October is Disability Awareness Month. In addition, a week in early October is usually designated as Mental Illness Awareness Week. The National Alliance on Mental Illness (NAMI) is the organization behind this week. It was founded in 1979 as a "nonprofit, grassroots, self-help, support and advocacy organization of consumers, families, and friends of people with severe mental illnesses, such as schizophrenia, major depression, bipolar disorder, obsessive-compulsive disorder, and anxiety disorders." (NAMI Fact Sheet, 10/98)
This organization has done a lot to reduce the stigma of persons suffering from these disorders. The focus is on the fact that these disorders have a clear biological component, and that they should be treated like any other illness. They go as far as to use the term "severe brain disorders" when describing these illnesses. This is in keeping with the 1990s' emphasis on "the decade of the brain" in psychiatry.
Are mental illnesses disabilities? They certainly can be disabling. Are they really brain disorders? I think of brain tumors and seizure disorders when I think of brain disorders. NAMI has generally defined mental illness that way. Their 1998 Campaign to End Discrimination, for example, was cosponsored by nine corporations, all drug companies. This is certainly one way to put mental illness on a par with physical illness - by defining it as a physical illness. Unfortunately this is only a part of the picture.
The mind and body are complex and interconnected. We can no longer state clearly where the mind ends and the body begins. Many severe mental illnesses have a clear biological component, and genetic factors have been implicated in some disorders. This is not the whole picture, however. Other severe mental illnesses seem to be caused primarily by environmental and family factors. Child abuse has been implicated as a causal factor in Borderline Personality Disorder and Dissociative Disorders, for example. Post-Traumatic Stress Disorder is an anxiety disorder which is caused by a trauma in the environment. Recent research suggests that exposure to trauma can actually change the way that the brain develops.
If mental illnesses are brain disorders, then the treatments must be medications, shock therapy, or brain surgery, right? These are certainly some of the effective treatments. Some disorders, such as bipolar disorder and schizophrenia, are treated primarily with medications. Psychotherapy is also used as an adjunct with these disorders. Depression is often treated with medications, but psychotherapy can play a central role in treatment. Research has shown that therapy alone is sometimes sufficient to treat a depression which is biological in origin. A combination of therapy and medications is often most helpful. There are no effective medications for treatment of personality disorders or dissociative disorders. Drugs can be helpful, but psychotherapy is the treatment of choice.
It helps to be aware of mental illness during this time of year and other times of year. You may also want to also be aware that there are severe mental disorders other than the "brain disorders" that NAMI champions.
Note: Since this article was written NAMI changed it's name from The National Alliance for the Mentally Ill to The National Alliance on Mental Illness . They have also added information on trauma-related disorders to their Website. This is a welcome step in the right direction. Many NAMI members are parents of patients with mental disorders, and there is still a strong theme throughout the organization suggesting that brain disorders are the main problem; and that upbringing issues - such as child abuse - are not significant factors in most cases. This focus is understandable given the make-up of the organization. NAMI is to be commended for moving to a more moderate position on some of these issues.
Last updated 3/12/06
