Mental Health and Mental Disorder - Essay Example

Mental health and mental disorder module A mental illness is defined as a disorder of the brain that causes a distraction in a person's reflection, sensation, moods, and communication with others. Mental illness is separate from the legal idea of sanity and insanity. Most psychologists ascribe mental disease to organic/neurochemical reasons that can be cured with psychiatric treatment, psychotherapy, improvement of the way of life and other helpful measures; but, many of the reasons of mental disease are still unknown. The fight between "nature" and "nurture" continues. Neuroscience and genetics can’t thoroughly explain the results of genetic heritage and developmental environment. The existence of mental disease and the legality of the psychiatric specialization are not universally acknowledged. Some specialists, especially Doctor Thomas Szasz, Professor Emeritus of Psychiatry at Syracuse, seriously stand up against the practice of use of the definition "mental illness." The anti-psychiatry movement frequently refers to what it means by "myth of mental illness" and dispute against a biological cause for mental disorders, or also states that all human experience has a biological origin and so no type of behaviour can be called a disease per se. In this particular work I would like to study depression from the general point of view and from the point of view of Thomas Szasz in order to prove or disprove his position. So, is depression a disease or a myth? Depression is the most widespread disease of XX century. During all the past and in present century depression was considered as a normal condition of artistic, creative people. We heard more than once: «I am in depression, live me along ". Nowadays, depression is a dangerous disease, which causes unfeigned suffering. However there are some scientists who do not agree with it, they are Thomas Szasz and his colleagues Jeffrey A. Schaler and Ron Leifer. Thomas Szasz provides three basic points to prove that depression is not a disease: 1. The first point: “A disease scientifically is defined as a biological abnormality that affects living tissues. Trees can be diseased, plants, animals, and humans. A real disease is typhoid fever, we call it a literal disease. Spring fever sounds like a disease but it is not a disease. The whale is a real animal, but it is not a fish, it is a metaphorical fish. So when we say depression is not a disease, we do not minimize the human phenomenon suffering. It exists like the whale exists but it is not a disease.” (Thomas S. Szasz Cybercenter for Liberty and Responsibility, 1998). 2. The second point: “Treatment has got nothing to do with disease. None of us object to psychiatry between consenting adults, when psychiatrists talk about this treatment and disease, they mean locking up people in prisons that they call hospitals, and forcing on to them chemicals that they call treatment. We have no objection to voluntary treatments, like for diabetes. (Thomas S. Szasz Cybercenter for Liberty and Responsibility, 1998). 3. The third point: “And thirdly, suicide is not a medical problem. It is a moral problem, it is a legal problem, it is an existential problem. Killing oneself is as old as mankind, it is exactly like killing others, or killing animals. It's not a medical problem.” (Thomas S. Szasz Cybercenter for Liberty and Responsibility, 1998). Let’s analyze each of the scientist’s points. To begin with, I do not think it is right to compare depression with spring fever. Spring fever is definitely not a disease. It is a normal state of the human organism in spring. But for it, human race, maybe, would disappear. Depression is not a normal state. It is an abnormal state and like any other disease it has a diagnosis. The diagnosis of depression is not very easy task. The picture of the basic symptoms "is "decorated" with a variety of additional: difficulty to concentrate on any business, the attention "is floating". A known phenomenon "the lights are on but nobody's home" is from this area - it is necessary to re-read the same for thirty times to catch sense at last (is sclerosis a disease?). It is difficult to select word while communicating with other people, the string of conversation is constantly lost; there is a strange indecision, constant doubts even at performance of the most usual tasks. The self-confidence vanishes, it seems, that all the tasks are done wrong; the global feeling of fault may arise before relatives and friends, the person feels like a burden in the family, unnecessary, superfluous at work. His internal monologue sound approximately so: "I am a loser. I have achieved nothing and now full professional bankruptcy is waiting for me”. Both the past and the future are imagined gloomy and pessimistic. The person collects the most unattractive facts of the biography, completely ignoring those moments when he was happy, achieved success. From time to time there is an idea that, perhaps, the simplest way is to leave the life; there is diversified disorder of dream: it is difficult to fall asleep in the evening, general duration is reduced because of often awakenings, and as a result the wakes up at 4-5 o'clock in the morning. There is also a constant drowsiness; the person is ready to fall asleep at any time; appetite is falling - feeling of hunger practically does not arise, there may even feel disgust to the taste of food. As a rule, psychologists and psychiatrists speak about light depressive disorder already at the presence of two typical symptoms and at least two additional symptoms: “if there are all three typical symptoms and more than four additional, that state is already called heavy depressive disorder” (Bloom Floyd E, Lazerson Arlyne 1988). The second point of Thomas Szasz is rather a statement about poor treatment of depression, than about non-existence of depression as a disease. Very often wrong treatment is a result of wrong diagnosis. To determine the fact of depression is only the half of the task Psychologists defined two main kinds of depression and their symptoms are the same. Floyd E. Bloom, Arlyne Lazerson and G.N. Stewart in their works defined and described these two kinds of depression, which called endogenous and exogenous. It is very essential to define if the depression was caused environmentally or by the internal factors. Though the concepts of endogenous (caused by the internal reasons) and exogenous (arising under influence of external conditions) depressions are enough traditional, it is necessary to consider them more in detail: “…sometimes it is very important for person to understand, why depression may arise contrary to his desire and will power. Besides at the administration of treatment it is necessary to know, whether the problem endogenous or exogenous by its character. The psychotherapy held within several years, may not give any effect in a case of endogenous depression, as well as the most strong medicines are powerless at exogenous” ("Brain, Mind, and Behavior", Floyd E. Bloom and Arlyne Lazerson, 1988). The reasons of endogenous depression occurrence are the following: lack of substances which are included in "a cocktail of happiness", such as serotonin and dopamine; surplus of substances which have oppressing influence on the central nervous system; deficiency of those substances which are necessary for development of "cocktail of happiness", such as tryptophan, phenylalanine, vitamin B6 and lecithin; lack of thyroid hormones and cortisol. Women may have differences of mood because of the fluctuation of oestrogen and progesterone levels; hypoglycemia (a low level of sugar in blood) which is frequently caused by the abundance of refined carbohydrates in food may become the reason of depression; seasonal affective disorder; the postnatal depression caused by fluctuation of female sexual hormone level. The reasons of exogenous depression are the following: depression may grow out of any events in human life, such as loss of work, conflicts with associates, loss of the nearest person; presence of toxic substances in the person’s organism. Nicotine and aldehydes which are the products of disintegration of alcohol; some medicines, such as steroids, antibiotics, and also those medications which adversely influence a thyroid and the level of sugar in blood; food allergy; environmental contamination when harmful substances may act in the organism of a person together with air and food; the infections caused in most cases by various viruses as well as mycotic and parasitic infections, lack of physical exercises that results in decrease of development of own endorphins and enkephalins by the organism. The right determination of the kind of depression is extremely important. Quite different treatment is used for curing of exogenous and endogenous depression. Endogenous depression is cured with the help of different medicines, which cannot be applied to exogenous depression that needs to be cured with the help of conversation. Unfortunately, it is very difficult to define the right kind of depression. Almost half of a sample of patients with endogenous depression had serious marital distress that happened before the beginning of their depression. That is why it is very difficult to make distinctions. There are some of researchers who adhere to the point of view that depressions represent certain continued line, and there is no basic division into exogenous and endogenous depressions. Therefore, such doctors always use antidepressants in complex therapy. However, patients usually badly bear medicines with strong effect. It conducts to the irregularity of their taking and even to its termination. If depression is environmentally caused it cannot be cured by using medicines, it needs special therapy. As it was mentioned above, depression may have the same symptoms, but not the same reasons. Speaking about the third point, I also can’t agree that killing is not medical problem. Maybe, it is not always medical, but it connected with medicine and disease. People, who had to kill at war, can not live normal life, their past follows them and medicine can help. If a person likes to kill, he is a maniac that means he is sick. He may have neglected depression that developed into more serious, already incurable problem. If not to consider depression to be a disease and not to cure it, we will have many maniacs. I agree with Szasz that suicide caused by depression is a form of killing and if a desire to kill is a disease, suicide caused by depression is also a disease. There is a famous statement of Thomas Szasz that should be analyzed: “Mental illness is not something a person has, it is something he does or is” (Szasz 1972/Summary). This statement is supported by his colleague Jeffrey Schaler: “Now, depression most certainly is not a disease, because depression is a word that we use to describe activity, and activities are behaviors based in values. They aren't physical, they are ways of moving in the world. Now, if by a disease you mean something physiological, if you have a particular way of deciding that a person's brain is not producing enough serotonin, for example, or uptaking enough, or there's a problem in uptake or transmission of serotonin, then perhaps what you've discovered and outlined would qualify as a bona fide disease. In that case, though, you don't rely primarily on activity or symptoms, I beg to differ, a diagnosis is not made on the basis of a cluster of symptoms, it is made on the basis of a cluster of signs. And when we talk about signs in medicine we are talking about physiological lesions, neurochemical imbalances, etc. Depression is not found in a corpse at autopsy, because depression does not refer to anything physiological, it refers to how a person conducts himself, or moves in the world.” Szasz Thomas S. (1998) Cybercenter for Liberty and Responsibility. This statement can be commented in the following way: now it is already proved that the risk of falling sick with depression depends on the conditions the person lives in. Nice psychological conditions, calm life atmosphere are the pledge of psychological health of the people. On the contrary, bad, tense psychological atmosphere may cause serious illness. Manic depression is one of the diseases that can be environmentally caused. And it is a disease called exogenous depression that I already described above. It is essential to consider a very interesting point of view of another colleague of Thomas Szasz Ron Leifer: “I'd like to say that I have a different view of depression. In my view, and I'm a Buddhist, which is shown by my book, in my view, depression is a spiritual problem. The main symptoms of depression are hopelessness and helplessness. The main problem is that we're all living life with hopes and with some desire to control our lives. If our hopes are unrealistic, our hopes are going to be dashed. In my view, depression is dashed hope, and a feeling of being out of control of one's life. Depression is about the future, it's a sense of not having the possibility of being happy in the future. When we get into this kind of spiritual predicament, our body can bog down. I think that the spiritual problem causes changes in the body, so that all those changes are present. The question is, are they cause or effect. I think they are effect rather than cause, an effect of a spiritual problem.” (Szasz Thomas S. (1998) Cybercenter for Liberty and Responsibility) Here I will not comment spiritual problem or religion. This is very individual. I would like just to say that losing of hope is one of the results of depression. A person in depression looks at the world through “glasses” that depression creates for him. Through these black-coloured glasses he usually sees the world as hopeless. Nothing can make him happy. And when other people try to suggest the opposite to him, he simply can’t realise it because depression prevents him from doing that. Of course, lose of hope also can be treated as a cause of exogenous depression. Exogenous depression may not be caused by very hard incidents in the past. It may be caused by simple failures, conflicts, and controversies. Plain failure can develop into really hard disease. “The mental illness called depression is a dramatisation of the proposition I am unhappy”. (Szasz 1961/1972 p.202). I have to disagree that it is a plain dramatisation. Let us assume that depression is the result of the social conflict. You have no or very few friends, you lost your job, you lost the game or were ruined. There are the reasons of the conflict with your own soul. . Poverty is one of the reasons for depression. However, poverty does not mean careless unemployed or the vagabond, poverty has another face. The succeeding businessman sells the automobiles, which came from Japan and became a bit poorer after the taxes had risen. The businessman underwent an ordinary market and legal attack of the competitor and his business started moving downwards. He is much richer than a beggar, but he became poorer than he was. You expected much more from the life, but could not receive. You begin to think that have lost competitive struggle. In “Mental Disorders Are Not Diseases” Thomas Szasz criticized the law that considers criminals to be not guilty because of their mental illness: ”Because the idea of mental illness combines a mistaken conceptualization (of nondisease as disease) with an immoral justification (of coercion as cure), the effect is two-pronged--it corrupts language and curtails freedom and responsibility. Because psychiatrists have power over persons denominated as patients, their descriptive statements typically function as covert prescriptions. For instance, psychiatrists may describe a man who asserts that he hears God's voice telling him to kill his wife as schizophrenic. This "diagnosis" functions as a prescription--for example, to hospitalize the patient involuntarily (lest he kill his wife) or, after he has killed her, to acquit him as not guilty by reason of insanity and again hospitalize him against his will. This coercive-tactical feature of psychiatric diagnosis is best appreciated by contrasting medical with psychiatric diagnosis. Diagnosis of bodily illness is the operative word that justifies a physician to admit to a hospital a patient who wants to be so admitted. Diagnosis of mental illness is the operative word that justifies a judge to incarcerate in a mental hospital a sex criminal who has completed his prison sentence.” (Szasz Thomas. (2000) Mental Disorders Are Not Diseases, USA Today (Magazine)) I think that it is right to keep a maniac in the hospital after his time in prison is over. I consider mental disorder to be a disease and diseases must be cured. Here the question is not that people with mental diseases must not be kept in hospitals, the question is what the result of their living in hospitals is. The scientist is quite right: people are usually simply dying in hospitals not receiving any positive treatment. The hospitals can’t help: they are just prisons and usually for innocent. I can’t agree with Thomas Szasz that mental disorder is not a disease, but still having analysed all the material studied above, one can’t but make a conclusion that the theory of Szasz is very helpful and we should be grateful for it. This theory makes us think about all the imperfection of modern psychiatry. It is still not enough developed. Being used as the rule of contraries Szazs’s theory makes us understand what is not right in modern diagnosis and treatment that let people consider mental illness not to be a disease. However, just an idea about non-existence of mental illnesses can’t help a sick person. A person should know that he is seriously sick, accept it and try to fight with it. Thinking about suicide a person should remember that it is his illness that makes him look at the world in this way. It would help to struggle with manic depression that is a serious, unfeigned disease that must be carefully cured like any other. References: 1. Bloom Floyd E. Lazerson Arlyne (1988) "Brain, Mind, and Behavior", New York: Freeman 2. Szasz Thomas S. (1998) Cybercenter for Liberty and Responsibility, available at www.szasz.com 3. Szasz, T. (1961/1972) The Myth of Mental Illness. Foundations of a Theory of Personal Conduct. (Paladin edition, abbreviated with a summary, 1972*) 4. Szasz Thomas. (2000) Mental Disorders Are Not Diseases, USA Today (Magazine) Read More