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Suzanne Allison

      From that day on, there were times Nash was productive, but there were also times when he had disordered thoughts, mumbled to himself without thought of those around him, and experienced delusions of situations that did not exist. He felt there were individuals around him who put him in danger. He even wrote letters to officials in the U.S. government to suggest that these individuals were setting up alternative governments. John Nash suffered from schizophrenia.

      In Terri Cheney’s memoir, Manic (2008), the author, who rose to success as an entertainment attorney in Beverly Hills, told of her experience of exceptional energy. She described one time she was in Santa Fe, New Mexico:

      The mania came in four-day spurts. Four days of not eating, not sleeping, barely sitting in one place for more than a few minutes at a time. Four days of constant shopping—and Canyon Road is all about commerce, however artsy its façade.

      She further described her experiences:

      Mostly, however, I talked to men. Canyon Road has a number of extremely lively, extremely friendly bars and clubs, all of which were in walking distance of my hacienda. It wasn’t hard for a redhead with a ready smile and a feverish glow in her eyes to strike up a conversation and then continue that conversation well into the early-morning hours, his place or mine. (pp. 6–7)

      —Excerpt from Manic by Terri Cheney. Copyright © 2008, 2009 by Terri Cheney. Reprinted by permission of HarperCollins Publishers.

      Of course, many individuals experience feelings of high energy or sexuality that would not be considered a mental disorder. However, as you will see in Chapter 6 on mood disorders, those with bipolar disorder often experience high levels of energy for long periods of time and an intense desire to engage in sexual activity, gambling, or shopping. Our task is to understand which types of activities would be considered as psychopathology or mental illness.

      Understanding Psychopathology: Definitions and Key Considerations

      At one time in our history, health professionals made a sharp distinction between physical disorders and mental disorders—physical disorders involved the body, and mental disorders involved the mind. For example, addiction was at one time seen as a lack of will, with little to do with physiology. Today, we have come to see the close connection of the brain with what were previously considered mental processes. Mental disorders are brain disorders. Further, those physiological processes involved in physical disorders such as the immune system, the turning on and off of genes, and the chemical processes of the body are also equally involved in mental disorders.

      In this book, I will use the terms psychopathology, mental disorders, or mental illness to refer to those disorders traditionally described in scientific and professional research and practice. Psychopathology is the word commonly used in the neurosciences and the one you would want to use when performing literature searches in research and clinical journals. Abnormal psychology as a research area has a long tradition in psychology, and I will refer to this tradition by that term.

      Defining Psychopathology and Understanding Its Components

      Mental disorders are part of our human condition. We have many names for these conditions. We speak of people with mental illness. For over a century, psychologists have studied these conditions in terms of abnormal psychology, which is the study of abnormal behavior. Others have used the term psychopathology. This is in contrast with pathophysiology, or pathology of our physiology. Slang words such as crazy or nuts have been around for hundreds of years. One of the oldest terms is insanity, or insane, which comes from the Latin meaning “not healthy.”

      Mental disorders have been with us throughout our human history. Since the time that written language became a part of our experience, humans have included descriptions of mental disorders. We find such descriptions in Egyptian, Greek, Chinese, Indian, and other texts throughout world history. Today, our films, novels, plays, and television programs often portray problems experienced by those with mental disorders.

      abnormal psychology: the study of psychological dysfunctions that the person experiences in terms of distress or impairment in functioning; a complete definition of abnormal behavior includes behaviors and experiences accepted in the person’s culture

      psychopathology: the scientific study of mental illness and its causes

      The experiences of the individuals described in the chapter opening give us insights into the nature of mental illness. Terri Cheney told how she experienced great energy, which lasted for 4 days. She described the experience of mental illness as something happening to her. In this sense, Terri Cheney and John Nash did not feel they had an alternative way of acting. Thus, one important characteristic of mental illness is the lack of control over one’s experience. This can also be described as a loss of freedom or an inability to consider alternative ways of thinking, feeling, or doing. Some individuals show this loss mainly in terms of emotional experiences, as in the case of Terri Cheney with bipolar disorder. Others show the loss in terms of cognitive processes, such as the experiences of John Nash. At the beginning of many of the chapters of this book, you will read first-person accounts from individuals with particular disorders.

      Another common theme seen in psychopathology is the loss of genuine personal contact. Individuals with depression or schizophrenia often find it difficult to have social interactions as experienced by other people. Just having a simple conversation or talking to clerks in stores may seem impossible. Mental illness not only affects individuals’ interpersonal relationships but also their relationship with themselves, their intrapersonal relationship. When individuals with schizophrenia or depression talk to themselves, they often think negative thoughts about who they are and what will happen in the future.

      In addition, in most cases, the experience of a mental disorder results in personal distress. Not being able to get out of bed, or feeling that a voice in your head is telling you that you are evil, or worrying that even a rice cake or an apple will make you fat all represent different degrees of distress. Thus, we can consider four important personal components in psychopathology.

      These are first, a loss of freedom or ability to consider alternatives; second, a loss of genuine personal contact; third, a loss of connection with one’s self and the ability to live in a productive manner; and fourth, personal distress. As you will see with the disorders presented in this book, personal distress over time is one of the criteria required for a diagnosis to be made. There is also a more global component in which the person’s behavior and experiences are considered to be deviant in terms of cultural and statistical norms.

      Table 1.1

      Today, the National Institute of Mental Health (NIMH) estimates that at least 18.1% of the U.S. population experiences a diagnosable mental disorder during a given year (http://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-us-adults.shtml). This represents almost 48 million people in the United States (see Figure 1.1).

      Having a mental disorder results in lost productivity, lost personal enjoyment, and potentially even premature death. The World Health Organization (WHO) estimated that in the United States and Canada, mental disorders cause a greater loss in what they refer to as disability-adjusted life years (DALYs) than cardiovascular disease or cancer. DALYs represent the total number of years lost due to illness, disability, or premature death (http://www.nimh.nih.gov/health/statistics/disability/file_148328.pdf).

      With mental illness being so common, you might think that we as humans would have a complete understanding of the factors involved. However, this is not the case. We are

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