In the same way that we know that having a fever is protective and beneficial to recovering from sickness, we can look for similarities in psychological disorders. We can also ask questions concerning why particular disorders continue to exist. Individuals with schizophrenia, for example, generally have fewer children than those without the disorder. Thus, you might expect that schizophrenia would have gradually disappeared over our evolutionary history through the production of fewer children with the genetics related to the disorder. However, this is not the case, and in fact, schizophrenia occurs in approximately the same percentage (1% of the population) throughout the world in both developed and developing countries. As I will discuss in more detail later in this book, this suggests that schizophrenia is an old disorder that has existed since humans migrated out of Africa around 100,000 years ago. It also suggests that the multiple genes associated with schizophrenia may be associated with more positive human traits such as creativity.
In summary, the three themes—behavior and experience, neuroscience, and the evolutionary perspective—give us important perspectives for thinking about psychopathology.
Levels of Analysis
As we explore together the themes of behavior and experience, neuroscience contributions, and evolutionary perspectives as related to psychopathology, you will see that we will move across a variety of levels of analysis ranging from culture to genetics. Higher-level understandings include culture and society as well as our social relationships. From there, we can look at what makes up the social level as well as the individual level, which includes our actions and our experiences. We can then ask what makes up the individual in terms of sensory, motor, emotional, and cognitive systems. We can examine each of these levels as it influences our behavior and experience. One can ask how each of these systems works and look at the physiological processes that make up our central and peripheral nervous systems. This will take us to the cortical network level, and you will see how neurons and their connections form the basis of information transfer and processing. The most basic level you will be introduced to in this book is the genetic level, which in turn will require us to understand how environmental conditions influence genetic processes. You will also learn about a related process, epigenetics, in which genes can be turned on or off by the environment, and these mechanisms can be passed on to future generations without actually changing the basic genetic structure.
levels of analysis: examination of psychopathology ranging from culture and society at a higher level to the individual at a middle level and physiology and genetics at the lower levels
Lens
American Attitudes Toward Mental Illness
© iStockphoto.com/Rich Legg
Throughout our history, a number of traditions and themes have developed in relation to American society. At times, these themes create a dynamic tension. For example, there is often a call for the federal government to tax less. However, in times of disaster, we expect the government to spend money to help our community. Such desires create a dynamic tension between different ideas and values.
There is also such a dynamic tension in relation to individuals with mental illness. This partly comes from our desire to take care of those who are not able to take care of themselves. Historically, in many countries from which Americans originally came, the king, queen, or government took care of those who could not care for themselves. However, there is also a tradition in America related to pioneers’ settlement of our vast lands. This is represented by the pioneer or cowboy spirit in which we support the individual’s right to do what he or she wants and to live the type of life desired.
As Americans, we have contradictory attitudes toward mental illness. In terms of treatment, 94% of Americans believe it can help people with mental illness lead normal lives. This might suggest that society would encourage treatment of mental illness and reduce any stigma around seeking help. However, it is estimated that only about 20% of those with a mental disorder actually sought help in the prior year. This may have resulted from embarrassment or an attempt to hide the condition from others. This leads to less treatment and may, in turn, affect work and life opportunities. The attempt to hide mental problems may also reflect a reality, as only around 60% of Americans believe that people are generally caring and sympathetic to people with mental illness.
The picture becomes more complicated when we realize that in any given year, about one fourth of all adult Americans have a mental disorder, including anxiety, depression, and substance abuse. Emotional problems and psychological distress are also experienced by those with chronic physical conditions such as arthritis, cancer, diabetes, and cardiovascular problems. Given the large number of individuals experiencing different types of emotional problems and psychological distress, you might expect that these conditions would be more accepted. However, stigma and negative attitudes toward mental illness are common in the United States.
The dynamic tension between taking care of others and being independent becomes clear when we see homeless individuals in our community who have a mental illness. This raises a number of questions. Can we take these individuals off the street if they don’t want to be taken to a shelter? If they do not want to take medication, can we force them to take it if this would help them function better in our community? Should it be the police or health care workers that work with these individuals? In the final chapter of this book, which focuses on legal and ethical issues and mental health, a number of these questions will be considered.
Thought Question: Who do you believe should take care of the mentally ill in American society?
Note: Data presented above are taken from Centers for Disease Control and Prevention (CDC) (2012).
How do our sensory, motor, emotional, and cognitive systems work together?
© iStockphoto.com/maurusone
How do physiological processes influence our behavior and experience?
© iStockphoto.com/Eraxion
How do our neurons form networks?
© Can Stock Photo/iDesign
In order to help focus their work, scientists often concentrate primarily on one of these levels of analysis. However, in this book I want to consider a more integrative approach that draws on a number of these levels. Further, you should not take any one of these levels of analysis as more important or truer than another. A similar plea was made by George Engel in 1977 when he helped to develop the biopsychosocial approach to understanding mental illness.
Biopsychosocial Approach
In his 1977 paper in the journal Science, George Engel introduced the term biopsychosocial. He suggested that individuals with mental illness or another medical disorder should be understood from more than just a biological perspective. Diabetes is a disorder, but it is also related to how the person eats and exercises. Likewise, depression and anxiety can be influenced by social and emotional factors. Thus, it is necessary to see the signs and symptoms of the disorder in a larger context. Otherwise, one has a limited perspective that ignores the social, psychological, and behavioral dimensions of any disorder. Therefore, as a mental health professional, you would want to know more about an individual than just the symptoms that the person describes, as represented in Figure 1.2. This could be his or her family life, work conditions, and cultural practices as well as eating habits and how the person exercises.
As