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In Transition

Introductory Column


Dr. Peter Melgaard Thompson

In Transition is a column that appears in Armchair World. The column is written for anyone wanting greater awareness about issues concerning mental health and mental illness. I will write this column using the same philosophy that I use in treating patients: that is to combine the known science of mental processes with the individuality of the patient's needs. The result is sometimes biased and sometimes ethereal.

If after reading this column, readers have questions about treatment, they should contact their local American Psychiatric Association or National Alliance for the Mentally Ill (NAMI) chapter.

As with all medical illnesses, psychiatry traces its roots to the Greeks. Around 400 B.C. both Hippocrates and later Aristotle spoke of mental processes and their pathology in terms of a bodily process - not in terms of magic or morality. This enlightenment continued until the early middle ages. From that time until the 17th century, mental illness was attributed to demonic influence or a moral malady. It was not until Emil Kraepelin in the late 1800's and a little later with Josef Breuer and Sigmund Freud that the tenets of modern psychiatry were clearly articulated. Modern psychiatry views mental illness and abnormal behavior as a result of brain function, not due to a sinful or amoral life.

Even today, we in the modern era struggle with the concept that mental illness is due to brain function and not to defects in moral character. This problem still stigmatizes and ostracizes most mentally ill people. In later columns I will discuss the premise that most people suffer from some form of mental illness, however slight. Mental illness can range from mild anxiety to moderate depression to severe forms of schizophrenia. Having a mental illness in one's life time is probably normal. Those that have never had a mental illness can be thought of as super-normal.

What is normal? Stedman's Medical Dictionary defines normal as "typical, usual, healthy, according to the rule or standard."

What is abnormal? What is a mental illness? The Diagnostic and Statistical Manual of Mental Disorders-IV (APA Press, 1994) uses the following definition for mental illness; "A clinically significant behavior or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., painful syndrome) or disability (e.g., impairment in one or more important areas of functioning) or with a significant increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expected and culturally sanctioned response to a particular event, for example, the death of a loved one. Whatever its original cause, it must be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual. Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, as described".

Both of the above definitions are arbitrary and relative. However certain behaviors are consistent across cultures and times. Some are adaptive and others are not. What counts on the individual level, and is hard to describe, is that patients who seek treatment from a psychiatrist are in pain and want relief. More about normality vs. mental illness next time.

© 1996 Peter Melgaard Thompson

More In Transition Columns

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