Mental illnesses have long been a major cause of death and disability. From 30 to 60 per cent of all patients who consult doctors do so primarily for complaints due to emotional disorders. Many productive persons continuously maintain a chronically neurotic adjustment to life. And most individuals have minor emotional disturbances often not recognized but of medical significance.
In spite of all this, the average person has a curious attitude toward mental health. He admits the importance of physical health, realizes that not everyone who’s up and about is physically well, and may even go so far as to take some elementary precautions against disease. If not exactly intelligent about physical health, he is at least interested and will seek advice from physicians, quacks, or advertisements.
But in regard to his mental health his attitude until recently has been strangely indifferent. If he thinks about it at all, he regards it as something quite foreign to him, much as he might give passing attention to the antics of a foreign bandit. He considers his friends and associates as in perfect mental health; when his attention is forced to this subject by the “sudden” onset of a mental illness in someone he knows, he is surprised and shocked.
If the affected person is a member of his own family, he attributes the disease to overwork, to worry about finances, to physical illness, or to some other socially acceptable factor. If the affected person is merely an acquaintance, he is likely to consider heredity, alcohol, and syphilis as probable causes. Only rarely does he try to think intelligently as to why these things happen or attempt to inform him by reading or by consulting specialists in the field. This attitude seems particularly strange when one considers the horror with which mental illness is generally regarded.
But even when one does try to inform one’s self, one meets with difficulties. In unguided reading, one finds discrepancies and confusion which may seem completely baffling.
Definite instructions for avoiding mental illness cannot be given but a general understanding of the problems and processes involved frequently helps enormously in the handling of minor emotional distresses, the neglect of which is an important factor in the development of graver disorders. Then in addition to the problem of avoiding actual insanity, knowledge of the mechanisms leading to mental disturbance is the best guarantee against inefficiency, failure, and unhappiness in life.
Few realize that the psychiatrist deals not only with the actual insanity but with all those borderline conditions and maladjustment which are not ordinarily regarded as belonging in the category of mental Illnesses.
Types of Mental Disorders
Among the mental disorders are conditions so grave that even trained person recognizes that the patient is insane. These illnesses or psychoses, however, usually go unrecognized until they are so far advanced that treatment becomes exceedingly difficult. No severe mental illness ever comes suddenly “out of the blue.” The symptoms are present for months or years but usually are disguised as nervous breakdown, neurasthenia, or physical illnesses.
A second group comprises persons who are not considered insane by their associates but who present various peculiar symptoms of almost any degree of severity. Morbid fears, compulsions, and obsessions, generally diagnosed as psychoneuroses with some modifying term, are particularly characteristic of this group. With these also might be placed chronic invalidism, when physical examination fails to reveal an adequate basis for the symptoms presented.
The third group consists of individuals who are apparently neither mentally nor physically sick, but who fail to make a socially adequate adjustment. It includes certain types of alcoholics, delinquents, vagrants, and persons of unusual sexual behavior. In this group we might include also those persons who, while apparently making a good social adjustment, nevertheless are tremendously hampered by feelings of inadequacy, emotional instability, fears, and other personality disturbances which interfere with efficiency and happiness.
Problem of children constitute a fourth group
It is now generally recognized that difficulties of training, poor habits, school problems, temper tantrums, enuresis, and childhood delinquencies are evidences of emotional disturbance which may be corrected by proper investigation and treatment.
Feeble mindedness is an incurable congenital deficiency with a strong hereditary basis and, as such has little relation to mental or emotional disorders. It is primarily a problem of eugenics and sociology.
Even such an incomplete listing of psychiatric problems forces us to recognize that we can no longer regard mental illness or insanity as the only field for psychiatric investigation. Emotional disturbances and personality problems, which may be regarded as lesser forms of mental illness, constitute ever-present problems, touching all of us.
Theory of Mental Illness
From the scientific data at hand, we have no reason to conclude that heredity is a major factor in the causation of mental illnesses. In spite of this, heredity is commonly believed to be their most important cause. This belief is unfortunate, for the assumption that mental illness is caused by heredity leads to the conclusion that it cannot be prevented or cured.
To assume that a mental illness is hereditary because it “runs in a family” is erroneous, because it is impossible to separate the effects of environment, or so-called “social heredity,” from those of physical heredity. By social heredity is meant the transference of traits of character or types of behavior by contact with and imitation of those persons with whom one lives, while physical heredity implies the transmission of characteristics or types of behavior through the reproductive cells.
One has only to consider the abnormal environment which exists in a family in which there is a mentally ill person, to realize the great possibility of a child in such a family becoming mentally unbalanced, even though no hereditary factors are active at all. In order to establish the hereditary character of a disease one must demonstrate that the disease was not caused by environmental factors and that it follows recognized laws of inheritance. Neither of these requirements has been met in the case of most mental diseases.
Furthermore, it does not follow that, even if a hereditary factor Were present, the development of the disease could not be avoided by the manipulation of environmental factors. Hence, we shall do well to turn our attention from the heredity theory of mental illness to what may be more profitable approaches.
Certain mental illnesses have a definite physical basis. For example, the psychoses of general paresis, arteriosclerosis, senility, injury, brain tumor, etc., are due directly to destruction of brain tissue.
Furthermore, delinquency, hallucinations, fears, compulsions, or other emotional disorders may be due to disturbances in the functioning of the glands of internal secretion; to infectious processes, the toxins of which give rise to states of delirium; the action of drugs; or to actual destruction of brain tissue. Such conditions may, and do, give rise to strange thinking and behavior. Their prevention and cure are problems of physical health, just as are the prevention and cure of any other physical disease.
On the other hand, ideas and emotional attitudes are more often a product of the social environment than of physical disease. A man may let his hair grow to shoulder length because his thinking has been deranged by the activity of the spirochete of syphilis in the cortex of his brain; or he may wear his hair long because he has been taught a religious belief in which long hair is worn as a symbol of the Christ like life. In the first case, we, explain and treat his unusual behavior on a physical basis. In the second, we explain it in psychological and social terms.
In the investigation and treatment of the abnormal behavior and thinking which constitute the material of poor mental health, it is necessary both to investigate those physical disturbances which may interfere with the complex functions of behavior and belief and to recognize those factors in the environment which may disturb these same functions. There is no real dichotomy or conflict in these approaches. In some cases physical disturbances predominate, while in others mental and social situations are of major importance.