Although tremendous advances have been made in the understanding and treatment of mental illnesses, the stigma surrounding them persists. For example, people with mental illness may be blamed for their illness or viewed as lazy or irresponsible. Mental illness may be seen as less real or legitimate than physical illness, leading to reluctance on the part of policy makers and insurance companies to pay for treatment. Parents may be blamed for causing mental illness in their children. The public may shun people with mental illness and avoid living near them, working with them, and socializing with them.
Currently, mental illness is thought to be caused by a complex interaction of genetics and environment. Chemical messengers in the brain called neurotransmitters appear to be disordered in some mental illnesses. By providing images of brain dysfunction, brain imaging techniques, such as magnetic resonance imaging (MRI) and positron emission tomography (PET), have shown that many mental health disorders have a physical component. Research has shown that there is a hereditary component to many mental health disorders. Often, a mental health disorder occurs when people whose genetic make-up makes them vulnerable to such disorders experience extra stress in their family or social life or at work.
Mental illness cannot always be clearly differentiated from normal behavior. Distinguishing normal bereavement from depression, for example, may be difficult in the face of a significant loss, such as the death of a spouse or child. Likewise, a diagnosis of anxiety disorder in relation to a person's worry and stress regarding work is somewhat arbitrary, because most people experience these feelings at some time. The line between a person's having certain personality traits and having a personality disorder can be blurry. Mental illness and mental health, therefore, are best thought of as a continuum. Any dividing line is usually based on how long symptoms last, how much people change from their usual self, and how severely symptoms affect their life.
A movement in recent decades to bring mentally ill people out of institutions has been made possible by the development of effective drugs, along with some change in attitude about the mentally ill. With the deinstitutionalization movement, greater emphasis has been placed on viewing mentally ill people as members of families and communities.
Research has demonstrated that certain interactions between families and patients can improve or worsen mental illness. Therefore, family therapy techniques that dramatically prevent the chronically mentally ill from needing to be reinstitutionalized have been developed. Today, the family of a mentally ill person is more involved than ever as an ally in treatment. The family doctor also plays an important role in rehabilitating a mentally ill person into the community. In addition, mentally ill people who must be hospitalized are less likely to be isolated and restrained than in the past, and they are often discharged early into day treatment centers. These settings are less expensive because fewer staff members are needed, the emphasis is on group therapy rather than individual therapy, and people sleep at home or in halfway houses.
However, the deinstitutionalization movement has had its share of problems. Because mentally ill people who are not a danger to themselves or society can no longer be institutionalized or treated against their will, many have become homeless or ended up in the prison system. Although these legal measures protect people's civil rights, they make it more difficult to provide needed treatment to many mentally ill people, some of whom may be extremely irrational when untreated. Homelessness also has an effect on society.
Everyone requires a social network to satisfy the human need to be cared for, accepted, and emotionally supported, particularly in times of stress. Research has demonstrated that strong social support may significantly improve recovery from both physical and mental illnesses. Changes in society have diminished the traditional support once offered by neighbors and families. As an alternative, self-help groups and mutual aid groups have sprung up throughout the country.
Some self-help groups, such as Alcoholics Anonymous and Narcotics Anonymous, focus on addictive behavior. Others act as advocates for certain segments of the population, such as the handicapped and older people. Still others, such as the National Alliance for the Mentally Ill, provide support for family members of people who have a severe mental illness.
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