Mental health concepts and outcomes

Mental Illness: What's in a Label?

In a civil society, everyone is expected to adhere to certain set of "norms." Those that do not adhere to the prescribed norms are labeled and abnormal. Public knowledge about mental illness is at a level never before experienced in any society. The mass media promotes societal norms, that may not be considered all that normal to some (Wahl, 2003, 1595). Television shows, such as Dr. Phil have brought the mental health profession to the general public. Although this awareness has brought increased levels of awareness to the general public, it has also led to a trend towards labeling. This research examines the practice of "labeling" someone as mentally ill and the effects that is has on their lives and on public perceptions of them.

Society and Attitudes Towards Mental Illness

There is a fine line between behavior that is regarded as mental illness and that which is considered merely a variation on human behavior (Bentall, 2004, 95). Whether to regard a behavior as an illness represents a judgment made by the viewer of the behavior. Every individual has a unique personality with many variations. What one person might consider to be normal, someone else might consider to be a sign of mental illness. Deciding when a behavior is abnormal is the first task with which everyone is faced.

In the past, being labeled with a mental illness was regarding as carrying a stigma with it. The person that had been labeled would be treated with caution from the general public, if they knew about it. This inability to accept those with a mental illness caused many to hide. Therefore, they did not receive treatment for their condition for fear of being "discovered." Having the signs and symptoms of a mental illness was something to be hidden from the rest of the world. (Feldman & Crandall, 2007, 138)

Things have changed over the past fifty years or so. It may even be considered "fashionable" to have a mental illness, but not a serious one. It seems that everyone in is on Prozac or some type of mood altering drug. These types of things are admitted freely in public. Having a minor mental illness no longer carries the stigma that it once did. However, there is still no societal tolerance for illnesses that cause someone to harm another (Link, Yang, & Collins, 2004, 540).

Implications of Labeling People with Mental Illness

Being labeled with a mental impairment can have an effect on the ability to perform some basic tasks in our society. For instance, those that are seriously mentally impaired may not be able to get a driver's license, especially if their particular condition has an impact on their concentration, judgment, or presence of mind (Elder et al., 2005, 51-63).. If a mental illness prevents someone from performing a certain job, they may be denied employment if the impairment is discovered (SAMHSA, 2007).

Societal attitudes have changed towards those with a minor impairment, such as minor depression or eating disorders. Having a child with ADD is no longer considered an anomaly (Fothergill, Satherley, & Webber, 2003). There have a higher number of people in society being treated for a mental illness than in the past. Labeling can have the positive effect that the person received the needed intervention. This is especially the case with children where early intervention can mean drastic differences in the outcome of the treatment. The person might also be eligible for social services, such as disability, that they might not be able to receive without a positive diagnosis and label.

Being labeled with a mental illness has two opposing effects on the individual. They might be restricted from certain freedoms that are inherent with life in our society. However, being labeled with a mental illness can also have several benefits, including the ability to receive necessary treatments. When a person is labeled with a mental illness it also has an effect on the family. It is often a financial burden, even when the person has insurance. Some mental illnesses are not covered by the insurance and the patient and their family must absorb the entire cost of treatment (Stuart, 2006, 525). These effects can have a negative impact on the person and on their family as well. These factors must be considered when deciding to make a positive diagnosis of a mental condition.

The effects of Deinstitutionalization on Those with Mental Illness

Historically, persons that were diagnosed with a mental illness were institutionalized until the condition resolved itself, or the person died. Having a person in the house with a mental illness carried a stigma, not to mention that it may be dangerous for those that are not trained to handle a person with violent or unpredictable behavior. In the days of high levels of institutionalization, there were few resources that would allow the family to care for the mentally ill person. There were few support groups and the general attitude of society was that institutionalization was the best way for the person to receive the treatment that they needed (Boyce, 2006, 3).

Now families have many more resources than they had in the past. These resources are what allows the family to care for a mentally ill person at home, rather than in an institutional setting. Caring for the mentally ill at home takes a considerable amount of dedication. In some cases, the mental condition might make the person argumentative, or abusive at times (Stuart, 2003, 121). The person might have memory lapses, as in Alzheimer's disease. The mental illness may cause the person unable to work or may make them unable to care for themselves in many ways.

However, unlike those that suffered in the past, there are many more options in home care available. There are health care professionals available to help with almost every aspect of the mental illness. As a result, fewer people are institutionalized for mental illnesses (Goodwin, 2007, 62). Institutionalization is now the last resort, instead of the first line of attack. Institutionalization is typically only reserved for the most severe cases or cases where the person is a danger to themselves or society. Many more conditions can be resolved through counseling, medication, or a combination of treatments.

Settings in Which Individuals May Receive Treatment for Disturbed Behavior

Today, advanced in medical science leave people with many more treatment options than in the past. The list of pharmacological interventions has grown significantly in the past 20 years. Often these medications can be given at home without the need to stay in a residential facility. The most common form of intervention takes place in an office setting and is similar to a trip to the physician (Waraich et al., 2004, 125). In some cases, such as drug or alcohol treatment, the person must go for a short stay in a residential treatment facility. After the person completes this phase of the treatment, follow-ups can be continued on an out-patient basis.

For those that are unable to leave the house, there are in-home services available. Hospitals are becoming increasingly versed in mental illnesses and are able to treat crisis situations and refer the patient to appropriate resources for follow-up treatment. The number of treatment options is much more flexible than in the past. An emphasis has been placed on providing a treatment that will be effective, while still considering factors such as cost and the ability of the person to pay. Treatment programs are becoming more personalized to the needs of the patient. Treatment options tend to progress from the least invasive to the complete institutionalization when all other options have failed.

Culture and Mental Illness

Carl Jaspers and Kurt Schneider felt that mental illness was indicated when the clinician was unable to form and empathic understanding with the patient's experiences (Bentall, 2004, 95). In the presence of certain symptoms a diagnosis of mental illness was eminent. However, others took a broader view of mental illness and recognized that there is a wide spectrum of behaviors and that not every eccentric behavior constituted a mental illness (Bentall, 2004, 96). Wittenstein argues that psychosis is simply a human variation and should be treated as such (Bentall, 2004, 96). Wittenstein attacks the unscientific nature of diagnosing and labeling a person with mental illnesses. He calls those diagnosed with mental illness "eccentrics" who are "victimized" and "misunderstood" by those around them (Bentall, 2004, 96).

Both Jasper and Schneider's work is based more on societal norms and marginally on medical evidence. According to Jasper, the diagnosis of a mental illness ban be the result of a personality conflict, or "mismatch" between the mental health professional and the patient (Bentall, 2004, 95). Using strict criteria for the diagnosis of a mental disorder is one way to ensure that the clinician's own opinions and background do not influence their judgement regarding a patient's condition.

Although the criteria for diagnosing mental illness would seem to be the most reliable way to ensure a correct diagnosis, using the criteria in making the decision to label someone with mental illness is not as easy as one would seem. When one throws the element of ethnicity into the mix, the process of diagnosis becomes even more difficult. Let us take, for instance the effect of religion on the diagnosis of a mental illness.

In some religions it is considered to be "normal" to experience visions, see ghosts, and talk to the dead. However, from a strict clinical standpoint, these things do not exist and therefore indicate a break from reality. There have certainly been people diagnosed with a serious mental illness for "hallucinating." However, it is much more difficult to determine when to label such a happening a "hallucination" or a "vision." For the person being diagnosed, the experience does not change. However, the label that is applied to the experience can mean the difference between the accepted norm and mental illness (Griffiths et al., 2006, 2).

There are differences in reactions to clinicians that are culturally based as well. For instance, in Asian cultures it is considered to be a lack of respect to disagree with a physician regarding certain symptoms or a diagnosis. Certain Middle Eastern and Asian cultures permit a certain degree of physical punishment in order to keep wives and children in line. The use of opium holds fewer societal consequences and is considered to be socially acceptable in countries such as Turkey and Pakistan. There are many more examples throughout the world where normal behavior in one culture is socially unacceptable in another.

Conclusion

This study focused on various factors that effect the decision to diagnose and label a person as mentally ill. As a health care professional one must be continually aware of the effects that our decisions have on the patient and the patient's family. Once the diagnosis of a mental illness is made and the person has that label, it will have an effect on them for the rest of their lives. They will always have that on their record, even after they have been successfully treated and have recovered there will still be some form of record that will have an impact on their lives. For example, employers and insurance carriers might access this information and use it as a part of their decision to employ or insure that person. Although being diagnosed with a mental illness no longer carries the stigma that it once did, there is still the feeling that a person that is diagnosed with a mental illness will be less reliable on the job than someone that has not been diagnosed with a mental illness.