Treatment Approaches

Anyone interacting with a person suffering from a severe mental disorder
comes to think of him or her as being different from normal human beings.
The behavior of those with mental illness is regarded, with some justification,
as bizarre and unpredictable. They are often labeled with a term that
sets them apart, such as “crazy” or “mad.” There are many words in the English
language that have been, or are, used to describe these persons�"many
of them quite cruel and derogatory. Since the nineteenth century, professionals
have used the term“psychotic” to denote severe mental illness or disorders.
Interestingly, one translation of psychotic is “of a sickness of the
soul” and reflects the earlier belief regarding the etiology or cause of mental
illness. This belief is still held by some therapists and pastoral counselors in
the twenty-first century. Until the end of the twentieth century, the term
“neurosis” connoted more moderate dysfunction than the term“psychosis.”
However, whether neurosis is always less disabling or disturbing than psychosis
has been an open question. An attempt was made to deal with this
dilemma in 1980, when the American Psychiatric Association’s Diagnostic
and Statistical Manual of Mental Disorders (3d ed., 1980, DSM-III) officially
dropped the term “neurosis” from the diagnostic terms.
The current approach to mental disorders, at its best, offers hope and
healing to patients and their families. However, much about the etiology of
mental disorders remains unknown to social scientists and physicians. In
1963, President John F. Kennedy signed the Community Mental Health and
Retardation Act. Its goal was to set up centers throughout the United States
offering services to mentally and emotionally disturbed citizens and their
families, incorporating the best that had been learned and that would be
learned from science and from medicine. Outpatient services in the community,
emergency services, “partial” hospitalizations (adult day care), consultation,
education, and research were among the programs supported by
the act. Although imperfect, it nevertheless demonstrated how far science
had come from the days when witches were burned at the stake and the possessed
were stoned to death.
When one deals with mental disorders, one is dealing with human behavior�"
both the behavior of the individual identified as having the problem
and the behavior of the community. The response of the community is critical
for the successful treatment of disorders. For example, D. L. Rosenhan,
in a well-known 1973 study titled “On Being Sane in Insane Places,” showed
how easy it is to be labeled “crazy” and how difficult it is to get rid of the label.
He demonstrated how one’s behavior is interpreted and understood on
the basis of the labels that have been applied. (The “pseudopatients” in the
study had been admitted to a mental hospital and given a diagnosis�"a label�"of schizophrenia. Consequently, even their writing of notes in a notebook
was regarded as evidence of their illness.) To understand mental disorders
is not merely to understand personal dysfunction or distress but also to
understand social and cultural biases of the community, from the family to
the federal government. The prognosis for eventual mental and emotional
health depends not only on appropriate therapy but also on the reasonable
and humane response of the relevant communities.
Sources for Further Study
American Psychiatric Association. Diagnostic and Statistical Manual of Disorders:
DSM-IV-TR. Rev. 4th ed. Washington, D.C.: Author, 2000. This is the
official manual for the classification of mental disorders used by clinicians
and researchers in a variety of settings. The manual also is used for
educational purposes as disorders are described with respect to diagnostic
features, cultural and age considerations, prevalence, course, and familial
patterns. The language is accessible to advanced students.
Berrios, German E., and Roy Porter. A History of Clinical Psychiatry: The Origin
and History of Psychiatric Disorders. Washington Square: New York University
Press, 1995. This book addresses the clinical and social history of
mental disorders and is a good follow-up for readers interested in studying
a particular type of disorder. A major theme throughout involves
tracking the interaction between clinical signals of disorder, successive
historical periods, and psychosocial contexts. For advanced students.
Frankl, Viktor Emil. Man’s Search for Meaning: An Introduction to Logotherapy.
New York: Insight Books, 1997. A powerful book which serves as an example
of many publications that emphasize what has been called “moral
treatment.” Frankl’s book is partly autobiographical, based on his experiences
as a Jew in a German concentration camp. The book then goes on
to develop some ideas related to abnormal behavior.
Freud, Sigmund. The Freud Reader. Edited by Peter Gay. 1989. Reprint. New
York: W. W. Norton, 1995. This book offers a selection of essays and excerpts
meant to give the reader an understanding of the breadth of
Freud’s seminal work. Topics include Freud’s psychosexual theory of human
development, his theory of mind, psychoanalysis, and his ideas on
the arts, religion, and culture. The editor offers introductions for each selection.
Good overview of a historically important thinker.
Grob, Gerald N. The Mad Among Us: A History of the Care of America’s Mentally
Ill. New York: Free Press, 1994. This history of the care and treatment of
the mentally ill in America begins with the colonial period and ends with
the modern period. It is a thoughtful analysis of changing societal perceptions
of moral obligation and of the historically varying policies regarding
presumed effective care. Documents the contradictory policies
of confinement versus community living for the disordered. Also looks at
the question of whether the public need for protection overrides the
needs of the individual. Written for the general reader.

Porter, Roy. The Greatest Benefit to Mankind: A Medical History of Humanity.
New York:W.W. Norton, 1997. An engaging book that includes a chapter
on psychiatry, a short history of mental disorders covering the eighteenth
through the twentieth centuries in Britain, Europe, and North America.
Good discussions of the asylum movement, degeneration theory and
Nazi psychiatry, psychoanalysis, and modern developments. Porter was a
social historian of medicine whose scholarship is accessible to the general
reader. There is an extensive list of sources for further reading. Highly
recommended.
__________. Madness: A Brief History. New York: Oxford University Press,
2002. A history of Western ideas about mental illness by one of the most
respected historians of medicine. Changing ideas about “madness” help
trace the evolution of psychology.
Robinson, Daniel N. An Intellectual History of Psychology. 3d ed. Madison: University
ofWisconsin Press, 1995. Although mental illness as such occupies
a small part of this book, it is a genuinely important book in helping
to understand the philosophical and intellectual currents which have
played such a major role in the psychological and scientific understanding
of mental illness. A sometimes demanding book to read, it is well
worth the intellectual energy for one who wants to understand various intellectual
disciplines.
Rosenhan, David L. “On Being Sane in Insane Places.” Science 179 (January
19, 1973): 250-258. More of a “naturalistic illustration” than a scientific
experiment, this article raises provocative questions and puts forth some
controversial conclusions. Enjoyable reading that does not require much
psychological background on the part of the reader.
James Taylor Henderson; updated by Tanja Bekhuis
See also: Psychology: Fields of Specialization; Psychosurgery; Schizophrenia:
Background, Types, and Symptoms; Schizophrenia: Theoretical Explanations;
Thought: Study and Measurement.