Types And Classifications Of Mental Illness

Manic-depressive psychoses involve extreme swings in mood, far beyond the essentially normal feelings of elation or depression. (Ev­eryone has some mood swings.) The hyper-manic may talk incessantly, pursue a flight of ideas, and sometimes require restraint for his protection. In acute depression the patient may feel so guilty, project so much anger upon himself, that he does not want to con­tinue living. He may absolutely refuse to eat and may plan or attempt suicide. The manic stage can be likened to reactions beyond those more commonly observed as extroversion. Manic-depressive reactions often, but not necessarily, move in a cycle. For weeks, months or years the person is depressed; then, for no apparent reason he feels unduly elated — and vice versa. The intellectual and emotional faculties are not impaired.

Related to the depressive phase of the cycle is the condition known as involutional melancholia, which usually occurs in women at the menopause.

Senile dementia describes the childishness of old age, the deterioration of mental and emotional facilities that sometimes accompa­nies the aging process. Often, however, there is some actual damage to the blood-vessels of the brain. This condition rarely occurs be­fore 60.

Hysteria describes the neurotic reaction characterized by lack of control over acts and emotions and by conversion of inner anxiety into physical symptoms (e.g. hysterical pa­ralysis

"Shell shock" was a term used in World War I. as was the term "combat fatigue" in World War II, to describe an essentially hys­terical psychosomatic reaction to military situations involving danger. The soldier's ego seeks to be removed from and escape the zone of danger without disgrace. "If you're sick, you can't fight," runs the winning argument in the unconscious mind.

"Nervous breakdown'' is a popular phrase used to describe almost any kind of mental illness, mild or severe, which incapacitates an individual and compels him to retire from his regular work or haunts. In a more professional vocabulary the milder breakdowns are often described as neurasthenia, psychasthenia, anx­iety state, or mild hysteria

Psychopathic personality is a vague term used to denote individuals who have no par­ticular mental disease but who cannot adjust themselves morally, socially, or legally to their environment. A high proportion of crim­inals vagrants, and delinquents fall into this category.

Particularly to be deplored is the label "psy­cho" on any individual who has ever suffered a mental illness. Careful study of the inti­mate lives of great and famous people reveals that many of them at one time or another suffered from some form of mental illness. Abraham Lincoln, for example, was subject to deep fits of depression.

More than half of all hospital patients are in mental hospitals, and more than half of these are suffering from schizophrenia. Most of these patients (90%) are in state hospitals, of which there are about 600 in the United States. Most of these are large hospitals, with 2000 to 12,000 beds, and most are badly overcrowded and woefully understaffed.

The cost of caring for these patients is high. Approximately 25% of the income of some states must be appropriated for the care of the mentally ill (and the feeble-minded). It costs United States taxpayers over $1 billion a year —or about $3 million a day —to care for mentally ill patients. In strange contrast, rel­atively few millions yearly are spent on research in mental illness.

Types And Classifications Of Mental Illness

Basically mental illness is classified by the severity of its symptoms, by the degree to which they incapacitate the patient for nor­mal living. Broadly and popularly, then, we speak of two major categories of mental illness: psychoses, which are the severe types of mental illness that often require a period of hospitalization; and neuroses, the less ex­treme forms of personality derangement. The difference between psychoses and neuroses is one of degree. The words "psychoneurosis" and   "neurosis"   are   used   interchangeably.

The   psychiatrist, of course,  makes more extensive and exact diagnoses and uses more elaborate descriptions of mental illness. The American Psychiatric Association has a classification of about 60 categories of mental illness, but there is a strong trend toward avoiding categorical diagnosis of mental ill­ness. As Karl Menninger has pointed out, patients recover from their mental illnesses but not from their diagnoses. It is preferable, therefore, to speak of "schizophrenic reac­tions" rather than schizophrenia. Since the diagnosis of mental illness is a job for the psychiatrist, not the college student, we shall limit the further description of mental ill­nesses to the few broadest types.

Schizophrenia, sometimes called dementia praecox, is the most common of the serious mental illnesses and the one for which hospi­talization is most often required. Literally the term means "split personality." Emotional disorganization is the hallmark of this condi­tion. The victims may be unaccountably sad or happy; they do not respond appropriately to real-life situations; they are withdrawn and usually apathetic; they are ready to day­dream their lives away; they often suffer from fantastic delusions and hallucinations. Delu­sions are false-fixed ideas; hallucinations are imaginary voices or visions.

Some schizophrenics act and talk silly and childishly, without orientation to time and place; others fall into a stupor or a state of muscular rigidity; still others go into a frenzy of excitement or overactivity. But mostly they withdraw draw from reality, and attempt to live in little worlds of their own.

Generally speaking, schizophrenics do not lose their mental capacities, as measured by I.Q. tests, but their intelligence is divorced from other phases of their personality. Schizo­phrenia usually develops gradually and is gen­erally apparent before the age of 40. The outlook for schizophrenic patients has im­proved in recent years.

Important recent research in the cause and treatment   of   schizophrenia   offers   greater promi.se than ever before of a "break-through" in the management of this tragic and crip­pling illness. For example, an unusual serum factor has been found in the blood of many schizophrenics. This suggests the possibility of an antiserum or other drug to combat the illness. Progress is also being made in ac­quiring basic information about childhood schizophrenia and ways of treating it  partially through family interviewing and counseling. When the disease appears in young children (under six), it is important to distinguish between childhood schizophrenia and mental retardation The schizophrenia may be curable.

Paranoia describes a state of mental illness characterized by persistent delusions of gran­deur or persecution. It is related to schizophre­nia but far less common. Many paranoiacs are "rational" on all subjects except one or two on which they have some irrational fixed idea. There are many paranoid personalities among people who are not hospitalized for mental illness. Adolf Hitler, for example, was one of the world's most dangerous paranoiacs.

Types And Classifications Of Mental Illness

With the introduction of new drugs and treatments, the outlook for patients in mental hospitals is steadily improving. In the best mental hospitals the improvement and recov­ery rate runs as high as 85'/i More and more patients can now be successfully treated on an out-patient basis in mental hospitals, in psychiatric wards or departments of general hospitals, in mental hygiene clinics, and in physicians' offices.

The present situation with mental hospitals is that the number of admissions, first and repeated, is continuing to rise. Rising also, however, are the number of discharges. The average length of stay and the total popula­tion of the hospitals are therefore both de­clining. As we empty mental hospital beds of young psychotics. however, these beds are immediately filled up by the aged. The geriat­ric problem is the big one. (Geriatrics means care of the aged.)

Who Treats Mental Illness?

Who treats mental illness? There is such a shortage of adequately trained physicians and psychiatrists and such a host of troubled peo­ple in the world that the treatment of mental illness has perforce fallen into many hands, some well qualified, many not. Lee R. Steiner, who has studied for many years the question of where people take their troubles, points out that they take them not only to psychiatrists and physicians but also to clinical psychologists, psychoanalysts, social workers, ministers, rabbis, priests, marriage counselors, vocational counselors, guidance counselors, bartenders, beauticians, fortune tellers, astrologers, and a miscellaneous as­sortment of self-appointed experts and char­latans. Steiner's most trenchant observation is that the outcome of treatment appears to depend more on the rapport, or personal rela­tionship, established between the patient and his "healer" (therapist) than on any other factor.

The psychiatrist, of course, is the best-qualified person to treat the whole range of mental illness and certainly the psychoses. All psychiatrists are doctors of medicine (M.D.'s) who have taken postgraduate train­ing in their specialty. Most are certified as medical specialists by the American Board of Psychiatry and Neurology. There are, how­ever, less than 20.000 psychiatrists in the whole United States. Not all psychoanalysts are M.D.'s.