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About Mental Illness

Some Basics

Mental illnesses include such disorders as schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, panic and other severe anxiety disorders, autism and pervasive developmental disorders, attention deficit/hyperactivity disorder, borderline personality disorder, and other severe and persistent mental illnesses that affect the brain.

These disorders can profoundly disrupt a person’s thinking, feeling, moods, ability to relate to others and capacity for coping with the demands of life.

Mental illnesses can affect persons of any age, race, religion, or income. Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing.

Mental illnesses are treatable. Most people with serious mental illness need medication to help control symptoms, but also rely on supportive counseling, self-help groups, assistance with housing, vocational rehabilitation, income assistance and other community services in order to achieve their highest level of recovery.

Here are some important facts about mental illness and recovery:

  • Mental illnesses are biologically based brain disorders. They cannot be overcome through “will power” and are not related to a person’s “character” or intelligence.
  • Mental disorders fall along a continuum of severity. The most serious and disabling conditions affect five to ten million adults (2.6 – 5.4%) and three to five million children ages five to seventeen (5 – 9%) in the United States.
  • Mental disorders are the leading cause of disability (lost years of productive life) in the North America, Europe and, increasingly, in the world. By 2020, Major Depressive illness will be the leading cause of disability in the world for women and children.
  • Mental illnesses strike individuals in the prime of their lives, often during adolescence and young adulthood. All ages are susceptible, but the young and the old are especially vulnerable.
  • Without treatment the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives; The economic cost of untreated mental illness is more than 100 billion dollars each year in the United States.
  • The best treatments for serious mental illnesses today are highly effective; between 70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports;
  • Early identification and treatment is of vital importance; By getting people the treatment they need early, recovery is accelerated and the brain is protected from further harm related to the course of illness.
  • Stigma erodes confidence that mental disorders are real, treatable health conditions. We have allowed stigma and a now unwarranted sense of hopelessness to erect attitudinal, structural and financial barriers to effective treatment and recovery. It is time to take these barriers down.

To find out more about specific illnesses visit the “By Illness” page of NAMI National website.

Anosognosia Keeps Patients From Realizing They’re Ill

A growing body of evidence points to the fact that for many people with serious mental illness, lack of insight is a medically based condition. About half of the people with schizophrenia and bipolar disorder may not be getting the treatment they need because of a brain deficit that renders them unable to perceive that they are ill, according to one expert. Xavier Amador, Ph.D.: “People will come up with illogical and even bizarre explanations for symptoms and life circumstances stemming from their illness.”

Anosognosia, meaning “unawareness of illness,” is a syndrome commonly seen in people with serious mental illness and some neurological disorders, according to Xavier Amador, Ph.D.. People with this syndrome do not believe they are ill despite evidence to the contrary, said Amador, who is director of psychology at the New York State Psychiatric Institute and professor of psychology in the department of psychiatry at Columbia University College of Physicians and Surgeons.

Amador’s quest to understand the basis of this syndrome lies a little closer to home. It was his experience as a clinician and as a brother of someone with schizophrenia, Amador said, that led him to do research on anosognosia, “which is not to be confused with denial,” he emphasized, although in the beginning, he did not make that distinction. “That’s what I called it when my brother refused to take his medications, and that is what I called it when after his third hospitalization, I found his Haldol in the trashcan,” said Amador. “This is someone who taught me to throw a baseball and ride a bicycle. I really looked up to him and was appalled by what I thought was his immaturity, stubbornness, and defensiveness.” But research points to a much more complex problem. Intrigued by a 1986 study by William H. Wilson, M.D., and colleagues that found that 89 percent of patients with schizophrenia denied having an illness, Amador conducted his own investigation of the issue.

Amador and his colleagues found in a 1994 study that nearly 60 percent of a sample of 221 patients with schizophrenia did not believe they were ill. Amador also described what it is like to work with someone who has anosognosia. One patient encountered by Amador had a lesion on the frontal lobe of his brain. He was unaware that he was paralyzed on his left side or that he had problems writing. When asked to draw a clock, the patient thought he did fine, Amador recalled. However, when Amador pointed out to the patient that the numbers were outside of the circle, the patient became upset. “The more I talked to him [about the drawing], the more flustered he got. . . . Then he got angry and pushed the paper away, saying ‘it’s not mine-it’s not my drawing.’ ” Amador finds the same reaction appears when he talks to people with severe mental illness, which sometimes involves similar frontal lobe deficits. “Instead of being an ally, I end up being an adversary,” he said. Amador urged family members and mental health professionals to understand that collaboration with treatment by someone who has a severe mental illness and anosognosia is a goal, not a given. “Don’t expect them to comply with any treatment plan, because they don’t believe they are ill,” noted Amador. It is important instead to develop a partnership with the patient around those things that can be agreed upon. Amador said that family members and clinicians should first listen to the patient’s fears, such as being placed in the hospital against his or her will. Empathy with the patient’s frustrations and even delusional beliefs is also important, remarked Amador, who said that the phrase “I understand how you feel” can make a world of difference. The most difficult thing for family members to do in building a trusting relationship, he said, is to restrict discussion to the problems that the person with mental illness perceives as problems. “You might see the hallucinations or delusions as the big problem,” said Amador. “Your loved one, however, may be complaining about not getting to sleep at night. That is the problem you should be discussing.” Perhaps a patient will only take his or her medications to get family members and clinicians to quit bothering them, and this is sometimes enough, Amador said. “You have to find out what motivates them to take their medications, then reflect that reason back and highlight the perceived benefits.”

Amador wrote about getting people with serious mental illness to accept treatment in a book titled,I am Not Sick, I Don’t Need Help: A Practical Guide for Families and Therapists, published in 2000 by Vida Press.

  • Watch Dr. Amador’s video

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