1. Chapter 12
Mental Health

2. Mental Health: What Is It?
One definition: “how we think, feel, and act as we cope with life” (Kellogg, R. (2008). Quoted in What is mental health? [Press Release]).
What is good mental health?
One definition: “a state of well-being that allows someone to be productive, have fulfilling relationships, cope with difficult circumstances, and adapt to change.”
For starters, mental health is essential for well-being, and for a person to live a healthy, enjoyable life. Poor mental health can interfere with a person’s ability to hold a job, maintain relationships, feel satisfaction in everyday activities, and function in day-to-day life. But how can we define “mental health”? [This is a good time to have students offer some definitions.] One definition of good mental health could be “how we think, feel, and act as we cope with life.” Mental disorders can be defined as health conditions marked by changes or abnormalities in mood, thinking, or behavior (or a combination of the three) that produce distress or impair functioning.

3. Mental health and physical health are connected.
Mental health affects physical health (being depressed increases the risk for heart disease).
Physical health affects mental health (lack of air can cause a panic attack; regular exercise lowers the risk for depression).
The distinction between mental health and physical health is useful, but largely artificial. Consider the brain, which governs our ability to think, feel, and respond—everything we think of as “mental health.” Things that affect the brain—nutritional deficiencies, thyroid problems, physical damage—also affect our minds. Additionally, mental health influences physical health: having depression increases the risk for a heart attack, for example.

4. Mental illness is common, but it doesn’t mean a person is crazy.
1 in 5 adults (45 million Americans) suffer from a diagnosable mental disorder in a given year.
Half of all Americans will experience some form of mental illness during their lives.
People with mental illnesses love others, hold jobs, and contribute to society.
Mental illnesses, just like physical illnesses, are very common. If you do not have some form of mental illness, you likely know someone who is mentally ill or who has been. Fortunately, just as people can recover from the flu or chicken pox, or live with diabetes, people can recover from (and live with) mental illness as well. Half of all people will experience some form of mental illness in their lifetime.

5. What Affects Mental Health?
Biology
Some mental illnesses have genetic components.
Neurotransmitters, hormones, physical health and other factors can affect mental illnesses and how they are perceived.
Social and Psychosocial Factors
The way women are treated affects their mental health
Biological factors vary among mental illnesses, but they often include genetic predisposition to a disease, abnormal brain structure or function, irregular levels or activity of neurotransmitters or hormones, head or brain injuries, or prenatal exposure to illegal drugs or alcohol.
Social and psychosocial factors change throughout a woman’s lifetime and influence the way a woman views herself and interacts with others

6. What Affects Mental Health?
Stress
Chronic stress, and the way people react to it, affect mental health.
Women are more likely than men to internalize stress.
Traumatic events can cause or contribute to mental illness.
Coping with stress in a positive manner can improve mental health.
How do you respond to stress?
Stressors can range from daily hassles to life-altering events, and people experience and react to them in different ways. Women and men often perceive, evaluate, and respond to stress in different ways. Men may respond positively with physical activity, but negatively through aggression and substance abuse. In contrast, women often internalize their stress, which can cause feelings of failure and self-blame.
Positive ways of coping with stress include relaxation techniques; supportive, positive interactions with friends and family; and exercise). People with better coping skills are less distressed overall and suffer from less pain, anxiety, depression, illnesses, and “burnout.”

7. Costs of Mental Illness to Society
Undefined burden of mental problems
Refers to the economic and social burden for families, communities, and countries
Hidden burden of mental problems
Refers to the stigma and violations of human rights and freedoms associated with mental problems
Costs of Mental Illness to Society
Mental illnesses impose a huge cost, in terms of years of life lost, reduced quality of life, and dollars spent on health care. Depression is a leading cause of lost years of life. Stigma, wages lost from mentally ill people losing or being unable to hold jobs, and other factors impose additional costs.

8. What Mental Illnesses Affect Women
Compared to men, women are more likely to have
Depression (2x)
Seasonal affective disorder (4x)
Anorexia, bulimia (9x)
Phobias, panic disorder (~2x)
Borderline, histrionic personality disorder.
Women are less likely to have schizophrenia, antisocial personality disorder, attention-deficit disorder, and to be violent as a result of mental illness.
Men and women are equally likely to suffer from mental disorders. However, the prevalence of certain disorders, and the way those disorders affect men and women, differs by gender. Many factors contribute to these differences: different levels of sex hormones, different social pressures, even differences in the ways that brains develop in childhood.

9. The Economic Burden of Mental Illness
Need for mental health and social services
Lost employment and reduced productivity
Financial burden placed on families and caregivers
Increased levels of crime and threat to public safety
Negative effects of premature mortality
Poor mental health and mental illnesses have a huge effect on our economy. [Ask your students if they can think of any additional costs that mental health care imposes (for example, research on medications, classes and training for therapists, etc.).]

10. Legal Dimensions: The Mental Illness/Crime Paradox
Given treatment, people with mental illness are no more likely to commit crimes than the general public.
Without treatment, however, the mentally ill are more likely to commit crimes and to be arrested.
Most people with mental disorders are law-abiding citizens. If they have access to proper treatment, people with mental disorders are not more likely to commit crimes than the general population. However, if mental illnesses are left untreated or are not treated properly, a correlation between mental illness and crime does exist, especially among individuals with psychotic and mood disorders. Many people are not identified as suffering from a mental disorder during the legal and criminal process. A 2006 study by the Bureau of Justice Statistics found that more than half of prison and jail inmates suffered from at least one mental disorder, most often mania, depression, and psychotic disorders. These people often go without treatment: fewer than one-third of prisoners who had a mental health problem had received treatment since they were incarcerated.

11. Clinical Dimensions of Mental Health
Mood Disorders
Unipolar disorder: depression and dysthymia
Bipolar disorder: manic depression
Types of depression
Premenstrual dysphoric disorder (PMDD)
Postpartum depression
Seasonal affective disorder (SAD)
Mood disorders (also known as affective disorders) are mental disorders characterized by extreme disturbances of mood, the dominant emotion (or emotional tendency) a person feels at any given moment. Mood disorders include unipolar disorders (depression and dysthymia) and bipolar disorder.

12. Persistent, inescapable feelings of sadness, low energy and apathy.
Depression
Persistent, inescapable feelings of sadness, low energy and apathy.
Treatment for depression
Antidepressant drugs
Psychotherapy
Combination of therapy and drugs
Depression is a serious mood disorder in which a person feels overwhelming combinations of sadness, inadequacy, and numbness. Women are twice as likely as men to experience depression.

13. Bipolar Disorder Both highs and lows
Highs: feelings of wonder and euphoria and/or overly stimulated, easily distracted, and easily irritated
Lows: deep, persistent feelings of sadness, anxiety, hopelessness, or guilt; they might also have low energy, a reduced sense of pleasure and a lowered sex drive, and thoughts of suicide
Bipolar disorder, sometimes also referred to as manic depressive disorder, is somewhat like depression in that it affects a person’s emotions and ability to function. But bipolar disorder is characterized by shifts in emotion, not by a single mood. A person with bipolar disorder experiences episodes of both mania (“highs”) and depression (“lows”).

14. Anxiety Disorders Generalized anxiety disorder (GAD) Phobias
Panic disorder
Obsessive-compulsive disorder (OCD)
Post-traumatic stress disorder (PTSD)
Anxiety disorders occur when anxiety, normally a healthy reaction to stress, grows to unhealthy levels, or when it appears in situations in which no risks exist. People with anxiety disorders often know that the worries, fears, or behaviors caused by the disorders are unhelpful and unrealistic, but this knowledge does not eliminate the symptoms. Anxiety disorders include generalized anxiety disorder (GAD), social phobias (also known as social anxiety disorder), specific phobias, panic disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

15. Anxiety Disorders Treatment for anxiety disorders
Cognitive behavioral therapy
Antianxiety medications
Antidepressants
Medication and therapy together

16. Treating Mood Disorders
and Anxiety Disorders
Treatment CAN and USUALLY does help. But…
It is difficult.
It takes time.
Treatment can include medications, psychotherapy, or a combination of the two (both together normally work better than either alone).
With treatment, most people with mood or anxiety disorders will recover and live satisfying, productive lives. Anxiety and mood disorders can be treated with medications, psychotherapy, or a combination of the two, depending on individual needs and preferences. Medications are a powerful, yet imperfect tool—they can help, but they’re not a “quick fix.” Medications often provide slow, gradual help, and they may have serious side effects. Many forms of psychotherapy (some form of “talk therapy”) exist.

17. Eating Disorders Anorexia Nervosa
Deprivation of food and a body weight of at least 15% below the normal weight based on height and age
Symptoms
Refusal to maintain an adequate weight
Intense fear of gaining weight
Distorted body image
In women, absence of three consecutive menstrual periods
Eating disorders are serious mental illnesses characterized by dysfunctional eating patterns. But an eating disorder is much more than an unhealthy eating habit or a desire “not to eat.” Like other mental illnesses, eating disorders have biological and environmental causes, distinct symptoms, and harmful consequences for the body. Anorexia is characterized by a refusal to eat, to the point where the body and mind cannot function normally.

18. Eating Disorders Bulimia Nervosa
Cyclic binge eating followed by purging
Symptoms
Recurrent episodes of bingeing and vomiting
Feeling out of control during a binge
Purging after a binge
Extreme concern with body weight and shape
Bulimia is characterized by cyclic binge eating followed by purging (causing the body to get rid of the food before it is digested, either through vomiting, laxatives, diet pills, or other methods). Bulimia has traditionally afflicted adolescent and young adult females from middle-class backgrounds, but it affects other groups of women and men as well.

19. Eating Disorders Binge Eating Disorder
Compulsive overeating without purging
At least three of the following:
Rapid, continuous eating (thousands of calories)
Eating when not physically hungry
Eating while alone
Eating beyond the point of comfort
Feeling self-disgust after a binge
Binge eating disorder, or BED, is similar to bulimia, except it is usually not followed by purging. During a binge a person may eat thousands, or even tens of thousands of calories.

20. Treatment for Eating Disorders
Psychotherapy
Behavior modification therapy
Family therapy
Antidepressants
Treating eating disorders is a difficult, multilevel process. Stopping the pattern of dysfunctional eating is essential for successfully treating an eating disorder, but this is not the only requirement. Healthful eating habits must be learned and established to replace the harmful behaviors. Additionally, people with eating disorders need professional help to develop a realistic body image, develop positive self-esteem, and resolve the underlying control issues that may have contributed to the eating disorder.

21. Personality Disorders
Antisocial
Avoidant
Borderline
Dependent
Histrionic
Narcissistic
Obsessive-compulsive
Paranoid
Passive-aggressive
Schizoid
Schizotypal
Personality disorders are characterized by distorted and inflexible thoughts and behaviors that make it impossible for a person to live a productive life or establish fulfilling relationships.

22. Schizophrenia
Psychosis—severe mental disorder characterized by lack of contact with reality and severe personality changes
Schizophrenia—type of psychosis; afflicts about 2.5 million Americans, with men and women equally afflicted
Symptoms include hallucinations, delusions, disordered thinking, and impaired ability to interact with others
Treatment: antipsychotics and psychotherapy
Schizophrenia is a severely debilitating mental disorder. Living with schizophrenia can be terrifying. People with schizophrenia experience hallucinations (sensory perceptions, such as sights, voices, or smells, that are not there) and delusions (beliefs that are not true, such as that people are reading the person’s mind, planning to harm or trap the person, or controlling the person’s thoughts). To the person experiencing them, these hallucinations and delusions appear utterly real.

23. Dissociative Disorders
Unconscious way to protect self from emotional traumas by detaching from a part of one’s personality
Several types: dissociative identity disorder (multiple personality disorder), dissociative amnesia
Dissociative disorders develop as an unconscious way to protect oneself from emotional traumas by detaching from a part of one’s personality. These disorders often occur as an adaptive response to serious, debilitating trauma that otherwise would not allow a person to function. Treating dissociative disorders often requires examining and dealing with this underlying trauma.

24. Suicide
Risk factors
Adverse life events in combination with depression
Prior suicide attempt
Family history of mental disorder or substance abuse
Family history of suicide
Family violence, including physical or sexual abuse
Firearms in home
Incarceration
Suicide is perhaps the most serious harm produced by mental illness. There are almost always warning signs that a person is at risk of suicide. This slide lists major risk factors that increase a person’s likelihood of committing suicide.

25. Informed Decision Making: Healthful Ways to Cope with Stress
Watching a funny movie or show, telling and listening to jokes, or other activities that bring laughter
Exercise (regular activity is best, but any amount of exercise brings benefits)
Meditation or prayer
Gardening
Spending time with a pet or pets
Getting a massage
Good mental health is more than merely the absence of mental illness, just as good physical health is more than just the absence of disease. There may be no perfect definition of good mental health, but being able to engage in rational thought and decision making, feeling a variety of emotions without being controlled by those emotions, being able to maintain stable, fulfilling relationships, and being able to cope with difficult circumstances are all signs of a healthy mind.

26. If you have some form of mental illness:
You are not alone.
Help is available—and it can make a difference.
As discussed earlier, half of all Americans will experience some form of mental illness. Unfortunately, many people do not seek help, because of stigma, because they don’t know how to find services, or because they are ashamed or embarrassed. Treatment, whether through medication, therapy, or a combination of the two, can and does help speed the recovery process.

27. Informed Decision Making: Healthful Ways to Cope with Stress
Visualization (imagining yourself on a calm beach, a quiet meadow, or some other peaceful, relaxing situation)
Listening to music
Naps or simply lying down, closing one’s eyes and relaxing
Regular exercise
Creative endeavors (writing, drawing or painting, dancing, etc.)
Of course, one of the best ways to fight mental illness is to prevent it. Healthful habits can help a person cope with stress. They also help a person avoid dysfunctional ways of coping that can add to stress and further contribute to mental illness.