Treatment Approaches

Anyone interacting with a person suffering from a severe mental disorder comes to think of him or her as being different from normal human beings. The behavior of those with mental illness is regarded, with some justification, as bizarre and unpredictable. They are often labeled with a term that sets them apart, such as "crazy" or "mad." There are many words in the English language that have been, or are, used to describe these persons—many of them quite cruel and derogatory. Since the nineteenth century, professionals have used the term "psychotic" to denote severe mental illness or disorders. Interestingly, one translation of psychotic is "of a sickness of the soul" and reflects the earlier belief regarding the etiology or cause of mental illness. This belief is still held by some therapists and pastoral counselors in the twenty-first century. Until the end of the twentieth century, the term "neurosis" connoted more moderate dysfunction than the term "psychosis." However, whether neurosis is always less disabling or disturbing than psychosis has been an open question. An attempt was made to deal with this dilemma in 1980, when the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (3d ed., 1980, DSM-III) officially dropped the term "neurosis" from the diagnostic terms.

The current approach to mental disorders, at its best, offers hope and healing to patients and their families. However, much about the etiology of mental disorders remains unknown to social scientists and physicians. In 1963, President John F. Kennedy signed the Community Mental Health and Retardation Act. Its goal was to set up centers throughout the United States offering services to mentally and emotionally disturbed citizens and their families, incorporating the best that had been learned and that would be learned from science and from medicine. Outpatient services in the community, emergency services, "partial" hospitalizations (adult day care), consultation, education, and research were among the programs supported by the act. Although imperfect, it nevertheless demonstrated how far science had come from the days when witches were burned at the stake and the possessed were stoned to death.

When one deals with mental disorders, one is dealing with human behavior—both the behavior of the individual identified as having the problem and the behavior of the community. The response of the community is critical for the successful treatment of disorders. For example, D. L. Rosenhan, in a well-known 1973 study titled "On Being Sane in Insane Places," showed how easy it is to be labeled "crazy" and how difficult it is to get rid of the label. He demonstrated how one's behavior is interpreted and understood on the basis of the labels that have been applied. (The "pseudopatients" in the study had been admitted to a mental hospital and given a diagnosis—a la bel—of schizophrenia. Consequently, even their writing of notes in a notebook was regarded as evidence of their illness.) To understand mental disorders is not merely to understand personal dysfunction or distress but also to understand social and cultural biases of the community, from the family to the federal government. The prognosis for eventual mental and emotional health depends not only on appropriate therapy but also on the reasonable and humane response of the relevant communities.

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Breaking Bulimia

Breaking Bulimia

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