Mental Health

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 U.S. Surgeon General has defined mental health as "a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with people, and the ability to adapt to change and to cope with adversity." 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 health issues include anxiety disorders. They 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: They 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 heartbeat, 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 attack).

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.
• Persistent depressive disorder, also referred to as dysthymia sufferers experience depression and milder levels of the symptoms of major depression. In this condition, the symptoms are fairly consistent for more than two years.
• 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.

Other types of mental health issues include:

• 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 more common mental health issues. Illnesses like eating disorders and schizophrenia, that are less common but perhaps quite devastating to the life of the person with the condition, are omitted.

Mental disorders are often the result of a complex group of genetic, psychological, and environmental factors.

• Heredity: One frequently asked question about mental illness is if it is hereditary. 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: Physical 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.
• Medication use: 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.
• Environmental factors: 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: 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.
• 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: This 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.

There is no one test that definitively indicates that someone has a mental health problem. 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.

Psychotherapies

• 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 achieve the highest level of functioning possible.
• 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 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

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. Examples of medications used to treat mental health conditions include:

• Antidepressants are the primary medical treatment for the anxiety characterized by anxiety disorders, as well as the depressive symptoms of depressive disorders and bipolar disorder.
• Benzodiazepines are often used to treat anxiety, particularly when it is sudden and severe, as in panic attacks. This class of medications does have addictive properties.
• Beta-blockers are sometimes used to treat the physical symptoms associated with anxiety.
• Mood-stabilizers can be useful in treating active (acute) symptoms of manic or mixed episodes of bipolar disorder.

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 cope.

National Alliance on Mental Illness (NAMI)

3803 N. Fairfax Dr., Ste. 100
Arlington, VA 22203
Main: 703-524-7600
Fax: 703-524-9094
Member services: 888-999-NAMI (6264)

National Depression and Bipolar Support Alliance (DBSA)
730 N. Franklin Street, Suite 501
Chicago, Illinois 60654-7225 USA
Toll-free phone: 800-826-3632
Fax: 312-642-7243
http://www.DBSAlliance.org

National Foundation for Depressive Illness, Inc.
PO Box 2257
New York, NY 10116
800-239-1265
http://www.depression.org/

Mental Health America
2000 N. Beauregard Street, 6th Floor
Alexandria, VA 22311
Phone: 703-684-7722
Toll-free phone: 800-969-6642
Fax: 703-684-5968

National Institute of Mental Health
9000 Rockville Pike
Bethesda, Maryland 20892
[email protected]
301-496-4000

Substance Abuse and Mental Health Services Administration (SAMHSA)
SAMHSA's Health Information Network
PO Box 2345
Rockville, MD 20847-2345
Phone: 877-SAMHSA-7 (877-726-4727)
[email protected]
http://store.samhsa.gov/