Support And Family Education: Session One - What causes mental illness?

Session One - What causes mental illness?

Materials Needed:
Handout C: "What is Mental Illness"
Handout D: "Biopsychosocial Model and Diathesis Stress Model"
Video: NAMI Science and Treatment Video

What is mental illness?
1. Distribute Handout C: "What is mental illness?" (Bisbee, 1991)
  1. Every organ in the human body has a function, and numerous problems can arise with each organ. The specific problem with the organ and the resultant disorder dictate the appropriate treatments. This chart places mental illness in the context of other forms of illnesses
  2. Mental illness is brain dysfunction, affecting:
    1. Perception
      - Patients may experience the world with their senses (vision, smell, taste, touch, hearing) in unusual and/or strange ways (e.g., hearing voices, seeing things that others do not see)
    2. Thinking
      - Thoughts may occur very quickly/slowly, may be poorly organized, confusing, illogical, irrational, etc.
    3. Mood
      - All human beings experience a variety of moods (e.g., depression, anxiety, mania) and mood changes. Mental illness can emerge when the symptoms cause significant distress over time and impair one's ability to function in daily life.
    4. Behavior
    - Patients' behavior may be quite bizarre and confusing for those who do not understand the mental illness (e.g., a patient with PTSD hiding in the closet when he hears helicopters; a patient with obsessive-compulsive disorder checking the stove 20 times before leaving the house; a depressed individual lying in bed for days at a time)
2. Effective treatment of mental illness includes a combination of several elements: medications, healthy life style, patient and family education, psychotherapy and rehabilitation.
Categories of mental illness
1. Many different classification systems for mental disorders exist, but some general categories include:
  - Write on Board (and very briefly define each disorder)
  Schizophrenia
  Major depressive disorder
  Bipolar disorder / manic-depressive disorder
  Anxiety disorders (including PTSD)
  Substance use disorders
  Organic disorders (e.g., Alzheimer's disease)
  Personality disorders

What are the causes of mental illness?

Given the limited time and participants' family members having different mental illnesses, overall themes in the causes of mental illness will be discussed rather than addressing the specifics of each disorder. Time will be available at the end of the session for specific questions.

Discussion Question:
- What are some commonly held beliefs about the causes of mental illness?
Examples:
1. Mental illness does not exist.
2. Mental illness is a normal response to a sick society.
3. Mental illness is caused by the devil, demons, or turning away from God.
4. Mental illness is caused by poor parenting.
5. Mental illness is caused by being lazy and weak.
6. Mental illness is caused by poor family communication
7. Others?
Over the years, different theories have been proposed regarding the causes of mental illness. Myths such as these develop because people need an explanation for confusing behaviors. The myths can be transmitted down through many generations without being checked for accuracy. Sometimes myths are a means of denial or of avoiding responsibility for the mental illness in the family.

What our science does know:

Distribute Handout D: "Biopsychosocial Model and Diathesis Stress Model" (adapted from Bisbee, 1991)

Biopsychosocial model: Mental illnesses have several dimensions that are helpful to review
- Write on board: Bio, Psych, Social
- Each area can contribute to the individual being at risk for mental illness.
BIO biology
- Refers to the structure of the brain, chemicals in the brain, genes inherited from parents, etc. Our science is gaining more knowledge about the large influence of biology in the risk for acquiring a mental illness.
PSYCH psychology
- Refers to personality, personal beliefs, thoughts, experiences, etc.
SOCIAL sociology
- Refers to environmental stress (e.g., trauma of war, assault), cultural factors, discrimination, etc.
Therefore … Treatment needs to be aimed at all 3 of these areas:

BIO medication, nutrition, general physical health

PSYCHeducation (S.A.F.E. Program), psychotherapy, coping skills

SOCIAL environmental management, stigma of mental illness, advocacy
Videotape: Show and discuss 10-minute videotape, NAMI Science and Treatment Video, which emphasizes the biological etiology of mental illness.

Diathesis-Stress model (Vulnerability stress model)

One can inherit a predisposition or increased vulnerability ("diathesis") to a certain illness (or class of illnesses). The importance of family history with some medical problems (e.g., cancer) is well known. Investigating family history with mental illness can similarly provide very valuable information. Having a family history of a mental illness does not mean you will necessarily get the illness, but you do have an increased risk.

Example: schizophrenia:

1% incidence in general population
13% if 1 parent has the disorder
46% if both parents have the disorder

Fraternal twins: 10-15% incidence rate
Identical twins: 35-50% incidence rate

Precisely what is inherited that makes a person more likely to get schizophrenia is still unknown, but research continues to study the various causes of mental illnesses.

Then life experience ("stress") can trigger the emergence of a mental illness. All people struggle in coping with major life events; however, individuals with a predisposition for mental illness can have a harder time with the event and some symptoms of mental illness may emerge.

Discussion Questions:
- Do you have any questions about either model?
- Do you have questions about the causes of any
  specific disorder(s)?