Some 27 million adults and 7.5 million children in the United States suffer from a mental illness–that’s more than the combined number of people with cancer, heart disease and lung disorders. Though so many people are troubled by mental health disorders, the majority of them do not seek help. The tragedy of this is that in the last two decades, treatments have emerged that can lead to recovery for most sufferers.
Just as the body can break down under the strain of day-to-day living, so can the mind. Unfortunately, many people with emotional problems do not realize what’s wrong. Others mistakenly believe that nothing can help, or that they can simply “pull themselves up by their bootstraps.” While it’s normal to occasionally feel discouraged, unhappy, or inadequate, it’s not okay to feel sad, anxious or angry for long stretches of time. It’s wise to reach out for help when you can’t spring back from such moods or when emotional difficulties (even if they’re not severe) begin to interfere with work, relationships or other aspects of your life. The sooner a problem is diagnosed, the sooner recovery can begin.
Common Mental Disorders
Just about everyone experiences bouts of anxiety or the blues, but what distinguishes mental disorders from simply feeling down in the dumps is their severity or persistence over time. The following is a description of the most common mental disorders:
1) Anxiety disorders are the most prevalent type of mental illness. Such disorders include generalized anxiety disorder, marked by feelings of tension or distress in the absence of any identified stress or threat; panic attacks, episodes of sudden, inexplicable terror; and phobias, inordinate fears of certain objects or situations.
2) Major Depression, like anxiety, affects both mind and body. People who are depressed often feel a sense of helplessness, hopelessness or despair. They lose interest in their favorite activities, may experience changes in appetite, weight and sleep patterns, have difficulty concentrating, and be preoccupied with death or suicide.
3) Dysthymia is chronic, mild depression. Although this condition is less intense than major depression, people with dysthymia are depressed most of the day, and more days than not, for a period of at least two years. They may feel a sense of hopelessness, have low self-esteem, eat and sleep more or less than usual, lack energy, and have problems concentrating or making decisions.
4) Substance Abuse is characterized by the repeated and uncontrollable use of alcohol or a drug. According to the American Psychiatric Association, 10 million adults and 3 million children under age 18 are alcoholics.
| Most Common Mental Disorders Among Americans | % Affected in the Past Year | % Affected at Some Point in Life |
| Anxiety Disorders (including phobias) | 17% | 25% |
| Major Depression | 10 | 17 |
| Alcohol dependence or abuse | 7 | 14 |
| Drug dependence or abuse | 4 | 12 |
| Dysthymia (chronic mild depression) | 3 | 6 |
Source: Kessler, Ronald et al. “Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the United States,” Archives of General Psychiatry, vol. 51, January 1994.
How Do You Know If You Need Help?
If you are unsure about whether to seek help for a psychological or emotional problem, ask yourself, “Could I use some help right now?” not, “Am I mentally ill?” The questions below may help you decide:
- Is the problem interfering with your work, relationships or other aspects of your personal life?
- Have you been feeling less happy, less confident and less in control than usual for a period of several weeks or longer?
- Have close, trusted friends or family members commented on changes in your behavior and personality?
- Have your own efforts to deal with a problem failed to change your behavior or improve the situation?
- Is dealing with everyday problems more of a struggle than before?
Does a Loved One Need Help?
If you notice changes in the personality or behavior of a partner, parent or friend, it helps to pull back and look at this person as objectively as possible. What precisely seems to have changed? In what ways is this person acting differently? How long have you noticed these changes? Do they seem to be getting worse? In particular, ask whether this person:
- Has seemed sad, depressed or moody for several weeks
- Seems to lack energy and feels tired all the time
- Doesn’t seem to get any pleasure from enjoyable activities
- Complains of problems sleeping
- Seems preoccupied with death or talks about suicide
- Has extreme mood swings
- Seems tense, nervous or restless
- Appears confused or has problems concentrating or thinking
- Experiences sudden feelings of panic or terror
- Has become extremely suspicious or fearful of others
- Is unusually irritable
- Has difficulty getting along with people at home or work
- Drinks more than usual
- Uses illegal drugs
- Has not bounced back from a crisis or loss that happened several months ago
- Seems unable to control or stop destructive behavior, like gambling
- Has lost interest in sex or cannot perform as usual
- Complains of troubling physical symptoms that, according to doctors, have no known medical cause
- Mentions unrealistically bizarre or grandiose ideas
- Has become threatening, aggressive, or violent
If you identify specific signs of trouble, you may want to talk to other family members and friends to see if they have also spotted these changes. Depending on your relationship with the individual, you may choose different ways of expressing your concerns. A spouse may try to have a quiet, intimate conversation. Close friends may choose to put their worries into a letter or to get together with others and voice their shared concerns.
If your loved one refuses absolutely to hear what you are saying, but you think he or she is being self-destructive, is suicidal or may cause harm to others–do not hesitate to contact a mental health professional immediately. If the situation is not so extreme but the person’s behavior is clearly off base and getting more so, the best option may be going to see a mental health professional yourself. Often skilled and experienced therapists can offer insight and advice into how to deal with your particular circumstances.
According to the National Mental Health Advisory Council and the American Psychiatric Association, treatments for severe mental illnesses are as effective or more effective than those available in other branches of medicine, including surgery. For example, treatments tailored to each individual’s condition and needs can help 80 to 90 percent of those suffering from depression and manic-depression and 70 to 80 percent of those with panic disorder.
1) Psychotherapy. Talking to a psychological counselor can provide relief, lead to new insights, and help replace unhealthy behaviors with more effective ways of coping with problems. Most mental health professionals tailor their approach to the needs, problems, and personality of the person seeking help, and they may combine different techniques in the course of therapy. Many individuals are turning to short-term psychotherapy which may last several weeks to several months. Most likely to benefit are those interested in solving an immediate problem. Here are various types of therapy available:
- Psychodynamic Psychotherapy. Psychodynamic therapists discuss their patients’ early experiences and repressed feelings in order to provide insight into current problems and to bring about behavioral change. Therapy may be brief or it may continue for several years (i.e., Freudian psychoanalysis is often a lengthy process requiring four to five sessions a week over a period of months or years).
- Interpersonal Therapy (IPT). IPT does not delve into the psychological origins of symptoms, rather it concentrates on relationships as the key to understanding and overcoming emotional difficulties. The overall goal of IPT is to relieve symptoms of depression, improve self-esteem, and help patients get what they want or need from relationships in a positive way. The bond that the client develops with the therapist is a crucial component of this therapy. People with major depression, chronic difficulties developing relationships, dysthymia or bulimia are most likely to benefit.
- Supportive Psychotherapy. The goal of supportive psychotherapy, which can be brief or long-term, is to help men and women who may temporarily feel unable to cope during times of great stress, such as after learning that they have a serious physical illness. It also helps those with severe psychiatric disorders, like schizophrenia. Although many people think of supportive psychotherapy as simply giving comfort and advice, the process is far more complex and may include many therapeutic techniques, including education, reassurance, reinforcement, setting limits, social skills training and medication.
- Cognitive Therapy. According to proponents of this approach, how you feel is the result of how you think. Cognitive therapists help patients identify distorted or negative ways of thinking and replace them with more positive perceptions. Depression is relieved by altering an unrealistically negative view of one self and the world. People with major depression or anxiety disorders may benefit most.
- Behavioral Therapy. This approach is based on the premise that depressed individuals behave in ways that bring about negative consequences. Behavioral counselors help people change what they do in order to change how they feel. People may be encouraged to become more active or add pleasurable activities to their lives, learn to assert themselves, relax, or modify their reactions to unsettling daily experiences. Behavior therapies work best for disorders characterized by specific, abnormal patterns of acting, such as alcohol and drug abuse, anxiety disorders and phobias, and for changing destructive habits or inappropriate behavior patterns.
2) Psychiatric Drugs. Mental health care has been revolutionized thanks to the recent development of a new generation of effective medications, called selective serotonin receptor inhibitors, including fluoxetine (Prozac), sertaline (Zoloft) and paroxetine (Paxil). These drugs, which alter brain chemistry and relieve psychiatric symptoms, can be used in conjunction with psychotherapy or as the primary treatment. They can alleviate tremendous suffering and lower the costs of mental illness by reducing the need for hospitalization and by restoring a person’s ability to live up to his or her potential. They can improve an individual’s alertness, attention, coordination, energy, mood, judgment, sleep patterns and relationships.
The prescribing physician must take a thorough history of a patient, including the presence of any emotional disorders in family members, and assess his or her overall health to rule out any illnesses that might be causing psychiatric symptoms. Doctors must also weigh the benefits and risks. While many psychiatric drugs are not habit-forming, others can be if they’re not taken with appropriate caution. And as with any drug, these can cause side effects that range from mildly irritating (dry mouth, for example) to more bothersome (dizziness or constipation) to life-threatening (seizures or arrhythmias). Mild side effects tend to diminish or disappear after a few weeks.
If a particular psychiatric drug does not help, there are many alternatives. Psychiatrists with an expertise in drug therapy can usually find a medication that works even if it means switching drugs several times. In some cases, psychiatrists prescribe more than one medication to be taken at the same time. The use of combined medications requires clinical expertise as well as close supervision to ensure maximum benefits and minimal complications. These are some of the questions consumers should ask prior to beginning drug therapy:
- Why do you feel medication is necessary?
- What specific symptoms will it relieve?
- What are the possible side effects?
- How long will it take the medication to work?
- Do I have to avoid eating before or after taking it?
- How can I tell if the drug is working?
- Is there any danger from skipping a dose?
- What are the risks of overdosing?
- Should I avoid other medications, alcohol or certain foods while I take this medication?
- How long will I have to take this drug?
- Is there a danger that I’ll become addicted?
- What if this medication doesn’t work?
Simple Ways to Ease Your Mind
Self-help strategies play an important role in maintaining mental health. Among the most useful are:
- Exercise. Studies show that aerobic workouts, such as walking or jogging, greatly improve the mood of mildly depressed or anxious individuals. Even non-aerobic exercise, such as weight-lifting, can boost spirits, improve sleep and appetite, reduce irritability and anger and produce feelings of mastery and accomplishment.
- Tuning into Problems. Analyzing recent events to identify possible sources of stress, either alone or with a close friend or loved one, can help a person regain a better perspective. If life has been particularly tumultuous, a lazy weekend away may make help.
- Self-talk. All of us silently “talk” to ourselves, commenting on how we look and act. Individuals whose inner voice is constantly critical should try to make note of unrealistically negative or critical remarks and focus more on the things they like about themselves.
- Keep a Journal. Writing about problems and concerns in a psychological journal can ease anxiety and help individuals work through painful feelings. To get started, reflect upon each day or week, and identify the most meaningful parts of it. If you experience an intense emotion–positive or negative–write down the circumstances and the effects of the Experience. Analyze any encounter that makes you feel bad.
- Self-help Groups. Many people with physical or mental disorders find that talking with people with similar problems is extremely useful. Hospitals and community mental health centers often sponsor informal support groups. Such groups, especially those associated with a specific problem such as depression or alcoholism, also help in preventing recurrences and relapses.
Who Can Help?
Anyone can hang out a shingle that says “psychotherapist,” but this is not an official designation. In general, it’s best to turn to licensed counselors (see below) who have demonstrated a basic level of competence and have passed state or national qualifying examinations.
Before selecting a mental health professional, check his or her background with the national associations or their local chapters (see “For More Information“). The National Mental Health Association advises avoiding any person or organization that: Will not answer questions satisfactorily, promises financial rewards if you participate in a program, pressures you through a third party, offers or implies a guarantee of success, or tries to involve you in a long-term financial commitment.
The most common types of mental health professionals:
- Psychiatrists are licensed medical doctors (M.D.s), and they can prescribe medications. These physicians complete medical school, a year-long internship that includes training in internal medicine and neurology, and a three-year residency program that provides training in various forms of psychotherapy (including couples, family and group therapy) and psychopharmacology (the study of drugs that affect the mind). Board-certified psychiatrists have passed oral and written examinations following their residency.
- Psychologists may have a Ph.D. in psychology or a Psy.D. (doctorate in clinical psychology). They are trained in a variety of psychotherapeutic techniques rather than in one particular school or theory. Some have additional training in working with children and/or families. However, they do not study medicine and cannot prescribe medication. Psychologists must be licensed in most states in order to practice independently.
- Certified social workers or licensed clinical social workers (LCSWs) usually complete a two-year graduate program (some have doctoral degrees), plus specialized training in assessment and treatment of emotional disorders. Most states certify or license social work as an independent profession, requiring two years of supervised post-graduate clinical work and a qualifying examination.
- Marriage and family therapists are licensed in some but not all states. They usually have a graduate degree, often in psychology, and at least two years of supervised clinical training in relationship problems. Psychiatrists, psychologists and clinical social workers may devote much of their practices to helping couples and families. In the course of therapy, a person may see several professionals. For example, a social worker may refer a client to a psychiatrist to determine whether medications are needed. A psychiatrist may suggest that an individual undergoing individual treatment for a mental disorder also participate in couples therapy with a marital counselor.
How To Get A Referral
In order to get the names of several therapists, ask your own physician, mental health professionals you know, friends or relatives who are in treatment, or an employee assistance program where you work. If you belong to a health maintenance organization or another health care plan, you should have a list of participating therapists; your “gatekeeper” or primary care physician may have to make a referral.
Within the community, city or county health departments, neighborhood health centers, hospital clinics and local branches of national service organizations, may offer help or provide referrals. Mental health clinics usually charge lower fees, often based on a sliding scale according to income, and they offer a wider range of services than any single therapist might. However, clinics often have waiting periods and limit the number of therapy sessions. In addition, therapists usually are assigned, rather than chosen by the consumer.
Cost can be a barrier to getting mental health care. Health insurance policies and health care programs and organizations may pay only part of a therapist’s fee or limit coverage to a preset number of sessions or days of treatment in a hospital or residential facility. Check your own health coverage. If you do not have mental health coverage, local and state agencies and advocacy groups may be able to direct you to publicly supported services or suggest ways of handling the costs of treating mental health.
Choosing A Therapist
Think of yourself as a savvy consumer when you start looking for a psychological counselor. First, arrange a brief telephone interview. Explain who referred you and what is troubling you. Mention if you have a specific treatment in mind. If that therapist cannot help you, he or she may be able to suggest an alternative treatment or refer you to a colleague who has the expertise you want. You should not hesitate to talk about fees, insurance coverage, payment plans and other practical matters in this introductory call. The initial phone conversation with a therapist sets the stage for building a rapport in therapy. Ideally, you should feel that the therapist has listened to you and will work to understand you and your problem. If you decide that he or she is likely to meet these criteria, set up a consultation. Be sure to inquire if you can have a free trial visit and, if not, what the fee will be.
Once you’ve met with one or more mental health professionals and discussed treatment options, use your instincts as well as your intelligence to make a final decision. Remember, a therapist who is not understanding and caring probably is not the right choice regardless of that person’s qualifications or reputation. Here are some considerations and questions to keep in mind:
- Do you feel the therapist takes you seriously, treats you with respect, and shares or accepts your values?
- Is your therapist willing to explore all treatment options to find what works best for you?
- If the therapist is not a physician and medication may be necessary, how will your care be coordinated? Who will be your primary therapist? Who will prescribe and monitor your medication?
- If you decide to involve a partner or family member, will your therapist help educate that person about your problem and explain how to help you manage it?
- • Will he or she be supportive if you want a second opinion about treatment and work with you to evaluate others’ recommendations?
If after a few months you don’t feel that you are making progress, discuss this with your therapist. Almost always, there are ways of augmenting or bolstering treatment, or combining therapies to be more effective. Or you may need a different therapist.
Our thanks to Carol Koplan, M.D., Consultant, Carter Center, Mental Health Program, Atlanta, GA, for reviewing this article.
Major Depression
The incidence of major depression has soared over the last two decades. According to data from the National Institute of Mental Health (NIMH), Some 9.4 million Americans develop major depression at some point in life. Unfortunately, fewer than one of every three depressed people ever seeks treatment. One reason is that many people still do not think of depression as a real condition that should be treated. This perception is wrong. Depression is a potentially life-threatening disorder.
The characteristic symptoms of major depression include:
- Feeling depressed, sad, empty, discouraged, for several weeks
- Loss of interest or pleasure in once-enjoyable activities (like sex)
- Gaining or losing weight
- Sleeping too little or too much
- Feeling slowed down or restless
- Lack of energy
- Feeling helpless, hopeless, worthless, inadequate
- Difficulty thinking clearly, making decisions or concentrating
- Persistent thoughts of suicide
- Withdrawal from others
- Physical symptoms (headaches, digestive problems, and pains)
Most cases of major depression can be successfully treated, usually with psychotherapy, medication or both. Psychotherapy alone works in more than half of mild-to-moderate episodes of major depression. Two specific psychotherapies–cognitive-behavioral therapy and interpersonal therapy–have proved as helpful as antidepressant drugs in treating mild cases of depression, although they take longer than medication to achieve results. Antidepressant drugs work in more than half of those with moderate to severe depression and may be useful in treating mild depression in people who do not improve with psychotherapy alone. These medications generally take three or four weeks to produce significant benefits and may not have their full impact for up to eight weeks. Combining psychotherapy and medication helps individuals with severe chronic or recurrent major depression as well as those who do not fully improve with medication or psychotherapy alone.
In people with moderate or severe major depression who cannot take antidepressant medications because of medical problems or who do not improve with psychotherapy or drugs, electroconvulsive therapy (ECT)–the administration of a controlled electrical current to the scalp–is the safest and most effective treatment.
About 75 to 80 percent of depressed patients improve dramatically within three to four months of starting psychotherapy and/or antidepressant medication. Signs of improvement should be evident within about eight weeks. If you or someone you know does not experience any relief within that amount of time, talk to the physician or therapist or seek a second opinion. A change in therapy approach, medication or dosage may make a significant difference.
“Maintenance” therapy with medication and/or psychotherapy can lower the risk of recurrence of depression. Some people may continue on medication indefinitely. Others gradually reduce their dosage over time.
Other forms of depression include: Manic depression, which causes mood swings that may take people from ‘manic’ states of feeling euphoric and energetic to depressive states of utter despair. In episodes of full mania, a person may become so impulsive and out of touch with reality that their careers, relationships, health and survival are endangered.
Medication is the keystone of treatment, although psychotherapy plays a critical role in helping people understand their illness and rebuild their lives. Lithium carbonate, a natural mineral, helps in both treatment and the prevention of recurrences. Other medications, primarily anticonvulsant drugs, are also playing an increasingly important role.
Seasonal affective disorder (SAD) is a form of depression triggered by the shorter periods of light in winter. Annual episodes usually begin in the fall and end in March or April, with the coming of spring.
According to NIMH estimates, some 10 million Americans have SAD. Sufferers feel helpless, guilt-ridden and have difficulty thinking and making decisions. They typically crave carbohydrate-rich foods and gain weight during the cold months, and spend many more hours asleep, yet feel chronically exhausted.
SAD often improves with phototherapy, a treatment that involves sitting in front of a specially designed light box for about an hour every day during the wintertime. Severe SAD may require both phototherapy and antidepressant medications.
The Toll of Mental Illness
Mental disorders can alter forever a life course, destroy dreams, shatter relationships and cost billions of dollars. Consider some statistics:
- Each year 29,000 Americans, most with treatable forms of mental illness, take their own lives.
- The depressive disorders alone–treated and untreated–cost the US nearly $44 billion a year, according to researchers from the Massachusetts Institute of Technology and the Analysis Group of Boston. Direct costs, including medication and psychotherapy, come to about $12 billion. Indirect costs, such as decreased productivity and absences from work, total $23.8 billion annually.
- The mentally ill make up the largest single disabled group and account for one fourth of all recipients of federal disability funds.
- Schizophrenia is more prevalent than Alzheimer’s disease, insulin-dependent diabetes, multiple sclerosis or muscular dystrophy. People with this illness occupy one-fourth of the nation’s hospital beds and account for forty percent of treatment days at long-term care facilities.
The following organizations offer information and free pamphlets on various mental illnesses. Local chapters of these organizations can give you professional referrals and guide you to low-cost treatment programs in the area:
- National Institute of Mental Health
301-443-4513 - National Mental Health Association
703-684-7722 - National Alliance for the Mentally Ill
800-950-NAMI - National Mental Health Consumers’ Self-Help Clearinghouse
800-553-4539 - American Association for Marriage and Family Therapy
800-374-2638 - The American Psychiatric Association
202-682-622
