Mental Illness - the Facts

One in five Australians will experience a mental illness in their lifetime. Some families are more predisposed to certain illnesses but anyone can develop a mental illness...

Mental Illness is a general term that refers to a group of illnesses. They are not a form of intellectual disability or brain damage.

Episodes of Mental Illness can come and go in periods through people's lives. Some people experience their illness only once and fully recover. For others it recurs throughout their life.

Most mental illness can be effectively treated. Though we know that many mental illnesses are caused by a physical dysfunction of the brain, we do not know exactly what triggers this. Reluctance to talk openly about mental illness is a barrier to seeking early treatment.

Stress may trigger or prolong some mental illnesses. Stress can also result when a person develops a mental illness.

Mental illness can cause great suffering and pain in the family. People can be disturbed or frightened by their own illness or that of a family member. They can also suffer rejection or discrimination in the community.

People with a mental illness need the same understanding and support given to those with a physical illness.

It is rarely possible for someone with a mental illness to make the symptoms go away by strength of will. To suggest this is not helpful in any way.

Depressive Illnesses have increased over the past 100 years in both first and third world countries. Around 1900 it was estimated that about 5% of the population were affected. Since 1945 the estimate has increased to 20% and the fear that there is a high percentage of the population with undiagnosed disorders.

Travel and crossing the Equator are known stressors of Mental Illness.

Mental illnesses can be separated into two main categories: psychotic and non-psychotic.

Psychotic Illnesses

A psychosis is a condition caused by any one of a group of illnesses that are known or thought to affect the brain causing changes to thinking, emotion and behaviour.

People experiencing an acute stage of psychotic illness lose touch with reality. Their feeling and thoughts are seriously affected.

Psychotic illnesses include schizophrenia and bipolar mood disorder.

During an episode, what people feel, see and hear is real to them but people around them do not share their experience. People may develop delusions – false beliefs of persecution, guilt or grandeur, or they may experience hallucinations where they see, hear, smell, feel or taste things that are not really there. They may be depressed or elated out of all proportion to their life experience.

To those around them these episodes may be threatening or confusing. People not familiar with this behaviour may find it hard to understand the fear and confusion with which people with these conditions live.

Effective medication and support from medical health professionals and counselors mean that most people who experience psychotic illness are able to live productive and rewarding lives.

Bipolar Mood Disorder

This is the new name for what used to be called manic depressive illness. The new name better describes the extreme mood swings – from depression and sadness to elation and excitement – that people with this illness experience.

These moods can be recurrent episodes that can be mild to severe. Mania describes the most severe state of extreme elation and overactivity. Some people do not experience depressive episodes – only the episodes of elation and excitement.

Mania:

• Elevated mood – the person feels extremely high, happy, full of energy and possibly invincible
• Increased energy and overactivity
• Reduced need for sleep
• Irritability – anger and irritability with others who dismiss their often unrealistic plans or ideas
• Rapid thinking and speech –jumping from subject to subject
• Lack of inhibitions – often due to an inability to foresee consequences of actions
• Grandiose plans and beliefs – it is common for such people to believe they are unusually talented or gifted, important people
• Lack of insight – unlikely to recognize their own behaviour or thoughts as unrealistic or inappropriate.

Depression:

• Can be triggered by a stressful or unhappy event but more often occurs without obvious cause
• Loss of interest and pleasure in activities
• Withdrawal from friends and social activities
• Difficulty doing simple tasks such as shopping and showering
• Overwhelmed by a deep sense of sadness
• Loss of appetite and subsequent loss of weight
• Lack of concentration and associated feelings of guilt and hopelessness
• Some may attempt suicide because life becomes meaningless or they feel too guilty to go on – cannot see any way out of their sadness
• Others develop delusions of persecutions and guilt or that they are evil

Bipolar mood disorder affects two people in every hundred in Australia. Men and women have an equal chance of developing the disorder. It is most common in people in their twenties. It is believed that it is caused by a combination of factors including genetics, biochemistry (chemical imbalance in the brain which can be corrected with medication), stress and even the seasons. Although 2% of the population has this disorder, it accounts for 20-25% of suicide attempts each year.

Effective treatments are available. Early intervention is preferable and will assist with a more positive outcome. Some people may need to be admitted to hospital for treatment. Psychotherapy and counseling are used with medication to help the person understand the illness and better manage its effects on their lives. With access to appropriate treatment and support, most people with bipolar mood disorder lead full and productive lives.

Unipolar disorder:

This condition has the extremes of depression which last much longer than Bipolar episodes with little or no hypomania or mania.

Schizophrenia:

Schizophrenia affects about 1% of the population. It interferes with the mental functioning of a person and, in the long term, may cause personality changes. First onset is more common in adolescence or young adulthood. The onset may be rapid with acute symptoms developing over several weeks or it may develop over months or years. During onset the person often withdraws, becomes depressed and anxious and develops extreme fears and obsessions.

Major symptoms include:

Delusions – false beliefs of persecution, guilt or grandeur or being under outside control. People may withdraw and hide as they fear plots against them or think they have special gifts and powers.

Hallucinations – most commonly involving hearing voices. Other less common experiences can include seeing, feeling, tasting or smelling things which to the person are real but which do not actually exist.

Thought disorder – speech may be jumbled and disjointed due to the lack of logical connection.

Other symptoms include:

Loss of drive – including the lack of initiative or motivation in daily tasks. This is part of the illness and not laziness.

Blunted expression of emotion – the ability to express emotion is greatly reduced and may be accompanied by a lack of response or inappropriate response to emotional occasions.

Social withdrawal – may be caused by a fear that they will be harmed or because of the lack of social skills.

Lack of insight or awareness of other conditions – because the hallucinations and delusions appear to be so real it is common for people with schizophrenia to be unaware that they are ill. Therefore they may refuse to accept treatment for other conditions.

Thinking difficulties – concentration, memory and ability to plan and organise may be affected, making it more difficult to reason, communicate and complete daily tasks.

Causes:

No one cause has been identified but several factors are believed to contribute to the onset of schizophrenia in some people:

Genetic factors – a predisposition to Schizophrenia can run in families. If one parent suffers from it, the children have a 10% chance of developing the illness.

Biochemical factors – certain biochemical substances in the brain are believed to be involved in this condition. One likely cause of this chemical imbalance is the person's genetic predisposition to the illness.

Family relationships – Some people with schizophrenia are sensitive to any family tension which, for them, may be associated with relapses. Children can also learn and mimic Schizophrenic behaviour from a parent.

Environment – It is well recognized that stressful incidents often precede the onset of schizophrenia and can act as precipitating events. However often people with schizophrenia become anxious, irritable and unable to concentrate before any acute symptoms are evident. This can cause relationships to deteriorate, possibly leading to divorce or unemployment. It is hard to often determine whether the stress is a cause or result of the illness.

Drug use – the use of some drugs, especially LSD and Cannabis is likely to cause a relapse.

It is incorrectly believed that people with schizophrenia have a split personality, an intellectual disability and are dangerous. A minority of people may become aggressive when experiencing an untreated acute episode. This aggression is usually expressed to family and friends rather than to strangers. Medication to treat the illness is not addictive. Most people, with professional help and social support, learn to manage their symptoms and have a satisfactory quality of life. It is a fact that about 20-30% of people with schizophrenia have only one or two psychotic episodes in their lives.

The most effective treatment involves anti-psychosis medication, psychological counselling and help with managing its impact on everyday life. Some people will need to take medication indefinitely to prevent a relapse and keep symptoms under control.

Non-Psychotic Illness

Everyone has experienced strong feelings of depression, sadness, fear or tension however, some people's feelings can become so disturbing and overwhelming that they have difficulty coping with day to day activities. These states describe a group of illnesses that are called non-psychotic illness. They include phobias, anxiety, some forms of depression, eating disorders, obsessive-compulsive disorder and physical symptoms involving tiredness or pain.

These symptoms can cause great personal distress.

Most such illnesses can be effectively treated and help the person manage the symptoms and lead satisfying lives.

Anxiety Disorders:

Anxiety is a term which describes a normal feeling people experience when faced with threat of danger or when stressed. Anxiety disorders are a group of illnesses, each characterized by persistent feelings of high anxiety. These are feelings of extreme or continual discomfort and tension, with the fear of panic attacks, usually without discernible cause. People are usually diagnosed when their level of anxiety and panic are so extreme that they significantly interfere with daily life and stop them doing what they want to do. Disorders affect the way the person thinks, feels and behaves.

Generalised anxiety disorder –

People worry constantly about possible harm to themselves or their loved ones and is accompanied by a feeling of constant apprehension.

Agoraphobia –

This is a fear of being in places or situations from which it may be difficult or embarrassing to get away, or the fear that help may be unavailable if needed. Comfort is found in the company of a safe person or object. More men than women seek treatment for this disorder.

Panic disorder –

People experience extreme panic attacks in situations where most people would not be afraid. Attacks are accompanied by the unpleasant physical symptoms of anxiety, with a fear that the attack will lead to death or loss of control. This can lead to agoraphobia.

Specific phobia –

Phobias are intense fears about particular objects or situations which interfere with our lives. When confronted with the specific object or situation the person can become highly anxious and experience a panic attack. People can go to extraordinary lengths to avoid such objects or situations.

Social phobia –

People fear that others will judge everything they do in a negative way. They believe that they are flawed or worthless if not perfect. Gradually people withdraw socially as they cannot keep up the perfectionist front.

Obsessive compulsive disorder –

This disorder involves constant, unwanted thoughts and often results in the performance of elaborate rituals in an attempt to control or banish the persistent thought. These rituals interfere with daily living and are often highly embarrassing.

Post-traumatic stress disorder –

Many people who have experienced major traumas continue to feel terror long after the event is over. They may experience nightmares or flashbacks for years.

Causes:

The causes of each disorder may vary and it is not always easy to determine a cause. People with certain characteristics are more prone to anxiety disorders, such as those who are easily aroused, highly sensitive and emotional. Some people may learn and perpetuate an inappropriate response to objects and events that have been traumatic or scary. Heredity also plays an important part and children may imitate family responses and anxieties.

Treatment:

Many professionals such as your doctor, psychologists, social workers or counselors can assist in the treatment of anxiety disorders. Treatment can include education and counseling to help the person understand their thoughts, emotions and behaviour. People can develop new ways of thinking about their anxiety and learn how to deal more effectively with feelings of anxiety. Medication is sometimes used to help control the high levels of anxiety, panic attack or depression.

Eating disorders:

Anorexia and bulimia are the two most common eating disorders. Each illness involves a preoccupation with control over body weight, eating and feed.

Anorexia –

This illness affects about 2% of teenage girls. Males can also suffer from the disorder. Anorexia is characterized by:

• A loss of at least 15% of body weight resulting from refusal to eat enough food, despite extreme hunger;
• A false perception of body image in that the person may regard themselves as fat even as they become thinner;
• An intense fear of becoming fat;
• A tendency to exercise obsessively;
• A preoccupation with the preparation of food;
• Making lists of 'good' and 'bad' foods;
• Erratic eating behaviour.

Bulimia:

About 40% of people with anorexia will later develop bulimia.

Bulimia is characterized by:

• Eating binges during which the person feels a loss of personal control and self disgust;
• Attempts to compensate for binges by self induced vomiting and/or abuse of laxatives and fluid tablets;
• A combination of restricted eating and compulsive exercise so that control of weight dominates the person's life.

Bulimia often starts with rigid weight loss. Inadequate nutrition causes tiredness and powerful urges to binge. Vomiting after a binge seems to bring relief but this is temporary and soon turns to depression and guilt. The use of laxatives only causes the body to lose vital trace elements and to dehydrate the body. Frantic efforts may be made to break the cycle but the behaviour and associated feelings may have become compulsive and uncontrollable. People with bulimia may experience chemical imbalances in the body which bring about lethargy, depression and clouded thinking.

Causes:

The causes of bulimia and anorexia are unclear. Biological, social and psychological factors are involved. The following factors may contribute:

Social influences – e.g. media and family comments on the ideal shape of the body and a tendency to stereotype fat people in a negative manner.

Personal factors – changes in life circumstances such as adolescence, breakdown of relationships, trauma, death of a loved one, fear of the responsibilities of adulthood, poor family communication or parental reluctance to allow independence as children mature or a belief that love from family and friends depends on high achievement and looks.

Biological factors – these include chemical and hormonal imbalances.

Effects on the body:

Physical effects are harmful but can be reversible if treated properly and tackled early. If left untreated the conditions can be life threatening. Both illnesses when severe can cause:

• Harm to the kidneys
• Urinary tract infections and damage to the colon
• Dehydration, constipation and diarrhea
• Seizures, muscle spasm or cramp
• Chronic indigestion
• Loss of menstruation or irregular periods
• Strain on most body organs
• Inability to think rationally and to concentrate
• Erosion of dental enamel due to vomiting
• Swollen salivary glands, chronic sore throat and gullet
• Possibility of a ruptured stomach

Emotional and psychological effects:

• Difficulties with activities that involve food
• Loneliness due to self imposed isolation and a reluctance to develop personal relationships
• Deceptive behaviours relating to food
• Fear of the disapproval of others if the illness becomes known, tinged with the hope that family or friends might intervene and provide assistance
• Mood swings, changes in personality, emotional outbursts or depression.

Treatment:

Hospitalisation may be needed in severe cases but otherwise outpatient treatment and attendance at special programmes are preferable. Treatment can include medication for those severely malnourished. Dietary education assists with learning new patterns of healthy eating. Counselling and specific therapies are used to help change unhealthy thoughts about eating and educating the person that family and friends are supportive.