I.

Introduction

Mental Disorders, abnormal or unstable behaviour, thoughts, or feelings. People are defined as mentally disordered because they behave, think, or feel differently from most others. However, even the most bizarre and strange behaviour can often make sense, once it is understood why the person is thinking and feeling that way. It is impossible to identify the precise number of people suffering from mental disorders, but it has been suggested that they may affect some 15 per cent of the population in developed countries.

Psychiatrists have developed systems for classifying mental disorders that describe the kinds of symptoms and behaviour which are commonly seen among those considered to be mentally disordered. These fall into two main groups: personality disorders, and psychoses. Another common group of disorders is usually termed anxiety disorders.

II.

Personality Disorders

Personality disorders are demonstrated in many forms. In severe cases it affects the person’s ability to lead a normal life; in milder instances it may mean that a person is seen as being slightly eccentric, or as having mildly compulsive habits, or finding it difficult to make friends. Serious personality disorder is more often associated with anti-social behaviour, and problems in dealing with others. The most widely known form of personality disorder is psychopathic disorder. Personality disorders involve personality traits which are so inflexible that they make it impossible for the person to exist socially or to hold down a job and may cause considerable distress to others if not to the people themselves.

A.

Types of Personality Disorder

The paranoid personality is unduly suspicious and mistrustful. Schizoid personalities are devoid of the capacity, or the desire, for love and social relationships. Schizotypal disorders are marked by disconnected thought, speech, perception, and behaviour. Histrionic personalities have overly dramatic behaviour and expression. Self-importance and the need for constant attention and admiration are the marks of narcissistic personalities.

Those with anti-social personality disorders have a history of violating the rights of others and failing to observe socially accepted norms. Borderline personality disorder is marked by unstable behaviour towards others, and in mood and self-image. A person with an avoidant personality disorder is hypersensitive to potential rejection, humiliation, or shame. The dependent personality is overly passive, always allowing others to assume responsibility. Compulsive personalities are perfectionists and unable to express warm feelings. The passive-aggressive personality resists demands indirectly by procrastination and dawdling. These latter four may be considered in the milder range of personality disorders.

Personality disorder is not a mental illness that tends to develop quite suddenly and usually in response to particular stresses. Personality disorder develops slowly, as the person grows up, and is thought to be mainly due to environment and upbringing. For example, someone who grows up in a family where they are constantly criticized and shouted at may develop an anxious, neurotic personality. Similarly, someone who grows up in a family where everyone is aggressive and violent may develop an anti-social or paranoid personality. A growing body of evidence suggests that early sexual abuse also distorts personality development.

The psychopathic personality, or psychopath, usually shows the signs of being abnormal very early in life. Truanting and stealing are common, and some will enjoy showing deliberate cruelty to animals or to other children. Typically such people have a long history of anti-social and violent behaviour by the time they become adults. Sometimes their violent behaviour includes sexual offences such as rape, and some become murderers.

B.

Causes of Personality Disorder

The exact causes of personality disorder are not known. It may be learned or it may be genetically inherited. The problem is in knowing how much may be due to inherited characteristics, and how much may be learned. Anxiety, depression, and violence all seem to run in families, but it is not certain (and very hard to prove) whether they are inherited or learned characteristics.

Research done mainly in the United States suggests that serious personality disorder, such as psychopathy, may be linked to brain abnormality. The cause of the abnormality is also disputed: while some believe it is genetic, others think that it is the result of brain injury which may have happened when the child was physically abused by a violent parent, or it may come from birth difficulties or an early head injury.

Abnormal personality development probably results from a distortion of the interaction between the growing child and its environment. If, for example, a child has problems of learning, problem solving, or emotional control, this not only affects the way that he or she behaves, but may also result in other people responding negatively. The child then comes to expect the worst from the world around him or her, and thus tends to behave in a way that actually makes hostility and rejection more likely. So develops a vicious circle which, if it continues over years, distorts the child’s psychological development.

Psychological treatment can try to correct this distortion by helping the person to understand their problems and why they react as they do. The treatment involves the patient not only reaching this understanding, but also re-learning how to relate to others. Both psychotherapy and cognitive behavioural treatments can be helpful. Psychotherapy attempts to look at the way in which the person’s earliest experiences have contributed to their problems. Cognitive behavioural treatment is more concerned with the here and now, and tries to encourage the patient to learn new ways of thinking and behaving which are more effective.

III.

Psychoses

Psychosis is a serious mental illness, in which the patient develops a distorted view of reality. The two main types of psychosis are schizophrenia and affective psychosis (sometimes called manic-depressive psychosis). Both tend to develop quite suddenly, often when the person is under stress. Schizophrenia can occur at any age, but commonly begins in late teens or early twenties. Manic depressive psychosis tends to develop rather later in life.

A.

Schizophrenia

Typically, schizophrenia begins with a distortion of perception. Sometimes, this simply can be that colours seem brighter than normal, or sounds seem louder than usual. As the illness progresses, the sufferers may start to think that they are being followed, or watched. Sometimes they begin to see or hear things that are not really there, and often this feels very frightening. Some people may even feel things touching them, or imagine that there are insects crawling over them. Some may feel that their body has changed in some way.

The most commonly reported symptoms is to “hear voices”. The sufferer does not usually think that the voices are inside their head. Often the voices will comment on the person’s life, behaviour, or thoughts, or they will tell the person to do or say things. “Magical” thinking is common, in which the sufferer may begin to think that they have special powers or are being asked to fulfil some special mission. Some patients may believe that the voices are those of God or the devil. In rare cases, this may result in offences such as murder. Most schizophrenics are not violent and are able to lead relatively normal lives, with some support for their condition from drugs. Antipsychotic drugs, which are mainly used to treat schizophrenia, act to manage its acute symptoms and prevent relapses by blocking the action of the neurotransmitter dopamine in the brain. Some drugs interact with other neuroreceptors. The main groups of drugs used include the phenothiazines, thioxanthenes, and butyrophenones.

B.

Affective Psychosis (Manic-Depressive Psychosis)

Affective, or manic-depressive psychosis results in changes in mood. A sufferer may swing between being overactive, talkative, and impulsive (manic) to being morose, withdrawn, and even suicidal (depressive). Judgement is also often affected and the sufferers may say or do things that they would not normally do. A common result is that they seriously overspend, or make unrealistic plans which never get carried out. Some people may become aggressive. Sleep patterns are disturbed, and in the manic phase, sufferers may not sleep for several days at a time. Often the family are more distressed by this than the sufferer, who may feel very happy and energetic, and often fails to understand the effect that this behaviour is having on those around them.

C.

Causes of Psychosis

As with personality disorder, the causes of psychosis are not fully understood. Mental illness seems to run in families, with close relatives at particular risk of developing symptoms.

However, it is also accepted that stress often triggers off the illness, and may causes relapses later on. Once again an interaction between the inherited characteristics and the environment seems likely. What appears to be inherited is a vulnerability to the disorder, but whether it actually appears or not will depend on life experiences.

Psychotic conditions are not usually fully curable, although some people will have one breakdown and never have another. Many, however, will have a series of breakdowns or relapses throughout their lives. In recent years many new drugs have become available which control the worst of the symptoms. Drug treatment is very important in controlling the symptoms of psychosis. However, once the symptoms are under control, psychotherapy to examine the underlying problems and stresses can also be helpful. Once the symptoms have settled, sufferers can usually live a reasonably normal life in the community. For those who have been ill for some years, however, rehabilitation may be needed to restore social and self-care skills.

More recently, a specific form of psychological therapy for psychosis has been developed. This is a form of cognitive behaviour therapy, which is an approach that encourages sufferers to examine the evidence for their distorted beliefs, and with the help of the therapist, to consider alternative explanations of their experiences. It aims to increase people’s understanding of their symptoms and how they arise, so that even if the symptoms persist, they may become more easily tolerated.

IV.

Other Forms of Mental Disorder

It is possible to have more than one form of personality disorder at the same time, or to have a personality disorder and a mental illness together. Some types of mental illness do not fit neatly into one category or another, and it is possible for individuals to show symptoms of more than one type of illness at the same time.

Brain damage may also produce unusual behaviour and symptoms of mental illness. If the injury happens early in life, it can affect the later development of the sufferer’s personality and behaviour. It is becoming accepted that the earlier the injury occurs, the more generalized the effect will be. Some forms of brain injury produce symptoms which mimic mental illness, and people who have suffered brain injury appear to be more prone to develop mental illness afterwards.

Diseases of the brain can also produce symptoms of mental illness. Older people may suffer from destruction of the brain tissue as a result of dementia, often caused by Alzheimer’s disease, and this can result in disturbed perceptions, speech, memory, or behaviour. Epilepsy, which is a disturbance of the electrical activity of the brain, is rarely associated with severe mental disorder, even though resulting fits may appear dramatic and frightening. For most sufferers drugs can now control these for much or all of the time.

Minor forms of mental disturbance are not uncommon, and may affect anyone. Many people become depressed for a while after losing someone they love, or losing a job. Others may become anxious if threatened with redundancy, or if a loved one is seriously ill. These are common reactions in these kinds of situation. In most cases problems will disappear in a few weeks or months once the situation has been accepted or resolved. It is only when symptoms persist over months or years, and begin to affect normal life, that such reactions might begin to be considered abnormal, and require specialist treatment.

V.

Anxiety Disorders

Anxiety is the predominant symptom in two conditions: panic disorder and generalized anxiety disorder.

In phobias and obsessive-compulsive disorders, also considered anxiety disorders, fear is experienced when an individual tries to master other symptoms. A phobia is an irrational fear of a specific object, activity, or situation that is classed as a disorder when it becomes so intense that it interferes with everyday life. Among the most disturbing of these is agoraphobia, the fear of open spaces. The most common phobic problem among people seeking psychiatric help, it often prevents them from leaving their homes for any reason. Obsessions are repetitive thoughts, images, ideas, or impulses that make no sense to the person, who can fear being unable to avoid committing a violent act, for example, or worry over whether some small duty has been performed. Compulsions are repetitive behaviours performed dutifully to try to ward off some future event. Examples of such behaviour include repeated washing of the hands or counting and recounting possessions or other objects.

VI.

Other Neurotic Disorders

In addition to neurotic depression and anxiety disorders, other conditions that have historically been considered neurotic include hysteria, conversion reactions, psychogenic pain, hypochondriasis, and dissociative disorders.

The so-called somatoform disorders are characterized by physical symptoms for which no physical cause is evident. In hysteria, complaints are presented dramatically, if vaguely, usually beginning during the teen years and continuing through adult life. Women have been much more frequently diagnosed as having hysteria than men. The rare conversion disorders (hysterical neurosis) commonly mimic a neurological disease such as paralysis. Psychogenic pain is pain for which no physical cause is apparent. In hypochondriasis, the patient is preoccupied with the fear of illness.

Included in the dissociative disorders are a form of amnesia that apparently stems from psychological causes and multiple personality—a rare condition in which the manifestation of two or more separate personalities exist in the same person.

VII.

Childhood Disorders

Several mental disorders are first evident in infancy, childhood, and adolescence.

Mental underdevelopment is characterized by the inability to learn normally and to become as independent and socially responsible as others of the same age in the same culture. People having an intelligence quotient (IQ) of less than 70 are considered retarded.

Attention-deficit hyperactivity disorder includes conditions marked by inappropriate lack of attention, by impulsiveness, and by hyperactivity, in which the child has difficulty organizing and completing work, is unable to stick to activities or follow instructions, and is excessively restless.

Anxiety disorders include fear of leaving home and parents (separation), excessive shrinking from contact with strangers (avoidance), and excessive, unfocused worrying and fearful behaviour.

Pervasive developmental disorders are characterized by distortions in several psychological functions, such as attention, perception, reality testing, and motor movement. An example is infantile autism, a condition marked by unresponsiveness to other people, bizarre responses, and gross inability to communicate.

Among the other childhood disorders are those involving behaviour problems, overeating, anorexia nervosa (self-starvation), tics, stuttering and other speech disorders, and bed-wetting (enuresis).