Section 7. Mental Health Disorders

Chapter 98. Overview of Mental Health Care

Topics: Introduction | Mental Illness in Society | Classification and Diagnosis of Mental Illness | Treatment of Mental Illness

Treatment of Mental Illness

Extraordinary advances have been made in the treatment of mental illness. An understanding of what causes some mental health disorders has led to greater sophistication in tailoring treatment to the underlying basis of each disorder. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders.

Most treatment methods for mental health disorders can be categorized as either somatic or psychotherapeutic. Somatic treatments include drug therapy and electroconvulsive therapy. Psychotherapeutic treatments include individual, group, or family and marital psychotherapy; behavior therapy techniques (such as relaxation training or exposure therapy); and hypnotherapy. Most studies suggest that for major mental health disorders, a treatment approach involving both drugs and psychotherapy is more effective than either treatment method used alone.

Psychiatrists are not the only mental health care professionals trained to treat mental illness. Others include clinical psychologists, social workers, nurses, and some pastoral counselors. However, psychiatrists are the only mental health care professionals licensed to prescribe drugs. Other mental health care professionals primarily practice psychotherapy.

See the table Types of Mental Health Care Professionals.

Drug Therapy

Over the last 40 years, a number of psychoactive drugs have been developed that are highly effective and widely used by psychiatrists and other medical doctors. These drugs are often categorized according to the disorder for which they are primarily prescribed. For example, antidepressants are used to treat depression. Selective serotonin reuptake inhibitors are the newest and most widely used class of antidepressants. Other new classes of antidepressants are being developed. Antipsychotic drugs, such as chlorpromazine, haloperidol, and thiothixene, are helpful in treating psychotic disorders such as schizophrenia. Newer antipsychotic drugs, such as clozapine, risperidone, olanzapine, and quetiapine, are increasingly being used because they have fewer side effects. Antianxiety drugs, such as clonazepam and diazepam, as well as selective serotonin reuptake inhibitors (which are antidepressants), are used to treat anxiety disorders, such as panic disorder and phobias. Mood stabilizers, such as lithium, carbamazepine, and valproate, have been used with some success to treat manic-depressive illness (bipolar disorder).

Electroconvulsive Therapy

With electroconvulsive therapy, electrodes are attached to the head, and a series of electrical shocks are delivered to the brain to induce seizures. This therapy has consistently been shown to be the most effective treatment for severe depression. Many people treated with electroconvulsive therapy experience temporary memory loss. However, contrary to its portrayal in the media, electroconvulsive therapy is safe and rarely causes any other complications. The modern use of anesthetics and muscle relaxants has greatly reduced any risk to the person.

Psychotherapeutic Treatments

In recent years, significant advances have been made in the field of psychotherapeutic treatments. Psychotherapy, sometimes referred to as "talk" therapy, works on the assumption that each person has within himself the cure for his own suffering and that this cure can be facilitated through a trusting, supportive relationship with a psychotherapist. By creating an empathetic and accepting atmosphere, the therapist often is able to help the person identify the source of his problems and consider alternatives for dealing with them. The emotional awareness and insight that the person gains through psychotherapy often results in a change in attitude and behavior that allows the person to live a fuller and more satisfying life.

Psychotherapy is appropriate in a wide range of conditions. Even people who do not have a mental health disorder may find psychotherapy helpful in coping with such problems as employment difficulties, bereavement, or chronic illness in the family. Group psychotherapy, couples' therapy, and family therapy are also widely used.

Most mental health professionals practice within one of five types of psychotherapy: psychoanalysis, psychodynamic psychotherapy, cognitive therapy, behavior therapy, or interpersonal therapy.

Psychoanalysis is the oldest form of psychotherapy and was developed by Sigmund Freud in the first part of the 20th century. The person typically lies on a couch in the therapist's office 4 or 5 times a week and attempts to say whatever comes into his mind, a practice called free association. Much of the focus is on understanding how past patterns of relationships repeat themselves in the present. The relationship between the person and the therapist is a key part of this focus. An understanding of how the past affects the present helps the person develop new and more adaptive ways of functioning in relationships and in work settings.

Psychodynamic psychotherapy, like psychoanalysis, emphasizes the identification of unconscious patterns in current thoughts, feelings, and behaviors. However, the person is usually sitting instead of lying on a couch and attends only 1 to 3 sessions per week. In addition, less emphasis is placed on the relationship between the person and therapist.

Cognitive therapy helps people identify distortions in thinking and understand how these distortions lead to problems in their lives. The underlying premise is that how people feel and behave are determined by how they interpret experiences. Through the identification of core beliefs and assumptions, people can begin to think in different ways about their experiences, resulting in improvement in symptoms, behavior, and feelings.

Behavior therapy is related to cognitive therapy. Sometimes, a combination of the two, known as cognitive-behavior therapy, is used. The theoretical basis of behavior therapy is learning theory, which holds that abnormal behaviors are due to faulty learning. Behavior therapy involves a number of interventions that are designed to help the person unlearn maladaptive behaviors while learning adaptive behaviors. Exposure therapy is one example of a behavior therapy (see Section 7, Chapter 100).

Interpersonal therapy was initially conceived as a brief psychologic treatment for depression and is designed to improve the quality of a depressed person's relationships. It focuses on unresolved grief, conflicts that arise when people fill roles that differ from their expectations (such as when a woman enters a relationship expecting to be a stay-at-home mother and finds that she must also be the major provider for the family), social role transitions (such as going from being an active worker to being retired), and difficulty communicating with others. The therapist teaches the person to improve aspects of interpersonal relationships, such as overcoming social isolation and responding in a less habitual way to others.

Hypnosis and Hypnotherapy

Hypnosis and hypnotherapy are often used to manage pain and treat physical disorders that have a psychologic component. Hypnosis is simply the induction of a trance or altered state of consciousness, whereas hypnotherapy involves psychotherapeutic intervention in conjunction with the hypnotic state. These techniques may promote relaxation and thereby lower anxiety and reduce tension. For example, hypnosis and hypnotherapy can help people with cancer who have anxiety or depression in addition to pain.