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The Difficulties in Defining Whether a Person Can Be Mentally Ill?

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In this essay an historical look at the perception of mental illness will be reviewed in conjunction with how society acuity towards mental illness has changed though time, it will then discuss the society current concept of mental health. A consideration of the current classification and diagnosis systems followed by a critical evaluation of the theoretical models used to understand and treat mental disorders, a study on how the stigma of mental health issues effect individual and steps taking to change perceptions will conclude this essay.

Psychological abnormality is perceived as a dysfunction within a person that is considered to be deviant, distressful and dangerous behaviour that is not a typical normative or culturally accepted. (Comer 2007, Barlow and Durand 2005). The history of psychological disorders can be traced back to prehistoric societies,(Comer 2007) and as we look back through history there appears to be three distinctive approaches in the way that mental illness is viewed those being �the Supernatural, Biological and Psychological traditions’.(Barlow and Durand 2005, p26).

Supernatural traditions believe that abnormal behaviour comes from an individual being affected by the moon or lunar activities this is where the derivative of lunatic originated. Or that a person is possessed by evil sprits or the devil, these views where up held by the church and subsequent treatment including exorcism was given by the clergy. (Barlow and Durand 2005).

The biological approach to disorders are considered to be diseases or chemical imbalances with in the body, treatment is though medical interventions which include surgery and drugs. (Comer 2007) While the psychological tradition thought that the behaviour originated from defective psychological development and the influences of society. The treatment used in this approached started with moral therapy and have now developed in the psychotherapy. (Comer 2007, Davidson and Neale 1996)

Presently, the �Scientific method with Interactive approach’ (Barlow and Durand 2005, p26) the use of psychotropic medications in conjunction with cognitive and behavioural sciences for a basis of treatments, with more of an emphasis on prevention as well as cure. (Comer 2007)

Society’s focus and concept of health has been generally on ill health and the need to conquer disease, medicine in particular has been at the fore of this belief. (Breslow1972). However, in society today a more positive approach has emerged, health as defined by the World Health Organisation (WHO) (1946) is �physical, mental and social well-being, not merely the absence of disease or infirmity’. The WHO (1946) also states that

Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

In today’s society the term mental health is becoming more prevalent rather than the term mental illness, but the term is embedded in history and generally refers to the �medical diagnosable mental disorders’ (Means-Christensen et al. 2006)

The terms disorders, disease, or illness are used are all medical terms used the diagnosis of mental illnesses. There are certain illness such as schizophrenia that when present are more identifiable, but for other such as depression the indicators are not so clear, as an individuals mental health exist on a continuum and there is no clear demarcation separating illness from health. (Comer 2007, Barlow and Durand 2005) Moreover, as stated by Kress et al. (2005) and Winstead & Sanchez (2005 cited Comber 2007) the indictors of mental disorders vary with age, gender, race, culture and socioeconomic status.

In order to assist in diagnoses a systematic approach to the classification and diagnosis of mental illness has been developed. The diagnosis of mental disorders can be difficult as there are no definitive tests that can identify mental illness. The diagnosis of mental disorders must rest with information taken from the patient in the form of dialogue, tests and observations reports of symptoms. When recognizable patterns are observed they are known as syndromes, if the syndrome meets all the diagnosis criteria, it constitutes a mental disorder. (Comer 2007, Davidson and Neale 1996, Barlow and Durand 2005) Disorders are categorised and listed with a description of the symptoms and guidelines for attributing a category to a person, this is know as a classification system.

The World Health Organization’s International Classification of Diseases Tenth Revision (ICD-10) (2005) is a list of all diseases. The ICD-10 provides codes to classify diseases; each disease can be allotted a unique category and given a code, up to six characters long. Chapter Five covers the Mental and behavioural disorders, these categories are expanded upon in DSM-IV-TR. The ICD- 10 is the official classification for mortality and morbidity statistics for all signatories to the U.N. The publication of ICD-11 is planned for 2011. (WHO 2005)

The manual mostly used for diagnosis of mental disorders in the United States is the

Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, diagnostic criteria changed where made in 2000, so the most up to date addition is DSM-IV-TR (American Psychiatric Association 2000). The DSM-IV-TR is a multi-axial system as it organises diagnostic information into one of the five axes relating to different aspects of a disorder. Diagnosis is usually from either Axis I or Axis II, but can get diagnosed from both. DSM-IV-TR also lists diagnostic “subtypes” for some disorders. A subtype is a subgroup within a diagnosis that confers greater specificity. (Comer 2007)

Although at first sight both the DSM-IV-TR and the ICD-10 classification system appears to provide a beneficial and successful structure on which to view presented symptoms, but it is not to be assumed that either system are conclusive or even correct. There are criticisms of the systems, Foullette and Houts (1996) and Kupfer (et al. 2002 cited Barlow and Durand 2005) both state that there are indistinct categories that can on occasion make diagnosis difficult; consequently individuals can be attributed more than one psychological disorder this is known as comorbidity. There appears to be no immediate solution to this issue and further research may produce a solution in time.

The DSM-IV-TR and the ICD-10 are also criticised for there reliability and conceptual validity. Reeb (2000) and Nathan



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