in the person's lifetime.
Bipolar disorder is one kind of mood disorder that afflicts more than 1%
of adults in the United States, up to as many as 4 million people.
Substance use disorders, like substance abuse and substance
dependence, involve the use of a substance that interferes with the social,
emotional, physical, educational, or vocational functioning of the person
using it. These disorders afflict millions of people and a variety of legal (for
example, alcohol and inhalants like household cleaners) and/or illegal (for
example, marijuana in most states, cocaine, Ecstasy, and opiates)
substances may be involved.
Developmental disorders, like a learning disability, Asperger's disorder, or
mental retardation, are often included in diagnostic manuals for mental
disorders, but this group of conditions does not by definition mean the
person involved has a problem with their mood.
It is important to understand that the list of conditions above is by no means
exhaustive. This article focuses on the more common mental illnesses;
illnesses like eating disorders and schizophrenia, that are less common but
perhaps quite devastating to the life of the person with the condition, are
One frequently asked question about mental illness is if it is hereditary.
Most mental disorders are not directly passed from one generation to
another genetically, and there is no single cause for mental illness. Rather,
it is the result of a complex group of genetic, psychological, and
environmental factors. Genetically, it seems that more often than not, there
seems to be a genetic predisposition to developing a mental illness.
Everything from mood, behavioral, developmental, and thought disorders
are thought to have a genetic risk for developing the condition.
Medical conditions may predispose an individual to developing a mental
illness. For example, depression is more likely to occur with certain medical
illnesses. These "co-occurring" conditions include heart disease, stroke,
diabetes, cancer, hormonal disorders (especially perimenopause or
hypothyroidism, known as "low thyroid"), Parkinson's disease, and
Alzheimer's disease. While it does not appear that allergies cause
depression or visa versa, people who suffer from nonfood allergies have
been found to be somewhat more vulnerable to also having depression
compared to people who do not have allergies. Some medications used for
long periods, such as prednisone, certain blood pressure medicines,
sleeping pills, antibiotics, and even birth control pills, in some cases, can
cause depression or make an existing depression worse. Some antiseizure
medications, like lamotrigine (Lamictal), topiramate (Topamax), and
gabapentin (Neurontin), may be associated with a higher risk of suicide.
Despite the impact that taking certain medications or having a medical
illness can have on a person's emotional state, clinical depression should
not be considered a normal or natural reaction to either issue. It should
therefore always be aggressively treated.
Environmentally, the risks of developing mental illness can even occur
before birth. For example, the risk of schizophrenia is increased in
individuals whose mother had one of certain infections during pregnancy.
Difficult life circumstances during childhood, like the early loss of a parent,
poverty, bullying, witnessing parental violence; being the victim of
emotional, sexual, or physical abuse or of physical or emotional neglect;
and insecure attachment have all been associated with the development of
schizophrenia as well. Even factors like how well represented an ethnic
group is in a neighborhood can be a risk or protective factor for developing
a mental illness. For example, some research indicates that ethnic
minorities may be more at risk for developing mental disorders if there are
fewer members of the ethnic group to which the individual belongs in their
Stress has been found to be a significant contributor to the development of
most mental illnesses, including bipolar disorder. For example, gay,
lesbian, and bisexual people are thought to experience increased
emotional struggles associated with the multiple social stressors associated
with coping with reactions to their homosexuality or bisexuality in society.
Unemployment significantly increases the odds ratio of an individual
developing a psychiatric disorder. It almost quadruples the odds of
developing drug dependence and triples the odds of having a phobia or a
psychotic illness like schizophrenia. Being unemployed more than doubles
the chances of experiencing depression, generalized anxiety disorder
(GAD), and obsessive-compulsive disorder.
While everyone experiences sadness, anxiety, irritability, and moodiness at
times, moods, thoughts, behaviors, or use of substances that interfere with
a person's ability to function well physically, socially, at work, school, or
home are characteristics of mental illness. Mental illness can have virtually
any physical symptom associated with it, from insomnia, headaches,
stomach upset to even paralysis. Socially, the person with a mental illness
may avoid or have trouble making or keeping friends. Emotional problems
can result in the person being unable to focus and therefore perform at
work or school.
How is mental illness diagnosed?
There is no one test that definitively indicates that someone has a mental
illness. Therefore, health-care practitioners diagnose a mental disorder by
gathering comprehensive medical, family, and mental-health information.
Patients tend to benefit when the professional takes into account their
client's entire life and background. This includes but is not limited to the
person's gender, sexual orientation, cultural, religious and ethnic
background, and socioeconomic status. The symptom sufferer might be
asked to fill out a self-test that the professional will review if the person
being evaluated is able to complete it. The practitioner will also either
perform a physical examination or request that the individual's primary-care
doctor or other medical professional perform one. The medical examination
will usually include lab tests to evaluate the person's general health and to
explore whether or not the individual has a medical condition that might
produce psychological symptoms.
In asking questions about mental-health symptoms, the counselor or other
mental-health professional often explores if the individual suffers from
hallucinations or delusions, depression and/or manic symptoms, anxiety,
substance abuse, as well as some personality disorders (for example,
schizotypal personality disorder) and developmental disorders (for
example, autism spectrum disorders). Since some of the symptoms of any
one mental disorder can also occur in other mental illnesses, the mental-
health screening is to determine if the individual suffers from a psychotic
depressive, bipolar, anxiety, behavioral, substance abuse, or personality
In addition to providing treatment that is appropriate to the diagnosis,
determining the presence of mental illnesses that may co-occur (be
comorbid) and addressing those issues is important when trying to improve
the life of individuals with a mental illness. For example, people with
schizophrenia are at increased risk of having a substance abuse,
depressive, or anxiety disorder and of committing suicide.
What is the treatment for a mental health problem?
Talk therapy (psychotherapy) is usually considered the first line of care in
helping a person with a mental illness. It is an important part of helping
individuals with a mental disorder achieves the highest level of functioning
possible. These interventions are therefore seen by some as being forms of
occupational therapy for people with mental illness. While medication can
be quite helpful in alleviating and preventing overt symptoms for many
psychiatric conditions, they do not address the many complex social and
psychological issues that can play a major role in how the person with such
a disease functions at work, at home, and in his or her relationships. For
example, since about 60% of people with bipolar disorder take less than
30% of their medications as prescribed, any support that can promote
compliance with treatment and otherwise promote the health of individuals
in the mentally disordered population is valuable.
Psychotherapies that have been found to be effective in treating many
mental disorders include family focused therapy, psycho-education,
cognitive therapy, interpersonal therapy, and social rhythm therapy. Family
focused therapy involves education of family members about the disorder
and how to help (psycho-education), communication-enhancement training,
and teaching family members problem-solving skills training. Psycho-
education services involve teaching the person with the illness and their
family members about the symptoms of the sufferer, as well as any warning
signs (for example, change in sleep pattern or appetite, increased
irritability) that the person is beginning to experience another episode of the
illness, when applicable. In cognitive behavioral therapy, the mental-health
professional works to help the person with a psychiatric condition identify,
challenge, and decrease negative thinking and otherwise dysfunctional
belief systems. The goal of interpersonal therapy tends to be identifying
and managing problems the sufferers of a mental illness may have in their
relationships with others. Social rhythm therapy encourages stability of
sleep-wake cycles, with the goal of preventing or alleviating the sleep
disturbances that may be associated with a psychiatric disorder.
Medications may play an important role in the treatment of a mental illness,
particularly when the symptoms are severe or do not adequately respond to
psychotherapy. For example, treatment of bipolar disorder with medications
tends to address two aspects: relieving already existing symptoms of mania
or depression and preventing symptoms from returning. Medications that
are thought to be particularly effective in treating manic and mixed
symptoms include olanzapine (Zyprexa), risperidone (Risperdal),
quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify),
paliperidone (Invega), and asenapine (Saphis). These medications belong
to a group of medications called neuroleptics and are known for having the
ability to work quickly compared to many other psychiatric medications. As
a group of medications, side effects that occur most often include
sleepiness, dizziness, and increased appetite. Weight gain, which may be
associated with higher blood sugar, higher lipid levels, and sometimes
increased levels of a hormone called prolactin may also occur. Although
older medications in this class that were not mentioned here are more likely
to cause muscle stiffness, shakiness, and very rarely uncoordinated muscle
twitches (tardive dyskinesia) that can be permanent, health-care
practitioners appropriately monitor the people they treat for these potential
side effects as well. Mood-stabilizer medications like lithium, divalproex
(Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal) can be
useful in treating active (acute) symptoms of manic or mixed episodes.
These medications may take a bit longer to work compared to the
neuroleptic medications, and some (for example, lithium, divalproex, and
carbamazepine) require monitoring of medication blood levels. Further,
some of these medications can be associated with birth defects when taken
by pregnant women.
Antidepressant medications are the primary medical treatment for the
anxiety characterized by anxiety disorders, as well as the depressive
symptoms of depressive disorders and bipolar disorder. Examples of those
medications that are commonly prescribed for those purposes include
serotonergic (SSRI) medications like fluoxetine (Prozac), sertraline (Zoloft),
paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro) and
combination serotonergic/adrenergic medications (SNRIs) like venlafaxine
(Effexor) and duloxetine (Cymbalta), as well as buproprion (Wellbutrin),
which is a dopaminergic antidepressant.
Medications like clonazepam (Klonopin) and lorazepam (Ativan) from the
benzodiazepine group are often used to treat anxiety, particularly when it is
sudden and severe, as in panic attacks. Medications from the beta-blocker
family (for example, propranolol [Inderal]) are sometimes used to treat the
physical symptoms associated with anxiety as well.
Alzheimer's and other forms of dementia are often treated with medications
like memantine (Namenda), galantamine (Razadyne), donezepil (Aricept),
rivastigmine (Exelon), and tacrine (Cognex). These medications tend to
slow the progression of dementia, thereby helping sufferers of dementia
remain functional longer than they would without treatment.
Despite its stigmatized history, electroconvulsive therapy (ECT) can be a
viable treatment for people whose symptoms of depression, bipolar, or
thought disorder have inadequately responded to psychotherapies and a
number of medication trials. Although alternative treatments for mood
disorders like St. John's wort or ginkgo biloba are not recognized standard
care for bipolar disorder, as many as one-third of some patients being
treated for a mental illness use them.
Can mental health disorders be prevented?
A variety of factors can contribute to the prevention of mental-health
disorders. For example, people who feel less isolated and alone tend to be
less likely to develop a mental-health disorder. Those who engage in
regular practice of endurance exercise seem to have a more favorable self-
image, more resistance to drug and alcohol addiction, and a higher sense
of general physical and psychological well-being compared to those who do
not exercise regularly. Adolescents who engage regularly in physical
activity are characterized by lower levels of anxiety and depression
compared to their more sedentary counterparts.
Clear communication by parents about the negative effects of alcohol, as
well as about their expectations regarding drug use, has been found to
significantly decrease alcohol and other drug use in teens. Adequate
parental supervision has also been found to be a deterrent to substance
use in children and adolescents. Alcohol and other drug use has been
found to occur most often between the hours of 3 p.m. and 6 p.m.,
immediately after school and prior to parents' arrival home from work. Teen
participation in extracurricular activities has therefore been revealed to be
an important measure in preventing use of alcohol in this age group.
Parents can also help educate teens about appropriate coping and stress-
management strategies. For example, 15- to 16-year-olds who use religion
to cope with stress tend to use drugs significantly less often and have less
problems as a result of drinking than their peers who do not use religion to