Intended learning outcomes

1. Identify criteria that define mental illness

2. Recognize cultural variations of mental illness
3. Explain how mental illness is diagnosed
4. Recognize explanations of mental illness

2
Defining mental illness

3
Mental illness / psychological disorders is a fuzzy
concept. What actually distinguish abnormality from
normality? 4
•Defining mental illness
•Several criteria are relevant
•No single criterion can define mental illness
•Deviance, Distress, Dysfunctional

5
Deviance (statistical rarity. Some mental disorders (e.g.,
schizophrenia) are rare, but some are not. According to WHO, it
is estimated that in 2019, 1 in every 8 people were living with a
mental disorder. Also, some rare conditions (e.g., exceptional
athletic ability and creativity) are not considered an illness.
6
 “in my lifetime I have murdered 21
human beings. I have committed
thousands of burglaries, robberies,
larcenys, arsons...For all of these
things I am not the least bit sorry. I
have no conscience so that does not
worry me.” (Quote from Carl Panzram,
a serial killer, burglar, and arsonist)

Distress. Many mental disorders (e.g., depression)

produce intensive distress for individuals, but some
disorders (e.g., personality disorders) typically do not
generate distress. 7
 Vicki Larrieux…is frightened of vegetables. She survives on a
diet of meat, potatoes, cereals and an occasional apple. “I
would get feelings of panic, start sweating and my heart rate
would shoot up…it is a bit of an ordeal to go to the
supermarket because the veg is usually right by the door,” she
said. “It is good that my boyfriend is not a vegetarian because
it just wouldn’t work.”

Dysfunctional (impairment). Most mental disorders

impairs people’s functioning in everyday life (e.g., job,
marriage, relationships). Some conditions (e.g., rudeness,
laziness) also impair functioning but they are not
considered as disorders. 8
•Cultural variations
•Culture-bound syndromes: mental symptoms
or illnesses that are specific to one or a limited
number of societies

9
 “…in the Assam and Bengal regions of India during the
summer and fall of 1982. Cases apparently numbered in the
thousands, as males claimed penile shrinkage while females
perceived that their breasts were getting smaller. The panic
reached such proportions that medical authorities toured the
area, reassuring people through loud speakers… Parents
typically tied string to their sons’ penises to halt retraction, a
practice that occasionally produced penile ulcers…authorities
measured penises at intervals to demonstrate that no
shrinkage was occurring.” (Bartholomew, 1994)
Koro is characterized by sudden and intense anxiety that one’s
genitals are retracting into the body and possibly cause death. It
is found primarily in Southeast Asia and some parts of Africa. It
is not recognized as a mental disorder but is considered as a
culture-bound syndrome. 10
There are over a million of “hikikomori” cases in Japan,
constituting a social crisis. It used to be considered as a
cultural syndrome, but cases resembling “hikikomori”
have been reported outside Japan (Kato et al., 2012). 11
 “…they traveled hundreds of miles
west—to Kyoto, Osaka and Nara… They
took touristy pictures under cherry trees,
frolicked like children on merry-go-
rounds and slurped noodles on street
corners. Now, after three years together,
they are virtually inseparable. ‘I’ve
experienced so many amazing things
because of her,’ Nisan told me, rubbing
Nemutan’s leg warmly. ‘She has really
changed my life.’” (Katayama, 2009)
Reported in Japan and a few other countries, men
develop lasting romantic relationships with imaginative
or anime characters. Is it a culture-bound syndrome? Is
it a mental illness? 12
•Changes over time
•Some conditions that are now accepted as
normal were once classified as mental disorders

13
Homosexuality was once classified as a mental disorder
by the American Psychiatric Association (APA) and the
World Health Organization (WHO). In 1973, it was
removed from the diagnostic manual by the APA. The
WHO followed in 1990. 14
Diagnosis

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•Diagnosis
•Pinpointing the problem a person is
experiencing
•Informing the design of treatment plans
•Facilitating communication among mental
health professionals

16
Diagnostic and Statistical Manual of Mental Disorders (DSM) is
a diagnostic system developed by the American Psychiatric
Association. It includes 237 disorders. The manual gives an
overview of each disorder, lists its specific symptoms required
for diagnosis, prevalence information, and risk factors. 17
Here is the complete listing of chapters in DSM-5. 18
The International Classification of Diseases (ICD), another
classification system, is published by the WHO. The categories
of mental disorders in ICD are similar to those in the DSM, but
some differences exist. 19
•Diagnosis
•Made by a mental health professional (e.g.,
psychiatrist, psychologist)
•Based on clinical interview, physical
examination, psychological testing, diagnostic
criteria

20
The diagnostic criteria for each disorder are specified.
Shown above are the criteria for major depressive
disorder. 21
DSM-5 also provides information about comorbidity (co-
occurrence of two mental disorders). For instance, it states that
41% of people with obsessive-compulsive disorder (OCD) also
meet the diagnostic criteria for major depressive disorder.
Findings also show that over half of people who have a primary
diagnosis of depressive disorder are estimated to exhibit some
sort of anxiety disorder, and the reverse is true too. 22
•Medicalization
•Increasing number of diagnoses in DSM and
number of people on medications for
psychological problems (Barber, 2008)
•Concern that mild and normal disturbances are
too easily classified as pathological (Frances &
Widiger, 2012)

23
 “Previous DSM editions have highlighted the need to
consider, and usually exclude, bereavement before
diagnosis of a major depressive disorder…”
(Editorial, The Lancet, 2012)

Is grief normal or abnormal? DSM-5 now allows

individuals to be diagnosed as having major depressive
disorder following loss of a loved one, including the
death of a spouse, as long as they meet the diagnostic
criteria (Lilienfeld et al., 2015). 24
Explaining mental illness

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Supernatural theories. In the Middle Ages and earlier times, odd
behaviors and psychotic experiences were often attributed to
possession by evil or demonic spirits. Religious ceremonies and
such bizarre treatments as exorcisms, witchhunting, and
trephination were used to treat mental illness. 26
Trephination. It was believed that drilling holes in the
skull could cure mental illness by allowing evil spirits
trapped within the skull to be released. 27
Somatogenic theories. Under this view, mental illness was
attributed to disturbances in physical functioning resulting from
either illness, genetic inheritance, or brain damage or imbalance.
For instance, Hippocrates (460–370 BC) considered mental
illness as caused by a deficiency in or an excess of one of the
four essential bodily fluids)—blood, yellow bile, black bile, and
phlegm. Someone who was too temperamental suffered from
having too much blood; blood-letting was the necessary
treatment. 28
Psychogenic theories view mental illness as resulted from
traumatic or stressful experiences and maladaptive cognitions
and behaviors. Psychogenic treatment such as compassionate
care, psychoanalysis, and behavioral and cognitive approaches to
psychology therapy has been developed accordingly. 29
The biopsychosocial approach considers psychological
disorders as an outcome of the interaction between
biological, psychological, and socio-cultural factors. Past
experience, irrational thoughts, and family dynamics, for
example, are now considered. 30