Part One
Blog post headline: The Disorder Stigma Wars
Our society is forever creating “standards.” Standards are not a bad thing; however, some types of standards in certain cases are not necessarily a good thing either and need to be changed. Lets’ look at some of the old standards and stigmas surrounding mental health and the ongoing process of changing them. The observation that on mental health illness from the World Health Organization that the lower the socioeconomic class, the higher the incidence of mental disorders (World Health Organization, 2014).
The strength of this statement allows us to believe that the less economic and financial stability a person has, the more prone they are to dealing with a mental disorder as opposed to those who are doing better financially. However, this correlation is not concrete but varies with different types of mental disorders. For example, antisocial personality disorder is strongly related to socioeconomic status (SES), occurring about three times as often in the lowest income category as in the highest income category, whereas depressive disorders occur only about 1.5 times as often in the lowest income category as in the highest income category (Kessler & Zhao, 1999; Monroe et al., 2009). Meaning, that even those with financial stability and wealth can encounter challenges in large numbers with mental health illnesses as well.
With this information in hand, we are going to be looking at these three disorders.
1. Obsessive Compulsive Disorder - OCD
2. Anxiety Disorder or GAD
3. Post Traumatic Stress Disorder - PTSD
In your own words, identify and describe the main diagnostic features of each of the disorders selected.
Obsessive Compulsive Disorder: OCD is a disorder that affects individuals who are inundated with intrusive and obsessive thoughts that they attempt to drown out through repetitive compulsive behaviors. These behaviors are triggered by stress and they help to distract from the real fears the individual faces. The repetitive behavior becomes a stress factor as the activity disrupts the daily anxiety patterns. The behavior tends to bring comfort to the individual, and many who deal with it may not see anything wrong with their behavior.
Generalized Anxiety Disorder (GAD): This is a disorder that is stimulated when normal stressors linger with an individual and become persistent enough and results in developing excessive worry about certain everyday events. These individuals tend to feel they have very little control over their emotions and can find it hard to complete simple daily tasks. They can also develop avoidance issues as a defense mechanism to avoid treatment.
Post Traumatic Stress Disorder: PTSD is a coping mechanism disorder that is due to one traumatic event or a compilation of events that tend to remain in our minds and able to strongly affect us long after the event. These traumas cause the individual to have consistent nightmares and overwhelming negative thoughts, that trigger flashbacks to those events and cause interruptions in their daily lives.
Consider biomedical factors: Describe what it means to characterize the disorders as “diseases of the nervous system and the body.”
There are more than 600 diseases that can impact the nervous system and these types of diseases are referred to as neurological diseases (Seladi-Schulman, 2022). Mental illnesses were once thought to be inherently biological diseases, with problems of the central nervous, autonomic, and/or endocrine systems and were considered to be either inherited or the result of a pathological process (Hooley et al., 2019).
However, most mental disorders are not caused by neurological damage (Hooley et al., 2019) yet an emerging concern is growing as research looks at the complex link between mental health and neurological disorders, such as dementia and Alzheimer’s. The evidence suggests that having a mental illness is a risk factor for developing different forms of dementia (Rosenhaft, 2023).
While we can see early signs of nervous system illness showing up in Alzheimer’s and dementia, we can now look to continued research that seems to be narrowing the link more specifically to other mental disorders. This detail is explained by Ph. D and Neuroscientist Melissa Galinato, who writes, “while neurological disorders involve damage to and degeneration of the nervous system, sometimes that damage can alter the communication between neurons. When it does, those changes can manifest themselves in problems with behavior, body control, memory, and mood” (Galinato, 2018). PTSD, GAD, and OCD are generally seen as overall problems with behavior, body control, memory, and mood.
· PTSD: The neurological signs that are specifically linked to the onset of PTSD include decreasing cortisol levels, increased glucocorticoid receptor responsiveness, and the increased sensitivity of the HPA negative feedback inhibition (Uwaifo, 2023).
· OCD: Developing studies and research are leading the way in substantiating a link to neurological markers in discovering a genetic defect located in the front of the brain which is accessing the deeper levels that use serotonin. These communication receptors are shown to work more normally with serotonin-based medications or with cognitive behavior therapy (Gluck, 2022).
· GAD: The biological factors seen in GAD is credited to genetics, neurotransmitter abnormalities, and neurobiological differences. (Hooley et al., 2019). More specifically, chemicals in the brain that help to regulate fear and other emotions such as dopamine and serotonin, have also been associated with the disorder (Harrison, 2023).
Consider clinical factors: Describe the similarities between the disorders selected. In what ways might these similarities impact diagnosis and treatment?
The main factors that OCD, PTSD, and Anxiety disorder have in common is that they are all listed in the DSM-5 as mental health conditions. Each has:
· Intrusive thoughts
· Emotional distress
· Difficulty with sleep
· Feelings of guilt
· Feeling of having little control over their emotions and/or behavior.
Matthew Tull, Professor of Psychology at the University of Toledo, states that “Each [of these disorders] also tend to engage in neutralizing behaviors to reduce their anxiety from [their] distressing thoughts” (Tull, 2023).
Due to their similarities in symptoms, it would require the clinician to follow the DSM-5 guidelines on the specific parameters that differentiate each disorder. These include, but are not limited to, how long they last, the level of intensity, and in the difficulty in controlling the experience.
Consider historical factors: Describe the ways deinstitutionalization has impacted patient rights, levels of care, and access to treatment of the disorders over time.
The historical factors regarding mental health disorders have progressed immensely. In the 17th century, when mental health disorders were being observed as a growing crisis in society, asylums were built to house the mentally ill as the solution to fixing the problem.
Today, the asylums have mostly disappeared and now replaced with more effective forms of treatment (Francis & Francis, 2023) and modernized facilities with the impetus being to treat mental illness under a more humane structure. However, health care professionals became concerned that deinstitutionalization was creating another problem of individuals wanting to escape from everyday problems in the hopes of allowing others to take care of their needs (Hooley et al., 2019).
Deinstitutionalization also caused an abandonment gap to exist once many of those who were discharged no longer had access to consistent treatment and were left with nowhere to go other than to the streets and into homeless situations that would involve law enforcement from time to time (Hooley et al., 2019). This became a “failure of society to develop ways to fill the gaps in mental health care services in the community” (Hooley et al., 2019).
While yet another parallel issue developed alongside deinstitutionalization as many began falling through the cracks in other ways. This is due to some of the prevailing stigmas that are still attached to mental illness, new and developing medication that only temporarily helps to control (some) symptoms, and many opting to only being treated by their primary care physician rather than a professional therapist, (Hooley et al., 2019) including treatment being administered on an outpatient basis as opposed to the preferred inpatient care (O’Donnell et al., 2000) & (Hooley et al., 2019).
What is more disconcerting is that the lack of available facilities and mental healthcare clinicians, budget cuts, non-authorized medical insurance for hospital stays, and the inability to find adequate treatment in the community, has created a list of unintended consequences, more specifically for the disadvantaged members in society (Hooley et al., 2019).
Consider sociocultural factors: Describe the social and cultural changes that have caused shifts in the public’s perception of the disorders over time.
Sociocultural factors such as race, diverse family units, global public attitudes and perceptions, global digital technology, neighborhood options, education, and new laws and policies, affect how mental health disorders are recognized in society. These factors have had both positive and negative perceptions to how we look at mental health overall.
Since the Diagnostic and Statistical Manual of Mental Disorders (DSM) was published in 1952, which classified and established professional guidelines to address mental health disorders, provided a significant step in looking at these disorders in a more conscientious and humane manner (Vagelos College of Physicians and Surgeons, 2023).
This has offered a dramatically positive change as now individual’s who are dealing with mental health issues can now receive a more accurate professional diagnosis, treatment, and access to available healthcare insurance (Vagelos College of Physicians and Surgeons, 2023). The creation of the DSM allowed many of the professional stigmas revolving around the types of institutional facilities that were previously operational, to dissipate and to upgrade in others in order to provide better treatment.
On the other sides, many social stigma’s still exist. In many communities, whether marginalized or affluent, the personal stigma’s of shame, blame, and mistrust still exist.
In his interview with Abigail Fagan for Psychology Today, Author and Anthropologist Roy Richard Grinker, stated “Most of the world blames the family at large, God, a malevolent spirit, karma, or the stress of war, poverty, or an abusive relationship (Fagan & Grinker, 2021). Many in our society still find it hard to accept that mental illness can and does still occur and does not require an attachment for not always living up to the capitalist image of being valued in society (Fagan & Grinker, 2021).
Global technology has also opened up accessibility to more information on mental health illness to be available. This has allowed others in society to learn ways to create better perceptions on mental health illness.
Additionally, improved educational resources has opened doors for educators, health care facilitators, and communities to learn better ways to support friends, acquaintances, family members and loved ones who are dealing with mental health concerns. These, and other cultural changes, help to decrease some of the old stigma’s regarding the perception, care, management, and treatment toward those with mental health disorders.
Part Two
One selected disorder:
Anxiety Disorder: This is a disorder that is stimulated when normal stressors linger with an individual and become persistent enough and results in developing excessive worry about certain everyday events. These individuals tend to feel they have very little control over their emotions and can find it hard to complete simple daily tasks. They can also develop avoidance issues as a defense mechanism to avoid treatment.
Consider the mind-body connection: Describe whether a discernible bidirectional relationship exists between the disorder and physical illness. If so, explain.
It is well known that physical and mental health are closely related and widely agreed that they are interrelated (Doan et al., 2022) & (Green, 2023). The links between anxiety disorders and physical illness can lead to damaging or inhibit poor health behaviors that can lead to reduced health such as substance abuse, sleep disorders, and physical inactivity, just to name a few (Doan et al., 2022).
These factors can even increase the risk for more serious health concerns such as cancer or cardiovascular diseases (Doan et al., 2022). Likewise, certain mental health disorders can cause stress that triggers and induce changes to the brain (Green, 2023).
Consider the impact of language and messaging: Describe how the words we use (e.g., in casual conversation, in media communications) when discussing a disorder influence our willingness or ability to manage the disorder.
How we talk about mental ill-health in our immediate environment is critical, but it is also evolving. Words, like “nutter,” “nutcase,” and “mental,” are clearly discriminatory and should not be used (Kousoulis & Former Director of England and Wales, 2019). However, there have been strides made to illuminate some words from use under this subject, as in the use of words like “psychotic” and “neurotic” are today outdated and stigmatizing. Our language is evolving (Kousoulis & Former Director of England and Wales, 2019).
Healthcare Mediator (MHS) and founder of “MH Mediate” Dan Berstein, discussed in his 2017 TEDx Talk about how to overcome barriers in discussing mental health issues. Dan has discovered that conflict resolution through mediation was a great tool to access when communication with others regarding mental health issues in an environment where it may be difficult to do alone. These can be with family members, managers at work or with school/college administrators. Dan states,
“Mediators don’t take sides or give advice. Instead, we just listen and validate peoples perspective and ask open-ended questions…and help people get past their barriers so hey can have a dialog” (TEDx Talks & Berstein, 2017).
Simply put, Dan talked about “giving someone space to talk, and listening to how they're feeling” (How to Help Someone Seek Mental Health Support, 2017).
Consider the effect of lifestyle choices: Describe the small, but significant, changes in attitude/behavior we can make that could help us to manage the symptoms of the disorder.
We should always try to be mindful and engage in using supportive language when talking to others who are dealing with mental illness or just be proactive in just listening. When we find ourselves at a loss for words or in not having enough knowledge on a given subject to engage in conversation, its best to stay calm, be patient, listen, be reassuring, and leave assumptions behind and offer emotional support through keeping things as normal as possible
References
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Fagan, A. F., & Grinker, R. R. G. (2021, January 12). DEMENTIA The Link Between Mental Illness and Dementia. Psychology Today. https://www.psychologytoday.com/us/blog/turning-straw-gold/201109/4-tips-slowing-down-reduce-stress
Francis, & Francis. (2023, May 19). Do mental health asylums still exist? Healing Picks. https://healingpicks.com/do-mental-health-asylums-still-exist/
Green, R. (2023, May 19). The connection between mental health and physical health. Verywell Mind. https://www.verywellmind.com/the-mental-and-physical-health-connection-7255857
Galinato, M. (2018, July 6). What is the difference between neurological and psychiatric disorders? BrainFacts.org. https://www.brainfacts.org/Diseases-and-Disorders/Mental-Health/2018/What-is-the-difference-between-neurological-and-psychiatric-disorders-070618
Gluck, S. G. (2022, January 10). OCD causes: Is OCD genetic, hereditary? | HealthyPlace. Healthy Place. https://www.healthyplace.com/ocd-related-disorders/ocd/ocd-causes-is-ocd-genetic-hereditary
Harrison, D. J. H. (2023, January 24). Is generalized anxiety disorder (GAD) genetic? MentalHealth.com. https://www.mentalhealth.com/disorder/generalized-anxiety-disorder-gad/is-gad-genetic#resource-1
Hooley, J. M., Nock, M. K., & Butcher, J. N. (2019). Abnormal Psychology (18th ed.). Pearson Education (US) pg. 59. https://mbsdirect.vitalsource.com/books/9780135191033
How to help someone seek mental health support. (2017, December). Mind.com. https://www.mind.org.uk/information-support/guides-to-support-and-services/seeking-help-for-a-mental-health-problem/helping-someone-else-seek-help/#:~:text=Simply%20giving%20someone%20space%20to,feel%20lonely%2C%20and%20sometimes%20scary.
Kousoulis, A. K. & Former Director of England and Wales. (2019, May 2). Why the language we use to describe mental health matters. Mental Health Foundation. https://www.mentalhealth.org.uk/explore-mental-health/blogs/why-language-we-use-describe-mental-health-matters
O’Donnell, R., Rome, D., Godin, M., & Fulton, P. (2000). Changes in inpatient utilization and quality of care performance measures in a capitated HMO population, 1989–1999. Psychiatry. Clin. North Am., 23(2), 319–33.Rege, S. (2023, May 11). Post Traumatic Stress Disorder (PTSD) - Neurobiology and management. Psych Scene Hub. https://psychscenehub.com/psychinsights/post-traumatic-stress-disorder/
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Seladi-Schulman, J., PhD. (2022, December 8). What are nervous system (Neurological) diseases? Healthline. https://www.healthline.com/health/nervous-system-diseases
TEDx Talks, & Berstein, D. B. (2017, June 8). How to talk about mental health without offending everyone | Dan Berstein | TEDxCooperUnion [Video]. YouTube. https://www.youtube.com/watch?v=nstRHTVv0Aw
Tull, M., PhD. (2023, January 3). The link between PTSD and OCD. Verywell Mind. https://www.verywellmind.com/trauma-ptsd-and-ocd-2797516
Uwaifo, G. I. (2023, July 4). Hypercortisolism. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK551526/
Vagelos College of Physicians and Surgeons. (2023, July 20). Columbia and the DSM: The Evolution of Psychiatric Diagnosis. https://www.vagelos.columbia.edu/about-us/columbia-medicine-magazine/archives/spring-summer-2023/featured-stories/columbia-and-dsm-evolution-psychiatric-diagnosis