What Is Mental Illness?

Mental illnesses include such disorders as schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, panic, severe anxiety, personality disorders and other severe and persistent mental illnesses that affect the brain.

These disorders can profoundly disrupt a person's thinking, feeling, moods, ability to relate to others and capacity for coping with the demands of life.

Mental illnesses can affect persons of any age, race, religion, or income. Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing.

Mental illnesses are treatable. Most people with serious mental illness need medication to help control symptoms, but also rely on supportive counseling, self-help groups, assistance with housing, vocational rehabilitation, income assistance and other community services in order to achieve their highest level of recovery.

Here are some important facts about mental illness and recovery:

  • Mental illnesses are biologically based brain disorders.  They cannot be overcome through "will power" and are not related to a person's "character" or intelligence.
  • Mental disorders fall along a continuum of severity. The most serious and disabling conditions affect five to ten million adults (2.6 – 5.4%) and three to five million children ages five to seventeen (5 – 9%) in the United States. 
  • Mental disorders are the leading cause of disability (lost years of productive life) in the North America, Europe and, increasingly, in the world. By 2020, Major Depressive illness will be the leading cause of disability in the world for women and children.  
  • Mental illnesses strike individuals in the prime of their lives, often during adolescence and young adulthood. All ages are susceptible, but the young and the old are especially vulnerable.
  • Without treatment, the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives; The economic cost of untreated mental illness is more than 100 billion dollars each year in the United States.
  • The best treatments for serious mental illnesses today are highly effective; between 70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports;
  • Early identification and treatment is of vital importance; By getting people the treatment they need early, recovery is accelerated and the brain is protected from further harm related to the course of illness.
  • Stigma erodes confidence that mental disorders are real, treatable health conditions. We have allowed stigma and a now unwarranted sense of hopelessness to erect attitudinal, structural and financial barriers to effective treatment and recovery. It is time to take these barriers down.

Anosognosia (lack of insight)

What is anosognosia?

When a person cannot understand that they have a serious psychiatric illness, a tremendous challenge to family members and caregivers can ensue.  About one half of people living with schizophrenia, and a smaller percentage who live with bipolar disorder, have this clinical feature.  Individuals with Alzheimer’s disease and dementia also often have this feature.  The medical term for not seeing what affects you is anosognosia – also known as lack of insight or lack of awareness.  Having a lack of awareness raises the risks of treatment and service non adherence.  From the peron’s point of view, if they feel they are not ill, why should they go to appointments, take medication or engage in therapy?

Why can’t a person see what is so apparent to those around them?

The best thinking indicates this is a core feature of the neurobiology of the mental illness.  Frontal lobes organize information and help interpret experiences.  In conditions like schizophrenia and Alzheimer’s disease, frontal lobe difficulty is central to the neurological processes that underlie the disorders.  Psychological denial is not the reason for the lack of insight into these illnesses.

What can you do?

Efforts to get people to see that the are ill are frequently fraught with frustration and may be met with denial or anger.  Approaching the person in a supportive way will be beneficial for your relationship.  Finding out what goals a person has, such as getting a job, forming relationships and living independently, can be a good place to start engaging in next steps.  Check to see if the service system has outreach workers who work on engaging people who lack insight.  Working with the person’s goals does not mean you have to pretend he or she is well.  For example, if the person applies for disability services, encourage the doctor to review the diagnosis:  getting the person to agree to disagree can be a first step.  You don’t need to argue about diagnosis to have a person participate in or respect basic household chores and rules.

There are situations where a person’s lack of insight can create dangerous situations.  This combination of no insight and dangerous acts often requires intervention.  In more than 40 states, there are laws for Assisted Outpatient Treatment (AOT), also known as outpatient commitment.  AOT status requires a person to engage in treatment and gives the state authority to bring the person to a treatment center if they do not.  All states that have these laws have protections and a process for assessing whether this intervention is appropriate.  In most states, doctors are required to submit an affidavit of the person’s state and the reasons for the requested AOT status and a judge decides.

Adapted information  provided by NAMI, National Alliance on Mental Illness.