A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a name for community personnel who worked in the new community mental health agencies begun in the 1970s to assist individuals moving from state hospitals, to prevent admissions, and to provide support in homes, jobs, education, and community. These individuals (i.e., state office personnel, private sector personnel, and non-profit, now voluntary sector personnel) were the forefront brigade to develop the community programs, which today may be referred to by names such as supported housing, psychiatric rehabilitation, supported or transitional employment, sheltered workshops, supported education, daily living skills, affirmative industries, dual diagnosis treatment,[1] individual and family psychoeducation, adult day care, foster care, family services and mental health counseling.
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Introduction

Flint's Water and the American Urban Tragedy: A Personal Journey

Flint's Water and the American Urban Tragedy

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Introduction

Fostering Mental Health and Wellbeing Within the Family Unit

Fostering Mental Health and Wellbeing Within the Family Unit

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Stigma, originally referring to the visible marking of people considered inferior, has evolved in modern society into a social concept that applies to different groups or individuals based on certain characteristics such as socioeconomic status, culture, gender, race, religion, and health status. Social stigma can take different forms and depends on the specific time and place in which it arises. Once a person is stigmatized, they are often associated with stereotypes that lead to discrimination, marginalization, and psychological problems.[1]

The Impact of Stigma on Mental Health: Breaking Down Barriers and Building Understanding

Stigma, originally referring to the visible marking of people considered inferior, has evolved in modern society into a social concept that applies to different groups or individuals based on certain characteristics such as socioeconomic status, culture, gender, race, religion, and health status. Social stigma can take different forms and depends on the specific time and place in which it arises. Once a person is stigmatized, they are often associated with stereotypes that lead to discrimination

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Recovery coaching is a form of strengths-based support for people with addictions or in recovery from alcohol, other drugs, codependency, or other addictive behaviors.[1] There are multiple models, with some programs using self-identified peers who draw from their own lived experience with substance use and recovery and some utilizing people who have no lived experience but some training in support, depending on local standards and availability.[2] They help clients find ways to stop addiction (abstinence) or reduce harm associated with addictive behaviors. These coaches can help a client find resources for harm reduction, detox, treatment, family support and education, local or online support groups; or help a client create a change plan to recover on their own.[3]

The Ultimate Guide to Recovery Coaching: What You Need to Know

Recovery Coaching

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Introduction

The Controversial Legacy of 'The Birth of a Nation' by D.W. Griffith: A Critical Analysis

The Controversial Legacy of 'The Birth of a Nation' by D.W. Griffith: A Critical Analysis

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Schizophrenia is a challenging mental health condition that impacts millions globally. Navigating the path to recovery can feel overwhelming, but support groups are essential in this journey. One such group is Schizophrenia Anonymous (S.A.), which creates a welcoming space for those facing the intricacies of schizophrenia. In this post, we’ll explore how Schizophrenia Anonymous supports its members in their recovery journey. What is Schizophrenia Anonymous? Schizophrenia Anonymous is a peer-support group inspired by the principles of Alcoholics Anonymous. It offers a place where individuals struggling with schizophrenia can come together to share their experiences and find support. Members benefit from a compassionate environment where they can discuss their journeys openly. Being part of a group like S.A. can significantly enhance one’s recovery. Emotional support and practical advice from members who face similar challenges can make daily life manageable. For instance, a member who has found effective ways to handle anxiety might share those techniques with others in the group. The Importance of Peer Support Studies indicate that peer support can greatly influence recovery and well-being for individuals with mental health conditions. In fact, a recent survey showed that 85% of participants felt more hopeful after attending support groups. In Schizophrenia Anonymous, members openly share their recovery stories. This transparency helps to reduce the stigma often associated with mental health issues. By discussing their realities, members build strong connections with one another. These bonds can lead to life-changing friendships, providing emotional and practical backing during tough times. A tranquil space designed for group discussions and support. Strategies for Coping During meetings, members of Schizophrenia Anonymous exchange useful coping strategies and techniques. These shared experiences empower individuals to take control of their symptoms. For example, conversations may highlight mindfulness practices, medication routines, or lifestyle changes like exercise and nutrition. Each member shares what has worked for them. This exchange of information creates a rich resource of collective wisdom. When someone wants to try meditation to cope with anxiety or needs advice on adhering to medication, support from the group can be invaluable. Breaking Down Stigmas The stigma around mental health remains a considerable obstacle for many. Schizophrenia Anonymous actively challenges perceptions by encouraging open dialogue. Members educate each other and the public, dismantling myths that propagate stigma. This educational approach has profound effects. For example, when members share their experiences, it helps others understand that schizophrenia is a medical condition that deserves compassion and treatment. Consequently, communities become more accepting, promoting greater support for those living with schizophrenia. Building a Network of Support Joining Schizophrenia Anonymous allows members to create a strong support network. The relationships built during meetings often extend beyond the formal setting. For instance, a member might reach out to a friend made in the group during a challenging episode. Knowing there is someone who truly understands their struggles can be a powerful comfort. This external support is crucial in navigating daily challenges, ensuring that individuals do not have to face them alone. Encouraging Personal Growth Schizophrenia Anonymous goes beyond symptom management; it promotes personal growth as well. Members often find inspiration in each other's stories of resilience. The group instills hope, encouraging individuals to transform their struggles into motivation for self-improvement. For example, participants may be encouraged to pursue educational opportunities or seek employment, demonstrating that a fulfilling life is achievable despite a diagnosis. Learning from each other's success stories opens doors to new possibilities and destinations in the journey toward recovery. A peaceful natural environment representing growth and healing. Maintaining Confidentiality A vital aspect of Schizophrenia Anonymous is its strict commitment to confidentiality. Members know that what they share in the group stays within those walls. This assurance builds trust and encourages participants to be open about their thoughts and feelings. An atmosphere of authenticity allows for deeper conversations, fostering increased support among members. With trust firmly established, individuals feel safe exploring their genuine selves. Final Thoughts Schizophrenia Anonymous is an essential resource for individuals grappling with schizophrenia. By offering peer support, shared experiences, and practical coping strategies, the organization empowers members to progress on their recovery journey with dignity. Through its work to dismantle stigma and promote understanding, Schizophrenia Anonymous creates a supportive community where individuals can thrive. As the group continually evolves, it remains a beacon of hope for those affected by schizophrenia, illuminating a path toward recovery and fellowship. A cozy community center ideal for support groups and meetings.

Understanding the Role of Schizophrenia Anonymous in Recovery and Support

Schizophrenia is a challenging mental health condition that impacts millions globally. Navigating the path to recovery can feel...

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Schizophrenia often comes with a heavy cloak of stigma and misunderstanding. The struggles related to this condition can feel incredibly isolating. However, there is hope and support available through Schizophrenia Anonymous, a community focused on understanding, healing, and connection.

Navigating the Unknown: A Personal Journey with Schizophrenia Anonymous

Schizophrenia Anonymous

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Growing up, I often felt like I was living in two worlds. On one side, there was a bubble of love, laughter, and support. On the other, a shadowy world filled with whispers of my family's mental health struggles. I frequently asked, "Is mental illness hereditary?" As I began my own journey of understanding, the answer became increasingly clear. Exploring my family's history revealed complexities that went beyond simple genetics. Mental illness intertwined with our environment, experiences, and many factors that shaped our lives. This legacy is not just a family secret; it has profoundly influenced my life, relationships, and outlook.

My Family's Legacy of Mental Illness and What It Taught Me

Mental Health is important to know it starts with parents

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Intellectual disability, often framed within the outdated term "mental retardation," is frequently obscured by a veil of stigma. This stigma can shape public perceptions and affect the lives of those who live with these challenges. During my journey of education and exploration, I recognized how deeply embedded this stigma is, fueling discrimination and misunderstanding. In this post, I reflect on my experiences and observations, showing how confronting stigma can lead to better support and understanding for those affected by intellectual disabilities.

Confronting the Stigma: My Journey Understanding How It Fuels Mental Retardation

Mental Retardation is caused by stigma

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The conversation about mental health is more important than ever. With rising awareness, people now recognize the value of innovative treatments. One particularly noteworthy option is medical marijuana. Dr. Robert Booker stands out as an advocate for using medical marijuana to address various mental health challenges. His personal story not only shapes his understanding of this therapy but also influences countless patients' lives.

Dr. Robert Booker's Personal Journey with Medical Marijuana in Addressing Mental Health Challenges

Dr. Robert Booker support medical marijuana for mental health

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As a healthcare professional, my journey into the world of medical marijuana started with a simple goal: to find effective treatments for chronic pain and other health issues. Over time, I gathered a wide range of resources, research, and personal stories that reshaped my view on cannabis as a valuable medicinal option. Here’s a detailed overview of how 10 essential steps guided me in discovering medical marijuana and its potential benefits.

How I Discovered Medical Marijuana Through 10 Essential Steps

How 10 steps help Dr. Robert Booker discovered Medical Marijuana

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The path to acknowledging the therapeutic benefits of marijuana has seen its fair share of obstacles and milestones. Dr. Robert Booker is one of the leading figures in this transformative quest, reshaping how we view medical marijuana. In this article, we will look at ten vital insights into how Dr. Booker revolutionized the understanding of medical marijuana and the wider effects of his work.

10 Key Insights on How Dr. Robert Booker Pioneered Medical Marijuana Research

How Dr. Robert Booker discovered Medical Marijuana

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Dr. Robert Booker’s journey into the world of medical marijuana highlights not only his dedication to science and medicine but also the increasing demand for innovative addiction treatments. As stigma surrounding marijuana fades and research reveals its potential benefits, Dr. Booker's insights play a crucial role in reshaping discussions about cannabis therapy. This post explores his groundbreaking findings and their challenge to traditional views on substance use and recovery.

The Journey of Discovery: Dr. Robert Booker's Pioneering Insights on Medical Marijuana for Addiction Treatment

How Dr. Robert Booker discovered Medical Marijuana

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The world of medicine is constantly changing, filled with breakthroughs that redefine treatments and improve patient care. Among the trailblazers in this field, Dr. Robert Booker shines for his passion and commitment to understanding the healing properties of cannabis. His journey into medical marijuana has not only influenced his career but has also offered hope to many seeking relief from various ailments. This blog post examines how Dr. Booker's exploration has transformed our understanding of medical marijuana.

The Journey of Discovery How Dr. Robert Booker Unraveled the Benefits of Medical Marijuana

How Dr. Robert Booker discovered Medical Marijuana

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Medical marijuana has become a major topic of discussion, capturing the attention of patients, healthcare providers, and researchers. Many people are seeking to understand its potential benefits, which has led to a surge in studies and testimonials supporting its use. Among the leading voices in this field is Dr. Robert Booker. His groundbreaking research has significantly expanded our understanding of medical marijuana and its applications.

How Dr. Robert Booker Uncovered the Secrets to Medical Marijuana Through Innovative Research

How Dr. Robert Booker discovered Medical Marijuana

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Facing mental health challenges can feel overwhelming and isolating. Many people battle feelings of despair and uncertainty. I was among them. My recovery became possible through the guidance of Dr. Robert Booker. In this blog post, I share the steps I took that transformed my life and offer hope and practical advice for those walking a similar path.

How I Navigated My Journey to Mental Health Recovery with Dr. Robert Booker

Dr. Robert Booker Mental Health Recovery

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Mental health recovery is a deeply personal journey filled with unique challenges and valuable lessons. As I navigated my own struggles, the insights of Dr. Robert Booker shaped my understanding of mental health and provided practical strategies that were crucial for my healing process. His story serves as a powerful reminder that the path to recovery can be illuminated by shared experiences and compassionate guidance.

My Journey Through Mental Health Recovery: Lessons Learned from Dr. Robert Booker's Experience

Dr. Robert Booker mental health recovery

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When I first started exploring medical marijuana, I felt a mix of excitement and uncertainty. With so much information and so many choices, it was easy to feel lost. From learning how to obtain a medical card to finding the right strain for my condition, my journey was a learning experience. Here, I’ll share the 10 steps I took that helped me confidently navigate this complex world.

My Journey Through 10 Steps to Successfully Navigate Medical Marijuana

10 Steps for Medical Marijuana

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The journey to medical marijuana can truly change lives. For many looking for alternatives to traditional treatments, it offers a glimmer of hope. With an increasing number of patients seeking natural remedies, understanding how to obtain medical marijuana is essential. This post will guide you through 10 steps to medical marijuana , sharing personal experiences that reflect the challenges and victories encountered along the way.

Navigating the Journey to Medical Marijuana: A Personal Story of Hope and Healing

10 Steps to medical marijuana

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Obtaining medical marijuana can feel like a complex journey, especially with the varying laws from one state to another. If you're thinking about using medical marijuana for a specific health issue, knowing the steps involved is critical. This practical guide will walk you through each phase, helping you access the treatment you need with confidence.

How to Navigate the 10 Essential Steps to Obtain Medical Marijuana

10 Steps to Medical Marijuana

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Finding access to medical marijuana can feel overwhelming, especially if you are new to this process. My journey through the 10 essential steps to medical marijuana was filled with challenges, valuable insights, and a sense of empowerment. If you're thinking about pursuing medical cannabis, I hope my experiences offer a helpful roadmap for you.

My Journey Through the 10 Essential Steps to Access Medical Marijuana

10 Steps to Medical Marijuana

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Navigating the complexities of meetings can feel overwhelming, especially if you want to lead effectively. For those eager to enhance their leadership skills, understanding parliamentary procedure is key. Robert's Rules of Order stands out as a reliable method for structuring meetings. This system not only organizes discussions but also empowers leaders to facilitate dialogue and decision-making fluidly.

Mastering Robert's Rules of Order for Confident Leadership in Any Meeting

Mastering Robert's Rules of Order for Confident Leadership in Any Meeting

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Addiction remains one of the most complex issues in today’s society, often steeped in stigma and confusion. Understanding the intersection of addiction and mental health is vital. Many individuals are caught in a difficult battle, hiding their struggles while seeking help. This post sheds light on the daily challenges those experiencing addiction face and emphasizes the critical role mental health facilities play in their recovery.

The Hidden Struggles Behind the Great Pretender: Understanding Addiction and Substance Abuse in Mental Health Settings

The Great Pretender to Mental Hospitals

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The discussion about medical marijuana is growing, and for those in recovery from addiction, it’s essential to understand how this treatment can help. With the right knowledge and approach, individuals can make informed choices that impact their healing journey. Here are ten essential steps to consider when exploring medical marijuana as a potential aid for addiction recovery.

Navigating the Unknown: 10 Essential Steps to Exploring Medical Marijuana for Addiction Recovery

10 Steps to Medical Marijuana

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Mental health plays an increasingly important role in our daily lives, and mental hospitals are central to this conversation in America. Once seen as places for long-term confinement, these institutions have transformed in response to new understandings of mental health. This blog post explores the historical journey, current trends, and future capabilities of mental hospitals in America.

Exploring the Evolving Role of Mental Hospitals in America's Healthcare System

Mental Hospital in America

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Marijuana can often feel like a safe escape for those using it recreationally or to cope with difficult emotions. Like many others, I turned to cannabis to ease my stress and numb my feelings. However, it didn’t take long for me to realize that my reliance on it was becoming harmful. In my search for healing, I found Marijuana Anonymous. There, I embraced the powerful 10 Steps of Recovery, which transformed my journey and provided a clear path forward.

How I Found Healing Through the 10 Steps of Recovery with Marijuana Anonymous

How I Found Healing Through the 10 Steps of Recovery with Marijuana Anonymous

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The journey of recovery can be both challenging and rewarding. For those exploring the world of medical marijuana, it can feel overwhelming at times. Yet, by following a structured approach and embracing personal insights, you can unlock the potential benefits that this natural remedy offers. This blog explores ten key steps designed to help you navigate your recovery while integrating medical marijuana into your healing process.

Navigating Recovery: A Personal Journey Through 10 Steps with Medical Marijuana

Navigating Recovery: A Personal Journey Through 10 Steps with Medical Marijuana

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Recovery is a journey that many individuals embark upon, whether from addiction, mental illness, or trauma. While recovery often focuses on personal efforts, the power of community is crucial. A supportive community can be a significant force in recovery, providing emotional encouragement, practical assistance, and a sense of belonging. This post explores how community support can profoundly impact recovery journeys.

Exploring the Unseen Impact of Community in Transformative Recovery Journeys

Exploring the Unseen Impact of Community in Transformative Recovery Journeys

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Addiction recovery can be a tough road to navigate, filled with hurdles that many people may not understand. One of the biggest challenges is stigma—a burden that can affect self-esteem, access to resources, and the desire to seek help. But here’s the good news: community support can make a significant difference in overcoming this stigma. In this post, we will examine how community networks can be vital in addiction recovery and how individuals can effectively confront the stigma associated with addiction.

Navigating the Unknown: Embracing Community Support to Overcome Addiction Recovery Stigmas

Navigating the Unknown: Embracing Community Support to Overcome Addiction Recovery Stigmas

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The mental health crisis in urban communities represents a pressing challenge needing immediate attention and long-term strategies. Urban areas, often marked by high population density and diverse cultures, may restrict access to essential mental health resources. This complex environment can significantly impact mental well-being. By exploring effective support and intervention methods, we can advance public awareness and foster healthier communities.

Navigating the Unseen: Strategies for Addressing the Mental Health Crisis in Urban Communities

Navigating the Unseen: Strategies for Addressing the Mental Health Crisis in Urban Communities

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Addiction and mental health disorders often coexist, complicating the recovery journey for many individuals. However, with the right strategies and support in place, those struggling can find a path toward healing. This article focuses on three critical areas for a comprehensive recovery approach: understanding dual diagnosis, the power of peer support, and holistic methods of recovery.

Exploring the Intersection of Mental Health and Substance Abuse Recovery Strategies

Exploring the Intersection of Mental Health and Substance Abuse Recovery Strategies

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Research has found that attempted suicide rates and suicidal ideation among lesbian, gay, bisexual, transgender and queer (LGBTQ) people are significantly higher than among the general population.[1][2]

Understanding the Alarming Rates of Suicide Among LGBTQ Individuals and How to Address Them

Research has found that attempted suicide rates and suicidal ideation among lesbian, gay, bisexual, transgender and queer (LGBTQ) people...

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Risk factors and the minority stress model

Understanding the Unique Mental Health Challenges Faced by LGBTQ Individuals

Understanding the Unique Mental Health Challenges Faced by LGBTQ Individuals

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Mental disorders encompass a wide range of conditions that significantly affect how individuals think, feel, and behave. These disorders are characterized by ongoing patterns of thoughts or behaviors that can lead to considerable distress or hinder daily functioning. Gaining a solid understanding of these disorders requires examining their definitions, classifications, causes, and effects on everyday life. Mental disorders are generally classified using frameworks established by healthcare professionals, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). These classifications help identify and categorize various disorders based on specific symptoms and criteria, guiding healthcare providers in both diagnosis and treatment. The Classification of Mental Disorders The classification of mental disorders is extensive and intricate. It comprises several categories, including mood disorders, anxiety disorders, personality disorders, psychotic disorders, and neurodevelopmental disorders. Each category includes various specific disorders: Mood Disorders: This category includes conditions like major depression and bipolar disorder. For example, major depression affects about 7% of adults in the U.S., impacting their ability to function daily. Anxiety Disorders: These disorders feature excessive fear or worry. Approximately 19.1% of adults in the U.S. experience anxiety disorders annually, including generalized anxiety disorder and panic disorder. Personality Disorders: These entrenched patterns of behavior deviate from societal norms. Borderline personality disorder, for example, affects about 1.4% of the adult population, leading to turbulent relationships and emotional instability. Psychotic Disorders: Schizophrenia is a primary example, affecting nearly 1% of the population and characterized by distorted thoughts and perceptions. Neurodevelopmental Disorders: Conditions like autism spectrum disorders begin in early childhood and influence social, communication, and behavioral skills. The prevalence of autism has increased, with estimates showing 1 in 44 children diagnosed in the U.S. Each category highlights the diverse experiences of those affected, emphasizing the intricate nature of mental health.

Exploring the Complex Spectrum of Mental Disorders and Their Impact on Human Experience

Exploring the Complex Spectrum of Mental Disorders and Their Impact on Human Experience

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Imagine feeling trapped in a cycle that you can't escape. Addiction is that cycle for millions worldwide. It affects not only the individual but also friends, family, and entire communities. As people strive to break free from addiction, mental health professionals offer the support and strategies needed for recovery. This post delves into how these skilled individuals help guide those struggling with addiction toward a healthier future.

Navigating the Shadows: The Role of Mental Health Professionals in Overcoming Addiction


Mental health professional

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Mental health professionals are essential in confronting addiction and substance abuse. They specialize in understanding the psychological aspects of addiction and have the skills needed to deliver effective treatment. As substance abuse rates continue to climb, understanding the significance of mental health professionals is more crucial than ever. This blog explores their roles, therapeutic methods, and the collaborative frameworks necessary to tackle these urgent issues. Understanding Addiction Addiction is a complicated issue that often involves relentless drug-seeking behavior and continued use despite serious consequences. This condition impacts not just individuals, but families, communities, and society at large. According to the National Institute on Drug Abuse, nearly 21 million Americans struggle with substance use disorders, a staggering statistic that highlights the magnitude of the problem. Addiction can arise from a mix of genetic, psychological, and environmental factors. Mental health professionals are trained to handle these complexities, which is critical for effective treatment.

The Crucial Role of Mental Health Professionals in Addressing Addiction and Substance Abuse Services

The Crucial Role of Mental Health Professionals in Addressing Addiction and Substance Abuse Services

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There are many factors that influence mental health including:

Ways to Improve Mental Health and Wellbeing Daily

Ways to Improve Mental Health and Wellbeing Daily

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Introduction Define intellectual disability and discuss its relevance in society. Briefly introduce the purpose of addressing myths and facts about intellectual disability. Highlight the importance of support strategies for individuals with intellectual disabilities. Myths Surrounding Intellectual Disability Discuss common misconceptions. - Myth 1: Intellectual disability is the same as mental illness.

Understanding Intellectual Disability: Myths, Facts, and Support Strategies

Understanding Intellectual Disability: Myths, Facts, and Support Strategies

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The path to recovery from addiction can be arduous and personal, but it is paved with incredible stories of hope and resilience. These narratives not only inspire those who are struggling but also highlight the transformative power of healing. In this article, we will explore some touching journeys to recovery, showcasing how dedication, support, and self-discovery can lead to profound changes.

Inspiring Journeys of Recovery from Addiction: Stories of Hope and Healing

The path to recovery from addiction can be arduous and personal, but it is paved with incredible stories of hope and resilience. These...

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Introduction

Understanding Mental Retardation: Effective Treatments and Support Strategies

Understanding Mental Retardation: Effective Treatments and Support Strategies

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Introduction

Understanding Mental Retardation: Insights and Perspectives

Mental Retardation

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Thank you for providing the topic. Let's create a blog post focused on "Recovery." ### Blog Post: The Journey to Recovery: Understanding Treatment Options **Introduction** Recovery from mental health issues and substance abuse is a challenging yet rewarding journey. At Recovery Association, we understand the complexities involved and are dedicated to providing comprehensive support to individuals seeking help. This blog post aims to shed light on the various treatment options available and the benefits of seeking professional assistance. **Understanding Recovery** Recovery is a deeply personal process that involves making significant changes to improve one's health and well-being. It is not just about abstaining from substance use but also about building a fulfilling life. Recovery encompasses various aspects, including physical health, mental well-being, and social connections. **Types of Treatment Options** 1. **Detoxification** Detoxification is often the first step in the recovery process. It involves clearing the body of substances while managing withdrawal symptoms. Medical supervision during detox is crucial to ensure safety and comfort. 2. **Inpatient Rehabilitation** Inpatient rehab provides a structured environment where individuals can focus entirely on their recovery. This type of treatment includes therapy sessions, medical care, and support groups, all within a residential setting. 3. **Outpatient Programs** Outpatient programs offer flexibility for individuals who cannot commit to a residential program. These programs provide therapy and support while allowing individuals to maintain their daily responsibilities. 4. **Therapy and Counseling** Therapy is a cornerstone of recovery. Various therapeutic approaches, such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and individual counseling, help individuals address underlying issues and develop coping strategies. 5. **Support Groups** Support groups, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), provide a sense of community and shared experiences. These groups offer emotional support and practical advice from others who have faced similar challenges.

Blog Post: The Journey to Recovery: Understanding Treatment Options

Blog Post: The Journey to Recovery: Understanding Treatment Options

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The weather can have a profound impact on our lives, influencing not only our physical health but also our mental well-being. One weather phenomenon that is particularly noteworthy in this regard is a medicane, a Mediterranean cyclone that can bring extreme weather conditions. For individuals with mental illnesses, such storms can cause additional stress and anxiety. In this blog post, we will explore what a medicane is, how it impacts mental health, coping strategies during a medicane, and available resources and support for those in need.

Understanding Medicine: Impact on Mental Health for Individuals Living with Mental Illness

Understanding Medicine: Impact on Mental Health for Individuals Living with Mental Illness

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A mental disorder, also referred to as a mental illness,[6] a mental health condition,[7] or a psychiatric disability,[2] is a behavioral or mental pattern that causes significant distress or impairment of personal functioning.[8] A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context.[9][10] Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders.[10][11] A mental disorder is one aspect of mental health. The causes of mental disorders are often unclear. Theories incorporate findings from a range of fields. Disorders may be associated with particular regions or functions of the brain. Disorders are usually diagnosed or assessed by a mental health professional, such as a clinical psychologist, psychiatrist, psychiatric nurse, or clinical social worker, using various methods such as psychometric tests, but often relying on observation and questioning. Cultural and religious beliefs, as well as social norms, should be taken into account when making a diagnosis.[12] Services for mental disorders are usually based in psychiatric hospitals, outpatient clinics, or in the community, Treatments are provided by mental health professionals. Common treatment options are psychotherapy or psychiatric medication, while lifestyle changes, social interventions, peer support, and self-help are also options. In a minority of cases, there may be involuntary detention or treatment. Prevention programs have been shown to reduce depression.[10][13] In 2019, common mental disorders around the globe include: depression, which affects about 264 million people; dementia, which affects about 50 million; bipolar disorder, which affects about 45 million; and schizophrenia and other psychoses, which affect about 20 million people.[10] Neurodevelopmental disorders include attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability, of which onset occurs early in the developmental period.[14][10] Stigma and discrimination can add to the suffering and disability associated with mental disorders, leading to various social movements attempting to increase understanding and challenge social exclusion. Definition "Nervous breakdown" redirects here. For other uses, see Nervous breakdown (disambiguation). The definition and classification of mental disorders are key issues for researchers as well as service providers and those who may be diagnosed. For a mental state to be classified as a disorder, it generally needs to cause dysfunction.[15] Most international clinical documents use the term mental "disorder", while "illness" is also common. It has been noted that using the term "mental" (i.e., of the mind) is not necessarily meant to imply separateness from the brain or body. According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published in 1994, a mental disorder is a psychological syndrome or pattern that is associated with distress (e.g., via a painful symptom), disability (impairment in one or more important areas of functioning), increased risk of death, or causes a significant loss of autonomy; however, it excludes normal responses such as the grief from loss of a loved one and also excludes deviant behavior for political, religious, or societal reasons not arising from a dysfunction in the individual.[16] DSM-IV predicates the definition with caveats, stating that, as in the case with many medical terms, mental disorder "lacks a consistent operational definition that covers all situations", noting that different levels of abstraction can be used for medical definitions, including pathology, symptomology, deviance from a normal range, or etiology, and that the same is true for mental disorders, so that sometimes one type of definition is appropriate and sometimes another, depending on the situation.[17] In 2013, the American Psychiatric Association (APA) redefined mental disorders in the DSM-5 as "a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning."[18] The final draft of ICD-11 contains a very similar definition.[19] The terms "mental breakdown" or "nervous breakdown" may be used by the general population to mean a mental disorder.[20] The terms "nervous breakdown" and "mental breakdown" have not been formally defined through a medical diagnostic system such as the DSM-5 or ICD-10 and are nearly absent from scientific literature regarding mental illness.[21][22] Although "nervous breakdown" is not rigorously defined, surveys of laypersons suggest that the term refers to a specific acute time-limited reactive disorder involving symptoms such as anxiety or depression, usually precipitated by external stressors.[21] Many health experts today refer to a nervous breakdown as a mental health crisis.[23] Nervous illness In addition to the concept of mental disorder, some people have argued for a return to the old-fashioned concept of nervous illness. In How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown (2013), Edward Shorter, a professor of psychiatry and the history of medicine, says: About half of them are depressed. Or at least that is the diagnosis that they got when they were put on antidepressants. ... They go to work but they are unhappy and uncomfortable; they are somewhat anxious; they are tired; they have various physical pains—and they tend to obsess about the whole business. There is a term for what they have, and it is a good old-fashioned term that has gone out of use. They have nerves or a nervous illness. It is an illness not just of mind or brain, but a disorder of the entire body. ... We have a package here of five symptoms—mild depression, some anxiety, fatigue, somatic pains, and obsessive thinking. ... We have had nervous illness for centuries. When you are too nervous to function ... it is a nervous breakdown. But that term has vanished from medicine, although not from the way we speak.... The nervous patients of yesteryear are the depressives of today. That is the bad news.... There is a deeper illness that drives depression and the symptoms of mood. We can call this deeper illness something else, or invent a neologism, but we need to get the discussion off depression and onto this deeper disorder in the brain and body. That is the point. — Edward Shorter, Faculty of Medicine, the University of Toronto[24] In eliminating the nervous breakdown, psychiatry has come close to having its own nervous breakdown. — David Healy, MD, FRCPsych, Professor of Psychiatry, University of Cardiff, Wales[25] "Nervous breakdown" is a pseudo-medical term to describe a wealth of stress-related feelings and they are often made worse by the belief that there is a real phenomenon called "nervous breakdown". — Richard E. Vatz, co-author of explication of views of Thomas Szasz in "Thomas Szasz: Primary Values and Major Contentions"[page needed] Nerves stand at the core of common mental illness, no matter how much we try to forget them. — Peter J. Tyrer, FMedSci, Professor of Community Psychiatry, Imperial College, London[26] Classifications Main article: Classification of mental disorders There are currently two widely established systems that classify mental disorders: ICD-11 Chapter 06: Mental, behavioural or neurodevelopmental disorders, part of the International Classification of Diseases produced by the WHO (in effect since 1 January 2022).[27] Diagnostic and Statistical Manual of Mental Disorders (DSM-5) produced by the APA since 1952. Both of these list categories of disorder and provide standardized criteria for diagnosis. They have deliberately converged their codes in recent revisions so that the manuals are often broadly comparable, although significant differences remain. Other classification schemes may be used in non-western cultures, for example, the Chinese Classification of Mental Disorders, and other manuals may be used by those of alternative theoretical persuasions, such as the Psychodynamic Diagnostic Manual. In general, mental disorders are classified separately from neurological disorders, learning disabilities or intellectual disability. Unlike the DSM and ICD, some approaches are not based on identifying distinct categories of disorder using dichotomous symptom profiles intended to separate the abnormal from the normal. There is significant scientific debate about the relative merits of categorical versus such non-categorical (or hybrid) schemes, also known as continuum or dimensional models. A spectrum approach may incorporate elements of both. In the scientific and academic literature on the definition or classification of mental disorder, one extreme argues that it is entirely a matter of value judgements (including of what is normal) while another proposes that it is or could be entirely objective and scientific (including by reference to statistical norms).[28] Common hybrid views argue that the concept of mental disorder is objective even if only a "fuzzy prototype" that can never be precisely defined, or conversely that the concept always involves a mixture of scientific facts and subjective value judgments.[29] Although the diagnostic categories are referred to as 'disorders', they are presented as medical diseases, but are not validated in the same way as most medical diagnoses. Some neurologists argue that classification will only be reliable and valid when based on neurobiological features rather than clinical interview, while others suggest that the differing ideological and practical perspectives need to be better integrated.[30][31] The DSM and ICD approach remains under attack both because of the implied causality model[32] and because some researchers believe it better to aim at underlying brain differences which can precede symptoms by many years.[33] Dimensional models The high degree of comorbidity between disorders in categorical models such as the DSM and ICD have led some to propose dimensional models. Studying comorbidity between disorders have demonstrated two latent (unobserved) factors or dimensions in the structure of mental disorders that are thought to possibly reflect etiological processes. These two dimensions reflect a distinction between internalizing disorders, such as mood or anxiety symptoms, and externalizing disorders such as behavioral or substance use symptoms.[34] A single general factor of psychopathology, similar to the g factor for intelligence, has been empirically supported. The p factor model supports the internalizing-externalizing distinction, but also supports the formation of a third dimension of thought disorders such as schizophrenia.[35] Biological evidence also supports the validity of the internalizing-externalizing structure of mental disorders, with twin and adoption studies supporting heritable factors for externalizing and internalizing disorders.[36][37][38] A leading dimensional model is the Hierarchical Taxonomy of Psychopathology. Disorders See also: List of mental disorders as defined by the DSM and ICD There are many different categories of mental disorder, and many different facets of human behavior and personality that can become disordered.[39][40][41][42] Anxiety disorders Main article: Anxiety disorder An anxiety disorder is anxiety or fear that interferes with normal functioning may be classified as an anxiety disorder.[40] Commonly recognized categories include specific phobias, generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, obsessive–compulsive disorder and post-traumatic stress disorder. Mood disorders Main article: Mood disorder Other affective (emotion/mood) processes can also become disordered. Mood disorder involving unusually intense and sustained sadness, melancholia, or despair is known as major depression (also known as unipolar or clinical depression). Milder, but still prolonged depression, can be diagnosed as dysthymia. Bipolar disorder (also known as manic depression) involves abnormally "high" or pressured mood states, known as mania or hypomania, alternating with normal or depressed moods. The extent to which unipolar and bipolar mood phenomena represent distinct categories of disorder, or mix and merge along a dimension or spectrum of mood, is subject to some scientific debate.[43][44] Psychotic disorders Main article: Psychotic disorder Patterns of belief, language use and perception of reality can become dysregulated (e.g., delusions, thought disorder, hallucinations). Psychotic disorders in this domain include schizophrenia, and delusional disorder. Schizoaffective disorder is a category used for individuals showing aspects of both schizophrenia and affective disorders. Schizotypy is a category used for individuals showing some of the characteristics associated with schizophrenia, but without meeting cutoff criteria. Personality disorders Main article: Personality disorder Personality—the fundamental characteristics of a person that influence thoughts and behaviors across situations and time—may be considered disordered if judged to be abnormally rigid and maladaptive. Although treated separately by some, the commonly used categorical schemes include them as mental disorders, albeit on a separate axis II in the case of the DSM-IV. A number of different personality disorders are listed, including those sometimes classed as eccentric, such as paranoid, schizoid and schizotypal personality disorders; types that have described as dramatic or emotional, such as antisocial, borderline, histrionic or narcissistic personality disorders; and those sometimes classed as fear-related, such as anxious-avoidant, dependent, or obsessive–compulsive personality disorders. Personality disorders, in general, are defined as emerging in childhood, or at least by adolescence or early adulthood. The ICD also has a category for enduring personality change after a catastrophic experience or psychiatric illness. If an inability to sufficiently adjust to life circumstances begins within three months of a particular event or situation, and ends within six months after the stressor stops or is eliminated, it may instead be classed as an adjustment disorder. There is an emerging consensus that personality disorders, similar to personality traits in general, incorporate a mixture of acute dysfunctional behaviors that may resolve in short periods, and maladaptive temperamental traits that are more enduring.[45] Furthermore, there are also non-categorical schemes that rate all individuals via a profile of different dimensions of personality without a symptom-based cutoff from normal personality variation, for example through schemes based on dimensional models.[46][47][non-primary source needed] Neurodevelopmental disorders Main article: Neurodevelopmental disorder Neurodevelopmental disorders is a group of mental disorder that affect the central nervous system, such as the brain and spinal cord.[48] These disorders can appear in early childhood.[49] They can even persist into adulthood.[50] A few of the common ones are attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), intellectual disabilities, motor disorders, and communication disorders among others. Some causes can contribute to these disorders like genetic factors (genetics, family medical history),[51] environmental factors (excessive stress, exposure to neurotoxins, pollution, viral infections, and bacterial infections),[52][53] physical factors (traumatic brain injury, illness),[54] and prenatal factors (birth defects, exposure to drugs during pregnancy, low birth weight).[55] Neurodevelopmental disorders can be managed with behavioral therapy, applied behavior analysis (ABA), educational interventions, specific medications, and other such treatments.[56] Approximately 8 in 10 people with autism suffer from a mental health problem in their lifetime, in comparison to 1 in 4 of the general population that suffers from a mental health problem in their lifetimes.[57][58][59] Eating disorders Main article: Eating disorder An eating disorder is a serious mental health condition that involves an unhealthy relationship with food and body image. They can cause severe physical and psychological problems.[60] Eating disorders involve disproportionate concern in matters of food and weight.[40] Categories of disorder in this area include anorexia nervosa, bulimia nervosa, exercise bulimia or binge eating disorder.[61][62] Sleep disorders Main article: Sleep disorder Sleep disorders are associated with disruption to normal sleep patterns. A common sleep disorder is insomnia, which is described as difficulty falling and/or staying asleep. Other sleep disorders include narcolepsy, sleep apnea, REM sleep behavior disorder, chronic sleep deprivation, and restless leg syndrome. Narcolepsy is a condition of extreme tendencies to fall asleep whenever and wherever. People with narcolepsy feel refreshed after their random sleep, but eventually get sleepy again. Narcolepsy diagnosis requires an overnight stay at a sleep center for analysis, during which doctors ask for a detailed sleep history and sleep records. Doctors also use actigraphs and polysomnography.[63] Doctors will do a multiple sleep latency test, which measures how long it takes a person to fall asleep.[63] Sleep apnea, when breathing repeatedly stops and starts during sleep, can be a serious sleep disorder. Three types of sleep apnea include obstructive sleep apnea, central sleep apnea, and complex sleep apnea.[64] Sleep apnea can be diagnosed at home or with polysomnography at a sleep center. An ear, nose, and throat doctor may further help with the sleeping habits. Sexuality related Sexual disorders include dyspareunia and various kinds of paraphilia (sexual arousal to objects, situations, or individuals that are considered abnormal or harmful to the person or others). Sexual dysfunction is common among psychiatric patients, yet the specific impact of psychopathology independent of factors like psychotropic substances or somatic symptom disorders, remains unclear. A systematic review explored the prevalence of sexual dysfunction in psychiatric patients free from psychotropic medications and somatic diseases.[65] The review included 24 studies with 1,199 participants and identified high rates of sexual dysfunction across various psychiatric disorders. Reported prevalence ranged from 45%-93% for depressive disorders, 33%-75% for anxiety disorders, 25%-81% for obsessive–compulsive disorder (OCD), and 25% for schizophrenia. Sexual desire was frequently impaired in depressive disorders, PTSD, and schizophrenia, while OCD and anxiety disorders were associated with difficulties during the orgasm phase. The findings emphasize the importance of addressing sexual health in psychiatric care through psychoeducation, sexual history assessments, and targeted interventions. This highlights the significant impact of psychopathology on sexual functioning.[65] Other Impulse control disorders: People who are abnormally unable to resist certain urges or impulses that could be harmful to themselves or others, may be classified as having an impulse control disorder, and disorders such as kleptomania (stealing) or pyromania (fire-setting). Various behavioral addictions, such as gambling addiction, may be classed as a disorder. Obsessive–compulsive disorder can sometimes involve an inability to resist certain acts but is classed separately as being primarily an anxiety disorder. Substance use disorders: This disorder refers to the use of drugs (legal or illegal, including alcohol) that persists despite significant problems or harm related to its use. Substance dependence and substance abuse fall under this umbrella category in the DSM. Substance use disorder may be due to a pattern of compulsive and repetitive use of a drug that results in tolerance to its effects and withdrawal symptoms when use is reduced or stopped. Dissociative disorders: People with severe disturbances of their self-identity, memory, and general awareness of themselves and their surroundings may be classified as having these types of disorders, including depersonalization derealization disorder or dissociative identity disorder (which was previously referred to as multiple personality disorder or "split personality"). Cognitive disorders: These affect cognitive abilities, including learning and memory. This category includes delirium and mild and major neurocognitive disorder (previously termed dementia). Somatoform disorders may be diagnosed when there are problems that appear to originate in the body that are thought to be manifestations of a mental disorder. This includes somatization disorder and conversion disorder. There are also disorders of how a person perceives their body, such as body dysmorphic disorder. Neurasthenia is an old diagnosis involving somatic complaints as well as fatigue and low spirits/depression, which is officially recognized by the ICD-10 but no longer by the DSM-IV.[66][non-primary source needed] Factitious disorders are diagnosed where symptoms are thought to be reported for personal gain. Symptoms are often deliberately produced or feigned, and may relate to either symptoms in the individual or in someone close to them, particularly people they care for. There are attempts to introduce a category of relational disorder, where the diagnosis is of a relationship rather than on any one individual in that relationship. The relationship may be between children and their parents, between couples, or others. There already exists, under the category of psychosis, a diagnosis of shared psychotic disorder where two or more individuals share a particular delusion because of their close relationship with each other. There are a number of uncommon psychiatric syndromes, which are often named after the person who first described them, such as Capgras syndrome, De Clerambault syndrome, Othello syndrome, Ganser syndrome, Cotard delusion, and Ekbom syndrome, and additional disorders such as the Couvade syndrome and Geschwind syndrome.[67] Signs and symptoms Course The onset of psychiatric disorders usually occurs from childhood to early adulthood.[68] Impulse-control disorders and a few anxiety disorders tend to appear in childhood. Some other anxiety disorders, substance disorders, and mood disorders emerge later in the mid-teens.[69] Symptoms of schizophrenia typically manifest from late adolescence to early twenties.[70] The likely course and outcome of mental disorders vary and are dependent on numerous factors related to the disorder itself, the individual as a whole, and the social environment. Some disorders may last a brief period of time, while others may be long-term in nature. All disorders can have a varied course. Long-term international studies of schizophrenia have found that over a half of individuals recover in terms of symptoms, and around a fifth to a third in terms of symptoms and functioning, with many requiring no medication. While some have serious difficulties and support needs for many years, "late" recovery is still plausible. The World Health Organization (WHO) concluded that the long-term studies' findings converged with others in "relieving patients, carers and clinicians of the chronicity paradigm which dominated thinking throughout much of the 20th century."[71][non-primary source needed][72] A follow-up study by Tohen and coworkers revealed that around half of people initially diagnosed with bipolar disorder achieve symptomatic recovery (no longer meeting criteria for the diagnosis) within six weeks, and nearly all achieve it within two years, with nearly half regaining their prior occupational and residential status in that period. Less than half go on to experience a new episode of mania or major depression within the next two years.[73][non-primary source needed] Disability Disorder Disability-adjusted life years[74] Major depressive disorder 65.5 million Alcohol-use disorder 23.7 million Schizophrenia 16.8 million Bipolar disorder 14.4 million Other drug-use disorders 8.4 million Panic disorder 7.0 million Obsessive–compulsive disorder 5.1 million Primary insomnia 3.6 million Post-traumatic stress disorder 3.5 million Some disorders may be very limited in their functional effects, while others may involve substantial disability and support needs. In this context, the terms psychiatric disability and psychological disability are sometimes used instead of mental disorder.[2][3] The degree of ability or disability may vary over time and across different life domains. Furthermore, psychiatric disability has been linked to institutionalization, discrimination and social exclusion as well as to the inherent effects of disorders. Alternatively, functioning may be affected by the stress of having to hide a condition in work or school, etc., by adverse effects of medications or other substances, or by mismatches between illness-related variations and demands for regularity.[75] It is also the case that, while often being characterized in purely negative terms, some mental traits or states labeled as psychiatric disabilities can also involve above-average creativity, non-conformity, goal-striving, meticulousness, or empathy.[76] In addition, the public perception of the level of disability associated with mental disorders can change.[77] Nevertheless, internationally, people report equal or greater disability from commonly occurring mental conditions than from commonly occurring physical conditions, particularly in their social roles and personal relationships. The proportion with access to professional help for mental disorders is far lower, however, even among those assessed as having a severe psychiatric disability.[78] Disability in this context may or may not involve such things as: Basic activities of daily living. Including looking after the self (health care, grooming, dressing, shopping, cooking etc.) or looking after accommodation (chores, DIY tasks, etc.) Interpersonal relationships. Including communication skills, ability to form relationships and sustain them, ability to leave the home or mix in crowds or particular settings Occupational functioning. Ability to acquire an employment and hold it, cognitive and social skills required for the job, dealing with workplace culture, or studying as a student. In terms of total disability-adjusted life years (DALYs), which is an estimate of how many years of life are lost due to premature death or to being in a state of poor health and disability, psychiatric disabilities rank amongst the most disabling conditions. Unipolar (also known as Major) depressive disorder is the third leading cause of disability worldwide, of any condition mental or physical, accounting for 65.5 million years lost. The first systematic description of global disability arising in youth, in 2011, found that among 10- to 24-year-olds nearly half of all disability (current and as estimated to continue) was due to psychiatric disabilities, including substance use disorders and conditions involving self-harm. Second to this were accidental injuries (mainly traffic collisions) accounting for 12 percent of disability, followed by communicable diseases at 10 percent. The psychiatric disabilities associated with most disabilities in high-income countries were unipolar major depression (20%) and alcohol use disorder (11%). In the eastern Mediterranean region, it was unipolar major depression (12%) and schizophrenia (7%), and in Africa it was unipolar major depression (7%) and bipolar disorder (5%).[79] Suicide, which is often attributed to some underlying mental disorder, is a leading cause of death among teenagers and adults under 35.[80][81] There are an estimated 10 to 20 million non-fatal attempted suicides every year worldwide.[82] Risk factors Main article: Causes of mental disorders The predominant view as of 2018 is that genetic, psychological, and environmental factors all contribute to the development or progression of mental disorders.[83] Different risk factors may be present at different ages, with risk occurring as early as during prenatal period.[84] Genetics Main article: Psychiatric genetics A number of psychiatric disorders are linked to a family history (including depression, narcissistic personality disorder[85][86] and anxiety).[87] Twin studies have also revealed a very high heritability for many mental disorders (especially autism and schizophrenia).[88] Although researchers have been looking for decades for clear linkages between genetics and mental disorders, that work has not yielded specific genetic biomarkers yet that might lead to better diagnosis and better treatments.[89] Statistical research looking at eleven disorders found widespread assortative mating between people with mental illness. That means that individuals with one of these disorders were two to three times more likely than the general population to have a partner with a mental disorder. Sometimes people seemed to have preferred partners with the same mental illness. Thus, people with schizophrenia or ADHD are seven times more likely to have affected partners with the same disorder. This is even more pronounced for people with Autism spectrum disorders who are 10 times more likely to have a spouse with the same disorder.[90] Environment Main article: Brain health and pollution The prevalence of mental illness is higher in more economically unequal countries. During the prenatal stage, factors like unwanted pregnancy, lack of adaptation to pregnancy or substance use during pregnancy increases the risk of developing a mental disorder.[84] Maternal stress and birth complications including prematurity and infections have also been implicated in increasing susceptibility for mental illness.[91] Infants neglected or not provided optimal nutrition have a higher risk of developing cognitive impairment.[84] Social influences have also been found to be important,[92] including abuse, neglect, bullying, social stress, traumatic events, and other negative or overwhelming life experiences. Aspects of the wider community have also been implicated,[93] including employment problems, socioeconomic inequality, lack of social cohesion, problems linked to migration, and features of particular societies and cultures. The specific risks and pathways to particular disorders are less clear, however. Nutrition also plays a role in mental disorders.[10][94] In schizophrenia and psychosis, risk factors include migration and discrimination, childhood trauma, bereavement or separation in families, recreational use of drugs,[95] and urbanicity.[93] In anxiety, risk factors may include parenting factors including parental rejection, lack of parental warmth, high hostility, harsh discipline, high maternal negative affect, anxious childrearing, modelling of dysfunctional and drug-abusing behavior, and child abuse (emotional, physical and sexual).[96] Adults with imbalance work to life are at higher risk for developing anxiety.[84] For bipolar disorder, stress (such as childhood adversity) is not a specific cause, but does place genetically and biologically vulnerable individuals at risk for a more severe course of illness.[97] Drug use Mental disorders are associated with drug use including: cannabis,[98] alcohol[99] and caffeine,[100] use of which appears to promote anxiety.[101] For psychosis and schizophrenia, usage of a number of drugs has been associated with development of the disorder, including cannabis, cocaine, and amphetamines.[102][98] There has been debate regarding the relationship between usage of cannabis and bipolar disorder.[103] Cannabis has also been associated with depression.[98] Adolescents are at increased risk for tobacco, alcohol and drug use; Peer pressure is the main reason why adolescents start using substances. At this age, the use of substances could be detrimental to the development of the brain and place them at higher risk of developing a mental disorder.[84] Chronic disease People living with chronic conditions like HIV and diabetes are at higher risk of developing a mental disorder. People living with diabetes experience significant stress from the biological impact of the disease, which places them at risk for developing anxiety and depression. Diabetic patients also have to deal with emotional stress trying to manage the disease. Conditions like heart disease, stroke, respiratory conditions, cancer, and arthritis increase the risk of developing a mental disorder when compared to the general population.[104] Personality traits Risk factors for mental illness include a propensity for high neuroticism[105][106] or "emotional instability". In anxiety, risk factors may include temperament and attitudes (e.g. pessimism).[87] Key personality traits, including Neuroticism, Extraversion, Agreeableness, Conscientiousness, and Openness, significantly influence various dimensions of mental health, as measured by the General Health Questionnaire(GHQ-12). The GHQ-12 assesses mental health across three dimensions: GHQ-12A (social dysfunction & anhedonia), GHQ-12B (depression & anxiety), and GHQ-12C (loss of confidence).[107] Neuroticism was found to be strongly linked to all three dimensions, indicating greater vulnerability to mental health issues, while Extraversion was negatively associated with social dysfunction and depression, suggesting better mental health outcomes.Agreeableness and Conscientiousness were both negatively related to social dysfunction and loss of confidence, highlighting their protective roles. Openness showed a negative relationship with depression and anxiety. These findings support several models of personality's impact on mental health, including the predisposition/vulnerability, complication/scar, and pathoplasty/exacerbation models.[108] This underscores the importance of considering personality traits in mental health assessments and interventions, as they help identify individuals at higher risk for mental health challenges and guide targeted psychological care. Causal models Mental disorders can arise from multiple sources, and in many cases there is no single accepted or consistent cause currently established. An eclectic or pluralistic mix of models may be used to explain particular disorders.[106][109] The primary paradigm of contemporary mainstream Western psychiatry is said to be the biopsychosocial model which incorporates biological, psychological and social factors, although this may not always be applied in practice. Biological psychiatry follows a biomedical model where many mental disorders are conceptualized as disorders of brain circuits likely caused by developmental processes shaped by a complex interplay of genetics and experience. A common assumption is that disorders may have resulted from genetic and developmental vulnerabilities, exposed by stress in life (for example in a diathesis–stress model), although there are various views on what causes differences between individuals. Some types of mental disorders may be viewed as primarily neurodevelopmental disorders.[citation needed] Evolutionary psychology may be used as an overall explanatory theory, while attachment theory is another kind of evolutionary-psychological approach sometimes applied in the context of mental disorders. Psychoanalytic theories have continued to evolve alongside and cognitive-behavioral and systemic-family approaches. A distinction is sometimes made between a "medical model" or a "social model" of psychiatric disability.[citation needed] Diagnosis Psychiatrists seek to provide a medical diagnosis of individuals by an assessment of symptoms, signs and impairment associated with particular types of mental disorder. Other mental health professionals, such as clinical psychologists, may or may not apply the same diagnostic categories to their clinical formulation of a client's difficulties and circumstances.[110] The majority of mental health problems are, at least initially, assessed and treated by family physicians (in the UK general practitioners) during consultations, who may refer a patient on for more specialist diagnosis in acute or chronic cases. Routine diagnostic practice in mental health services typically involves an interview known as a mental status examination, where evaluations are made of appearance and behavior, self-reported symptoms, mental health history, and current life circumstances. The views of other professionals, relatives, or other third parties may be taken into account. A physical examination to check for ill health or the effects of medications or other drugs may be conducted. Psychological testing is sometimes used via paper-and-pen or computerized questionnaires, which may include algorithms based on ticking off standardized diagnostic criteria, and in rare specialist cases neuroimaging tests may be requested, but such methods are more commonly found in research studies than routine clinical practice.[111][112] Time and budgetary constraints often limit practicing psychiatrists from conducting more thorough diagnostic evaluations.[113] It has been found that most clinicians evaluate patients using an unstructured, open-ended approach, with limited training in evidence-based assessment methods, and that inaccurate diagnosis may be common in routine practice.[114] In addition, comorbidity is very common in psychiatric diagnosis, where the same person meets the criteria for more than one disorder. On the other hand, a person may have several different difficulties only some of which meet the criteria for being diagnosed. There may be specific problems with accurate diagnosis in developing countries. More structured approaches are being increasingly used to measure levels of mental illness. HoNOS is the most widely used measure in English mental health services, being used by at least 61 trusts.[115] In HoNOS a score of 0–4 is given for each of 12 factors, based on functional living capacity.[116] Research has been supportive of HoNOS,[117] although some questions have been asked about whether it provides adequate coverage of the range and complexity of mental illness problems, and whether the fact that often only 3 of the 12 scales vary over time gives enough subtlety to accurately measure outcomes of treatment.[118]

Mental Health in the United States

A mental disorder, also referred to as a mental illness,[6] a mental health condition,[7] or a psychiatric disability,[2] is a behavioral...

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Mental health well-being is increasingly recognized as a vital part of our overall health, yet it often remains misunderstood. As we navigate today’s fast-paced world, the pressure to succeed often overshadows the need to care for our mental well-being. In this blog post, we will explore the hidden dimensions of mental health, emphasizing how individuals can cultivate a healthier mindset amidst the challenges of contemporary life.

Exploring the Hidden Dimensions of Mental Health Well-being in Contemporary Society

Mental Health Well-being

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Mental health is an essential aspect of overall well-being. For individuals grappling with mental illness, understanding the impact of environmental factors, such as weather phenomena, can provide valuable insights into their emotional states. One such phenomenon is the medicane, or Mediterranean hurricane. This blog post aims to educate and raise awareness about medicane, its effects on mental health, coping strategies for those affected, and resources available for support.

Understanding Medicane: Its Impact on Mental Health for Individuals with Mental Illness

Understanding Medicane: Its Impact on Mental Health for Individuals with Mental Illness

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Recovery coaching is a form of strengths-based support for people with addictions or in recovery from alcohol, other drugs, codependency, or other addictive behaviors.[1] There are multiple models, with some programs using self-identified peers who draw from their own lived experience with substance use and recovery and some utilizing people who have no lived experience but some training in support, depending on local standards and availability.[2] They help clients find ways to stop addiction (abstinence) or reduce harm associated with addictive behaviors. These coaches can help a client find resources for harm reduction, detox, treatment, family support and education, local or online support groups; or help a client create a change plan to recover on their own.[3]

Transform Your Life with Recovery Coaching: A Path to Healing and Growth

Transform Your Life with Recovery Coaching: A Path to Healing and Growth

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Addiction affects countless lives, extending its reach into families and communities. While therapies and rehabilitation programs are crucial for recovery, the significance of community support is often underestimated. Community is not just about being in the same place; it involves shared experiences, understanding, and a sense of belonging that can tremendously aid an individual’s recovery journey.

The Impact of Community Support on Overcoming Addiction Challenges

The Impact of Community Support on Overcoming Addiction Challenges

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In today's fast-paced world, prioritizing mental health has never been more critical. For those facing the challenges of recovery, the journey can be filled with both highs and lows. Self-care is not just a helpful practice; it is essential. It can greatly impact the recovery process. In this post, we will explore why self-care matters, share practical tips, and discuss its importance for maintaining mental health over the long run.

The Essential Role of Self-Care in Mental Health Recovery and Long-Term Wellness

The Essential Role of Self-Care in Mental Health Recovery and Long-Term Wellness

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Addiction and substance abuse present complex challenges that ripple through families, impacting not just the individual in crisis but also their loved ones. The stigma surrounding these issues often intensifies these challenges, profoundly affecting family mental health. By understanding the ripple effect of stigma, families can confront these challenges with empathy and resilience.

The Ripple Effect of Stigma on Family Mental Health in the Context of Addiction and Substance Abuse

The Ripple Effect of Stigma on Family Mental Health in the Context of Addiction and Substance Abuse

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Mental health awareness has significantly improved in recent years, yet stigma still looms large in many communities. This stigma doesn't just affect individuals grappling with mental health challenges; it ripples through families, influencing dynamics, relationships, and overall well-being. Studies show that more than 60% of individuals with mental health issues report feeling ashamed because of stigma, impacting how they interact with family members.

The Unseen Impact of Stigma on Family Mental Health Dynamics

The Unseen Impact of Stigma on Family Mental Health Dynamics

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Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. Mental health plays a crucial role in an individuals daily life when managing stress, engaging with others, and contributing to life overall. According to the World Health Organization (WHO), it is a "state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to his or her community".[1] It likewise determines how an individual handles stress, interpersonal relationships, and decision-making.[2] Mental health includes subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others.[3]

Understanding the Wide Spectrum of Mental Health Encompasses

Understanding the Wide Spectrum of Mental Health Encompasses

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Introduction

The Impact of Leprosy on Medieval European Society and Culture

The Impact of Leprosy on Medieval European Society and Culture

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Racism is not just a historical issue; it is a reality that affects countless lives today. It is deeply woven into the fabric of American society, influencing everything from education to employment. Although strides have been made toward equity, discriminatory practices and attitudes still persist. This post seeks to explore the complexities of racism in the U.S. by focusing on its origins, current manifestations, and the vital steps needed to combat it.

Unveiling the Unspoken: Analyzing the Complexities of Racism in the United States

Racism in the United States

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Addiction is often depicted as a solitary battle, one fought in isolation, shrouded in stigma and misunderstanding. However, at its core, the journey of recovery is seldom a solo endeavor. Instead, it thrives within the grounds of community, where shared experiences, mutual support, and collective resilience resonate profoundly. The ripple effect of such communal ties can be a lifeline, guiding individuals through the tumultuous waters of recovery. In this article, we will explore the vital role of community in addiction recovery, how it aids individuals not just in overcoming addiction but also in fostering a sense of belonging and purpose. Understanding the Ripple Effect The ripple effect refers to how a single action can influence broader outcomes, resembling the way ripples spread across a pond when a pebble is thrown into the water. In addiction recovery, this concept is particularly relevant. By nurturing relationships within a community, individuals experience newfound hope and encouragement, empowering them to confront their addiction. Furthermore, a supportive environment cultivates accountability and motivation, enabling members to lean on one another during challenging moments. The sense of fellowship becomes a vital support system, reducing feelings of isolation and despair that often accompany addiction. The Value of Shared Experiences One of the most powerful aspects of community in addiction recovery is the value of shared experiences. When individuals gather — whether in support groups, community centers, or social meetings — they share stories of struggle, resilience, and victory. Such exchanges help members realize that they are not alone in their journey. Knowing that others face similar challenges creates an atmosphere of understanding and compassion. Stories of recovery themselves can inspire hope and serve as tangible proof that change is possible. Witnessing the transformation of others often ignites the belief that one can achieve their own recovery. Building Trust and Accountability In a supportive community, trust and accountability flourish. While facing addiction can often foster a mindset of fear and shame, being part of a community encourages openness and honesty. When individuals share their struggles and victories with trusted peers, they build a foundation of accountability that is crucial for recovery. Accountability can act as an anchor, keeping individuals focused on their recovery goals. Moreover, being accountable to others can motivate individuals to remain committed to their sobriety, knowing that they are part of a larger mission of healing and support. The Importance of Connection Human beings are inherently social creatures; connection is critical for emotional and psychological well-being. Throughout the recovery process, forming meaningful connections can be a game-changer. Engaging with others not only alleviates feelings of loneliness but also promotes a sense of purpose. Many community initiatives provide opportunities for individuals to help others, thus reinforcing their own recovery journey. Helping peers can instill confidence and generate positive self-worth. Additionally, connections formed through community activities often lead to friendships that extend beyond recovery efforts, offering emotional support and companionship during times of need. Overcoming Stigma Together Stigma surrounding addiction can deter individuals from seeking help. However, when individuals are part of an understanding and non-judgmental community, the barriers presented by stigma can be dismantled. Communities often foster a culture of acceptance, where individuals celebrate milestones and offer support without criticism. This environment encourages individuals to seek help when needed and brings about an overarching transformation in how addiction is perceived in society. By standing together and sharing their narratives, affected individuals can challenge societal norms and reshape the dialogue surrounding addiction, contributing to a greater awareness on various platforms. The Role of Mentorship Mentorship within recovery communities can also be significantly impactful. Those who have traversed the path of addiction recovery can offer invaluable guidance to newcomers. Mentors share their experiences, strategies for coping, and insights into personal growth. The mentor-mentee relationship is often a source of strength, as it emphasizes that recovery is an ongoing journey and not merely an endpoint. Mentors play an essential role in encouraging others to engage with their feelings, challenges, and triumphs, fostering a cycle of care and support throughout the community. Engaging in Recreational Activities Recreational activities within community settings can provide an essential outlet for creativity, connection, and fun. Engaging in group sports, art classes, or outdoor adventures can serve to distract individuals from temptations and triggers, improving overall well-being. Positive recreational experiences often lead to the development of new interests, friendships, and the exploration of new, healthier lifestyles. Feeling joy and having fun plays a critical role in recovery and reinforces a sense of normalcy. Conclusion The journey to recovery from addiction is challenging; however, it is a path that need not be walked alone. The transformative power of community offers hope, strength, and resilience essential for overcoming obstacles. Shared experiences, accountability, connections, mentorship, and engaging activities weave together to create a tapestry of support that uplifts individuals. By nurturing and participating in these communities, we forge new beginnings rooted in compassion, understanding, and collective growth. As we continue to champion the ripple effect of community in addiction recovery, let us remember that those who stand together can conquer even the most difficult of challenges. Recovery is possible, and it flourishes in the heart of community.

The Transformative Power of Community in Navigating Addiction Recovery

Clive Staples Lewis FBA (29 November 1898 – 22 November 1963) was a British writer, literary scholar, and Anglican lay theologian. He held academic positions in English literature at both Magdalen College, Oxford (1925–1954), and Magdalene College, Cambridge (1954–1963). He is best known as the author of The Chronicles of Narnia, but he is also noted for his other works of fiction, such as The Screwtape Letters and The Space Trilogy, and for his non-fiction Christian apologetics, including Mere

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Introduction

Debate: God, Love, Sex, and the Meaning of Life

Debate God, Love, Sex, and the meaning of life

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The journey toward recovery from addiction and substance abuse is a deeply personal one, shaping the lives of those affected in myriad ways. However, this path, though individual, does not have to be traveled alone. Community support plays a crucial role in facilitating recovery, serving as a driving force that inspires hope and fosters resilience among individuals working to reclaim their lives. By harnessing the power of shared experiences, support systems, and understanding, individuals can navigate their recovery journeys with a reinforced sense of purpose and belonging.

The Transformative Power of Community Support in Overcoming Addiction and Substance Abuse

The journey toward recovery from addiction and substance abuse is a deeply personal one, shaping the lives of those affected in myriad...

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Addiction recovery is a complex and often challenging process that involves many facets, including personal determination, professional therapy, and importantly, community support. The role of community in this journey cannot be overstated; it acts as both a support network and a motivational force that empowers individuals to reclaim their lives.

The Impact of Community Support on Successful Addiction Recovery Journeys

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* Who is the target audience for this blog post? (e.g., general public, individuals in recovery, mental health professionals, etc.)

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In today's fast-paced world, personal effects shape our identities and how others see us. These items—ranging from clothing and accessories to grooming choices—play a crucial role in defining our sense of self. By understanding how these personal effects influence our outward appearance, we can better present ourselves to the world and build a stronger personal brand.

The Impact of Personal Effects on Professional Identity and Recognition

Praise for personal effects

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In a world filled with daunting challenges, a small group of dedicated individuals can make a remarkable impact. This is the tale of Chaney and The Dentists’ Last Stand, a story of resilience and unwavering passion in the pursuit of a dream, even when facing significant adversity.

The Untold Story of Chaney and The Dentists' Last Stand in the Face of Adversity

In a world filled with daunting challenges, a small group of dedicated individuals can make a remarkable impact. This is the tale of...

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In today's world, we are inundated with information from various sources, ranging from scientific studies to viral social media posts. Amidst this flood of information, some myths and misconceptions—often termed "junk science"—have managed to gain traction in popular culture. These myths can have serious implications, influencing public opinion, policy decisions, and personal health choices. This blog post aims to dissect some prevalent junk science myths, their origins, and their impact on society as a whole.

A Critical Examination of Junk Science Myths and Their Cultural Impact

A Junk Science Reckoning (of Sorts)

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The 21st century has brought incredible advancements in science and technology. Among these, the unveiling of DNA's secrets stands out. With the decoding of the human genome, we've entered an exciting new era. Our understanding of life at a molecular level is changing rapidly. This blog post will explore the DNA revolution, its effects on medicine, agriculture, and our overall comprehension of life itself.

Unveiling the DNA Revolution: The Hidden Forces Shaping Our Future

The DNA Revolution

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In today's digital age, we face a growing problem: the rise of junk science. This term refers to misleading or false scientific claims presented as legitimate. With the vast landscape of the internet, anyone can claim expertise, leading to an explosion of pseudoscience and misinformation. Understanding this trend is crucial because it influences public health, shapes policies, and alters societal views. For instance, a 2019 survey by the Pew Research Center found that 77% of Americans often encounter junk science in their daily lives. This alarming statistic highlights the urgency of addressing the issue. As we navigate the complex world of information, we must equip ourselves with the tools to discern fact from fiction. The Origins of Junk Science The phrase "junk science" gained traction in the late 20th century, primarily in legal contexts. Its roots can be traced back to a time when the public relied heavily on experts for accurate information. Unfortunately, this reliance has led to exploitation, particularly as scientific literacy has become more accessible. The advent of the Internet reshaped how we receive information. Platforms like social media and blogs have become channels for sharing opinions, often blurring the lines between credible science and “alternative facts.” For example, platforms like Facebook have been criticized for allowing the spread of false scientific claims, often prioritizing engagement over accuracy. Dazzling headlines often lure people into believing junk science, presenting quick, easy solutions to complex problems. As a result, false claims can overshadow valid scientific research, creating a cycle of misinformation that is difficult to break. The Role of Media and Misinformation In our click-driven world, the media plays a significant role in shaping perceptions of science. Sensational headlines attract more attention than nuanced discussions, which harms public understanding. According to a study by the American Psychological Association, articles focused on sensational findings were shared on social media 8 times more than those based on rigorous studies. Social media algorithms also amplify sensational or controversial content, allowing junk science to spread quickly. For example, misleading health advice about miracle cures has gathered widespread attention, often resulting in misplaced trust and fear. As misinformation circulates, it can overshadow scientific consensus, leading people to believe in false claims. The implications are serious: junk science distorts public understanding and can create anxiety about threats that do not exist. It can also promote reliance on ineffective remedies, which undermines public health. The Implications for Public Health One of the most significant impacts of junk science is on public health. A glaring example is the anti-vaccine movement, which has caused vaccination rates to drop significantly. According to the CDC, during 2019, the U.S. experienced the largest number of measles cases since 1992, in part due to misinformation about vaccine safety. Furthermore, junk science often spurs health fads. People may invest in unproven supplements or extreme diets, wasting money and potentially harming their health. For instance, a 2017 report found that nearly 75% of Americans use dietary supplements, many of which lack scientific backing. It is essential for individuals to differentiate between credible scientific research and dubious claims. Reliable public health policies should be based on rigorous studies. However, junk science can sway opinions, ultimately compromising these essential policies. The Environmental Impact Environmental issues are also deeply affected by junk science. Misleading information about climate change spreads rapidly, despite overwhelming scientific evidence that highlights its reality. Research published in Nature Communications indicates that nearly 70% of climate change misinformation comes from a small number of sources who manipulate data to suit their narrative. To combat this problem, it is crucial to emphasize scientific literacy and critical thinking skills. For example, understanding the basics of scientific inquiry can help individuals assess the reliability of information. In a world facing the effects of climate change, communities must advocate for education that promotes informed decision-making based on evidence. Combating Junk Science Addressing junk science requires a multi-faceted approach. Education is key; teaching scientific literacy from a young age helps people analyze information critically. A recent study showed that kids exposed to scientific concepts in school were 40% more likely to question dubious claims they encounter. Moreover, it is vital for scientists to engage the public effectively. By simplifying complex concepts without losing accuracy, they can help bridge the gap between scientific communities and everyday people. Encouraging a culture of skepticism is equally important. Individuals should question sources and seek out multiple perspectives. Fact-checking initiatives and responsible journalism are crucial for fostering an environment where accurate information prevails. The Fight for Scientific Integrity The rise of junk science poses a significant risk to society, affecting everything from public health to environmental policies. As we are bombarded with information, critical discernment is essential. We have a collective responsibility to cultivate informed perspectives. This includes seeking credible sources and questioning dubious claims. By promoting scientific literacy and skepticism, we can counter the effects of junk science in our daily lives. Together, we must strive for a society grounded in factual information, ensuring future generations can distinguish between science and speculation. The battle against junk science is not just about protecting facts; it is about preserving public trust in science and ensuring a healthier, more informed future for everyone.

The Dark Secrets Behind the Rise of Junk Science and Its Unseen Impact

The Rise of Junk science

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Mental health disorders affect millions globally, yet they are often surrounded by stigma and misunderstanding. The impact of these disorders can be significant, affecting individuals, families, and communities alike. This post examines the hidden effects of specific mental health disorders on daily experiences, relationships, and overall well-being.

Exploring the Unseen Impacts of Mental Health Disorders on Individual Lives

Impacts on specific disorders and Individuals with mental health disorders

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When individuals struggle with addiction and mental health disorders, their journey can feel overwhelming. The intertwined nature of these challenges demands our attention. This blog post examines how specific mental health disorders connect with addiction, highlighting their significant impacts on people's lives.

Navigating the Complex Interplay of Addiction and Mental Health Disorders

When individuals struggle with addiction and mental health disorders, their journey can feel overwhelming. The intertwined nature of...

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The COVID-19 pandemic has deeply affected life in America in ways many did not anticipate. While we are aware of the physical health challenges, the mental health consequences are just as critical, if not more so. The social isolation, relentless uncertainty, and overwhelming loss have intensified existing mental health conditions and fueled rising addiction rates. This post explores the profound impact of the COVID-19 pandemic on mental health and addiction in the United States, and it discusses potential pathways for recovery and support.

Navigating the Shadows: Unseen Effects of COVID-19 on Addiction and Mental Health in America

COVID-19 pandemic has impacted the mental health in America

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Addiction impacts everyone, not just the individual struggling with it. The family unit can either support the recovery process or contribute to the challenges that arise. This post explores how family dynamics shape recovery and offers insights into developing a supportive environment for everyone involved.

Exploring the Role of Family Dynamics in the Journey of Addiction Recovery

The Impact of the Drug War in America on Society and Policy

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Introduction Overview of the Drug War in America. Brief explanation of its historical context and initiation. Statement on the relevance and importance of examining its impact today. Historical Context Origins of the Drug War. - Introduction of key legislation such as the Controlled Substances Act. - Role of significant figures in shaping drug policy. Escalation of control measures throughout the decades. - Introduction of mandatory minimum sentences. - Shift towards a law enforcement approach. Societal Impact Public Health Concerns. - Increase in overdose deaths related to opioids and other substances. - Rise of mental health issues associated with drug abuse. Racial Disparities in Enforcement. - Statistics showcasing racial disparities in arrests and sentencing. - Discussion of systemic racism and its effects on communities of color. Social Stigma and Its Consequences. - Examination of societal views on addiction and its treatment. - Impact on families and individuals struggling with substance use. Economic Consequences Cost of the Drug War to taxpayers. - Analysis of federal and state spending on enforcement versus treatment. Loss of productivity. - Discussion of connection between substance abuse and workplace issues. Impact on local economies, particularly in hard-hit areas. - Exploration of how drug-related crime affects local businesses and investment. Legislative and Policy Responses Shifts in drug policy over recent years. - Introduction of initiatives aimed at decriminalization. - Overview of states that have legalized marijuana and its effects. Treatment versus incarceration debates. - Evaluation of harm reduction approaches and their effectiveness. Overview of proposed reforms. - Discussion of bipartisan efforts towards drug policy reform. Community and Grassroots Movements Role of community organizations in advocating for change. - Examples of successful grassroots campaigns. Importance of education and prevention programs. - Overview of initiatives aimed at reducing drug use through education. Building local coalitions to fight the impacts of the Drug War. - Case studies of collaboration between community leaders and activists. International Perspectives Comparison of the Drug War in America with other countries' approaches. - Examination of successful models in countries that have decriminalized drugs. Lessons learned from international policy shifts. - Discussion on the potential for reform based on global trends. Conclusion Recap of the multifaceted impact of the Drug War on American society and policy. Call to action for continued dialogue and reform. Vision for a future where drug policy focuses on health, prevention, and equity.

The Impact of the Drug War in America on Society and Policy

Understanding the Wide Spectrum of Mental Health Encompasses

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A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a name for community personnel who worked in the new community mental health agencies begun in the 1970s to assist individuals moving from state hospitals, to prevent admissions, and to provide support in homes, jobs, education, and community. These individuals (i.e., state office personnel, private sector personnel, and non-profit, now voluntary sector personnel) were the forefront brigade to develop the community programs, which today may be referred to by names such as supported housing, psychiatric rehabilitation, supported or transitional employment, sheltered workshops, supported education, daily living skills, affirmative industries, dual diagnosis treatment,[1] individual and family psychoeducation, adult day care, foster care, family services and mental health counseling. Psychiatrists - physicians who use the biomedical model to treat mental health problems - may prescribe medication. The term counselors often refers to office-based professionals who offer therapy sessions to their clients, operated by organizations such as pastoral counseling (which may or may not work with long-term services clients) and family counselors. Mental health counselors may refer to counselors working in residential services in the field of mental health in community programs. As community professionals As Dr. William Anthony, father of psychiatric rehabilitation, described, psychiatric nurses (RNMH, RMN, CPN), clinical psychologists (PsyD or PhD), clinical social workers (MSW or MSSW), mental health counselors (MA or MS), professional counselors, pharmacists, as well as many other professionals are often educated in "psychiatric fields" or conversely, educated in a generic community approach (e.g. human services programs or health and human services in 2013). However, his primary concern is education that leads to a willingness to work with "long-term services and supports" community support[2][3] in the community to lead to better life quality for the individual, the families and the community. The community support framework in the US of the 1970s[4][5][6] is taken-for-granted as the base for new treatment developments (e.g., eating disorders, drug addiction programs) which tend to be free-standing clinics for specific "disorders". Typically, the term "mental health professional" does not refer to other categorical disability areas, such as intellectual and developmental disability (which trains its own professionals and maintains its own journals, and US state systems and institutions). Psychiatric rehabilitation has also been reintroduced into the transfer to behavioral health care systems. As certified and licensed (across institutions and communities) These professionals often deal with the same illnesses, disorders, conditions, and issues (though may separate on-site locations, such as hospital or community for the same clientele); however, their scope of practice differs and more particularly, their positions and roles in the fields of mental health services and systems. The most significant difference between mental health professionals are the laws regarding required education and training across the various professions.[7] However, the most significant change has been the Supreme Court Olmstead decision on the most integrated setting which should further reduce state hospital utilization; yet with new professionals seeking right for community treatment orders and rights to administer medications (original community programs, residents taught to self-administer medications, 1970s). In 2013, new mental health practitioners are licensed or certified in the community (e.g., PhD, education in private clinical practice) by states, degrees and certifications are offered in fields such as psychiatric rehabilitation (MS, PhD), BA psychology (liberal arts, experimental/clinical/existential/community) to MA licensing is now more popular, BA (to PhD) mid-level program management, qualified civil service professionals, and social workers remain the mainstay of community admissions procedures (licensed by state, often generic training) in the US. Surprisingly, state direction has moved from psychiatry or clinical psychology to community leadership and professionalization of community services management. Entry level recruitment and training remain a primary concern (since the 1970s, then often competing with fast food positions), and the US Direct Support Workforce includes an emphasis on also training of psychiatric aides, behavioral aides, and addictions aides to work in homes and communities.[8] The Centers for Medicaid and Medicare have new provisions for "self-direction" in services and new options are in place for individual plans for better life outcomes. Community programs are increasingly using health care financing, such as Medicaid, and Mental Health Parity is now law in the US.

1. "How to Find the Right Mental Health Professional for You

A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a name for community personnel who worked in the new community mental health agencies begun in the 1970s to assist individuals moving from state hospitals, to prevent admissions, and to provide support in homes, jobs, education, and community. These individ

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Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. According to the World Health Organization (WHO), it is a "state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to his or her community".[1] It likewise determines how an individual handles stress, interpersonal relationships, and decision-making.[2] Mental health includes subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others.[3] From the perspectives of positive psychology or holism, mental health may include an individual's ability to enjoy life and to create a balance between life activities and efforts to achieve psychological resilience.[4] Cultural differences, personal philosophy, subjective assessments, and competing professional theories all affect how one defines "mental health".[5] Some early signs related to mental health difficulties are sleep irritation, lack of energy, lack of appetite, thinking of harming oneself or others, self-isolating (though introversion and isolation are not necessarily unhealthy), and frequently zoning out.[5] Mental disorders See also: Mental disorder Mental health, as defined by the Public Health Agency of Canada,[6] is an individual's capacity to feel, think, and act in ways to achieve a better quality of life while respecting personal, social, and cultural boundaries.[7] Impairment of any of these are risk factor for mental disorders, or mental illnesses,[8] which are a component of mental health. In 2019, about 970 million people worldwide suffered from a mental disorder, with anxiety and depression being the most common. The number of people suffering from mental disorders has risen significantly throughout the years.[9] Mental disorders are defined as health conditions that affect and alter cognitive functioning, emotional responses, and behavior associated with distress and/or impaired functioning.[10][11] The ICD-11 is the global standard used to diagnose, treat, research, and report various mental disorders.[12][13] In the United States, the DSM-5 is used as the classification system of mental disorders.[14] Mental health is associated with a number of lifestyle factors such as diet, exercise, stress, drug abuse, social connections and interactions.[14][15] Psychiatrists, psychologists, licensed professional clinical counselors, social workers, nurse practitioners, and family physicians can help manage mental illness with treatments such as therapy, counseling, and medication.[16] History See also: Well-being, Eudaimonia, and History of mental disorders Early history Highly stylized poster for the Hygiene Congress in Hamburg, 1912 In the mid-19th century, William Sweetser was the first to coin the term mental hygiene, which can be seen as the precursor to contemporary approaches to work on promoting positive mental health.[17][18] Isaac Ray, the fourth president[19] of the American Psychiatric Association and one of its founders, further defined mental hygiene as "the art of preserving the mind against all incidents and influences calculated to deteriorate its qualities, impair its energies, or derange its movements".[18] In American history, mentally ill patients were thought to be religiously punished. This response persisted through the 1700s, along with the inhumane confinement and stigmatization of such individuals.[20] Dorothea Dix (1802–1887) was an important figure in the development of the "mental hygiene" movement. Dix was a school teacher who endeavored to help people with mental disorders and to expose the sub-standard conditions into which they were put.[21] This became known as the "mental hygiene movement".[21] Before this movement, it was not uncommon that people affected by mental illness would be considerably neglected, often left alone in deplorable conditions without sufficient clothing.[21] From 1840 to 1880, she won the support of the federal government to set up over 30 state psychiatric hospitals; however, they were understaffed, under-resourced, and were accused of violating human rights.[20] Emil Kraepelin in 1896 developed the taxonomy of mental disorders which has dominated the field for nearly 80 years. Later, the proposed disease model of abnormality was subjected to analysis and considered normality to be relative to the physical, geographical and cultural aspects of the defining group.[22] At the beginning of the 20th century, Clifford Beers founded "Mental Health America – National Committee for Mental Hygiene", after publication of his accounts as a patient in several lunatic asylums, A Mind That Found Itself, in 1908[23][24][25] and opened the first outpatient mental health clinic in the United States.[24] The mental hygiene movement, similar to the social hygiene movement, had at times been associated with advocating eugenics and sterilization of those considered too mentally deficient to be assisted into productive work and contented family life.[26][27] In the post-WWII years, references to mental hygiene were gradually replaced by the term 'mental health' due to its positive aspect that evolves from the treatment of illness to preventive and promotive areas of healthcare.[25] Institutionalization and Deinstitutionalization When US government-run hospitals were accused of violating human rights, advocates pushed for deinstitutionalization: the replacement of federal mental hospitals for community mental health services. The closure of state-provisioned psychiatric hospitals was enforced by the Community Mental Health Centers Act in 1963 that laid out terms in which only patients who posed an imminent danger to others or themselves could be admitted into state facilities.[28] This was seen as an improvement from previous conditions. However, there remains a debate on the conditions of these community resources. It has been proven that this transition was beneficial for many patients: there was an increase in overall satisfaction, a better quality of life, and more friendships between patients all at an affordable cost. This proved to be true only in the circumstance that treatment facilities had enough funding for staff and equipment as well as proper management.[29] However, this idea is a polarizing issue. Critics of deinstitutionalization argue that poor living conditions prevailed, patients were lonely, and they did not acquire proper medical care in these treatment homes.[30] Additionally, patients that were moved from state psychiatric care to nursing and residential homes had deficits in crucial aspects of their treatment. Some cases result in the shift of care from health workers to patients' families, where they do not have the proper funding or medical expertise to give proper care.[30] On the other hand, patients that are treated in community mental health centers lack sufficient cancer testing, vaccinations, or otherwise regular medical check-ups.[30] Other critics of state deinstitutionalization argue that this was simply a transition to "transinstitutionalization", or the idea that prisons and state-provisioned hospitals are interdependent. In other words, patients become inmates. This draws on the Penrose Hypothesis of 1939, which theorized that there was an inverse relationship between prisons' population size and the number of psychiatric hospital beds.[31] This means that populations that require psychiatric mental care will transition between institutions, which in this case, includes state psychiatric hospitals and criminal justice systems. Thus, a decrease in available psychiatric hospital beds occurred at the same time as an increase in inmates.[31] Although some are skeptical that this is due to other external factors, others will reason this conclusion to a lack of empathy for the mentally ill. There is no argument for the social stigmatization of those with mental illnesses, they have been widely marginalized and discriminated against in society.[20] In this source, researchers analyze how most compensation prisoners (detainees who are unable or unwilling to pay a fine for petty crimes) are unemployed, homeless, and with an extraordinarily high degree of mental illnesses and substance use disorders.[31] Compensation prisoners then lose prospective job opportunities, face social marginalization, and lack access to resocialization programs, which ultimately facilitate reoffending.[31] The research sheds light on how the mentally ill—and in this case, the poor—are further punished for certain circumstances that are beyond their control, and that this is a vicious cycle that repeats itself. Thus, prisons embody another state-provisioned mental hospital. Families of patients, advocates, and mental health professionals still call for increase in more well-structured community facilities and treatment programs with a higher quality of long-term inpatient resources and care. With this more structured environment, the United States will continue with more access to mental health care and an increase in the overall treatment of the mentally ill. However, there is still a lack of studies for mental health conditions (MHCs) to raise awareness, knowledge development, and attitudes toward seeking medical treatment for MHCs in Bangladesh. People in rural areas often seek treatment from the traditional healers and MHCs are sometimes considered a spiritual matter.[32] Epidemiology See also: Prevalence of mental disorders Mental illnesses are more common than cancer, diabetes, or heart disease. As of 2021, over 22 percent of all Americans over the age of 18 meet the criteria for having a mental illness.[33] Evidence suggests that 970 million people worldwide have a mental disorder.[34] Major depression ranks third among the top 10 leading causes of disease worldwide. By 2030, it is predicted to become the leading cause of disease worldwide.[35] Over 700 thousand people commit suicide every year and around 14 million attempt it.[36] A World Health Organization (WHO) report estimates the global cost of mental illness at nearly $2.5 trillion (two-thirds in indirect costs) in 2010, with a projected increase to over $6 trillion by 2030.[37] Evidence from the WHO suggests that nearly half of the world's population is affected by mental illness with an impact on their self-esteem, relationships and ability to function in everyday life.[38] An individual's emotional health can impact their physical health. Poor mental health can lead to problems such as the inability to make adequate decisions and substance use disorders.[39] Good mental health can improve life quality whereas poor mental health can worsen it. According to Richards, Campania, & Muse-Burke, "There is growing evidence that is showing emotional abilities are associated with pro-social behaviors such as stress management and physical health."[39] Their research also concluded that people who lack emotional expression are inclined to anti-social behaviors (e.g., substance use disorder and alcohol use disorder, physical fights, vandalism), which reflects one's mental health and suppressed emotions.[39] Adults and children who face mental illness may experience social stigma, which can exacerbate the issues.[40] Global prevalence See also: Global mental health and Category:Mental health by country The Two Continua Model of Mental Health and Mental Illness Mental health can be seen as a continuum, where an individual's mental health may have many different possible values.[41] Mental wellness is viewed as a positive attribute; this definition of mental health highlights emotional well-being, the capacity to live a full and creative life, and the flexibility to deal with life's inevitable challenges. Some discussions are formulated in terms of contentment or happiness.[42] Many therapeutic systems and self-help books offer methods and philosophies espousing strategies and techniques vaunted as effective for further improving the mental wellness. Positive psychology is increasingly prominent in mental health. A holistic model of mental health generally includes concepts based upon anthropological, educational, psychological, religious, and sociological perspectives. There are also models as theoretical perspectives from personality, social, clinical, health and developmental psychology.[43][44] The tripartite model of mental well-being[41][45] views mental well-being as encompassing three components of emotional well-being, social well-being, and psychological well-being. Emotional well-being is defined as having high levels of positive emotions, whereas social and psychological well-being are defined as the presence of psychological and social skills and abilities that contribute to optimal functioning in daily life. The model has received empirical support across cultures.[45][46][47] The Mental Health Continuum-Short Form (MHC-SF) is the most widely used scale to measure the tripartite model of mental well-being.[48][49][50] Demographics Children and young adults Further information: Infant mental health, Mental disorders diagnosed in childhood, and Developmental psychopathology See also: Depression in childhood and adolescence and Adverse childhood experiences As of 2019, about one in seven of the world's 10–19 year olds experienced a mental health disorder; about 165 million young people in total.[51][52] A person's teenage years are a unique period where much crucial psychological development occurs, and is also a time of increased vulnerability to the development of adverse mental health conditions. More than half of mental health conditions start before a child reaches 20 years of age, with onset occurring in adolescence much more frequently than it does in early childhood or adulthood. Many such cases go undetected and untreated.[53][51][54][55] In the United States alone, in 2021, at least roughly 17.5% of the population (ages 18 and older) were recorded as having a mental illness. The comparison between reports and statistics of mental health issues in newer generations (18–25 years old to 26–49 years old) and the older generation (50 years or older) signifies an increase in mental health issues as only 15% of the older generation reported a mental health issue whereas the newer generations reported 33.7% (18–25) and 28.1% (26–49).[56] The role of caregivers for youth with mental health needs is valuable, and caregivers benefit most when they have sufficient psychoeducation and peer support.[57] Depression is one of the leading causes of illness and disability among adolescents.[51] Suicide is the fourth leading cause of death in 15-19-year-olds.[51] Exposure to childhood trauma can cause mental health disorders and poor academic achievement.[58] Ignoring mental health conditions in adolescents can impact adulthood.[59] 50% of preschool children show a natural reduction in behavioral problems. The remaining experience long-term consequences.[59] It impairs physical and mental health and limits opportunities to live fulfilling lives.[59] A result of depression during adolescence and adulthood may be substance abuse.[59][60] The average age of onset is between 11 and 14 years for depressive disorders.[60] Only approximately 25% of children with behavioral problems refer to medical services.[59] The majority of children go untreated.[59] Homeless population Further information: Homelessness and mental health Mental illness is thought to be highly prevalent among homeless populations, though access to proper diagnoses is limited. An article written by Lisa Goodman and her colleagues summarized Smith's research into PTSD in homeless single women and mothers in St. Louis, Missouri, which found that 53% of the respondents met diagnostic criteria, and which describes homelessness as a risk factor for mental illness.[61] At least two commonly reported symptoms of psychological trauma, social disaffiliation and learned helplessness are highly prevalent among homeless individuals and families.[62] While mental illness is prevalent, people infrequently receive appropriate care.[61] Case management linked to other services is an effective care approach for improving symptoms in people experiencing homelessness.[62] Case management reduced admission to hospitals, and it reduced substance use by those with substance abuse problems more than typical care.[62] Immigrants and refugees See also: Mental health of refugees States that produce refugees are sites of social upheaval, civil war, even genocide.[63] Most refugees experience trauma. It can be in the form of torture, sexual assault, family fragmentation, and death of loved ones.[63][64] Refugees and immigrants experience psychosocial stressors after resettlement.[65] These include discrimination, lack of economic stability, and social isolation causing emotional distress. For example, not far into the 1900s, campaigns targeting Japanese immigrants were being formed that inhibited their ability to participate in U.S. life, painting them as a threat to the American working-class. They were subject to prejudice and slandered by American media as well as anti-Japanese legislation being implemented.[66][63][64] For refugees family reunification can be one of the primary needs to improve quality of life.[63] Post-migration trauma is a cause of depressive disorders and psychological distress for immigrants.[63][64][65] Mental Health in Social Work See also: Mental health in aviation Mental health in social work Further information: Social work See also: Clinical social work Social work in mental health, also called psychiatric social work, is a process where an individual in a setting is helped to attain freedom from overlapping internal and external problems (social and economic situations, family and other relationships, the physical and organizational environment, psychiatric symptoms, etc.). It aims for harmony, quality of life, self-actualization and personal adaptation across all systems. Psychiatric social workers are mental health professionals that can assist patients and their family members in coping with both mental health issues and various economic or social problems caused by mental illness or psychiatric dysfunctions and to attain improved mental health and well-being. They are vital members of the treatment teams in Departments of Psychiatry and Behavioral Sciences in hospitals. They are employed in both outpatient and inpatient settings of a hospital, nursing homes, state and local governments, substance use clinics, correctional facilities, health care services, private practice, etc.[67] In the United States, social workers provide most of the mental health services. According to government sources, 60 percent of mental health professionals are clinically trained social workers, 10 percent are psychiatrists, 23 percent are psychologists, and 5 percent are psychiatric nurses.[68] Mental health social workers in Japan have professional knowledge of health and welfare and skills essential for person's well-being. Their social work training enables them as a professional to carry out Consultation assistance for mental disabilities and their social reintegration; Consultation regarding the rehabilitation of the victims; Advice and guidance for post-discharge residence and re-employment after hospitalized care, for major life events in regular life, money and self-management and other relevant matters to equip them to adapt in daily life. Social workers provide individual home visits for mentally ill and do welfare services available, with specialized training a range of procedural services are coordinated for home, workplace and school. In an administrative relationship, Psychiatric social workers provides consultation, leadership, conflict management and work direction. Psychiatric social workers who provides assessment and psychosocial interventions function as a clinician, counselor and municipal staff of the health centers.[69] Stigma of Mental Health Disparities in Care The stigma of mental health is perceived differently due to historical and cultural context. Attitude's regarding treatment's and seeking services is influenced by the impact of societies stigma associated with mental health. Many communities with different ethnic backgrounds, socioeconomic status', and cultural beliefs experience poor treatment and fewer easily accessible, quality-care resources. Race (add info) Gender Further information: Mental disorders and gender and Sex differences in psychology Existing evidence demonstrates that mental disorders are connected with gender. For example, an elevated risk of depression for women was observed at different phases of life, commencing in adolescence in different contexts.[70][71] Females have a higher risk of anxiety[72] and eating disorders,[73] whereas males have a higher chance of substance abuse and behavioral and developmental issues.[74] This does not imply that women are less likely to suffer from developmental disorders such autism spectrum disorder, attention deficit hyperactivity disorder, Tourette syndrome, or early-onset schizophrenia. Ethnicity and ethnic heterogeneity have also been identified as risk factors for the prevalence of mental disorders, with minority groups being at a higher risk due to discrimination and exclusion.[75] Approximately 8 in 10 people with autism suffer from a mental health problem in their lifetime, in comparison to 1 in 4 of the general population that suffers from a mental health problem in their lifetimes.[76][77][78] (add info regarding stigma) Financial Status (add info) Geography (add info) Cultural and religious considerations Mental health is a socially constructed concept; different societies, groups, cultures (both ethnic and national/regional), institutions, and professions have very different ways of conceptualizing its nature and causes, determining what is mentally healthy, and deciding what interventions, if any, are appropriate.[79] Thus, different professionals will have different cultural, class, political and religious backgrounds, which will impact the methodology applied during treatment. In the context of deaf mental health care, it is necessary for professionals to have cultural competency of deaf and hard of hearing people and to understand how to properly rely on trained, qualified, and certified interpreters when working with culturally Deaf clients. Research has shown that there is stigma attached to mental illness.[80] Due to such stigma, individuals may resist labeling and may be driven to respond to mental health diagnoses with denialism.[81] Family caregivers of individuals with mental disorders may also suffer discrimination or face stigma.[82] Addressing and eliminating the social stigma and perceived stigma attached to mental illness has been recognized as crucial to education and awareness surrounding mental health issues. In the United Kingdom, the Royal College of Psychiatrists organized the campaign Changing Minds (1998–2003) to help reduce stigma,[83] while in the United States, efforts by entities such as the Born This Way Foundation and The Manic Monologues specifically focus on removing the stigma surrounding mental illness.[84][85] The National Alliance on Mental Illness (NAMI) is a U.S. institution founded in 1979 to represent and advocate for those struggling with mental health issues. NAMI helps to educate about mental illnesses and health issues, while also working to eliminate stigma[86] attached to these disorders. Many mental health professionals are beginning to, or already understand, the importance of competency in religious diversity and spirituality, or the lack thereof. They are also partaking in cultural training to better understand which interventions work best for these different groups of people. The American Psychological Association explicitly states that religion must be respected. Education in spiritual and religious matters is also required by the American Psychiatric Association,[87] however, far less attention is paid to the damage that more rigid, fundamentalist faiths commonly practiced in the United States can cause.[88][unreliable source?] This theme has been widely politicized in 2018 such as with the creation of the Religious Liberty Task Force in July of that year.[89] Also, many providers and practitioners in the United States are only beginning to realize that the institution of mental healthcare lacks knowledge and competence of many non-Western cultures, leaving providers in the United States ill-equipped to treat patients from different cultures.[90] Risk factors and causes of mental health problems Main article: Causes of mental disorders There are many things that can contribute to mental health problems, including biological factors, genetic factors, life experiences (such as psychological trauma or abuse), and a family history of mental health problems.[91] Biological factors According to the National Institute of Health Curriculum Supplement Series book, most scientists believe that changes in neurotransmitters can cause mental illnesses. In the section "The Biology of Mental Illnesses" the issue is explained in detail, "...there may be disruptions in the neurotransmitters dopamine, glutamate, and norepinephrine in individuals who have schizophrenia". [92] Demographic factors Gender, age, ethnicity, life expectancy, longevity, population density, and community diversity are all demographic characteristics that can increase the risk and severity of mental disorders.[75] Disability The prevalence of mental illness is higher in more economically unequal countries. Emotional mental disorders are a leading cause of disabilities worldwide. Investigating the degree and severity of untreated emotional mental disorders throughout the world is a top priority of the World Mental Health (WMH) survey initiative,[93] which was created in 1998 by the World Health Organization (WHO).[94] "Neuropsychiatric disorders are the leading causes of disability worldwide, accounting for 37% of all healthy life years lost through disease. These disorders are most destructive to low and middle-income countries due to their inability to provide their citizens with proper aid. Despite modern treatment and rehabilitation for emotional mental health disorders, "even economically advantaged societies have competing priorities and budgetary constraints". Unhappy marriage and divorce Unhappily married couples suffer 3–25 times the risk of developing clinical depression, leading to divorce.[95][96][97] Stress Dementia Friends training The Centre for Addiction and Mental Health discusses how a certain amount of stress is a normal part of daily life. Small doses of stress help people meet deadlines, be prepared for presentations, be productive and arrive on time for important events. However, long-term stress can become harmful. When stress becomes overwhelming and prolonged, the risks for mental health problems and medical problems increase."[98] Also on that note, some studies have found language to deteriorate mental health and even harm humans.[99] The impact of a stressful environment has also been highlighted by different models. Mental health has often been understood from the lens of the vulnerability-stress model.[100] In that context, stressful situations may contribute to a preexisting vulnerability to negative mental health outcomes being realized. On the other hand, the differential susceptibility hypothesis suggests that mental health outcomes are better explained by an increased sensitivity to the environment than by vulnerability.[101] For example, it was found that children scoring higher on observer-rated environmental sensitivity often derive more harm from low-quality parenting, but also more benefits from high-quality parenting than those children scoring lower on that measure.[102] Unemployment Unemployment has been shown to hurt an individual's emotional well-being, self-esteem, and more broadly their mental health. Increasing unemployment has been shown to have a significant impact on mental health, predominantly depressive disorders.[103] This is an important consideration when reviewing the triggers for mental health disorders in any population survey.[104] According to a 2009 meta-analysis by Paul and Moser, countries with high income inequality and poor unemployment protections experience worse mental health outcomes among the unemployed.[105] Poverty These paragraphs are an excerpt from Poverty § Mental health.[edit] A psychological study has been conducted by four scientists during inaugural Convention of Psychological Science. The results find that people who thrive with financial stability or fall under low socioeconomic status (SES) tend to perform worse cognitively due to external pressure imposed upon them. The research found that stressors such as low income, inadequate health care, discrimination, and exposure to criminal activities all contribute to mental disorders. This study also found that children exposed to poverty-stricken environments have slower cognitive thinking.[106] It is seen that children perform better under the care of their parents and that children tend to adopt speaking language at a younger age. Since being in poverty from childhood is more harmful than it is for an adult, it is seen that children in poor households tend to fall behind in certain cognitive abilities compared to other average families.[107] The World Health Organization highlights that social determinants such as income inequality, lack of access to quality education, unemployment, insecure housing, and exposure to violence are strongly associated with poor mental health outcomes. These structural factors contribute significantly to disparities in mental well-being across different populations.[108] Environmental factors These paragraphs are an excerpt from Effects of climate change on mental health.[edit] The effects of climate change on mental health and wellbeing are being documented as the consequences of climate change become more tangible and impactful. This is especially the case for vulnerable populations and those with pre-existing serious mental illness.[109] There are three broad pathways by which these effects can take place: directly, indirectly or via awareness.[110] The direct pathway includes stress-related conditions caused by exposure to extreme weather events. These include post-traumatic stress disorder (PTSD). Scientific studies have linked mental health to several climate-related exposures. These include heat, humidity, rainfall, drought, wildfires and floods.[111] The indirect pathway can be disruption to economic and social activities. An example is when an area of farmland is less able to produce food.[111] The third pathway can be of mere awareness of the climate change threat, even by individuals who are not otherwise affected by it.[110] This especially manifests in the form of anxiety over the quality of life for future generations.[112] Diet and nutrition Recent findings suggest that dietary patterns may play a role in the development of mental health conditions. Diets low in nutrients and high in processed foods have been associated with increased risk of mood disorders. Research has also shown that disruptions in gut microbiota, which are influenced by diet, can impact inflammation, neurotransmitter function, and emotional regulation. These mechanisms may contribute to conditions such as depression and anxiety.[113] Prevention and promotion See also: Prevention of mental disorders "The terms mental health promotion and prevention have often been confused. Promotion is defined as intervening to optimize positive mental health by addressing determinants of positive mental health (i.e. protective factors) before a specific mental health problem has been identified, with the ultimate goal of improving the positive mental health of the population. Mental health prevention is defined as intervening to minimize mental health problems (i.e. risk factors) by addressing determinants of mental health problems before a specific mental health problem has been identified in the individual, group, or population of focus with the ultimate goal of reducing the number of future mental health problems in the population."[114][115] In order to improve mental health, the root of the issue has to be resolved. "Prevention emphasizes the avoidance of risk factors; promotion aims to enhance an individual's ability to achieve a positive sense of self-esteem, mastery, well-being, and social inclusion."[116] Mental health promotion attempts to increase protective factors and healthy behaviors that can help prevent the onset of a diagnosable mental disorder and reduce risk factors that can lead to the development of a mental disorder.[114] Yoga is an example of an activity that calms one's entire body and nerves.[117] According to a study on well-being by Richards, Campania, and Muse-Burke, "mindfulness is considered to be a purposeful state, it may be that those who practice it belief in its importance and value being mindful, so that valuing of self-care activities may influence the intentional component of mindfulness."[39] Akin to surgery, sometimes the body must be further damaged, before it can properly heal [118] Mental health is conventionally defined as a hybrid of the absence of a mental disorder and the presence of well-being. Focus is increasing on preventing mental disorders. Prevention is beginning to appear in mental health strategies, including the 2004 WHO report "Prevention of Mental Disorders", the 2008 EU "Pact for Mental Health" and the 2011 US National Prevention Strategy.[119][120][page needed] Some commentators have argued that a pragmatic and practical approach to mental disorder prevention at work would be to treat it the same way as physical injury prevention.[121] Prevention of a disorder at a young age may significantly decrease the chances that a child will have a disorder later in life, and shall be the most efficient and effective measure from a public health perspective.[122] Prevention may require the regular consultation of a physician for at least twice a year to detect any signs that reveal any mental health concerns. Additionally, social media is becoming a resource for prevention. In 2004, the Mental Health Services Act[123] began to fund marketing initiatives to educate the public on mental health. This California-based project is working to combat the negative perception with mental health and reduce the stigma associated with it. While social media can benefit mental health, it can also lead to deterioration if not managed properly.[124] Limiting social media intake is beneficial.[125] Studies report that patients in mental health care who can access and read their Electronic Health Records (EHR) or Open Notes online experience increased understanding of their mental health, feeling in control of their care, and enhanced trust in their clinicians. Patients' also reported feelings of greater validation, engagement, remembering their care plan, and acquiring a better awareness of potential side effects of their medications, when reading their mental health notes. Other common experiences were that shared mental health notes enhance patient empowerment and augment patient autonomy.[126][127][128][129][130][131] Furthermore, recent studies have shown that social media is an effective way to draw attention to mental health issues. By collecting data from Twitter, researchers found that social media presence is heightened after an event relating to behavioral health occurs.[132] Researchers continue to find effective ways to use social media to bring more awareness to mental health issues through online campaigns in other sites such as Facebook and Instagram.[133] Care navigation Main article: Mental health care navigator Mental health care navigation helps to guide patients and families through the fragmented, often confusing mental health industries. Care navigators work closely with patients and families through discussion and collaboration to provide information on best therapies as well as referrals to practitioners and facilities specializing in particular forms of emotional improvement. The difference between therapy and care navigation is that the care navigation process provides information and directs patients to therapy rather than providing therapy. Still, care navigators may offer diagnosis and treatment planning. Though many care navigators are also trained therapists and doctors. Care navigation is the link between the patient and the below therapies. A clear recognition that mental health requires medical intervention was demonstrated in a study by Kessler et al. of the prevalence and treatment of mental disorders from 1990 to 2003 in the United States. Despite the prevalence of mental health disorders remaining unchanged during this period, the number of patients seeking treatment for mental disorders increased threefold.[134] Methods Pharmacotherapy Pharmacotherapy is a therapy that uses pharmaceutical drugs. Pharmacotherapy is used in the treatment of mental illness through the use of antidepressants, benzodiazepines, and the use of elements such as lithium. It can only be prescribed by a medical professional trained in the field of Psychiatry. Physical activity Physical exercise can improve mental and physical health. Playing sports, walking, cycling, or doing any form of physical activity trigger the production of various hormones, sometimes including endorphins, which can elevate a person's mood.[135] Studies have shown that in some cases, physical activity can have the same impact as antidepressants when treating depression and anxiety.[136] Moreover, cessation of physical exercise may have adverse effects on some mental health conditions, such as depression and anxiety. This could lead to different negative outcomes such as obesity, skewed body image and many health risks associated with mental illnesses.[137] Exercise can improve mental health but it should not be used as an alternative to therapy.[138] Activity therapies Activity therapies also called recreation therapy and occupational therapy, promote healing through active engagement. An example of occupational therapy would be promoting an activity that improves daily life, such as self-care or improving hobbies.[139] Each of these therapies have proven to improve mental health and have resulted in healthier, happier individuals. In recent years, for example, coloring has been recognized as an activity that has been proven to significantly lower the levels of depressive symptoms and anxiety in many studies.[140] Expressive therapies Expressive therapies or creative arts therapies are a form of psychotherapy that involves the arts or artmaking. These therapies include art therapy, music therapy, drama therapy, dance therapy, and poetry therapy. It has been proven that music therapy is an effective way of helping people with a mental health disorder.[141] Drama therapy is approved by NICE for the treatment of psychosis.[142] Psychotherapy Main article: Psychotherapy Psychotherapy is the general term for the scientific based treatment of mental health issues based on modern medicine. It includes a number of schools, such as gestalt therapy, psychoanalysis, cognitive behavioral therapy, psychedelic therapy, transpersonal psychology/psychotherapy, and dialectical behavioral therapy. Group therapy involves any type of therapy that takes place in a setting involving multiple people. It can include psychodynamic groups, expressive therapy groups, support groups (including the Twelve-step program), problem-solving and psychoeducation groups. Occupational Therapy Toy making activity used during occupational therapy during World War 1 psychiatric hospital. Occupational therapy practitioners aim to improve and enable a client or group's participation in meaningful, everyday occupations.[143] In this sense, occupation is defined as any activity that "occupies one's time". Examples of those activities include daily tasks (dressing, bathing, eating, house chores, driving, etc.), sleep and rest, education, work, play, leisure (hobbies), and social interactions. The OT profession offers a vast range of services for all stages of life in a myriad of practice settings, though the foundations of OT come from mental health. OT services focused on mental health can be provided to persons, groups, and populations [143] across the lifespan and experiencing varying levels of mental health performance. For example, occupational therapy practitioners provide mental health services in school systems, military environments, hospitals, outpatient clinics, and inpatient mental health rehabilitation settings. Interventions or support can be provided directly through specific treatment interventions or indirectly by providing consultation to businesses, schools, or other larger groups to incorporate mental health strategies on a programmatic level. Even people who are mentally healthy can benefit from the health promotion and additional prevention strategies to reduce the impact of difficult situations. The interventions focus on positive functioning, sensory strategies, managing emotions, interpersonal relationships, sleep, community engagement, and other cognitive skills (i.e. visual-perceptual skills, attention, memory, arousal/energy management, etc.). Self-compassion Main article: Self-compassion According to Neff, self-compassion consists of three main positive components and their negative counterparts: Self-Kindness versus Self-Judgment, Common Humanity versus Isolation and Mindfulness versus Over-Identification.[144] Furthermore, there is evidence from a study by Shin & Lin suggesting specific components of self-compassion can predict specific dimensions of positive mental health (emotional, social, and psychological well-being).[145] Social-emotional learning Further information: Social emotional development § Social emotional learning & development in schools The Collaborative for academic, social, emotional learning (CASEL) addresses five broad and interrelated areas of competence and highlights examples for each: self-awareness, self-management, social awareness, relationship skills, and responsible decision-making.[146] A meta-analysis was done by Alexendru Boncu, Iuliana Costeau, & Mihaela Minulescu (2017) looking at social-emotional learning (SEL) studies and the effects on emotional and behavior outcomes. They found a small but significant effect size (across the studies looked into) for externalized problems and social-emotional skills.[147] Meditation Main articles: Meditation and Mindfulness-based cognitive therapy The practice of mindfulness meditation has several potential mental health benefits, such as bringing about reductions in depression, anxiety and stress.[148][149][150][151] Mindfulness meditation may also be effective in treating substance use disorders.[152] Lucid dreaming Lucid dreaming has been found to be associated with greater mental well-being. It also was not associated with poorer sleep quality nor with cognitive dissociation.[153] There is also some evidence lucid dreaming therapy can help with nightmare reduction.[154] Mental fitness Mental fitness is a mental health movement that encourages people to intentionally regulate and maintain their emotional wellbeing through friendship, regular human contact, and activities that include meditation, calming exercises, aerobic exercise, mindfulness, having a routine and maintaining adequate sleep. Mental fitness is intended to build resilience against every-day mental and potentially physical health challenges to prevent an escalation of anxiety, depression, and suicidal ideation.[155] This can help people, including older adults with health challenges, to more effectively cope with the escalation of those feelings if they occur.[156] Spiritual counseling Spiritual counsellors meet with people in need to offer comfort and support and to help them gain a better understanding of their issues and develop a problem-solving relation with spirituality. These types of counselors deliver care based on spiritual, psychological and theological principles.[157] Surveys The World Mental Health survey initiative has suggested a plan for countries to redesign their mental health care systems to best allocate resources. "A first step is documentation of services being used and the extent and nature of unmet treatment needs. A second step could be to do a cross-national comparison of service use and unmet needs in countries with different mental health care systems. Such comparisons can help to uncover optimum financing, national policies, and delivery systems for mental health care."[This quote needs a citation] Knowledge of how to provide effective emotional mental health care has become imperative worldwide. Unfortunately, most countries have insufficient data to guide decisions, absent or competing visions for resources, and near-constant pressures to cut insurance and entitlements. WMH surveys were done in Africa (Nigeria, South Africa), the Americas (Colombia, Mexico, United States), Asia and the Pacific (Japan, New Zealand, Beijing and Shanghai in the People's Republic of China), Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine), and the Middle East (Israel, Lebanon). Countries were classified with World Bank criteria as low-income (Nigeria), lower-middle-income (China, Colombia, South Africa, Ukraine), higher middle-income (Lebanon, Mexico), and high-income. The coordinated surveys on emotional mental health disorders, their severity, and treatments were implemented in the aforementioned countries. These surveys assessed the frequency, types, and adequacy of mental health service use in 17 countries in which WMH surveys are complete. The WMH also examined unmet needs for treatment in strata defined by the seriousness of mental disorders. Their research showed that "the number of respondents using any 12-month mental health service was generally lower in developing than in developed countries, and the proportion receiving services tended to correspond to countries' percentages of gross domestic product spent on health care". "High levels of unmet need worldwide are not surprising, since WHO Project ATLAS' findings of much lower mental health expenditures than was suggested by the magnitude of burdens from mental illnesses. Generally, unmet needs in low-income and middle-income countries might be attributable to these nations spending reduced amounts (usually <1%) of already diminished health budgets on mental health care, and they rely heavily on out-of-pocket spending by citizens who are ill-equipped for it". Laws and public health policies Globe icon. The examples and perspective in this section may not represent a worldwide view of the subject. You may improve this section, discuss the issue on the talk page, or create a new section, as appropriate. (April 2025) (Learn how and when to remove this message) See also: Mental health law and Public health There are many factors that influence mental health including: Mental illness, disability, and suicide are ultimately the result of a combination of biology, environment, and access to and utilization of mental health treatment. Public health policies can influence access and utilization, which subsequently may improve mental health and help to progress the negative consequences of depression and its associated disability. United States Emotional mental illnesses is a particular concern in the United States since the U.S. has the highest annual prevalence rates (26 percent) for mental illnesses among a comparison of 14 developing and developed countries.[158] While approximately 80 percent of all people in the United States with a mental disorder eventually receive some form of treatment, on average persons do not access care until nearly a decade following the development of their illness, and less than one-third of people who seek help receive minimally adequate care.[159] The government offers everyone programs and services, but veterans receive the most help, there is certain eligibility criteria that has to be met.[160] Policies Mental health policies in the United States have experienced four major reforms: the American asylum movement led by Dorothea Dix in 1843; the mental hygiene movement inspired by Clifford Beers in 1908; the deinstitutionalization started by Action for Mental Health in 1961; and the community support movement called for by The CMCH Act Amendments of 1975.[161] In 1843, Dorothea Dix submitted a Memorial to the Legislature of Massachusetts, describing the abusive treatment and horrible conditions received by the mentally ill patients in jails, cages, and almshouses. She revealed in her Memorial: "I proceed, gentlemen, briefly to call your attention to the present state of insane persons confined within this Commonwealth, in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience...."[162] Many asylums were built in that period, with high fences or walls separating the patients from other community members and strict rules regarding the entrance and exit. In 1866, a recommendation came to the New York State Legislature to establish a separate asylum for chronic mentally ill patients. Some hospitals placed the chronic patients into separate wings or wards, or different buildings.[163] In A Mind That Found Itself (1908) Clifford Whittingham Beers described the humiliating treatment he received and the deplorable conditions in the mental hospital.[164] One year later, the National Committee for Mental Hygiene (NCMH) was founded by a small group of reform-minded scholars and scientists—including Beers himself—which marked the beginning of the "mental hygiene" movement. The movement emphasized the importance of childhood prevention. World War I catalyzed this idea with an additional emphasis on the impact of maladjustment, which convinced the hygienists that prevention was the only practical approach to handle mental health issues.[165] However, prevention was not successful, especially for chronic illness; the condemnable conditions in the hospitals were even more prevalent, especially under the pressure of the increasing number of chronically ill and the influence of the depression.[161] In 1961, the Joint Commission on Mental Health published a report called Action for Mental Health, whose goal was for community clinic care to take on the burden of prevention and early intervention of the mental illness, therefore to leave space in the hospitals for severe and chronic patients. The court started to rule in favor of the patients' will on whether they should be forced to treatment. By 1977, 650 community mental health centers were built to cover 43 percent of the population and serve 1.9 million individuals a year, and the lengths of treatment decreased from 6 months to only 23 days.[166] However, issues still existed. Due to inflation, especially in the 1970s, the community nursing homes received less money to support the care and treatment provided. Fewer than half of the planned centers were created, and new methods did not fully replace the old approaches to carry out its full capacity of treating power.[166] Besides, the community helping system was not fully established to support the patients' housing, vocational opportunities, income supports, and other benefits.[161] Many patients returned to welfare and criminal justice institutions, and more became homeless. The movement of deinstitutionalization was facing great challenges.[167] After realizing that simply changing the location of mental health care from the state hospitals to nursing houses was insufficient to implement the idea of deinstitutionalization, the National Institute of Mental Health (NIMH) in 1975 created the Community Support Program (CSP) to provide funds for communities to set up a comprehensive mental health service and supports to help the mentally ill patients integrate successfully in the society. The program stressed the importance of other supports in addition to medical care, including housing, living expenses, employment, transportation, and education; and set up new national priority for people with serious mental disorders. In addition, the Congress enacted the Mental Health Systems Act of 1980 to prioritize the service to the mentally ill and emphasize the expansion of services beyond just clinical care alone.[168] Later in the 1980s, under the influence from the Congress and the Supreme Court, many programs started to help the patients regain their benefits. A new Medicaid service was also established to serve people who were diagnosed with a "chronic mental illness". People who were temporally hospitalized were also provided aid and care and a pre-release program was created to enable people to apply for reinstatement prior to discharge.[166] Not until 1990, around 35 years after the start of the deinstitutionalization, did the first state hospital begin to close. The number of hospitals dropped from around 300 by over 40 in the 1990s, and finally a Report on Mental Health showed the efficacy of mental health treatment, giving a range of treatments available for patients to choose.[168] However, several critics maintain that deinstitutionalization has, from a mental health point of view, been a thoroughgoing failure. The seriously mentally ill are either homeless, or in prison; in either case (especially the latter), they are getting little or no mental health care. This failure is attributed to a number of reasons over which there is some degree of contention, although there is general agreement that community support programs have been ineffective at best, due to a lack of funding.[167] The 2011 National Prevention Strategy included mental and emotional well-being, with recommendations including better parenting and early intervention programs, which increase the likelihood of prevention programs being included in future US mental health policies.[119][page needed] The NIMH is researching only suicide and HIV/AIDS prevention, but the National Prevention Strategy could lead to it focusing more broadly on longitudinal prevention studies.[169][failed verification] In 2013, United States Representative Tim Murphy introduced the Helping Families in Mental Health Crisis Act, HR2646. The bipartisan bill went through substantial revision and was reintroduced in 2015 by Murphy and Congresswoman Eddie Bernice Johnson. In November 2015, it passed the Health Subcommittee by an 18–12 vote.[170]

Mental Health Encompasses Emotional, Psychological, and Social Well-being

Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. According to the World Health Organization (WHO), it is a "state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to his or her community".[1] It likewise determines how an individual handles stress, interpersonal relationships, and decision-making.[2] Men

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Psychiatry is, and has historically been, viewed as controversial by those under its care, as well as sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis,[1] the use of diagnosis and treatment for social and political control including detaining citizens and treating them without consent,[2] the side effects of treatments such as electroconvulsive therapy,[3] antipsychotics[4] and historical procedures like the lobotomy[5]: 28  and other forms of psychosurgery[5] or insulin shock therapy,[6] and the history of racism within the profession in the United States. In addition, there are a number of groups who are either critical towards psychiatry or entirely hostile to the field. The Critical Psychiatry Network is a group of psychiatrists who are critical of psychiatry. Additionally, there are self-described psychiatric survivor groups such as MindFreedom International and religious groups such as Scientologists that are critical towards psychiatry. Challenges to conceptions of mental illness Vienna's Narrenturm — German for "fools' tower" — was one of the earliest buildings specifically designed as a "madhouse". It was built in 1784. Since the 1960s there have been challenges to the concept of mental illness. Sociologists Erving Goffman and Thomas Scheff argued that mental illness was merely another example of how society labels and controls non-conformists,[7]: 102  behavioral psychologists challenged psychiatry's fundamental reliance on unchallengable or unfalsifiable concepts,[8] and gay rights activists criticized the APA's inclusion of homosexuality as a mental disorder in the DSM.[9] As societal views on homosexuality have changed in recent decades, it is no longer considered a mental illness and is more widely accepted by society. As another example that challenged conceptions of mental illness, a widely publicized study by Professor David Rosenhan, known as the Rosenhan experiment, was viewed as an attack on the efficacy of psychiatric diagnosis.[10] Medicalization This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources in this section. Unsourced material may be challenged and removed. (May 2019) (Learn how and when to remove this message) Conversation between doctor and patient Medicalization, a concept in medical sociology, is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evidence or hypotheses about conditions, by changing social attitudes or economic considerations, or by the development of new medications or treatments. For many years, several psychiatrists, such as David Rosenhan, Peter Breggin, Paula Caplan, Thomas Szasz, Giorgio Antonucci and critics outside the field of psychiatry, such as Stuart A. Kirk, have "been accusing psychiatry of engaging in the systematic medicalization of normality".[11] More recently these concerns have come from insiders who have worked for the APA themselves (e.g., Robert Spitzer, Allen Frances).[12]: 185  For example, in 2013, Allen Frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".[1][13] The concept of medicalization was devised by sociologists to explain how medical knowledge is applied to behaviors which are not self-evidently medical or biological.[14] The term medicalization entered the sociology literature in the 1970s in the works of Irving Zola, Peter Conrad, and Thomas Szasz, among others. These sociologists viewed medicalization as a form of social control in which medical authority expanded into domains of everyday existence, and they rejected medicalization in the name of liberation. This critique was embodied in works such as Conrad's "The discovery of hyperkinesis: notes on medicalization of deviance", published in 1973 (hyperkinesis was the term then used to describe what we might now call ADHD), and Szasz's "The Myth of Mental Illness."[15][16] These sociologists did not believe medicalization to be a new phenomenon, arguing that medical authorities had always been concerned with social behavior and traditionally functioned as agents of social control (Foucault, 1965; Szasz, 1970; Rosen). However, these authors took the view that increasingly sophisticated technology had extended the potential reach of medicalization as a form of social control, especially in terms of "psychotechnology" (Chorover, 1973). In the 1975 book Limits to medicine: Medical nemesis (1975), Ivan Illich put forth one of the earliest uses of the term "medicalization". Illich, a philosopher, argued that the medical profession harms people through iatrogenesis, a process in which illness and social problems increase due to medical intervention. Illich saw iatrogenesis occurring on three levels: the clinical, involving serious side effects worse than the original condition; the social, whereby the general public is made docile and reliant on the medical profession to cope with life in their society; and the structural, whereby the idea of aging and dying as medical illnesses effectively "medicalized" human life and left individuals and societies less able to deal with these natural processes. Marxists such as Vicente Navarro (1980) linked medicalization to an oppressive capitalist society. They argued that medicine disguised the underlying causes of disease, such as social inequality and poverty, and instead presented health as an individual issue. Others examined the power and prestige of the medical profession, including use of terminology to mystify and of professional rules to exclude or subordinate others.[17] Some argue that in practice the process of medicalization tends to strip subjects of their social context, so they come to be understood in terms of the prevailing biomedical ideology, resulting in a disregard for overarching social causes such as unequal distribution of power and resources.[18] A series of publications by Mens Sana Monographs have focused on medicine as a corporate capitalist enterprise.[19][20][21] Political abuse Main article: Political abuse of psychiatry In unstable countries, political prisoners are sometimes confined and abused in mental institutions.[22]: 3  The diagnosis of mental illness allows the state to hold persons against their will and insist upon therapy in their interest and in the broader interests of society.[23] In addition, receiving a psychiatric diagnosis can in and of itself be regarded as oppressive.[24]: 94  In a monolithic state, psychiatry can be used to bypass standard legal procedures for establishing guilt or innocence and allow political incarceration without the ordinary odium attaching to such political trials.[23] The use of hospitals instead of jails prevents the victims from receiving legal aid before the courts, makes indefinite incarceration possible, and discredits the individuals and their ideas.[25]: 29  In that manner, whenever open trials are undesirable, they are avoided.[25]: 29  Examples of political abuse of the power, entrusted in physicians and particularly psychiatrists, are abundant in history and seen during the Nazi era and the Soviet rule when political dissenters were labeled as "mentally ill" and subjected to inhumane "treatments."[26] In the period from the 1960s up to 1986, abuse of psychiatry for political purposes was reported to be systematic in the Soviet Union, and occasional in other Eastern European countries such as Romania, Hungary, Czechoslovakia, and Yugoslavia.[23] The practice of incarceration of political dissidents in mental hospitals in Eastern Europe and the former USSR damaged the credibility of psychiatric practice in these states and entailed strong condemnation from the international community.[27] Political abuse of psychiatry also takes place in the People's Republic of China[28] and in Russia.[29] Psychiatric diagnoses such as the diagnosis of 'sluggish schizophrenia' in political dissidents in the USSR were used for political purposes.[30]: 77  History of racism in psychiatry in the United States The history of racism in psychiatry dates back to the days of slavery and segregation in the United States. Such racism in psychiatry exemplifies the concept of scientific racism, which falsely alleges that science and other empirical evidence supports racism and proves certain racial inferiorities.[31] Diagnosis Psychiatric diagnoses were influenced by Black people's status as free or enslaved. Enslaved people were not considered civilized enough to be diagnosed with insanity, while free Black people were over-diagnosed with insanity, having much higher diagnosis rates than white people.[31] Specific diagnoses in the 19th century were crafted specifically to fit Black people – drapetomania and dysesthesia aethiopica, disorders meant to explain why slaves ran away and why they were lazy or lacked a strong work ethic, respectively, and justify the institution of slavery.[31] Prominent political figures such as John C. Calhoun used this supposed evidence to argue for slavery, arguing that free Black people could not be entrusted with their lives and would ultimately develop lunacy.[31] All in all, throughout the 19th century, psychiatric diagnoses and scientifically racist theories were used to medicalize Blackness and uphold systems of slavery and racism, further constraining the rights, freedom, and humanity of Black people.[32] Scientific racism Main article: Scientific racism Proponents of scientific racism have historically attempted to "prove" that Black people are physiologically and cognitively inferior to white people based on faulty assumptions and prejudices. Perpetuated by the inaccurate application of biodeterminism, specialists in neuroanatomy and psychiatry compared disproportionate numbers of brains from Black and white individuals to support their racial agendas based on "science."[33][34] Compulsory sterilization Main article: Compulsory sterilization The proportion of Black individuals confined in establishments for "flawed and imbecile" patients increased throughout the late 19th and early 20th century.[35] Psychiatry contributed towards the inaccurate and racist belief that if they were left to their respective means, they would not be able to remain in decent condition.[35] At the beginning of the 20th century, Black people were disproportionally sterilized in eugenics programs that compulsorarily sterilized those classed as feebleminded or who received welfare payments.[36] The premise that the genes of those deemed mentally ill were undesirable was used to justify sterilization which was frequently supervised by physicians, including psychiatrists.[36] Hospitals Segregation within mental institutions and hospitals is another example of the history of racism within psychiatry. Many psychiatric hospitals in the 19th century either excluded or segregated Black patients or admitted Black slaves to work at the hospital in exchange for care.[31] The founding fathers of psychiatry themselves supported the notion that Black people were inferior, lower class citizens that must be treated separately and differently from white patients.[31] With time, racial segregation within hospitals became interspersed with entirely separate hospitals for white and Black patients, each with differential treatment and quality of care. Political figures in the post-Civil War era argued that emancipation had led to a significant increase in insanity cases amongst Black individuals, and they cited the need to accommodate this increase via segregated and Black-only insane asylums.[37] Many hospitals, especially in the southern United States, did not admit Black patients until they were eventually mandated to do so.[37] The last segregated hospital opened in 1933.[37] Popular arguments also circulated that Black patients were more difficult to take care of in mental institutions, making psychiatric care for them more difficult and justifying the need for segregated facilities. Until the late 1960s, many hospitals remained segregated.[38] This affected the experiences of racial minorities accessing psychiatric care in mental institutions and hospitals in the United States. When Lyndon B. Johnson's administration stated that no segregated hospital would receive federal Medicare funds, hospitals began to integrate quickly in order to be able to continue to access such funding.[38] In January 1966, around two-thirds of Southern hospitals were segregated facilities and many Northern facilities remain segregated in-effect.[38] One year later, by January 1967, there were very few hospitals in the United States that remained segregated. Segregation within mental institutions and hospitals is one example of the history of racism within psychiatry.[38] In the profession Black psychiatrists often experienced racism as practitioners within the field. Some of this history is detailed in Jeanne Spurlock's book titled Black Psychiatrists and American Psychiatry, published in 1999, in which she profiles Black psychiatrists who were influential in American psychiatry and their experiences in the profession.[39] During the Civil Rights Movement, Black psychiatrists expressed concerns to the APA that the needs of Black communities and Black psychiatrists were being ignored by the professional organization.[40] In 1969, a contingent of Black psychiatrists presented a list of 9 concerns to the APA Board of Trustees regarding experiences of structural racism in the field.[40] Their '9 points' represented a wide array of experiences of discrimination, both from the experiences of practitioners and patients, and on the institutional and individual level and the group demanded change from within the APA.[40] For example, they called for more Black leaders on APA committees as well as the desegregation of all mental health facilities, both public and private, in the United States.[40] As of 2020, within psychiatry, historically underrepresented groups continue to be less represented as residents, faculty, and practicing physicians in comparison to their proportion in the U.S. population.[41] Nature of diagnosis Arbitrariness Psychiatry has been criticized for its broad range of mental diseases and disorders. Which diagnoses exist and are considered valid have changed over time depending on society's norms. Homosexuality was considered a mental illness but due to changing attitudes, it is no longer recognised as an illness.[42] Historic disorders that are no longer recognised include orthorexia nervosa,[citation needed] sexual addiction, parental alienation syndrome, pathological demand avoidance, and Internet addiction disorder. New disorders include compulsive hoarding and binge eating disorder.[43] The act of diagnosis itself has been criticized for being arbitrary with some conditions being overdiagnosed.[44] Individuals may be diagnosed with a mental disorder despite having been perceived as having no issues with their behavior. In Virginia, U.S., it was found up to 33% of white boys are diagnosed with ADHD leading to alarm in the medical community.[45] Thomas Szasz argued that mental health diagnoses were used as a form of labelling violations of societies norms. Bill Fullford, introduced the idea of "value-laden" mental health diagnosis with mental health lying between physical health and a moral judgment. Under this system personality disorders are seen as not very factual and very value-laden while delirium is quite factual and not very value-laden.[7]: 104  Biological basis See also: Biological psychiatry and Biopsychiatry controversy In 2013, psychiatrist Allen Frances said that he believes that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests".[46][13][47] Mary Boyle argues that psychiatry is actually the study of behavior, but acts as if it is the study of the brain based on a presumed connection between patterns of behavior and the biological function of the brain. She argues that in the case of schizophrenia it is the bizarre behavior of individuals that justifies the presumption of a biological cause for this behavior rather than the existence of any evidence.[48]: 236  She argues that the concept of schizophrenia and its biological basis serves a social function for psychiatrists. She views the concept of schizophrenia as necessary for psychiatry to be considered as a medical field, that the claimed biological link gives psychiatrists protection from accusations of social control, and that the belief in the biological basis for schizophrenia is maintained through secondary source's misrepresentation of underlying data. She argues that schizophrenia and its biological basis also gives families, psychiatrists and society as a whole the ability to avoid blame for the damage they cause individuals and the ineffectiveness of treatment.[48]: 238  Schizophrenia diagnosis Main article: Diagnosis of schizophrenia Underlying issues associated with schizophrenia would be better addressed as a spectrum of conditions[49] or as individual dimensions along which everyone varies rather than by a diagnostic category based on an arbitrary cut-off between normal and ill.[50] This approach appears consistent with research on schizotypy, and with a relatively high prevalence of psychotic experiences, mostly non-distressing delusional beliefs, among the general public.[51][52][53] In concordance with this observation, psychologist Edgar Jones, and psychiatrists Tony David and Nassir Ghaemi, surveying the existing literature on delusions, pointed out that the consistency and completeness of the definition of delusion have been found wanting by many; delusions are neither necessarily fixed nor false, and need not involve the presence of incontrovertible evidence.[54][55][56] Nancy Andreasen has criticized the current DSM-IV and ICD-10 criteria for sacrificing diagnostic validity for the sake of artificially improving reliability.[citation needed] She argues that overemphasis on psychosis in the diagnostic criteria, while improving diagnostic reliability, ignores more fundamental cognitive impairments that are harder to assess due to large variations in presentation.[57][58] This view is supported by other psychiatrists.[59] In the same vein, Ming Tsuang and colleagues argue that psychotic symptoms may be a common end-state in a variety of disorders, including schizophrenia, rather than a reflection of the specific etiology of schizophrenia, and warn that there is little basis for regarding DSM's operational definition as the "true" construct of schizophrenia.[49] Neuropsychologist Michael Foster Green went further in suggesting the presence of specific neurocognitive deficits may be used to construct phenotypes that are alternatives to those that are purely symptom-based. These deficits take the form of a reduction or impairment in basic psychological functions such as memory, attention, executive function and problem solving.[60][61] The exclusion of affective components from the criteria for schizophrenia, despite their ubiquity in clinical settings, has also caused contention. This exclusion in the DSM has resulted in a "rather convoluted" separate disorder—schizoaffective disorder.[59] Citing poor interrater reliability, some psychiatrists have totally contested the concept of schizoaffective disorder as a separate entity.[62][63] The categorical distinction between mood disorders and schizophrenia, known as the Kraepelinian dichotomy, has also been challenged by data from genetic epidemiology.[64] Jonathan Metzl, in his book The Protest Psychosis, argues that the Ionia State Hospital in Ionia, Michigan disproportionately diagnosed African Americans with schizophrenia because of their civil rights activism.[65] ADHD Main article: Attention deficit hyperactivity disorder controversies ADHD, its diagnosis, and its treatment have been controversial since the 1970s.[66][67][68] The controversies involve clinicians, teachers, policymakers, parents, and the media. Positions range from the view that ADHD is within the normal range of behavior[69][70] to the hypothesis that ADHD is a genetic condition.[71] Other areas of controversy include the use of stimulant medications in children,[67][72] the method of diagnosis, and the possibility of overdiagnosis.[72] In 2012, the National Institute for Health and Care Excellence, while acknowledging the controversy, states that the current treatments and methods of diagnosis are based on the dominant view of the academic literature.[69] In 2014, Keith Conners, one of the early advocates for recognition of the disorder, spoke out against overdiagnosis in an article in The New York Times.[73] In contrast, a 2014 peer-reviewed medical literature review indicated that ADHD is underdiagnosed in adults.[74] With widely differing rates of diagnosis across countries, states within countries, races, and ethnicities, some suspect factors other than the presence of the symptoms of ADHD are playing a role in diagnosis.[75] Some sociologists consider ADHD to be an example of the medicalization of deviant behavior, that is, the turning of the previously non-medical issue of school performance into a medical one.[66][76] Most healthcare providers accept ADHD as a genuine disorder, at least in the small number of people with severe symptoms.[76] Among healthcare providers the debate mainly centers on diagnosis and treatment in the much larger number of people with less severe symptoms.[76][77][78] As of 2009, 8% of all United States Major League Baseball players had been diagnosed with ADHD, making the disorder common among this population. The increase coincided with the League's 2006 ban on stimulants, which has raised concern that some players are mimicking or falsifying the symptoms or history of ADHD to get around the ban on the use of stimulants in sport.[79] Treatment Psychosurgery See also: History of psychosurgery Psychosurgery is brain surgery with the aim of changing an individual's behavior or psychological function. Historically, this was achieved through ablative psychosurgery that removed or deliberately damaged (lesioning) a section of the brain, but more recently deep brain stimulation is used to remotely stimulate sections of the brain. One such practice was the lobotomy, that was used between the 1930s and 1950s,[5]: 20  for which one its creators, António Egas Moniz, received a Nobel Prize in 1949.[80] The lobotomy fell out of favor in by 1960s and 1970s.[81] Other forms of ablative psychosurgery were in use in the UK in the late 1970s to treat psychotic and mood disorders.[82] Bilateral cingulotomy was used to treat substance abuse disorder in Russia until 2002. Deep brain stimulation is used in China to treat substance abuse disorders.[83] In the US, the lobotomy, while initially received with positivity in the late 1930s, came to be seen more negative in the late 1940s and early 1950s. The New York Times discussed the personality changes of lobotomy in 1947, and in the same year the Science Digest reported on papers questioning the effects of lobotomy on personality and intelligence.[84] The lobotomy was prominently depicted a means to control nonconformity in the 1962 book One Flew Over the Cuckoo's Nest.[85]: 70  Psychosurgery was criticized in the US in the late 1960s and 1970s by psychiatrist Peter Breggin. He identified all psychosurgery with the lobotomy as a rhetorical device to criticize the practice of psychosurgery more broadly.[85]: 116  He stated that "psychosurgery is a crime against humanity, a crime that cannot be condoned on medical, ethical, or legal grounds". Psycho-surgeons William Beecher Scoville and Petter Lindström said that Breggin's critique was emotional and not based on facts.[85]: 121  Psychosurgery was investigated by the US Senate in the 1973 by the Health Subcommittee of the Senate's Committee on Labor and Public Welfare chaired by Senator Edward Kennedy due to growing concern about the ethical boundaries of science and medicine. At this committee Breggin argued that newer forms of psychosurgery were the same as the lobotomy since it had the same effects "emotional blunting, passivity, reduced capacity to learn" and said that psycho-surgeons "represent the greatest future threat that we are going to face for our traditional American values", arguing that if the US became a totalitarian regime lobotomy and psychosurgery would be the equivalent of the secret police. The subcommittee published a report in 1977 suggesting that data should be carefully collected about psychosurgery and that it should not be performed upon children or prisoners.[85]: 123  Electroconvulsive therapy Electroconvulsive therapy is a therapy method which was used widely between the 1930s and 1960s and is, in a modified form, still used today.[86][87] Electroconvulsive therapy was one treatment that the anti-psychiatry movement wanted to be eliminated from psychiatric practice.[88] Their arguments were that ECT damages the brain,[88] and was used as punishment or as a threat to keep the patients "in line".[88] Since then, ECT has improved considerably,[89][90] and is now performed under general anesthesia in a medically supervised environment.[91] The National Institute for Health and Care Excellence recommends ECT for the short-term treatment of severe, treatment-resistant depression, and advises against its use in schizophrenia.[92][93] According to the Canadian Network for Mood and Anxiety Treatments, ECT is more efficacious for the treatment of depression than antidepressants, with a response rate of 90% in first line treatment and 50-60% in treatment-resistant patients.[94] The most common side effects of ECT include headache, muscle soreness, confusion, and temporary loss of recent memory.[95][91][96] Patients may also experience permanent amnesia.[97] Marketing of antipsychotic drugs Psychiatry has greatly benefitted by advances in pharmacotherapy.[46]: 110–112 [98] However, the close relationship between those prescribing psychiatric medication and pharmaceutical companies, and the risk of a conflict of interest,[98] is also a source of concern. This relationship is often described as being part of the medical-industrial complex. This marketing by the pharmaceutical industry has an influence on practicing psychiatrists, which affects prescription.[98] Child psychiatry is one of the areas in which prescription of psychotropic medication has grown massively. In the past, prescription of these medications for children was rare, but nowadays child psychiatrists prescribe psychotropic substances, such as Ritalin, on a regular basis to children.[46]: 110–112  Joanna Moncrieff has argued that antipsychotic drug treatment is often undertaken as a means of control rather than to treat specific symptoms experienced by the patient.[99] Moncreiff has further argued, in the controversial and non-peer reviewed journal Medical Hypotheses, that the evidence for antipsychotics from discontinuation-relapse studies may be flawed, because they do not take into account that antipsychotics may sensitize the brain and provoke psychosis if discontinued, which may then be wrongly interpreted as a relapse of the original condition.[100] Use of this class of drugs has a history of criticism in residential care. As the drugs used can make patients calmer and more compliant, critics claim that the drugs can be overused. Outside doctors can feel pressure from care home staff.[101] In an official review commissioned by UK government ministers it was reported that the needless use of antipsychotic medication in dementia care was widespread and was linked to 1800 deaths per year.[102][103] In the US, the government has initiated legal action against the pharmaceutical company Johnson & Johnson for allegedly paying kickbacks to Omnicare to promote its antipsychotic risperidone (Risperdal) in nursing homes.[104] There has also been controversy about the role of pharmaceutical companies in marketing and promoting antipsychotics, including allegations of downplaying or covering up adverse effects, expanding the number of conditions or illegally promoting off-label usage; influencing drug trials (or their publication) to try to show that the expensive and profitable newer atypicals were superior to the older cheaper typicals that were out of patent.[citation needed] Following charges of illegal marketing, settlements by two large pharmaceutical companies in the US set records for the largest criminal fines ever imposed on corporations.[105] One case involved Eli Lilly and Company's antipsychotic Zyprexa, and the other involved Bextra. In the Bextra case, the government also charged Pfizer with illegally marketing another antipsychotic, Geodon.[105] In addition, Astrazeneca faces numerous personal-injury lawsuits from former users of Seroquel (quetiapine), amidst federal investigations of its marketing practices.[106] By expanding the conditions for which they were indicated, Astrazeneca's Seroquel and Eli Lilly's Zyprexa had become the biggest selling antipsychotics in 2008 with global sales of $5.5 billion and $5.4 billion respectively.[107] Harvard medical professor Joseph Biederman conducted research on bipolar disorder in children that led to an increase in such diagnoses. A 2008 Senate investigation found that Biederman also received $1.6 million in speaking and consulting fees between 2000 and 2007— some of them undisclosed to Harvard— from companies including the makers of antipsychotic drugs prescribed for children with bipolar disorder. Johnson & Johnson gave more than $700,000 to a research center that was headed by Biederman from 2002 to 2005, where research was conducted, in part, on Risperdal, the company's antipsychotic drug. Biederman has responded saying that the money did not influence him and that he did not promote a specific diagnosis or treatment.[105] In 2004, University of Minnesota research participant Dan Markingson committed suicide while enrolled in an industry-sponsored pharmaceutical trial comparing three FDA-approved atypical antipsychotics: Seroquel (quetiapine), Zyprexa (olanzapine), and Risperdal (risperidone). Writing on the circumstances surrounding Markingson's death in the study, which was designed and funded by Seroquel manufacturer AstraZeneca, University of Minnesota Professor of Bioethics Carl Elliott noted that Markingson was enrolled in the study against the wishes of his mother, Mary Weiss, and that he was forced to choose between enrolling in the study or being involuntarily committed to a state mental institution.[108] Further investigation revealed financial ties to AstraZeneca by Markingson's psychiatrist, Dr. Stephen C. Olson, oversights and biases in AstraZeneca's trial design, and the inadequacy of university Institutional Review Board (IRB) protections for research subjects.[109] A 2005 FDA investigation cleared the university. Nonetheless, controversy around the case has continued. Mother Jones resulted in a group of university faculty members sending a public letter to the university Board of Regents urging an external investigation into Markingson's death.[110] Pharmaceutical companies have also been accused of attempting to set the mental health agenda through activities such as funding consumer advocacy groups.[111] In an effort to reduce the potential for hidden conflicts of interest between researchers and pharmaceutical companies, the US Government issued a mandate in 2012 requiring that drug manufacturers receiving funds under the Medicare and Medicaid programs collect data, and make public, all gifts to doctors and hospitals.[12]: 317  Main article: Experimentation on prisoners Anti-psychiatry Main article: Anti-psychiatry The term anti-psychiatry was coined by psychiatrist David Cooper in 1967 and is understood in current psychiatry to mean opposition to psychiatry's perceived role aspects of treatment.[46] The anti-psychiatry message is that psychiatric treatments are "ultimately more damaging than helpful to patients". Psychiatry is seen to involve an "unequal power relationship between doctor and patient", and advocates of anti-psychiatry claim a subjective diagnostic process, leaving much room for opinions and interpretations.[46][112] Every society, including liberal Western society, permits compulsory treatment of mental patients.[46] The World Health Organization (WHO) recognizes that "poor quality services and human rights violations in mental health and social care facilities are still an everyday occurrence in many places", but has recently taken steps to improve the situation globally.[113] Electroconvulsive therapy is a therapy method, which was used widely between the 1930s and 1960s and is, in a modified form, still in use today. Valium and other sedatives have arguably been over-prescribed, leading to a claimed epidemic of dependence. These are a few of the arguments that the anti-psychiatry movement use to highlight the harms of psychiatric practice. Multiple authors are well known for the movement against psychiatry, including those who have been practicing psychiatrists. The most influential was R.D. Laing, who wrote a series of books, including; The Divided Self. Thomas Szasz rose to fame with the book The Myth of Mental Illness. Michel Foucault challenged the very basis of psychiatric practice and cast it as repressive and controlling. The term "anti-psychiatry" itself was coined by David Cooper in 1967.[46][112] The founder of the non-psychiatric approach to psychological suffering is Giorgio Antonucci. Divergence within psychiatry generated the anti-psychiatry movement in the 1960s and 1970s, and is still present. Issues remaining relevant in contemporary psychiatry are questions of; freedom versus coercion, mind versus brain, nature versus nurture, and the right to be different.[46] Psychiatric survivors movement See also: Outline of the psychiatric survivors movement The psychiatric survivors movement[114] arose out of the civil rights ferment of the late 1960s and early 1970s and the personal histories of psychiatric abuse experienced by some ex-patients rather than the intradisciplinary discourse of antipsychiatry.[115] The key text in the intellectual development of the survivor movement, at least in the US, was Judi Chamberlin's 1978 text, On Our Own: Patient Controlled Alternatives to the Mental Health System.[114][116] Chamberlin was an ex-patient and co-founder of the Mental Patients' Liberation Front.[117] Coalescing around the ex-patient newsletter Dendron,[118] in late 1988 leaders from several of the main national and grassroots psychiatric survivor groups felt that an independent, human rights coalition focused on problems in the mental health system was needed. That year the Support Coalition International (SCI) was formed. SCI's first public action was to stage a counter-conference and protest in New York City, in May, 1990, at the same time as (and directly outside of) the American Psychiatric Association's annual meeting.[119] In 2005 the SCI changed its name to Mind Freedom International with David W. Oaks as its director.[115]

Psychiatry is and has been historically viewed as controversial

Psychiatry is, and has historically been, viewed as controversial by those under its care, as well as sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis,[1] the use of diagnosis and treatment for social and political control including detaining citizens and treating them without consent,[2] the side effects of treatments such as electroconvulsive therapy,[3] antipsychotics[4] and historical procedures like

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Psychiatry is the medical specialty devoted to the diagnosis, treatment, and prevention of deleterious mental conditions.[1][2] These include matters related to cognition, perceptions, mood, emotion, and behavior. Initial psychiatric assessment of a person begins with creating a case history and conducting a mental status examination. Laboratory tests, physical examinations, and psychological tests may be conducted. On occasion, neuroimaging or neurophysiological studies are performed.[3] Mental disorders are diagnosed in accordance with diagnostic manuals such as the International Classification of Diseases (ICD),[4] edited by the World Health Organization (WHO), and the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA). The fifth edition of the DSM (DSM-5) was published in May 2013.[5] Treatment may include psychotropics (psychiatric medicines), psychotherapy,[6][7] substance-abuse treatment, and other modalities such as interventional approaches, assertive community treatment, community reinforcement, and supported employment. Treatment may be delivered on an inpatient or outpatient basis, depending on the severity of functional impairment or risk to the individual or community. Research within psychiatry is conducted by psychiatrists on an interdisciplinary basis with other professionals, including clinical psychologists, epidemiologists, nurses, social workers, and occupational therapists. Etymology The word psyche comes from the ancient Greek for 'soul' or 'butterfly'.[8] The fluttering insect appears in the coat of arms of Britain's Royal College of Psychiatrists.[9] The term psychiatry was first coined by the German physician Johann Christian Reil in 1808 and literally means the 'medical treatment of the soul' (ψυχή psych- 'soul' from Ancient Greek psykhē 'soul'; -iatry 'medical treatment' from Gk. ιατρικός iātrikos 'medical' from ιάσθαι iāsthai 'to heal'). A medical doctor specializing in psychiatry is a psychiatrist (for a historical overview, see: Timeline of psychiatry). Theory and focus "Psychiatry, more than any other branch of medicine, forces its practitioners to wrestle with the nature of evidence, the validity of introspection, problems in communication, and other long-standing philosophical issues" (Guze, 1992, p.4). Psychiatry refers to a field of medicine focused specifically on the mind, aiming to study, prevent, and treat mental disorders in humans.[10][11][12] It has been described as an intermediary between the world from a social context and the world from the perspective of those who are mentally ill.[13] People who specialize in psychiatry often differ from most other mental health professionals and physicians in that they must be familiar with both the social and biological sciences.[11] The discipline studies the operations of different organs and body systems as classified by the patient's subjective experiences and the objective physiology of the patient.[14] Psychiatry treats mental disorders, which are conventionally divided into three general categories: mental illnesses, severe learning disabilities, and personality disorders.[15] Although the focus of psychiatry has changed little over time, the diagnostic and treatment processes have evolved dramatically and continue to do so. Since the late 20th century, the field of psychiatry has continued to become more biological and less conceptually isolated from other medical fields.[16] Scope of practice Further information: Neurology § Overlap with psychiatry Disability-adjusted life year for neuropsychiatric conditions per 100,000 inhabitants in 2002 no data less than 10 10–20 20–30 30–40 40–50 50–60 60–80 80–100 100–120 120–140 140–150 more than 150 Though the medical specialty of psychiatry uses research in the field of neuroscience, psychology, medicine, biology, biochemistry, and pharmacology,[17] it has generally been considered a middle ground between neurology and psychology.[18] Because psychiatry and neurology are deeply intertwined medical specialties, all certification for both specialties and for their subspecialties is offered by a single board, the American Board of Psychiatry and Neurology, one of the member boards of the American Board of Medical Specialties.[19] Unlike other physicians and neurologists, psychiatrists specialize in the doctor–patient relationship and are trained to varying extents in the use of psychotherapy and other therapeutic communication techniques.[18] Psychiatrists also differ from psychologists in that they are physicians and have post-graduate training called residency (usually four to five years) in psychiatry; the quality and thoroughness of their graduate medical training is identical to that of all other physicians.[20] Psychiatrists can therefore counsel patients, prescribe medication, order laboratory tests, order neuroimaging, and conduct physical examinations.[3] As well, some psychiatrists are trained in interventional psychiatry and can deliver interventional treatments such as electroconvulsive therapy, transcranial magnetic stimulation, vagus nerve stimulation and ketamine.[21] Ethics See also: Ethical issues in psychiatry (disambiguation) The World Psychiatric Association issues an ethical code to govern the conduct of psychiatrists (like other purveyors of professional ethics). The psychiatric code of ethics, first set forth through the Declaration of Hawaii in 1977 has been expanded through a 1983 Vienna update and in the broader Madrid Declaration in 1996. The code was further revised during the organization's general assemblies in 1999, 2002, 2005, and 2011.[22] The World Psychiatric Association code covers such matters as confidentiality, the death penalty, ethnic or cultural discrimination,[22] euthanasia, genetics, the human dignity of incapacitated patients, media relations, organ transplantation, patient assessment, research ethics, sex selection,[23] coercion,[24] torture,[25][26] and up-to-date knowledge. In establishing such ethical codes, the profession has responded to a number of controversies about the practice of psychiatry, for example, surrounding the use of lobotomy and electroconvulsive therapy. Discredited psychiatrists who operated outside the norms of medical ethics include Harry Bailey, Donald Ewen Cameron, Samuel A. Cartwright, Henry Cotton, and Andrei Snezhnevsky.[27][page needed] Approaches Psychiatric illnesses can be conceptualised in a number of different ways. The biomedical approach examines signs and symptoms and compares them with diagnostic criteria. Mental illness can be assessed, conversely, through a narrative which tries to incorporate symptoms into a meaningful life history and to frame them as responses to external conditions. Both approaches are important in the field of psychiatry[28] but have not sufficiently reconciled to settle controversy over either the selection of a psychiatric paradigm or the specification of psychopathology. The notion of a "biopsychosocial model" is often used to underline the multifactorial nature of clinical impairment.[29][30][31] In this notion the word model is not used in a strictly scientific way though.[29] Alternatively, a Niall McLaren acknowledges the physiological basis for the mind's existence but identifies cognition as an irreducible and independent realm in which disorder may occur.[29][30][31] The biocognitive approach includes a mentalist etiology and provides a natural dualist (i.e., non-spiritual) revision of the biopsychosocial view, reflecting the efforts of Australian psychiatrist Niall McLaren to bring the discipline into scientific maturity in accordance with the paradigmatic standards of philosopher Thomas Kuhn.[29][30][31] Once a medical professional diagnoses a patient there are numerous ways that they could choose to treat the patient. Often psychiatrists will develop a treatment strategy that incorporates different facets of different approaches into one. Drug prescriptions are very commonly written to be regimented to patients along with any therapy they receive. There are three major pillars of psychotherapy that treatment strategies are most regularly drawn from. Humanistic psychology attempts to put the "whole" of the patient in perspective; it also focuses on self exploration.[32] Behaviorism is a therapeutic school of thought that elects to focus solely on real and observable events, rather than mining the unconscious or subconscious. Psychoanalysis, on the other hand, concentrates its dealings on early childhood, irrational drives, the unconscious, and conflict between conscious and unconscious streams.[33] Practitioners Main article: Psychiatrist This section relies largely or entirely upon a single source. Relevant discussion may be found on the talk page. Please help improve this article by introducing citations to additional sources at this section. (August 2017) (Learn how and when to remove this message) All physicians can diagnose mental disorders and prescribe treatments utilizing principles of psychiatry. Psychiatrists are trained physicians who specialize in psychiatry and are certified to treat mental illness. They may treat outpatients, inpatients, or both; they may practice as solo practitioners or as members of groups; they may be self-employed, be members of partnerships, or be employees of governmental, academic, nonprofit, or for-profit entities; employees of hospitals; they may treat military personnel as civilians or as members of the military; and in any of these settings they may function as clinicians, researchers, teachers, or some combination of these. Although psychiatrists may also go through significant training to conduct psychotherapy, psychoanalysis or cognitive behavioral therapy, it is their training as physicians that differentiates them from other mental health professionals. As a career choice in the US Psychiatry was not a popular career choice among medical students, even though medical school placements are rated favorably.[34] This has resulted in a significant shortage of psychiatrists in the United States and elsewhere.[35] Strategies to address this shortfall have included the use of short 'taster' placements early in the medical school curriculum[34] and attempts to extend psychiatry services further using telemedicine technologies and other methods.[36] Recently, however, there has been an increase in the number of medical students entering into a psychiatry residency. There are several reasons for this surge, including the intriguing nature of the field, growing interest in genetic biomarkers involved in psychiatric diagnoses, and newer pharmaceuticals on the drug market to treat psychiatric illnesses.[37] Subspecialties The field of psychiatry has many subspecialties that require additional training and certification by the American Board of Psychiatry and Neurology (ABPN). Such subspecialties include:[38] Addiction psychiatry, addiction medicine Brain injury medicine[39][40] Child and adolescent psychiatry Consultation-liaison psychiatry[41] Forensic psychiatry Geriatric psychiatry Hospice and palliative medicine Sleep medicine[42] Wikibooks has a book on the topic of: Psychiatry Wikiquote has quotations related to Psychiatry. Look up psychiatry in Wiktionary, the free dictionary. Wikiversity has learning resources about Psychiatry Wikimedia Commons has media related to Psychiatry. Additional psychiatry subspecialties, for which the ABPN does not provide formal certification, include:[43] Biological psychiatry Community psychiatry Cross-cultural psychiatry Emergency psychiatry Evolutionary psychiatry Global mental health Learning disabilities Military psychiatry Neurodevelopmental disorders Neuropsychiatry Interventional Psychiatry Social psychiatry Addiction psychiatry focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. Biological psychiatry is an approach to psychiatry that aims to understand mental disorders in terms of the biological function of the nervous system. Child and adolescent psychiatry is the branch of psychiatry that specializes in work with children, teenagers, and their families. Community psychiatry is an approach that reflects an inclusive public health perspective and is practiced in community mental health services.[44] Cross-cultural psychiatry is a branch of psychiatry concerned with the cultural and ethnic context of mental disorder and psychiatric services. Emergency psychiatry is the clinical application of psychiatry in emergency settings. Forensic psychiatry utilizes medical science generally, and psychiatric knowledge and assessment methods in particular, to help answer legal questions. Geriatric psychiatry is a branch of psychiatry dealing with the study, prevention, and treatment of mental disorders in the elderly. Global mental health is an area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide,[45] although some scholars consider it to be a neo-colonial, culturally insensitive project.[46][47][48][49] Liaison psychiatry is the branch of psychiatry that specializes in the interface between other medical specialties and psychiatry. Military psychiatry covers special aspects of psychiatry and mental disorders within the military context. Neuropsychiatry is a branch of medicine dealing with mental disorders attributable to diseases of the nervous system. Social psychiatry is a branch of psychiatry that focuses on the interpersonal and cultural context of mental disorder and mental well-being. In larger healthcare organizations, psychiatrists often serve in senior management roles, where they are responsible for the efficient and effective delivery of mental health services for the organization's constituents. For example, the Chief of Mental Health Services at most VA medical centers is usually a psychiatrist, although psychologists occasionally are selected for the position as well.[citation needed] In the United States, psychiatry is one of the few specialties which qualify for further education and board-certification in pain medicine, palliative medicine, and sleep medicine. Research Psychiatric research is, by its very nature, interdisciplinary; combining social, biological and psychological perspectives in attempt to understand the nature and treatment of mental disorders.[50] Clinical and research psychiatrists study basic and clinical psychiatric topics at research institutions and publish articles in journals.[17][51][52][53] Under the supervision of institutional review boards, psychiatric clinical researchers look at topics such as neuroimaging, genetics, and psychopharmacology in order to enhance diagnostic validity and reliability, to discover new treatment methods, and to classify new mental disorders.[54][page needed] Clinical application Diagnostic systems See also: Diagnostic classification and rating scales used in psychiatry Psychiatric diagnoses take place in a wide variety of settings and are performed by many different health professionals. Therefore, the diagnostic procedure may vary greatly based upon these factors. Typically, though, a psychiatric diagnosis utilizes a differential diagnosis procedure where a mental status examination and physical examination is conducted, with pathological, psychopathological or psychosocial histories obtained, and sometimes neuroimages or other neurophysiological measurements are taken, or personality tests or cognitive tests administered.[55][56][57][58][59] In some cases, a brain scan might be used to rule out other medical illnesses, but at this time relying on brain scans alone cannot accurately diagnose a mental illness or tell the risk of getting a mental illness in the future.[60] Some clinicians are beginning to utilize genetics[61][62][63] and automated speech assessment[64] during the diagnostic process but on the whole these remain research topics. Potential use of MRI/fMRI in diagnosis In 2018, the American Psychological Association commissioned a review to reach a consensus on whether modern clinical MRI/fMRI will be able to be used in the diagnosis of mental health disorders. The criteria presented by the APA stated that the biomarkers used in diagnosis should: "have a sensitivity of at least 80% for detecting a particular psychiatric disorder" "should have a specificity of at least 80% for distinguishing this disorder from other psychiatric or medical disorders" "should be reliable, reproducible, and ideally be noninvasive, simple to perform, and inexpensive" "proposed biomarkers should be verified by 2 independent studies each by a different investigator and different population samples and published in a peer-reviewed journal" The review concluded that although neuroimaging diagnosis may technically be feasible, very large studies are needed to evaluate specific biomarkers which were not available.[65] Diagnostic manuals See also: Diagnostic and Statistical Manual of Mental Disorders Three main diagnostic manuals used to classify mental health conditions are in use today. The ICD-11 is produced and published by the World Health Organization, includes a section on psychiatric conditions, and is used worldwide.[66] The Diagnostic and Statistical Manual of Mental Disorders, produced and published by the American Psychiatric Association (APA), is primarily focused on mental health conditions and is the main classification tool in the United States.[67] It is currently in its fifth revised edition and is also used worldwide.[67] The Chinese Society of Psychiatry has also produced a diagnostic manual, the Chinese Classification of Mental Disorders.[68] The stated intention of diagnostic manuals is typically to develop replicable and clinically useful categories and criteria, to facilitate consensus and agreed upon standards, whilst being atheoretical as regards etiology.[67][69] However, the categories are nevertheless based on particular psychiatric theories and data; they are broad and often specified by numerous possible combinations of symptoms, and many of the categories overlap in symptomology or typically occur together.[70] While originally intended only as a guide for experienced clinicians trained in its use, the nomenclature is now widely used by clinicians, administrators and insurance companies in many countries.[71] The DSM has attracted praise for standardizing psychiatric diagnostic categories and criteria. It has also attracted controversy and criticism. Some critics argue that the DSM represents an unscientific system that enshrines the opinions of a few powerful psychiatrists. There are ongoing issues concerning the validity and reliability of the diagnostic categories; the reliance on superficial symptoms; the use of artificial dividing lines between categories and from 'normality'; possible cultural bias; medicalization of human distress and financial conflicts of interest, including with the practice of psychiatrists and with the pharmaceutical industry; political controversies about the inclusion or exclusion of diagnoses from the manual, in general or in regard to specific issues; and the experience of those who are most directly affected by the manual by being diagnosed, including the consumer/survivor movement.[72][73][74][75] Treatment General considerations NIMH federal agency patient room for Psychiatric research, Maryland, US Individuals receiving psychiatric treatment are commonly referred to as patients but may also be called clients, consumers, or service recipients. They may come under the care of a psychiatric physician or other psychiatric practitioners by various paths, the two most common being self-referral or referral by a primary care physician. Alternatively, a person may be referred by hospital medical staff, by court order, involuntary commitment, or, in countries such as the UK and Australia, by sectioning under a mental health law. A psychiatrist or medical provider evaluates people through a psychiatric assessment for their mental and physical condition. This usually involves interviewing the person and often obtaining information from other sources such as other health and social care professionals, relatives, associates, law enforcement personnel, emergency medical personnel, and psychiatric rating scales. A mental status examination is carried out, and a physical examination is usually performed to establish or exclude other illnesses that may be contributing to the alleged psychiatric problems. A physical examination may also serve to identify any signs of self-harm; this examination is often performed by someone other than the psychiatrist, especially if blood tests and medical imaging are performed. Like most medications, psychiatric medications can cause adverse effects in patients, and some require ongoing therapeutic drug monitoring, for instance full blood counts, serum drug levels, renal function, liver function or thyroid function. Electroconvulsive therapy (ECT) is sometimes administered for serious conditions, such as those unresponsive to medication. The efficacy[76][77] and adverse effects of psychiatric drugs may vary from patient to patient. Inpatient treatment This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources in this section. Unsourced material may be challenged and removed. (August 2017) (Learn how and when to remove this message) Psychiatric treatments have changed over the past several decades. In the past, psychiatric patients were often hospitalized for six months or more, with some cases involving hospitalization for many years. Average inpatient psychiatric treatment stay has decreased significantly since the 1960s, a trend known as deinstitutionalization.[78][79][80][81] Today in most countries, people receiving psychiatric treatment are more likely to be seen as outpatients. If hospitalization is required, the average hospital stay is around one to two weeks, with only a small number receiving long-term hospitalization.[82] However, in Japan psychiatric hospitals continue to keep patients for long periods, sometimes even keeping them in physical restraints, strapped to their beds for periods of weeks or months.[83][84] Psychiatric inpatients are people admitted to a hospital or clinic to receive psychiatric care. Some are admitted involuntarily, perhaps committed to a secure hospital, or in some jurisdictions to a facility within the prison system. In many countries including the United States and Canada, the criteria for involuntary admission vary with local jurisdiction. They may be as broad as having a mental health condition, or as narrow as being an immediate danger to themselves or others. Bed availability is often the real determinant of admission decisions to hard pressed public facilities. People may be admitted voluntarily if the treating doctor considers that safety is not compromised by this less restrictive option. For many years, controversy has surrounded the use of involuntary treatment and use of the term "lack of insight" in describing patients. Internationally, mental health laws vary significantly but in many cases, involuntary psychiatric treatment is permitted when there is deemed to be a significant risk to the patient or others due to the patient's illness. Involuntary treatment refers to treatment that occurs based on a treating physician's recommendations, without requiring consent from the patient.[85] Inpatient psychiatric wards may be secure (for those thought to have a particular risk of violence or self-harm) or unlocked/open. Some wards are mixed-sex whilst same-sex wards are increasingly favored to protect women inpatients. Once in the care of a hospital, people are assessed, monitored, and often given medication and care from a multidisciplinary team, which may include physicians, pharmacists, psychiatric nurse practitioners, psychiatric nurses, clinical psychologists, psychotherapists, psychiatric social workers, occupational therapists and social workers. If a person receiving treatment in a psychiatric hospital is assessed as at particular risk of harming themselves or others, they may be put on constant or intermittent one-to-one supervision and may be put in physical restraints or medicated. People on inpatient wards may be allowed leave for periods of time, either accompanied or on their own.[86] In many developed countries there has been a massive reduction in psychiatric beds since the mid 20th century, with the growth of community care. Italy has been a pioneer in psychiatric reform, particularly through the no-restraint initiative that began nearly fifty years ago. The Italian movement, heavily influenced by Franco Basaglia, emphasizes ethical treatment and the elimination of physical restraints in psychiatric care. A study examining the application of these principles in Italy found that 14 general hospital psychiatric units reported zero restraint incidents in 2022.[87] Standards of inpatient care remain a challenge in some public and private facilities, due to levels of funding, and facilities in developing countries are typically grossly inadequate for the same reason. Even in developed countries, programs in public hospitals vary widely. Some may offer structured activities and therapies offered from many perspectives while others may only have the funding for medicating and monitoring patients. This may be problematic in that the maximum amount of therapeutic work might not actually take place in the hospital setting. This is why hospitals are increasingly used in limited situations and moments of crisis where patients are a direct threat to themselves or others. Alternatives to psychiatric hospitals that may actively offer more therapeutic approaches include rehabilitation centers or "rehab" as popularly termed.[citation needed] Outpatient treatment Outpatient treatment involves periodic visits to a psychiatrist for consultation in his or her office, or at a community-based outpatient clinic. During initial appointments, a psychiatrist generally conducts a psychiatric assessment or evaluation of the patient. Follow-up appointments then focus on making medication adjustments, reviewing potential medication interactions, considering the impact of other medical disorders on the patient's mental and emotional functioning, and counseling patients regarding changes they might make to facilitate healing and remission of symptoms. The frequency with which a psychiatrist sees people in treatment varies widely, from once a week to twice a year, depending on the type, severity and stability of each person's condition, and depending on what the clinician and patient decide would be best. Increasingly, psychiatrists are limiting their practices to psychopharmacology (prescribing medications), as opposed to previous practice in which a psychiatrist would provide traditional 50-minute psychotherapy sessions, of which psychopharmacology would be a part, but most of the consultation sessions consisted of "talk therapy". This shift began in the early 1980s and accelerated in the 1990s and 2000s.[88] A major reason for this change was the advent of managed care insurance plans,[clarification needed] which began to limit reimbursement for psychotherapy sessions provided by psychiatrists. The underlying assumption was that psychopharmacology was at least as effective as psychotherapy, and it could be delivered more efficiently because less time is required for the appointment.[89][90][91][92][a][excessive citations] Because of this shift in practice patterns, psychiatrists often refer patients whom they think would benefit from psychotherapy to other mental health professionals, e.g., clinical social workers and psychologists.[93] Telepsychiatry This section is an excerpt from Telepsychiatry.[edit] Telemental health session Telepsychiatry or telemental health refers to the use of telecommunications technology (mostly videoconferencing and phone calls) to deliver psychiatric care remotely for people with mental health conditions. It is a branch of telemedicine.[94][95] Telepsychiatry can be effective in treating people with mental health conditions. In the short-term it can be as acceptable and effective as face-to-face care.[96] Research also suggests comparable therapeutic factors, such as changes in problematic thinking or behaviour. [97] It can improve access to mental health services for some but might also represent a barrier for those lacking access to a suitable device, the internet or the necessary digital skills. Factors such as poverty that are associated with lack of internet access are also associated with greater risk of mental health problems, making digital exclusion an important problem of telemental health services.[96] During the COVID-19 pandemic mental health services were adapted to telemental health in high-income countries. It proved effective and acceptable for use in an emergency situation but there were concerns regarding its long-term implementation.[98] History Main article: History of psychiatry Earliest knowledge The earliest known texts on mental disorders are from ancient India and include the Ayurvedic text, Charaka Samhita.[99][100] The first hospitals for curing mental illness were established in India during the 3rd century BCE.[101] Greek philosophers, including Thales, Plato, and Aristotle (especially in his De Anima treatise), also addressed the workings of the mind. As early as the 4th century BC, the Greek physician Hippocrates theorized that mental disorders had physical rather than supernatural causes. In 387 BCE, Plato suggested that the brain is where mental processes take place. In 4th to 5th century B.C. Greece, Hippocrates wrote that he visited Democritus and found him in his garden cutting open animals. Democritus explained that he was attempting to discover the cause of madness and melancholy. Hippocrates praised his work. Democritus had with him a book on madness and melancholy.[102] During the 5th century BCE, mental disorders, especially those with psychotic traits, were considered supernatural in origin,[103] a view which existed throughout ancient Greece and Rome,[103] as well as Egyptian regions.[104][page needed] Alcmaeon, believed the brain, not the heart, was the "organ of thought". He tracked the ascending sensory nerves from the body to the brain, theorizing that mental activity originated in the CNS and that the cause of mental illness resided within the brain. He applied this understanding to classify mental diseases and treatments.[17][105] Religious leaders often turned to versions of exorcism to treat mental disorders often utilizing methods that many consider to be cruel or barbaric methods. Trepanning was one of these methods used throughout history.[103] In the 6th century AD, Lin Xie carried out an early psychological experiment, in which he asked people to draw a square with one hand and at the same time draw a circle with the other (ostensibly to test people's vulnerability to distraction). It has been cited that this was an early psychiatric experiment.[106] The Islamic Golden Age fostered early studies in Islamic psychology and psychiatry, with many scholars writing about mental disorders. The Persian physician Muhammad ibn Zakariya al-Razi, also known as "Rhazes", wrote texts about psychiatric conditions in the 9th century.[107] As chief physician of a hospital in Baghdad, he was also the director of one of the first bimaristans in the world.[107] The first bimaristan was founded in Baghdad in the 9th century, and several others of increasing complexity were created throughout the Arab world in the following centuries. Some of the bimaristans contained wards dedicated to the care of mentally ill patients.[108] During the Middle Ages, Psychiatric hospitals and lunatic asylums were built and expanded throughout Europe. Specialist hospitals such as Bethlem Royal Hospital in London were built in medieval Europe from the 13th century to treat mental disorders, but were used only as custodial institutions and did not provide any type of treatment. It is the oldest extant psychiatric hospital in the world.[109] An ancient text known as The Yellow Emperor's Classic of Internal Medicine identifies the brain as the nexus of wisdom and sensation, includes theories of personality based on yin–yang balance, and analyzes mental disorder in terms of physiological and social disequilibria. Chinese scholarship that focused on the brain advanced during the Qing Dynasty with the work of Western-educated Fang Yizhi (1611–1671), Liu Zhi (1660–1730), and Wang Qingren (1768–1831). Wang Qingren emphasized the importance of the brain as the center of the nervous system, linked mental disorder with brain diseases, investigated the causes of dreams, insomnia, psychosis, depression and epilepsy.[106] Medical specialty The beginning of psychiatry as a medical specialty is dated to the middle of the nineteenth century,[110] although its germination can be traced to the late eighteenth century. In the late 17th century, privately run asylums for the insane began to proliferate and expand in size. In 1713, the Bethel Hospital Norwich was opened, the first purpose-built asylum in England.[111] In 1656, Louis XIV of France created a public system of hospitals for those with mental disorders, but as in England, no real treatment was applied.[112] During the Enlightenment, attitudes towards the mentally ill began to change. It came to be viewed as a disorder that required compassionate treatment. In 1758, English physician William Battie wrote his Treatise on Madness on the management of mental disorder. It was a critique aimed particularly at the Bethlem Royal Hospital, where a conservative regime continued to use barbaric custodial treatment. Battie argued for a tailored management of patients entailing cleanliness, good food, fresh air, and distraction from friends and family. He argued that mental disorder originated from dysfunction of the material brain and body rather than the internal workings of the mind.[113][114] Dr. Philippe Pinel at the Salpêtrière, 1795 by Tony Robert-Fleury. Pinel ordering the removal of chains from patients at the Paris Asylum for insane women. The introduction of moral treatment was initiated independently by the French doctor Philippe Pinel and the English Quaker William Tuke.[103] In 1792, Pinel became the chief physician at the Bicêtre Hospital. Patients were allowed to move freely about the hospital grounds, and eventually dark dungeons were replaced with sunny, well-ventilated rooms. Pinel's student and successor, Jean Esquirol (1772–1840), went on to help establish 10 new mental hospitals that operated on the same principles.[115] Although Tuke, Pinel and others had tried to do away with physical restraint, it remained widespread into the 19th century. At the Lincoln Asylum in England, Robert Gardiner Hill, with the support of Edward Parker Charlesworth, pioneered a mode of treatment that suited "all types" of patients, so that mechanical restraints and coercion could be dispensed with—a situation he finally achieved in 1838. In 1839, Sergeant John Adams and Dr. John Conolly were impressed by the work of Hill, and introduced the method into their Hanwell Asylum, by then the largest in the country.[116][117][page needed] The modern era of institutionalized provision for the care of the mentally ill, began in the early 19th century with a large state-led effort. In England, the Lunacy Act 1845 was an important landmark in the treatment of the mentally ill, as it explicitly changed the status of mentally ill people to patients who required treatment. All asylums were required to have written regulations and to have a resident qualified physician.[118][full citation needed] In 1838, France enacted a law to regulate both the admissions into asylums and asylum services across the country. In the United States, the erection of state asylums began with the first law for the creation of one in New York, passed in 1842. The Utica State Hospital was opened around 1850. Many state hospitals in the United States were built in the 1850s and 1860s on the Kirkbride Plan, an architectural style meant to have curative effect.[119][page needed] At the turn of the century, England and France combined had only a few hundred individuals in asylums.[120] By the late 1890s and early 1900s, this number had risen to the hundreds of thousands. However, the idea that mental illness could be ameliorated through institutionalization ran into difficulties.[121] Psychiatrists were pressured by an ever-increasing patient population,[121] and asylums again became almost indistinguishable from custodial institutions.[122] In the early 1800s, psychiatry made advances in the diagnosis of mental illness by broadening the category of mental disease to include mood disorders, in addition to disease level delusion or irrationality.[123] The 20th century introduced a new psychiatry into the world, with different perspectives of looking at mental disorders. For Emil Kraepelin, the initial ideas behind biological psychiatry, stating that the different mental disorders are all biological in nature, evolved into a new concept of "nerves", and psychiatry became a rough approximation of neurology and neuropsychiatry.[124] Following Sigmund Freud's pioneering work, ideas stemming from psychoanalytic theory also began to take root in psychiatry.[125] The psychoanalytic theory became popular among psychiatrists because it allowed the patients to be treated in private practices instead of warehoused in asylums.[125] Otto Loewi's work led to the identification of the first neurotransmitter, acetylcholine. By the 1970s, however, the psychoanalytic school of thought became marginalized within the field.[125] Biological psychiatry reemerged during this time. Psychopharmacology and neurochemistry became the integral parts of psychiatry starting with Otto Loewi's discovery of the neuromodulatory properties of acetylcholine; thus identifying it as the first-known neurotransmitter. Subsequently, it has been shown that different neurotransmitters have different and multiple functions in regulation of behaviour. In a wide range of studies in neurochemistry using human and animal samples, individual differences in neurotransmitters' production, reuptake, receptors' density and locations were linked to differences in dispositions for specific psychiatric disorders. For example, the discovery of chlorpromazine's effectiveness in treating schizophrenia in 1952 revolutionized treatment of the disorder,[126] as did lithium carbonate's ability to stabilize mood highs and lows in bipolar disorder in 1948.[127] Psychotherapy was still utilized, but as a treatment for psychosocial issues.[128] This proved the idea of neurochemical nature of many psychiatric disorders. Another approach to look for biomarkers of psychiatric disorders is neuroimaging[129] that was first utilized as a tool for psychiatry in the 1980s.[130] In 1963, US president John F. Kennedy introduced legislation delegating the National Institute of Mental Health to administer Community Mental Health Centers for those being discharged from state psychiatric hospitals.[131] Later, though, the Community Mental Health Centers focus shifted to providing psychotherapy for those with acute but less serious mental disorders.[131] Ultimately there were no arrangements made for actively following and treating severely mentally ill patients who were being discharged from hospitals, resulting in a large population of chronically homeless people with mental illness.[131] Controversy and criticism Main article: Controversy surrounding psychiatry The institution of psychiatry has attracted controversy since its inception.[132]: 47  Scholars including those from social psychiatry, psychoanalysis, psychotherapy, and critical psychiatry have produced critiques.[132]: 47  It has been argued that psychiatry confuses disorders of the mind with disorders of the brain that can be treated with drugs;[132]: 53 : 47  that its use of drugs is in part due to lobbying by drug companies resulting in distortion of research;[132]: 51  and that the concept of "mental illness" is often used to label and control those with beliefs and behaviours that the majority of people disagree with;[132]: 50  and that it is too influenced by ideas from medicine causing it to misunderstand the nature of mental distress.[132] Critique of psychiatry from within the field comes from the critical psychiatry group in the UK. Double argues that most critical psychiatry is anti-reductionist. Rashed argues new mental health science has moved beyond this reductionist critique by seeking integrative and biopsychosocial models for conditions and that much of critical psychiatry now exists with orthodox psychiatry but notes that many critiques remain unaddressed.[133]: 237  The term anti-psychiatry was coined by psychiatrist David Cooper in 1967 and was later made popular by Thomas Szasz. The word Antipsychiatrie was already used in Germany in 1904.[134] The basic premise of the anti-psychiatry movement is that psychiatrists attempt to classify "normal" people as "deviant"; psychiatric treatments are ultimately more damaging than helpful to patients; and psychiatry's history involves (what may now be seen as) dangerous treatments, such as psychosurgery an example of this being the frontal lobectomy (commonly called a lobotomy).[135] The use of lobotomies largely disappeared by the late 1970s.

Psychiatry is the medical specialty devoted to the diagnosis, treatment, and prevention

Psychiatry is the medical specialty devoted to the diagnosis, treatment, and prevention of deleterious mental conditions.[1][2] These include matters related to cognition, perceptions, mood, emotion, and behavior.

Initial psychiatric assessment of a person begins with creating a case history and conducting a mental status examination. Laboratory tests, physical examinations, and psychological tests may be conducted. On occasion, neuroimaging or neurophysiological studies are performed.[3]

Ment

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The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight, and judgment.[1] There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains. The purpose of the MSE is to obtain a comprehensive cross-sectional description of the patient's mental state, which, when combined with the biographical and historical information of the psychiatric history, allows the clinician to make an accurate diagnosis and formulation, which are required for coherent treatment planning. The data are collected through a combination of direct and indirect means: unstructured observation while obtaining the biographical and social information, focused questions about current symptoms, and formalised psychological tests.[2] The MSE is not to be confused with the mini–mental state examination (MMSE), which is a brief neuropsychological screening test for dementia. Theoretical foundations The MSE derives from an approach to psychiatry known as descriptive psychopathology[3] or descriptive phenomenology,[4] which developed from the work of the philosopher and psychiatrist Karl Jaspers.[5] From Jaspers' perspective it was assumed that the only way to comprehend a patient's experience is through his or her own description (through an approach of empathic and non-theoretical enquiry), as distinct from an interpretive or psychoanalytic approach which assumes the analyst might understand experiences or processes of which the patient is unaware, such as defense mechanisms or unconscious drives. In practice, the MSE is a blend of empathic descriptive phenomenology and empirical clinical observation. It has been argued that the term phenomenology has become corrupted in clinical psychiatry: current usage, as a set of supposedly objective descriptions of a psychiatric patient (a synonym for signs and symptoms), is incompatible with the original meaning which was concerned with comprehending a patient's subjective experience.[6][7] Application The mental status examination is a core skill of qualified (mental) health personnel. It is a key part of the initial psychiatric assessment in an outpatient or psychiatric hospital setting. It is a systematic collection of data based on observation of the patient's behavior while the patient is in the clinician's view during the interview. The purpose is to obtain evidence of symptoms and signs of mental disorders, including danger to self and others, that are present at the time of the interview. Further, information on the patient's insight, judgment, and capacity for abstract reasoning is used to inform decisions about treatment strategy and the choice of an appropriate treatment setting.[8] It is carried out in the manner of an informal enquiry, using a combination of open and closed questions, supplemented by structured tests to assess cognition.[9] The MSE can also be considered part of the comprehensive physical examination performed by physicians and nurses although it may be performed in a cursory and abbreviated way in non-mental-health settings.[10] Information is usually recorded as free-form text using the standard headings,[11] but brief MSE checklists are available for use in emergency situations, for example, by paramedics or emergency department staff.[12][13] The information obtained in the MSE is used, together with the biographical and social information of the psychiatric history, to generate a diagnosis, a psychiatric formulation and a treatment plan. Domains The mnemonic ASEPTIC can be used to remember the domains of the MSE:[14] A - Appearance/Behavior S - Speech E - Emotion (Mood and Affect) P - Perception T - Thought Content and Process I - Insight and Judgement C - Cognition Appearance Clinicians assess the physical aspects such as the appearance of a patient, including apparent age, height, weight, and manner of dress and grooming. Colorful or bizarre clothing might suggest mania, while unkempt, dirty clothes might suggest schizophrenia or depression. If the patient appears much older than his or her chronological age this can suggest chronic poor self-care or ill-health. Clothing and accessories of a particular subculture, body modifications, or clothing not typical of the patient's gender, might give clues to personality. Observations of physical appearance might include the physical features of alcoholism or drug abuse, such as signs of malnutrition, nicotine stains, dental erosion, a rash around the mouth from inhalant abuse, or needle track marks from intravenous drug abuse. Observations can also include any odor which might suggest poor personal hygiene due to extreme self-neglect, or alcohol intoxication.[15] Weight loss could also signify a depressive disorder, physical illness, anorexia nervosa[14] or chronic anxiety.[16] Attitude Attitude, also known as rapport or cooperation,[17] refers to the patient's approach to the interview process and the quality of information obtained during the assessment.[18] Observations of attitude include whether the patient is cooperative, hostile, open or secretive.[14] Behavior Abnormalities of behavior, also called abnormalities of activity,[19] include observations of specific abnormal movements, as well as more general observations of the patient's level of activity and arousal, and observations of the patient's eye contact and gait.[14] Abnormal movements, for example choreiform, athetoid or choreoathetoid movements may indicate a neurological disorder. A tremor or dystonia may indicate a neurological condition or the side effects of antipsychotic medication. The patient may have tics (involuntary but quasi-purposeful movements or vocalizations) which may be a symptom of Tourette's syndrome. There are a range of abnormalities of movement which are typical of catatonia, such as echopraxia, catalepsy, waxy flexibility and paratonia (or gegenhalten[20]). Stereotypies (repetitive purposeless movements such as rocking or head banging) or mannerisms (repetitive quasi-purposeful abnormal movements such as a gesture or abnormal gait) may be a feature of chronic schizophrenia or autism. More global behavioural abnormalities may be noted, such as an increase in arousal and movement (described as psychomotor agitation or hyperactivity) which might reflect mania or delirium. An inability to sit still might represent akathisia, a side effect of antipsychotic medication. Similarly, a global decrease in arousal and movement (described as psychomotor retardation, akinesia or stupor) might indicate depression or a medical condition such as Parkinson's disease, dementia or delirium. The examiner would also comment on eye movements (repeatedly glancing to one side can suggest that the patient is experiencing hallucinations), and the quality of eye contact (which can provide clues to the patient's emotional state). Lack of eye contact may suggest depression or autism.[21][22][23] Mood and affect The distinction between mood and affect in the MSE is subject to some disagreement. For example, Trzepacz and Baker (1993)[24] describe affect as "the external and dynamic manifestations of a person's internal emotional state" and mood as "a person's predominant internal state at any one time", whereas Sims (1995)[25] refers to affect as "differentiated specific feelings" and mood as "a more prolonged state or disposition". This article will use the Trzepacz and Baker (1993) definitions, with mood regarded as a current subjective state as described by the patient, and affect as the examiner's inferences of the quality of the patient's emotional state based on objective observation.[26][14] Mood is described using the patient's own words, and can also be described in summary terms such as neutral, euthymic, dysphoric, euphoric, angry, anxious or apathetic. Alexithymic individuals may be unable to describe their subjective mood state. An individual who is unable to experience any pleasure may have anhedonia. Vincent van Gogh's 1889 Self Portrait suggests the artist's mood and affect in the time leading up to his suicide.[citation needed] Affect is described by labelling the apparent emotion conveyed by the person's nonverbal behavior (anxious, sad etc.), and also by using the parameters of appropriateness, intensity, range, reactivity and mobility. Affect may be described as appropriate or inappropriate to the current situation, and as congruent or incongruent with their thought content.[14] For example, someone who shows a bland affect when describing a very distressing experience would be described as showing incongruent affect, which might suggest schizophrenia. The intensity of the affect may be described as normal, blunted affect, exaggerated, flat, heightened or overly dramatic. A flat or blunted affect is associated with schizophrenia, depression or post-traumatic stress disorder; heightened affect might suggest mania, and an overly dramatic or exaggerated affect might suggest certain personality disorders. Mobility refers to the extent to which affect changes during the interview: the affect may be described as fixed, mobile, immobile, constricted/restricted or labile. The person may show a full range of affect, in other words a wide range of emotional expression during the assessment, or may be described as having restricted affect. The affect may also be described as reactive, in other words changing flexibly and appropriately with the flow of conversation, or as unreactive. A bland lack of concern for one's disability may be described as showing la belle indifférence,[27] a feature of conversion disorder, which is historically termed "hysteria" in older texts.[28][29][30] Speech Speech is assessed by observing the patient's spontaneous speech, and also by using structured tests of specific language functions. This heading is concerned with the production of speech rather than the content of speech, which is addressed under thought process and thought content (see below). When observing the patient's spontaneous speech, the interviewer will note and comment on paralinguistic features such as the loudness, rhythm, prosody, intonation, pitch, phonation, articulation, quantity, rate, spontaneity and latency of speech.[14] Many acoustic features have been shown to be significantly altered in mental health disorders.[31] A structured assessment of speech includes an assessment of expressive language by asking the patient to name objects, repeat short sentences, or produce as many words as possible from a certain category in a set time. Simple language tests also form part of the mini-mental state examination. In practice, the structured assessment of receptive and expressive language is often reported under Cognition (see below).[32] Language assessment will allow the recognition of medical conditions presenting with aphonia or dysarthria, neurological conditions such as stroke or dementia presenting with aphasia, and specific language disorders such as stuttering, cluttering or mutism. People with autism spectrum disorders may have abnormalities in paralinguistic and pragmatic aspects of their speech. Echolalia (repetition of another person's words) and palilalia (repetition of the subject's own words) can be heard with patients with autism, schizophrenia or Alzheimer's disease. A person with schizophrenia might use neologisms, which are made-up words which have a specific meaning to the person using them. Speech assessment also contributes to assessment of mood, for example people with mania or anxiety may have rapid, loud and pressured speech; on the other hand depressed patients will typically have a prolonged speech latency and speak in a slow, quiet and hesitant manner.[33][34][35] Thought process The paintings of the outsider artist Adolf Wölfli could be seen as a visual representation of formal thought disorder.[citation needed] Thought process in the MSE refers to the quantity, tempo (rate of flow) and form (or logical coherence) of thought. Thought process cannot be directly observed but can only be described by the patient, or inferred from a patient's speech. Form of the thought is captured in this category. One should describe the thought form as thought directed A→B (normal), versus formal thought disorders. A pattern of interruption or disorganization of thought processes is broadly referred to as formal thought disorder, and might be described more specifically as thought blocking, fusion, loosening of associations, tangential thinking, derailment of thought, knight's move thinking. Thought may be described as 'circumstantial' when a patient includes a great deal of irrelevant detail and makes frequent diversions, but remains focused on the broad topic. Circumstantial thinking might be observed in anxiety disorders or certain kinds of personality disorders.[36][37][38] Regarding the tempo of thought, some people may experience 'flight of ideas' (a manic symptom), when their thoughts are so rapid that their speech seems incoherent, although in flight of ideas a careful observer can discern a chain of poetic, syllabic, rhyming associations in the patient's speech (i.e., "I love to eat peaches, beach beaches, sand castles fall in the waves, braves are going to the finals, fee fi fo fum. Golden egg."). Alternatively an individual may be described as having retarded or inhibited thinking, in which thoughts seem to progress slowly with few associations. Poverty of thought is a global reduction in the quantity of thought and one of the negative symptoms of schizophrenia. It can also be a feature of severe depression or dementia. A patient with dementia might also experience thought perseveration. Thought perseveration refers to a pattern where a person keeps returning to the same limited set of ideas. Thought content A description of thought content would be the largest section of the MSE report. It would describe a patient's suicidal thoughts, depressed cognition, delusions, overvalued ideas, obsessions, phobias and preoccupations. One should separate the thought content into pathological thought, versus non-pathological thought. Importantly one should specify suicidal thoughts as either intrusive, unwanted, and not able to translate in the capacity to act on these thoughts (mens rea), versus suicidal thoughts that may lead to the act of suicide (actus reus). Abnormalities of thought content are established by exploring individuals' thoughts in an open-ended conversational manner with regard to their intensity, salience, the emotions associated with the thoughts, the extent to which the thoughts are experienced as one's own and under one's control, and the degree of belief or conviction associated with the thoughts.[39][40][41] Delusions A delusion has three essential qualities: it can be defined as "a false, unshakeable idea or belief (1) which is out of keeping with the patient's educational, cultural and social background (2) ... held with extraordinary conviction and subjective certainty (3)",[42] and is a core feature of psychotic disorders. For instance an alliance to a particular political party, or sports team would not be considered a delusion in some societies. The patient's delusions may be described within the SEGUE PM mnemonic as: somatic, erotomanic delusions, grandiose delusions, unspecified delusions, envious delusions (c.f. delusional jealousy), persecutory or paranoid delusions, or multifactorial delusions. There are several other forms of delusions, these include descriptions such as: delusions of reference, or delusional misidentification, or delusional memories (e.g., "I was a goat last year") among others. Delusional symptoms can be reported as on a continuum from: full symptoms (with no insight), partial symptoms (where they may start questioning these delusions), nil symptoms (where symptoms are resolved), or after complete treatment there are still delusional symptoms or ideas that could develop into delusions you can characterize this as residual symptoms. Delusions can suggest several diseases such as schizophrenia, schizophreniform disorder, brief psychotic disorder, mania, depression with psychotic features, or delusional disorders. One can differentiate delusional disorders from schizophrenia for example by the age of onset for delusional disorders being older with a more complete and unaffected personality, where the delusion may only partially impact their life and be fairly encapsulated off from the rest of their formed personality—for example, believing that a spider lives in their hair, but this belief not affecting their work, relationships, or education. Whereas schizophrenia typically arises earlier in life with a disintegration of personality and a failure to cope with work, relationships, or education. Other features differentiate diseases with delusions as well. Delusions may be described as mood-congruent (the delusional content in keeping with the mood), typical of manic or depressive psychosis, or mood-incongruent (delusional content not in keeping with the mood) which are more typical of schizophrenia. Delusions of control, or passivity experiences (in which the individual has the experience of the mind or body being under the influence or control of some kind of external force or agency), are typical of schizophrenia. Examples of this include experiences of thought withdrawal, thought insertion, thought broadcasting, and somatic passivity. Schneiderian first rank symptoms are a set of delusions and hallucinations which have been said to be highly suggestive of a diagnosis of schizophrenia. Delusions of guilt, delusions of poverty, and nihilistic delusions (belief that one has no mind or is already dead) are typical of depressive psychosis. Overvalued Ideas An overvalued idea is an emotionally charged belief that may be held with sufficient conviction to make believer emotionally charged or aggressive but that fails to possess all three characteristics of delusion—most importantly, incongruity with cultural norms. Therefore, any strong, fixed, false, but culturally normative belief can be considered an "overvalued idea". Hypochondriasis is an overvalued idea that one has an illness, dysmorphophobia that a part of one's body is abnormal, and anorexia nervosa that one is overweight or fat. Obsessions An obsession is an "undesired, unpleasant, intrusive thought that cannot be suppressed through the patient's volition",[43] but unlike passivity experiences described above, they are not experienced as imposed from outside the patient's mind. Obsessions are typically intrusive thoughts of violence, injury, dirt or sex, or obsessive ruminations on intellectual themes. A person can also describe obsessional doubt, with intrusive worries about whether they have made the wrong decision, or forgotten to do something, for example turn off the gas or lock the house. In obsessive-compulsive disorder, the individual experiences obsessions with or without compulsions (a sense of having to carry out certain ritualized and senseless actions against their wishes). Phobias A phobia is "a dread of an object or situation that does not in reality pose any threat",[44] and is distinct from a delusion in that the patient is aware that the fear is irrational. A phobia is usually highly specific to certain situations and will usually be reported by the patient rather than being observed by the clinician in the assessment interview. Preoccupations Preoccupations are thoughts which are not fixed, false or intrusive, but have an undue prominence in the person's mind. Clinically significant preoccupations would include thoughts of suicide, homicidal thoughts, suspicious or fearful beliefs associated with certain personality disorders, depressive beliefs (for example that one is unloved or a failure), or the cognitive distortions of anxiety and depression. Suicidal thoughts The MSE contributes to clinical risk assessment by including a thorough exploration of any suicidal or hostile thought content. Assessment of suicide risk includes detailed questioning about the nature of the person's suicidal thoughts, belief about death, reasons for living, and whether the person has made any specific plans to end his or her life. The most important questions to ask are: Do you have suicidal feeling now; have you ever attempted suicide (highly correlated with future suicide attempts); do you have plans to commit suicide in the future; and, do you have any deadlines where you may commit suicide (e.g., numerology calculation, doomsday belief, Mother's Day, anniversary, Christmas).[45] Perceptions A perception in this context is any sensory experience, and the three broad types of perceptual disturbance are hallucinations, pseudohallucinations and illusions. A hallucination is defined as a sensory perception in the absence of any external stimulus, and is experienced in external or objective space (i.e. experienced by the subject as real). An illusion is defined as a false sensory perception in the presence of an external stimulus, in other words a distortion of a sensory experience, and may be recognized as such by the subject. A pseudohallucination is experienced in internal or subjective space (for example as "voices in my head") and is regarded as akin to fantasy. Other sensory abnormalities include a distortion of the patient's sense of time, for example déjà vu, or a distortion of the sense of self (depersonalization) or sense of reality (derealization).[14] Hallucinations can occur in any of the five senses, although auditory and visual hallucinations are encountered more frequently than tactile (touch), olfactory (smell) or gustatory (taste) hallucinations. Auditory hallucinations are typical of psychoses: third-person hallucinations (i.e. voices talking about the patient) and hearing one's thoughts spoken aloud (gedankenlautwerden or écho de la pensée) are among the Schneiderian first rank symptoms indicative of schizophrenia, whereas second-person hallucinations (voices talking to the patient) threatening or insulting or telling them to commit suicide, may be a feature of psychotic depression or schizophrenia. Visual hallucinations are generally suggestive of organic conditions such as epilepsy, drug intoxication or drug withdrawal. Many of the visual effects of hallucinogenic drugs are more correctly described as visual illusions or visual pseudohallucinations, as they are distortions of sensory experiences, and are not experienced as existing in objective reality. Auditory pseudohallucinations are suggestive of dissociative disorders. Déjà vu, derealization and depersonalization are associated with temporal lobe epilepsy and dissociative disorders.[46][47] Cognition Further information: Cognitive test This section of the MSE covers the patient's level of alertness, orientation, attention, memory, visuospatial functioning, language functions and executive functions. Unlike other sections of the MSE, use is made of structured tests in addition to unstructured observation. Alertness is a global observation of level of consciousness, i.e. awareness of and responsiveness to the environment, and this might be described as alert, clouded, drowsy, or stuporous. Orientation is assessed by asking the patient where he or she is (for example what building, town and state) and what time it is (time, day, date). Attention and concentration are assessed by several tests, commonly serial sevens test subtracting 7 from 100 and subtracting 7 from the difference 5 times. Alternatively: spelling a five-letter word backwards, saying the months or days of the week in reverse order, serial threes (subtract three from twenty five times), and by testing digit span. Memory is assessed in terms of immediate registration (repeating a set of words), short-term memory (recalling the set of words after an interval, or recalling a short paragraph), and long-term memory (recollection of well known historical or geographical facts). Visuospatial functioning can be assessed by the ability to copy a diagram, draw a clock face, or draw a map of the consulting room. Language is assessed through the ability to name objects, repeat phrases, and by observing the individual's spontaneous speech and response to instructions. Executive functioning can be screened for by asking the "similarities" questions ("what do x and y have in common?") and by means of a verbal fluency task (e.g. "list as many words as you can starting with the letter F, in one minute"). The mini-mental state examination is a simple structured cognitive assessment which is in widespread use as a component of the MSE. Mild impairment of attention and concentration may occur in any mental illness where people are anxious and distractible (including psychotic states), but more extensive cognitive abnormalities are likely to indicate a gross disturbance of brain functioning such as delirium, dementia or intoxication. Specific language abnormalities may be associated with pathology in Wernicke's area or Broca's area of the brain. In Korsakoff's syndrome there is dramatic memory impairment with relative preservation of other cognitive functions. Visuospatial or constructional abnormalities here may be associated with parietal lobe pathology, and abnormalities in executive functioning tests may indicate frontal lobe pathology. This kind of brief cognitive testing is regarded as a screening process only, and any abnormalities are more carefully assessed using formal neuropsychological testing.[48] The MSE may include a brief neuropsychiatric examination in some situations. Frontal lobe pathology is suggested if the person cannot repetitively execute a motor sequence (e.g. "paper-scissors-rock"). The posterior columns are assessed by the person's ability to feel the vibrations of a tuning fork on the wrists and ankles. The parietal lobe can be assessed by the person's ability to identify objects by touch alone and with eyes closed. A cerebellar disorder may be present if the person cannot stand with arms extended, feet touching and eyes closed without swaying (Romberg's sign); if there is a tremor when the person reaches for an object; or if he or she is unable to touch a fixed point, close the eyes and touch the same point again. Pathology in the basal ganglia may be indicated by rigidity and resistance to movement of the limbs, and by the presence of characteristic involuntary movements. A lesion in the posterior fossa can be detected by asking the patient to roll his or her eyes upwards (Parinaud's syndrome). Focal neurological signs such as these might reflect the effects of some prescribed psychiatric medications, chronic drug or alcohol use, head injuries, tumors or other brain disorders.[49][50][51][52][53] Insight The person's understanding of his or her mental illness is evaluated by exploring his or her explanatory account of the problem, and understanding of the treatment options. In this context, insight can be said to have three components: recognition that one has a mental illness, compliance with treatment, and the ability to re-label unusual mental events (such as delusions and hallucinations) as pathological.[54] As insight is on a continuum, the clinician should not describe it as simply present or absent, but should report the patient's explanatory account descriptively.[55] Impaired insight is characteristic of psychosis and dementia, and is an important consideration in treatment planning and in assessing the capacity to consent to treatment.[56] Anosognosia is the clinical term for the condition in which the patient is unaware of their neurological deficit or psychiatric condition.[14][57] Judgment Judgment refers to the patient's capacity to make sound, reasoned and responsible decisions. One should frame judgement to the functions or domains that are normal versus impaired (e.g., poor judgement is isolated to petty theft, able to function in relationships, work, academics). Traditionally, the MSE included the use of standard hypothetical questions such as "what would you do if you found a stamped, addressed envelope lying in the street?"; however contemporary practice is to inquire about how the patient has responded or would respond to real-life challenges and contingencies. Assessment would take into account the individual's executive system capacity in terms of impulsiveness, social cognition, self-awareness and planning ability. Impaired judgment is not specific to any diagnosis but may be a prominent feature of disorders affecting the frontal lobe of the brain. If a person's judgment is impaired due to mental illness, there might be implications for the person's safety or the safety of others.[58] Cultural considerations There are potential problems when the MSE is applied in a cross-cultural context, when the clinician and patient are from different cultural backgrounds. For example, the patient's culture might have different norms for appearance, behavior and display of emotions. Culturally normative spiritual and religious beliefs need to be distinguished from delusions and hallucinations — these may seem similar to one who does not understand that they have different roots. Cognitive assessment must also take the patient's language and educational background into account. Clinician's racial bias is another potential confounder. Consultation with cultural leaders in community or clinicians when working with Aboriginal people can help guide if any cultural phenomena has been considered when completing an MSE with Aboriginal patients and things to consider from a cross-cultural context.[59][60][61] Children There are particular challenges in carrying out an MSE with young children and others with limited language such as people with intellectual impairment. The examiner would explore and clarify the individual's use of words to describe mood, thought content or perceptions, as words may be used idiosyncratically with a different meaning from that assumed by the examiner. In this group, tools such as play materials, puppets, art materials or diagrams (for instance with multiple choices of facial expressions depicting emotions) may be used to facilitate recall and explanation of experiences.[62]

The Mental Statue Examination (MSE)

The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight, and judgment.[1] There are some minor variations in the subdivision of the MSE and the sequence and names o

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One benefit of using the HEXACO is that of the facet of neuroticism within the factor of emotionality: trait neuroticism has been shown to have a moderate positive correlation with people with anxiety and depression. The identification of trait neuroticism on a scale, paired with anxiety, and/or depression is beneficial in a clinical setting for introductory screenings some personality disorders. Because the HEXACO has facets which help identify traits of neuroticism, it is also a helpful indicator of the dark triad.[35][36] Temperament Assessment In contrast to personality, i.e. the concept that relates to culturally- and socially-influenced behaviour and cognition, the concept of temperament' refers to biologically and neurochemically-based individual differences in behaviour. Unlike personality, temperament is relatively independent of learning, system of values, national, religious and gender identity and attitudes. There are multiple tests for evaluation of temperament traits (reviewed, for example, in,[37] majority of which were developed arbitrarily from opinions of early psychologists and psychiatrists but not from biological sciences. There are only two temperament tests that were based on neurochemical hypotheses: The Temperament and Character Inventory (TCI) and the Trofimova's Structure of Temperament Questionnaire-Compact (STQ-77).[38] The STQ-77 is based on the neurochemical framework Functional Ensemble of Temperament that summarizes the contribution of main neurochemical (neurotransmitter, hormonal and opioid) systems to behavioural regulation.[37][39][40] The STQ-77 assesses 12 temperament traits linked to the neurochemical components of the FET. The STQ-77 is freely available for non-commercial use in 24 languages for testing in adults and several language versions for testing children [41] Pseudopsychology (pop psychology) in assessment Although there have been many great advancements in the field of psychological evaluation, some issues have also developed. One of the main problems in the field is pseudopsychology, also called pop psychology. Psychological evaluation is one of the biggest aspects in pop psychology. In a clinical setting, patients are not aware that they are not receiving correct psychological treatment, and that belief is one of the main foundations of pseudopsychology. It is largely based upon the testimonies of previous patients, the avoidance of peer review (a critical aspect of any science), and poorly set up tests, which can include confusing language or conditions that are left up to interpretation.[42] Pseudopsychology can also occur when people claim to be psychologists, but lack qualifications.[43] A prime example of this is found in quizzes that can lead to a variety of false conclusions. These can be found in magazines, online, or just about anywhere accessible to the public. They usually consist of a small number of questions designed to tell the participant things about themselves. These often have no research or evidence to back up any claims made by the quizzes.[43] Ethics Concerns about privacy, cultural biases, tests that have not been validated, and inappropriate contexts have led groups such as the American Educational Research Association (AERA) and the American Psychological Association (APA) to publish guidelines for examiners in regards to assessment.[9] The American Psychological Association states that a client must give permission to release any of the information that may come from a psychologist.[44] The only exceptions to this are in the case of minors, when the clients are a danger to themselves or others, or if they are applying for a job that requires this information. Also, the issue of privacy occurs during the assessment itself. The client has the right to say as much or little as they would like, however they may feel the need to say more than they want or even may accidentally reveal information they would like to keep private.[9] Guidelines have been put in place to ensure the psychologist giving the assessments maintains a professional relationship with the client since their relationship can impact the outcomes of the assessment. The examiner's expectations may also influence the client's performance in the assessments.[9] The validity and reliability of the tests being used also can affect the outcomes of the assessments being used. When psychologists are choosing which assessments they are going to use, they should pick one that will be most effective for what they are looking at. Also, it is important for the psychologists are aware of the possibility of the client, either consciously or unconsciously, faking answers and consider use of tests that have validity scales within them.[9]

How Does Neuroticism Impact Emotional Well-being and Relationships?

One benefit of using the HEXACO is that of the facet of neuroticism within the factor of emotionality: trait neuroticism has been shown to have a moderate positive correlation with people with anxiety and depression. The identification of trait neuroticism on a scale, paired with anxiety, and/or depression is beneficial in a clinical setting for introductory screenings some personality disorders. Because the HEXACO has facets which help identify traits of neuroticism, it is also a helpful indica

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Psychological evaluation is a method to assess an individual's behavior, personality, cognitive abilities, and several other domains.[a][3] A common reason for a psychological evaluation is to identify psychological factors that may be inhibiting a person's ability to think, behave, or regulate emotion functionally or constructively. It is the mental equivalent of physical examination. Other psychological evaluations seek to better understand the individual's unique characteristics or personality to predict things like workplace performance or customer relationship management.[4] History Modern psychological evaluation has been around for roughly 200 years, with roots that stem as far back as 2200 B.C.[5] It started in China, and many psychologists throughout Europe worked to develop methods of testing into the 1900s. The first tests focused on aptitude. Eventually scientists tried to gauge mental processes in patients with brain damage, then children with special needs. Ancient psychological evaluation Earliest accounts of evaluation are seen as far back as 2200 B.C. when Chinese emperors were assessed to determine their fitness for office. These rudimentary tests were developed over time until 1370 A.D. when an understanding of classical Confucianism was introduced as a testing mechanism. As a preliminary evaluation for anyone seeking public office, candidates were required to spend one day and one night in a small space composing essays and writing poetry over assigned topics. Only the top 1% to 7% were selected for higher evaluations, which required three separate session of three days and three nights performing the same tasks. This process continued for one more round until a final group emerged, comprising less than 1% of the original group, became eligible for public office. The Chinese failure to validate their selection procedures, along with widespread discontent over such grueling processes, resulted in the eventual abolishment of the practice by royal decree.[5] Development of psychological evaluation in 1800-1900-s In the 1800s, Hubert von Grashey developed a battery to determine the abilities of brain-damaged patients. This test was also not favorable, as it took over 100 hours to administer. However, this influenced Wilhelm Wundt, who had the first psychological laboratory in Germany. His tests were shorter, but used similar techniques. Wundt also measured mental processes and acknowledged the fact that there are individual differences between people. Francis Galton established the first tests in London for measuring IQ. He tested thousands of people, examining their physical characteristics as a basis for his results and many of the records remain today.[5] James Cattell studied with him, and eventually worked on his own with brass instruments for evaluation. His studies led to his paper "Mental Tests and Measurements", one of the most famous writings on psychological evaluation. He also coined the term "mental test" in this paper. As the 1900s began, Alfred Binet was also studying evaluation. However, he was more interested in distinguishing children with special needs from their peers after he could not prove in his other research that magnets could cure hysteria. He did his research in France, with the help of Theodore Simon. They created a list of questions that were used to determine if children would receive regular instruction, or would participate in special education programs. Their battery was continually revised and developed, until 1911 when the Binet-Simon questionnaire was finalized for different age levels. After Binet's death, intelligence testing was further studied by Charles Spearman. He theorized that intelligence was made up of several different subcategories, which were all interrelated. He combined all the factors together to form a general intelligence, which he abbreviated as "g".[6] This led to William Stern's idea of an intelligence quotient. He believed that children of different ages should be compared to their peers to determine their mental age in relation to their chronological age. Lewis Terman combined the Binet-Simon questionnaire with the intelligence quotient and the result was the standard test we use today, with an average score of 100.[6] The large influx of non-English speaking immigrants into the US brought about a change in psychological testing that relied heavily on verbal skills for subjects that were not literate in English, or had speech/hearing difficulties. In 1913, R.H. Sylvester standardized the first non-verbal psychological test. In this particular test, participants fit different shaped blocks into their respective slots on a Seguin form board.[5] From this test, Knox developed a series of non-verbal psychological tests that he used while working at the Ellis Island immigrant station in 1914. In his tests, were a simple wooden puzzle as well as digit-symbol substitution test where each participant saw digits paired up with a particular symbol, they were then shown the digits and had to write in the symbol that was associated with it.[5] When the United States moved into World War I, Robert M. Yerkes convinced the government that they should be testing all of the recruits they were receiving into the Army. The results of the tests could be used to make sure that the "mentally incompetent" and "mentally exceptional" were assigned to appropriate jobs. Yerkes and his colleagues developed the Army Alpha and Army Beta tests to use on all new recruits.[5] These tests set a precedent for the development of psychological testing for the next several decades. After seeing the success of the Army standardized tests, college administration quickly picked up on the idea of group testing to decide entrance into their institutions. The College Entrance Examination Board was created to test applicants to colleges across the nation. In 1925, they developed tests that were no longer essay tests that were very open to interpretation, but now were objective tests that were also the first to be scored by machine. These early tests evolved into modern day College Board tests, like the Scholastic Assessment Test, Graduate Record Examination, and the Law School Admissions Test.[5] Formal and informal evaluation Formal psychological evaluation consists of standardized batteries of tests and highly structured clinician-run interviews, while informal evaluation takes on a completely different tone. In informal evaluation, assessments are based on unstructured, free-flowing interviews or observations that allow both the patient and the clinician to guide the content. Both of these methods have their pros and cons. A highly unstructured interview and informal observations provide key findings about the patient that are both efficient and effective. A potential issue with an unstructured, informal approach is the clinician may overlook certain areas of functioning or not notice them at all.[7] Or they might focus too much on presenting complaints. The highly structured interview, although very precise, can cause the clinician to make the mistake of focusing a specific answer to a specific question without considering the response in terms of a broader scope or life context.[7] They may fail to recognize how the patient's answers all fit together. There are many ways that the issues associated with the interview process can be mitigated. The benefits to more formal standardized evaluation types such as batteries and tests are many. First, they measure a large number of characteristics simultaneously. These include personality, cognitive, or neuropsychological characteristics. Second, these tests provide empirically quantified information. The obvious benefit to this is that we can more precisely measure patient characteristics as compared to any kind of structured or unstructured interview. Third, all of these tests have a standardized way of being scored and being administered.[7] Each patient is presented a standardized stimulus that serves as a benchmark that can be used to determine their characteristics. These types of tests eliminate any possibility of bias and produce results that could be harmful to the patient and cause legal and ethical issues. Fourth, tests are normed. This means that patients can be assessed not only based on their comparison to a "normal" individual, but how they compare to the rest of their peers who may have the same psychological issues that they face. Normed tests allow the clinician to make a more individualized assessment of the patient. Fifth, standardized tests that we commonly use today are both valid and reliable.[7] We know what specific scores mean, how reliable they are, and how the results will affect the patient. Most clinicians agree that a balanced battery of tests is the most effective way of helping patients. Clinicians should not become victims of blind adherence to any one particular method.[8] A balanced battery of tests allows there to be a mix of formal testing processes that allow the clinician to start making their assessment, while conducting more informal, unstructured interviews with the same patient may help the clinician to make more individualized evaluations and help piece together what could potentially be a very complex, unique-to-the-individual kind of issue or problem .[8] Modern uses Psychological assessment is most often used in the psychiatric, medical, legal, educational, or psychological clinic settings. The types of assessments and the purposes for them differ among these settings. In the psychiatric setting, the common needs for assessment are to determine risks, whether a person should be admitted or discharged, the location the patients should be held, as well as what therapy the patient should be receiving.[9] Within this setting, the psychologists need to be aware of the legal responsibilities that what they can legally do in each situation. Within a medical setting, psychological assessment is used to find a possible underlying psychological disorder, emotional factors that may be associated with medical complaints, assessment for neuropsychological deficit, psychological treatment for chronic pain, and the treatment of chemical dependency. There has been greater importance placed on the patient's neuropsychological status as neuropsychologists are becoming more concerned with the functioning of the brain.[9] Psychological assessment also has a role in the legal setting. Psychologists might be asked to assess the reliability of a witness, the quality of the testimony a witness gives, the competency of an accused person, or determine what might have happened during a crime. They also may help support a plea of insanity or to discount a plea. Judges may use the psychologist's report to change the sentence of a convicted person, and parole officers work with psychologists to create a program for the rehabilitation of a parolee. Problematic areas for psychologists include predicting how dangerous a person will be. The predictive accuracy of these assessments is debated; however, there is often a need for this prediction to prevent dangerous people from returning to society.[9] Psychologists may also be called on to assess a variety of things within an education setting. They may be asked to assess strengths and weaknesses of children who are having difficulty in the school systems, assess behavioral difficulties, assess a child's responsiveness to an intervention, or to help create an educational plan for a child. The assessment of children also allows for the psychologists to determine if the child will be willing to use the resources that may be provided.[9] In a psychological clinic setting, psychological assessment can be used to determine characteristics of the client that can be useful for developing a treatment plan. Within this setting, psychologists often are working with clients who may have medical or legal problems or sometimes students who were referred to this setting from their school psychologist.[9] Some psychological assessments have been validated for use when administered via computer or the Internet.[10] However, caution must be applied to these test results, as it is possible to fake in electronically mediated assessment.[11] Many electronic assessments do not truly measure what is claimed, such as the Meyers-Briggs personality test. Although one of the most well known personality assessments, it has been found both invalid and unreliable by many psychological researches, and should be used with caution.[12][13] Within clinical psychology, the "clinical method" is an approach to understanding and treating mental disorders that begins with a particular individual's personal history and is designed around that individual's psychological needs. It is sometimes posed as an alternative approach to the experimental method which focuses on the importance of conducting experiments in learning how to treat mental disorders, and the differential method which sorts patients by class (gender, race, income, age, etc.) and designs treatment plans based around broad social categories.[14][15] Taking a personal history along with clinical examination allow the health practitioners to fully establish a clinical diagnosis. A medical history of a patient provides insights into diagnostic possibilities as well as the patient's experiences with illnesses. The patients will be asked about current illness and the history of it, past medical history and family history, other drugs or dietary supplements being taken, lifestyle, and allergies.[16] The inquiry includes obtaining information about relevant diseases or conditions of other people in their family.[16][17] Self-reporting methods may be used, including questionnaires, structured interviews and rating scales.[18] Personality Assessment Personality traits are an individual's enduring manner of perceiving, feeling, evaluating, reacting, and interacting with other people specifically, and with their environment more generally.[19][20] Because reliable and valid personality inventories give a relatively accurate representation of a person's characteristics, they are beneficial in the clinical setting as supplementary material to standard initial assessment procedures such as a clinical interview; review of collateral information, e.g., reports from family members; and review of psychological and medical treatment records. Main article: Minnesota Multiphasic Personality Inventory MMPI History Developed by Starke R. Hathaway, PhD, and J. C. McKinley, MD, The Minnesota Multiphasic Personality Inventory (MMPI) is a personality inventory used to investigate not only personality, but also psychopathology.[21] The MMPI was developed using an empirical, atheoretical approach. This means that it was not developed using any of the frequently changing theories about psychodynamics at the time. There are two variations of the MMPI administered to adults, the MMPI-2 and the MMPI-2-RF, and two variations administered to teenagers, the MMPI-A and MMPI-A-RF. This inventory's validity has been confirmed by Hiller, Rosenthal, Bornstein, and Berry in their 1999 meta-analysis. Throughout history the MMPI in its various forms has been routinely administered in hospitals, clinical settings, prisons, and military settings.[22][non-primary source needed] MMPI-2 The MMPI-2 consists of 567 true or false questions aimed at measuring the reporting person's psychological wellbeing.[23] The MMPI-2 is commonly used in clinical settings and occupational health settings. There is a revised version of the MMPI-2 called the MMPI-2-RF (MMPI-2 Restructured Form).[24] The MMPI-2-RF is not intended to be a replacement for the MMPI-2, but is used to assess patients using the most current models of psychopathology and personality.[24] MMPI-2 and MMPI-2-RF Scales[25][26] Version Number of Items Number of Scales Scale Categories MMPI-2 567 120 Validity Indicators, Superlative Self-Presentation Subscales, Clinical Scales, Restructured Clinical (RC) Scales, Content Scales, Content Component Scales, Supplementary Scales, Clinical Subscales (Harris-Lingoes and Social Introversion Subscales) MMPI-2-RF 338 51 Validity, Higher-Order (H-O), Restructured Clinical (RC), Somatic, Cognitive, Internalizing, Externalizing, Interpersonal, Interest, Personality Psychopathology Five (PSY-5) MMPI-A The MMPI-A was published in 1992 and consists of 478 true or false questions.[27] This version of the MMPI is similar to the MMPI-2 but used for adolescents (age 14–18) rather than for adults. The restructured form of the MMPI-A, the MMPI-A-RF, was published in 2016 and consists of 241 true or false questions that can understood with a sixth grade reading level.[28][29] Both the MMPI-A and MMPI-A-RF are used to assess adolescents for personality and psychological disorders, as well as to evaluate cognitive processes.[29] MMPI-A and MMPI-A-RF Scales[30][31] Verson Number of Items Number of Scales Scale Categories MMPI-A 478 105 Validity Indicators, Clinical Scales, Clinical Subscales (Harris-Lingoes and Social Introversion Subscales), Content Scales, Content Component Scales, Supplementary Scales MMPI-A-RF 241 48 Validity, Higher-Order (H-O), Restructured Clinical (RC), Somatic/Cognitive, Internalizing, Externalizing, Interpersonal, Personality Psychopathology Five (PSY-5) NEO Personality Inventory The NEO Personality Inventory was developed by Paul Costa Jr. and Robert R. McCrae in 1978. When initially created, it only measured three of the Big Five personality traits: Neuroticism, Openness to Experience, and Extroversion. The inventory was then renamed as the Neuroticism-Extroversion-Openness Inventory (NEO-I). It was not until 1985 that Agreeableness and Conscientiousness were added to the personality assessment. With all Big Five personality traits being assessed, it was then renamed as the NEO Personality Inventory. Research for the NEO-PI continued over the next few years until a revised manual with six facets for each Big Five trait was published in 1992.[20] In the 1990s, now called the NEO PI-R, issues were found with the personality inventory. The developers of the assessment found it to be too difficult for younger people, and another revision was done to create the NEO PI-3.[32] The NEO Personality Inventory is administered in two forms: self-report and observer report. It consists of 240 personality items and a validity item. It can be administered in roughly 35–45 minutes. Every item is answered on a Likert scale, widely known as a scale from Strongly Disagree to Strongly Agree. If more than 40 items are missing or more than 150 responses or less than 50 responses are Strongly Agree/Disagree, the assessment should be viewed with great caution and has the potential to be invalid.[33] In the NEO report, each trait's T score is recorded along with the percentile they rank on compared to all data recorded for the assessment. Then, each trait is broken up into their six facets along with raw score, individual T-scores, and percentile. The next page goes on to list what each score means in words as well as what each facet entails. The exact responses to questions are given in a list as well as the validity response and amount of missing responses.[34] When an individual is given their NEO report, it is important to understand specifically what the facets are and what the corresponding scores mean.

How Does a Psychological Evaluation Help in Understanding Mental Health?

Psychological evaluation is a method to assess an individual's behavior, personality, cognitive abilities, and several other domains.[a][3] A common reason for a psychological evaluation is to identify psychological factors that may be inhibiting a person's ability to think, behave, or regulate emotion functionally or constructively. It is the mental equivalent of physical examination. Other psychological evaluations seek to better understand the individual's unique characteristics or personalit

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A mental disorder, also referred to as a mental illness,[6] a mental health condition,[7] or a psychiatric disability,[2] is a behavioral or mental pattern that causes significant distress or impairment of personal functioning.[8] A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context.[9][10] Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders.[10][11] A mental disorder is one aspect of mental health. The causes of mental disorders are often unclear. Theories incorporate findings from a range of fields. Disorders may be associated with particular regions or functions of the brain. Disorders are usually diagnosed or assessed by a mental health professional, such as a clinical psychologist, psychiatrist, psychiatric nurse, or clinical social worker, using various methods such as psychometric tests, but often relying on observation and questioning. Cultural and religious beliefs, as well as social norms, should be taken into account when making a diagnosis.[12] Services for mental disorders are usually based in psychiatric hospitals, outpatient clinics, or in the community, Treatments are provided by mental health professionals. Common treatment options are psychotherapy or psychiatric medication, while lifestyle changes, social interventions, peer support, and self-help are also options. In a minority of cases, there may be involuntary detention or treatment. Prevention programs have been shown to reduce depression.[10][13] In 2019, common mental disorders around the globe include: depression, which affects about 264 million people; dementia, which affects about 50 million; bipolar disorder, which affects about 45 million; and schizophrenia and other psychoses, which affect about 20 million people.[10] Neurodevelopmental disorders include attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability, of which onset occurs early in the developmental period.[14][10] Stigma and discrimination can add to the suffering and disability associated with mental disorders, leading to various social movements attempting to increase understanding and challenge social exclusion. Definition "Nervous breakdown" redirects here. For other uses, see Nervous breakdown (disambiguation). The definition and classification of mental disorders are key issues for researchers as well as service providers and those who may be diagnosed. For a mental state to be classified as a disorder, it generally needs to cause dysfunction.[15] Most international clinical documents use the term mental "disorder", while "illness" is also common. It has been noted that using the term "mental" (i.e., of the mind) is not necessarily meant to imply separateness from the brain or body. According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published in 1994, a mental disorder is a psychological syndrome or pattern that is associated with distress (e.g., via a painful symptom), disability (impairment in one or more important areas of functioning), increased risk of death, or causes a significant loss of autonomy; however, it excludes normal responses such as the grief from loss of a loved one and also excludes deviant behavior for political, religious, or societal reasons not arising from a dysfunction in the individual.[16] DSM-IV predicates the definition with caveats, stating that, as in the case with many medical terms, mental disorder "lacks a consistent operational definition that covers all situations", noting that different levels of abstraction can be used for medical definitions, including pathology, symptomology, deviance from a normal range, or etiology, and that the same is true for mental disorders, so that sometimes one type of definition is appropriate and sometimes another, depending on the situation.[17] In 2013, the American Psychiatric Association (APA) redefined mental disorders in the DSM-5 as "a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning."[18] The final draft of ICD-11 contains a very similar definition.[19] The terms "mental breakdown" or "nervous breakdown" may be used by the general population to mean a mental disorder.[20] The terms "nervous breakdown" and "mental breakdown" have not been formally defined through a medical diagnostic system such as the DSM-5 or ICD-10 and are nearly absent from scientific literature regarding mental illness.[21][22] Although "nervous breakdown" is not rigorously defined, surveys of laypersons suggest that the term refers to a specific acute time-limited reactive disorder involving symptoms such as anxiety or depression, usually precipitated by external stressors.[21] Many health experts today refer to a nervous breakdown as a mental health crisis.[23] Nervous illness In addition to the concept of mental disorder, some people have argued for a return to the old-fashioned concept of nervous illness. In How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown (2013), Edward Shorter, a professor of psychiatry and the history of medicine, says: About half of them are depressed. Or at least that is the diagnosis that they got when they were put on antidepressants. ... They go to work but they are unhappy and uncomfortable; they are somewhat anxious; they are tired; they have various physical pains—and they tend to obsess about the whole business. There is a term for what they have, and it is a good old-fashioned term that has gone out of use. They have nerves or a nervous illness. It is an illness not just of mind or brain, but a disorder of the entire body. ... We have a package here of five symptoms—mild depression, some anxiety, fatigue, somatic pains, and obsessive thinking. ... We have had nervous illness for centuries. When you are too nervous to function ... it is a nervous breakdown. But that term has vanished from medicine, although not from the way we speak.... The nervous patients of yesteryear are the depressives of today. That is the bad news.... There is a deeper illness that drives depression and the symptoms of mood. We can call this deeper illness something else, or invent a neologism, but we need to get the discussion off depression and onto this deeper disorder in the brain and body. That is the point. — Edward Shorter, Faculty of Medicine, the University of Toronto[24] In eliminating the nervous breakdown, psychiatry has come close to having its own nervous breakdown. — David Healy, MD, FRCPsych, Professor of Psychiatry, University of Cardiff, Wales[25] "Nervous breakdown" is a pseudo-medical term to describe a wealth of stress-related feelings and they are often made worse by the belief that there is a real phenomenon called "nervous breakdown". — Richard E. Vatz, co-author of explication of views of Thomas Szasz in "Thomas Szasz: Primary Values and Major Contentions"[page needed] Nerves stand at the core of common mental illness, no matter how much we try to forget them. — Peter J. Tyrer, FMedSci, Professor of Community Psychiatry, Imperial College, London[26] Classifications Main article: Classification of mental disorders There are currently two widely established systems that classify mental disorders: ICD-11 Chapter 06: Mental, behavioural or neurodevelopmental disorders, part of the International Classification of Diseases produced by the WHO (in effect since 1 January 2022).[27] Diagnostic and Statistical Manual of Mental Disorders (DSM-5) produced by the APA since 1952. Both of these list categories of disorder and provide standardized criteria for diagnosis. They have deliberately converged their codes in recent revisions so that the manuals are often broadly comparable, although significant differences remain. Other classification schemes may be used in non-western cultures, for example, the Chinese Classification of Mental Disorders, and other manuals may be used by those of alternative theoretical persuasions, such as the Psychodynamic Diagnostic Manual. In general, mental disorders are classified separately from neurological disorders, learning disabilities or intellectual disability. Unlike the DSM and ICD, some approaches are not based on identifying distinct categories of disorder using dichotomous symptom profiles intended to separate the abnormal from the normal. There is significant scientific debate about the relative merits of categorical versus such non-categorical (or hybrid) schemes, also known as continuum or dimensional models. A spectrum approach may incorporate elements of both. In the scientific and academic literature on the definition or classification of mental disorder, one extreme argues that it is entirely a matter of value judgements (including of what is normal) while another proposes that it is or could be entirely objective and scientific (including by reference to statistical norms).[28] Common hybrid views argue that the concept of mental disorder is objective even if only a "fuzzy prototype" that can never be precisely defined, or conversely that the concept always involves a mixture of scientific facts and subjective value judgments.[29] Although the diagnostic categories are referred to as 'disorders', they are presented as medical diseases, but are not validated in the same way as most medical diagnoses. Some neurologists argue that classification will only be reliable and valid when based on neurobiological features rather than clinical interview, while others suggest that the differing ideological and practical perspectives need to be better integrated.[30][31] The DSM and ICD approach remains under attack both because of the implied causality model[32] and because some researchers believe it better to aim at underlying brain differences which can precede symptoms by many years.[33] Dimensional models The high degree of comorbidity between disorders in categorical models such as the DSM and ICD have led some to propose dimensional models. Studying comorbidity between disorders have demonstrated two latent (unobserved) factors or dimensions in the structure of mental disorders that are thought to possibly reflect etiological processes. These two dimensions reflect a distinction between internalizing disorders, such as mood or anxiety symptoms, and externalizing disorders such as behavioral or substance use symptoms.[34] A single general factor of psychopathology, similar to the g factor for intelligence, has been empirically supported. The p factor model supports the internalizing-externalizing distinction, but also supports the formation of a third dimension of thought disorders such as schizophrenia.[35] Biological evidence also supports the validity of the internalizing-externalizing structure of mental disorders, with twin and adoption studies supporting heritable factors for externalizing and internalizing disorders.[36][37][38] A leading dimensional model is the Hierarchical Taxonomy of Psychopathology. Disorders See also: List of mental disorders as defined by the DSM and ICD There are many different categories of mental disorder, and many different facets of human behavior and personality that can become disordered.[39][40][41][42] Anxiety disorders Main article: Anxiety disorder An anxiety disorder is anxiety or fear that interferes with normal functioning may be classified as an anxiety disorder.[40] Commonly recognized categories include specific phobias, generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, obsessive–compulsive disorder and post-traumatic stress disorder. Mood disorders Main article: Mood disorder Other affective (emotion/mood) processes can also become disordered. Mood disorder involving unusually intense and sustained sadness, melancholia, or despair is known as major depression (also known as unipolar or clinical depression). Milder, but still prolonged depression, can be diagnosed as dysthymia. Bipolar disorder (also known as manic depression) involves abnormally "high" or pressured mood states, known as mania or hypomania, alternating with normal or depressed moods. The extent to which unipolar and bipolar mood phenomena represent distinct categories of disorder, or mix and merge along a dimension or spectrum of mood, is subject to some scientific debate.[43][44] Psychotic disorders Main article: Psychotic disorder Patterns of belief, language use and perception of reality can become dysregulated (e.g., delusions, thought disorder, hallucinations). Psychotic disorders in this domain include schizophrenia, and delusional disorder. Schizoaffective disorder is a category used for individuals showing aspects of both schizophrenia and affective disorders. Schizotypy is a category used for individuals showing some of the characteristics associated with schizophrenia, but without meeting cutoff criteria. Personality disorders Main article: Personality disorder Personality—the fundamental characteristics of a person that influence thoughts and behaviors across situations and time—may be considered disordered if judged to be abnormally rigid and maladaptive. Although treated separately by some, the commonly used categorical schemes include them as mental disorders, albeit on a separate axis II in the case of the DSM-IV. A number of different personality disorders are listed, including those sometimes classed as eccentric, such as paranoid, schizoid and schizotypal personality disorders; types that have described as dramatic or emotional, such as antisocial, borderline, histrionic or narcissistic personality disorders; and those sometimes classed as fear-related, such as anxious-avoidant, dependent, or obsessive–compulsive personality disorders. Personality disorders, in general, are defined as emerging in childhood, or at least by adolescence or early adulthood. The ICD also has a category for enduring personality change after a catastrophic experience or psychiatric illness. If an inability to sufficiently adjust to life circumstances begins within three months of a particular event or situation, and ends within six months after the stressor stops or is eliminated, it may instead be classed as an adjustment disorder. There is an emerging consensus that personality disorders, similar to personality traits in general, incorporate a mixture of acute dysfunctional behaviors that may resolve in short periods, and maladaptive temperamental traits that are more enduring.[45] Furthermore, there are also non-categorical schemes that rate all individuals via a profile of different dimensions of personality without a symptom-based cutoff from normal personality variation, for example through schemes based on dimensional models.[46][47][non-primary source needed] Neurodevelopmental disorders Main article: Neurodevelopmental disorder Neurodevelopmental disorders is a group of mental disorder that affect the central nervous system, such as the brain and spinal cord.[48] These disorders can appear in early childhood.[49] They can even persist into adulthood.[50] A few of the common ones are attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), intellectual disabilities, motor disorders, and communication disorders among others. Some causes can contribute to these disorders like genetic factors (genetics, family medical history),[51] environmental factors (excessive stress, exposure to neurotoxins, pollution, viral infections, and bacterial infections),[52][53] physical factors (traumatic brain injury, illness),[54] and prenatal factors (birth defects, exposure to drugs during pregnancy, low birth weight).[55] Neurodevelopmental disorders can be managed with behavioral therapy, applied behavior analysis (ABA), educational interventions, specific medications, and other such treatments.[56] Approximately 8 in 10 people with autism suffer from a mental health problem in their lifetime, in comparison to 1 in 4 of the general population that suffers from a mental health problem in their lifetimes.[57][58][59] Eating disorders Main article: Eating disorder An eating disorder is a serious mental health condition that involves an unhealthy relationship with food and body image. They can cause severe physical and psychological problems.[60] Eating disorders involve disproportionate concern in matters of food and weight.[40] Categories of disorder in this area include anorexia nervosa, bulimia nervosa, exercise bulimia or binge eating disorder.[61][62] Sleep disorders Main article: Sleep disorder Sleep disorders are associated with disruption to normal sleep patterns. A common sleep disorder is insomnia, which is described as difficulty falling and/or staying asleep. Other sleep disorders include narcolepsy, sleep apnea, REM sleep behavior disorder, chronic sleep deprivation, and restless leg syndrome. Narcolepsy is a condition of extreme tendencies to fall asleep whenever and wherever. People with narcolepsy feel refreshed after their random sleep, but eventually get sleepy again. Narcolepsy diagnosis requires an overnight stay at a sleep center for analysis, during which doctors ask for a detailed sleep history and sleep records. Doctors also use actigraphs and polysomnography.[63] Doctors will do a multiple sleep latency test, which measures how long it takes a person to fall asleep.[63] Sleep apnea, when breathing repeatedly stops and starts during sleep, can be a serious sleep disorder. Three types of sleep apnea include obstructive sleep apnea, central sleep apnea, and complex sleep apnea.[64] Sleep apnea can be diagnosed at home or with polysomnography at a sleep center. An ear, nose, and throat doctor may further help with the sleeping habits. Sexuality related Sexual disorders include dyspareunia and various kinds of paraphilia (sexual arousal to objects, situations, or individuals that are considered abnormal or harmful to the person or others). Sexual dysfunction is common among psychiatric patients, yet the specific impact of psychopathology independent of factors like psychotropic substances or somatic symptom disorders, remains unclear. A systematic review explored the prevalence of sexual dysfunction in psychiatric patients free from psychotropic medications and somatic diseases.[65] The review included 24 studies with 1,199 participants and identified high rates of sexual dysfunction across various psychiatric disorders. Reported prevalence ranged from 45%-93% for depressive disorders, 33%-75% for anxiety disorders, 25%-81% for obsessive–compulsive disorder (OCD), and 25% for schizophrenia. Sexual desire was frequently impaired in depressive disorders, PTSD, and schizophrenia, while OCD and anxiety disorders were associated with difficulties during the orgasm phase. The findings emphasize the importance of addressing sexual health in psychiatric care through psychoeducation, sexual history assessments, and targeted interventions. This highlights the significant impact of psychopathology on sexual functioning.[65] Other Impulse control disorders: People who are abnormally unable to resist certain urges or impulses that could be harmful to themselves or others, may be classified as having an impulse control disorder, and disorders such as kleptomania (stealing) or pyromania (fire-setting). Various behavioral addictions, such as gambling addiction, may be classed as a disorder. Obsessive–compulsive disorder can sometimes involve an inability to resist certain acts but is classed separately as being primarily an anxiety disorder. Substance use disorders: This disorder refers to the use of drugs (legal or illegal, including alcohol) that persists despite significant problems or harm related to its use. Substance dependence and substance abuse fall under this umbrella category in the DSM. Substance use disorder may be due to a pattern of compulsive and repetitive use of a drug that results in tolerance to its effects and withdrawal symptoms when use is reduced or stopped. Dissociative disorders: People with severe disturbances of their self-identity, memory, and general awareness of themselves and their surroundings may be classified as having these types of disorders, including depersonalization derealization disorder or dissociative identity disorder (which was previously referred to as multiple personality disorder or "split personality"). Cognitive disorders: These affect cognitive abilities, including learning and memory. This category includes delirium and mild and major neurocognitive disorder (previously termed dementia). Somatoform disorders may be diagnosed when there are problems that appear to originate in the body that are thought to be manifestations of a mental disorder. This includes somatization disorder and conversion disorder. There are also disorders of how a person perceives their body, such as body dysmorphic disorder. Neurasthenia is an old diagnosis involving somatic complaints as well as fatigue and low spirits/depression, which is officially recognized by the ICD-10 but no longer by the DSM-IV.[66][non-primary source needed] Factitious disorders are diagnosed where symptoms are thought to be reported for personal gain. Symptoms are often deliberately produced or feigned, and may relate to either symptoms in the individual or in someone close to them, particularly people they care for. There are attempts to introduce a category of relational disorder, where the diagnosis is of a relationship rather than on any one individual in that relationship. The relationship may be between children and their parents, between couples, or others. There already exists, under the category of psychosis, a diagnosis of shared psychotic disorder where two or more individuals share a particular delusion because of their close relationship with each other. There are a number of uncommon psychiatric syndromes, which are often named after the person who first described them, such as Capgras syndrome, De Clerambault syndrome, Othello syndrome, Ganser syndrome, Cotard delusion, and Ekbom syndrome, and additional disorders such as the Couvade syndrome and Geschwind syndrome.[67] Signs and symptoms Course The onset of psychiatric disorders usually occurs from childhood to early adulthood.[68] Impulse-control disorders and a few anxiety disorders tend to appear in childhood. Some other anxiety disorders, substance disorders, and mood disorders emerge later in the mid-teens.[69] Symptoms of schizophrenia typically manifest from late adolescence to early twenties.[70] The likely course and outcome of mental disorders vary and are dependent on numerous factors related to the disorder itself, the individual as a whole, and the social environment. Some disorders may last a brief period of time, while others may be long-term in nature. All disorders can have a varied course. Long-term international studies of schizophrenia have found that over a half of individuals recover in terms of symptoms, and around a fifth to a third in terms of symptoms and functioning, with many requiring no medication. While some have serious difficulties and support needs for many years, "late" recovery is still plausible. The World Health Organization (WHO) concluded that the long-term studies' findings converged with others in "relieving patients, carers and clinicians of the chronicity paradigm which dominated thinking throughout much of the 20th century."[71][non-primary source needed][72] A follow-up study by Tohen and coworkers revealed that around half of people initially diagnosed with bipolar disorder achieve symptomatic recovery (no longer meeting criteria for the diagnosis) within six weeks, and nearly all achieve it within two years, with nearly half regaining their prior occupational and residential status in that period. Less than half go on to experience a new episode of mania or major depression within the next two years.[73][non-primary source needed] Disability Disorder Disability-adjusted life years[74] Major depressive disorder 65.5 million Alcohol-use disorder 23.7 million Schizophrenia 16.8 million Bipolar disorder 14.4 million Other drug-use disorders 8.4 million Panic disorder 7.0 million Obsessive–compulsive disorder 5.1 million Primary insomnia 3.6 million Post-traumatic stress disorder 3.5 million Some disorders may be very limited in their functional effects, while others may involve substantial disability and support needs. In this context, the terms psychiatric disability and psychological disability are sometimes used instead of mental disorder.[2][3] The degree of ability or disability may vary over time and across different life domains. Furthermore, psychiatric disability has been linked to institutionalization, discrimination and social exclusion as well as to the inherent effects of disorders. Alternatively, functioning may be affected by the stress of having to hide a condition in work or school, etc., by adverse effects of medications or other substances, or by mismatches between illness-related variations and demands for regularity.[75] It is also the case that, while often being characterized in purely negative terms, some mental traits or states labeled as psychiatric disabilities can also involve above-average creativity, non-conformity, goal-striving, meticulousness, or empathy.[76] In addition, the public perception of the level of disability associated with mental disorders can change.[77] Nevertheless, internationally, people report equal or greater disability from commonly occurring mental conditions than from commonly occurring physical conditions, particularly in their social roles and personal relationships. The proportion with access to professional help for mental disorders is far lower, however, even among those assessed as having a severe psychiatric disability.[78] Disability in this context may or may not involve such things as: Basic activities of daily living. Including looking after the self (health care, grooming, dressing, shopping, cooking etc.) or looking after accommodation (chores, DIY tasks, etc.) Interpersonal relationships. Including communication skills, ability to form relationships and sustain them, ability to leave the home or mix in crowds or particular settings Occupational functioning. Ability to acquire an employment and hold it, cognitive and social skills required for the job, dealing with workplace culture, or studying as a student. In terms of total disability-adjusted life years (DALYs), which is an estimate of how many years of life are lost due to premature death or to being in a state of poor health and disability, psychiatric disabilities rank amongst the most disabling conditions. Unipolar (also known as Major) depressive disorder is the third leading cause of disability worldwide, of any condition mental or physical, accounting for 65.5 million years lost. The first systematic description of global disability arising in youth, in 2011, found that among 10- to 24-year-olds nearly half of all disability (current and as estimated to continue) was due to psychiatric disabilities, including substance use disorders and conditions involving self-harm. Second to this were accidental injuries (mainly traffic collisions) accounting for 12 percent of disability, followed by communicable diseases at 10 percent. The psychiatric disabilities associated with most disabilities in high-income countries were unipolar major depression (20%) and alcohol use disorder (11%). In the eastern Mediterranean region, it was unipolar major depression (12%) and schizophrenia (7%), and in Africa it was unipolar major depression (7%) and bipolar disorder (5%).[79] Suicide, which is often attributed to some underlying mental disorder, is a leading cause of death among teenagers and adults under 35.[80][81] There are an estimated 10 to 20 million non-fatal attempted suicides every year worldwide.[82] Risk factors Main article: Causes of mental disorders The predominant view as of 2018 is that genetic, psychological, and environmental factors all contribute to the development or progression of mental disorders.[83] Different risk factors may be present at different ages, with risk occurring as early as during prenatal period.[84] Genetics Main article: Psychiatric genetics A number of psychiatric disorders are linked to a family history (including depression, narcissistic personality disorder[85][86] and anxiety).[87] Twin studies have also revealed a very high heritability for many mental disorders (especially autism and schizophrenia).[88] Although researchers have been looking for decades for clear linkages between genetics and mental disorders, that work has not yielded specific genetic biomarkers yet that might lead to better diagnosis and better treatments.[89] Statistical research looking at eleven disorders found widespread assortative mating between people with mental illness. That means that individuals with one of these disorders were two to three times more likely than the general population to have a partner with a mental disorder. Sometimes people seemed to have preferred partners with the same mental illness. Thus, people with schizophrenia or ADHD are seven times more likely to have affected partners with the same disorder. This is even more pronounced for people with Autism spectrum disorders who are 10 times more likely to have a spouse with the same disorder.[90] Environment Main article: Brain health and pollution The prevalence of mental illness is higher in more economically unequal countries. During the prenatal stage, factors like unwanted pregnancy, lack of adaptation to pregnancy or substance use during pregnancy increases the risk of developing a mental disorder.[84] Maternal stress and birth complications including prematurity and infections have also been implicated in increasing susceptibility for mental illness.[91] Infants neglected or not provided optimal nutrition have a higher risk of developing cognitive impairment.[84] Social influences have also been found to be important,[92] including abuse, neglect, bullying, social stress, traumatic events, and other negative or overwhelming life experiences. Aspects of the wider community have also been implicated,[93] including employment problems, socioeconomic inequality, lack of social cohesion, problems linked to migration, and features of particular societies and cultures. The specific risks and pathways to particular disorders are less clear, however. Nutrition also plays a role in mental disorders.[10][94] In schizophrenia and psychosis, risk factors include migration and discrimination, childhood trauma, bereavement or separation in families, recreational use of drugs,[95] and urbanicity.[93] In anxiety, risk factors may include parenting factors including parental rejection, lack of parental warmth, high hostility, harsh discipline, high maternal negative affect, anxious childrearing, modelling of dysfunctional and drug-abusing behavior, and child abuse (emotional, physical and sexual).[96] Adults with imbalance work to life are at higher risk for developing anxiety.[84] For bipolar disorder, stress (such as childhood adversity) is not a specific cause, but does place genetically and biologically vulnerable individuals at risk for a more severe course of illness.[97] Drug use Mental disorders are associated with drug use including: cannabis,[98] alcohol[99] and caffeine,[100] use of which appears to promote anxiety.[101] For psychosis and schizophrenia, usage of a number of drugs has been associated with development of the disorder, including cannabis, cocaine, and amphetamines.[102][98] There has been debate regarding the relationship between usage of cannabis and bipolar disorder.[103] Cannabis has also been associated with depression.[98] Adolescents are at increased risk for tobacco, alcohol and drug use; Peer pressure is the main reason why adolescents start using substances. At this age, the use of substances could be detrimental to the development of the brain and place them at higher risk of developing a mental disorder.[84] Chronic disease People living with chronic conditions like HIV and diabetes are at higher risk of developing a mental disorder. People living with diabetes experience significant stress from the biological impact of the disease, which places them at risk for developing anxiety and depression. Diabetic patients also have to deal with emotional stress trying to manage the disease. Conditions like heart disease, stroke, respiratory conditions, cancer, and arthritis increase the risk of developing a mental disorder when compared to the general population.[104] Personality traits Risk factors for mental illness include a propensity for high neuroticism[105][106] or "emotional instability". In anxiety, risk factors may include temperament and attitudes (e.g. pessimism).[87] Key personality traits, including Neuroticism, Extraversion, Agreeableness, Conscientiousness, and Openness, significantly influence various dimensions of mental health, as measured by the General Health Questionnaire(GHQ-12). The GHQ-12 assesses mental health across three dimensions: GHQ-12A (social dysfunction & anhedonia), GHQ-12B (depression & anxiety), and GHQ-12C (loss of confidence).[107] Neuroticism was found to be strongly linked to all three dimensions, indicating greater vulnerability to mental health issues, while Extraversion was negatively associated with social dysfunction and depression, suggesting better mental health outcomes.Agreeableness and Conscientiousness were both negatively related to social dysfunction and loss of confidence, highlighting their protective roles. Openness showed a negative relationship with depression and anxiety. These findings support several models of personality's impact on mental health, including the predisposition/vulnerability, complication/scar, and pathoplasty/exacerbation models.[108] This underscores the importance of considering personality traits in mental health assessments and interventions, as they help identify individuals at higher risk for mental health challenges and guide targeted psychological care. Causal models Mental disorders can arise from multiple sources, and in many cases there is no single accepted or consistent cause currently established. An eclectic or pluralistic mix of models may be used to explain particular disorders.[106][109] The primary paradigm of contemporary mainstream Western psychiatry is said to be the biopsychosocial model which incorporates biological, psychological and social factors, although this may not always be applied in practice. Biological psychiatry follows a biomedical model where many mental disorders are conceptualized as disorders of brain circuits likely caused by developmental processes shaped by a complex interplay of genetics and experience. A common assumption is that disorders may have resulted from genetic and developmental vulnerabilities, exposed by stress in life (for example in a diathesis–stress model), although there are various views on what causes differences between individuals. Some types of mental disorders may be viewed as primarily neurodevelopmental disorders.[citation needed] Evolutionary psychology may be used as an overall explanatory theory, while attachment theory is another kind of evolutionary-psychological approach sometimes applied in the context of mental disorders. Psychoanalytic theories have continued to evolve alongside and cognitive-behavioral and systemic-family approaches. A distinction is sometimes made between a "medical model" or a "social model" of psychiatric disability.[citation needed] Diagnosis Psychiatrists seek to provide a medical diagnosis of individuals by an assessment of symptoms, signs and impairment associated with particular types of mental disorder. Other mental health professionals, such as clinical psychologists, may or may not apply the same diagnostic categories to their clinical formulation of a client's difficulties and circumstances.[110] The majority of mental health problems are, at least initially, assessed and treated by family physicians (in the UK general practitioners) during consultations, who may refer a patient on for more specialist diagnosis in acute or chronic cases. Routine diagnostic practice in mental health services typically involves an interview known as a mental status examination, where evaluations are made of appearance and behavior, self-reported symptoms, mental health history, and current life circumstances. The views of other professionals, relatives, or other third parties may be taken into account. A physical examination to check for ill health or the effects of medications or other drugs may be conducted. Psychological testing is sometimes used via paper-and-pen or computerized questionnaires, which may include algorithms based on ticking off standardized diagnostic criteria, and in rare specialist cases neuroimaging tests may be requested, but such methods are more commonly found in research studies than routine clinical practice.[111][112] Time and budgetary constraints often limit practicing psychiatrists from conducting more thorough diagnostic evaluations.[113] It has been found that most clinicians evaluate patients using an unstructured, open-ended approach, with limited training in evidence-based assessment methods, and that inaccurate diagnosis may be common in routine practice.[114] In addition, comorbidity is very common in psychiatric diagnosis, where the same person meets the criteria for more than one disorder. On the other hand, a person may have several different difficulties only some of which meet the criteria for being diagnosed. There may be specific problems with accurate diagnosis in developing countries. More structured approaches are being increasingly used to measure levels of mental illness. HoNOS is the most widely used measure in English mental health services, being used by at least 61 trusts.[115] In HoNOS a score of 0–4 is given for each of 12 factors, based on functional living capacity.[116] Research has been supportive of HoNOS,[117] although some questions have been asked about whether it provides adequate coverage of the range and complexity of mental illness problems, and whether the fact that often only 3 of the 12 scales vary over time gives enough subtlety to accurately measure outcomes of treatment.[118] Criticism This section relies excessively on references to primary sources. Please improve this section by adding secondary or tertiary sources. Find sources: "criticism" psychiatric diagnosis – news · newspapers · books · scholar · JSTOR (July 2021) (Learn how and when to remove this message) Since the 1980s, Paula Caplan has been concerned about the subjectivity of psychiatric diagnosis, and people being arbitrarily "slapped with a psychiatric label." Caplan says because psychiatric diagnosis is unregulated, doctors are not required to spend much time interviewing patients or to seek a second opinion. The Diagnostic and Statistical Manual of Mental Disorders can lead a psychiatrist to focus on narrow checklists of symptoms, with little consideration of what is actually causing the person's problems. So, according to Caplan, getting a psychiatric diagnosis and label often stands in the way of recovery.[119] In 2013, psychiatrist Allen Frances wrote a paper entitled "The New Crisis of Confidence in Psychiatric Diagnosis", which said that "psychiatric diagnosis... still relies exclusively on fallible subjective judgments rather than objective biological tests." Frances was also concerned about "unpredictable overdiagnosis".[120] For many years, marginalized psychiatrists (such as Peter Breggin, Thomas Szasz) and outside critics (such as Stuart A. Kirk) have "been accusing psychiatry of engaging in the systematic medicalization of normality." More recently these concerns have come from insiders who have worked for and promoted the American Psychiatric Association (e.g., Robert Spitzer, Allen Frances).[121] A 2002 editorial in the British Medical Journal warned of inappropriate medicalization leading to disease mongering, where the boundaries of the definition of illnesses are expanded to include personal problems as medical problems or risks of diseases are emphasized to broaden the market for medications.[122] Gary Greenberg, a psychoanalyst, in his book "the Book of Woe", argues that mental illness is really about suffering and how the DSM creates diagnostic labels to categorize people's suffering.[123] Indeed, the psychiatrist Thomas Szasz, in his book "the Medicalization of Everyday Life", also argues that what is psychiatric illness, is not always biological in nature (i.e. social problems, poverty, etc.), and may even be a part of the human condition.[124] Potential routine use of MRI/fMRI in diagnosis in 2018 the American Psychological Association commissioned a review to reach a consensus on whether modern clinical MRI/fMRI will be able to be used in the diagnosis of mental health disorders. The criteria presented by the APA stated that the biomarkers used in diagnosis should: "have a sensitivity of at least 80% for detecting a particular psychiatric disorder" should "have a specificity of at least 80% for distinguishing this disorder from other psychiatric or medical disorders" "should be reliable, reproducible, and ideally be noninvasive, simple to perform, and inexpensive" proposed biomarkers should be verified by 2 independent studies each by a different investigator and different population samples and published in a peer-reviewed journal. The review concluded that although neuroimaging diagnosis may technically be feasible, very large studies are needed to evaluate specific biomarkers which were not available.[125] Prevention Main article: Prevention of mental disorders The 2004 WHO report "Prevention of Mental Disorders" stated that "Prevention of these disorders is obviously one of the most effective ways to reduce the [disease] burden."[126] The 2011 European Psychiatric Association (EPA) guidance on prevention of mental disorders states "There is considerable evidence that various psychiatric conditions can be prevented through the implementation of effective evidence-based interventions."[127] A 2011 UK Department of Health report on the economic case for mental health promotion and mental illness prevention found that "many interventions are outstandingly good value for money, low in cost and often become self-financing over time, saving public expenditure".[128] In 2016, the National Institute of Mental Health re-affirmed prevention as a research priority area.[129] Parenting may affect the child's mental health, and evidence suggests that helping parents to be more effective with their children can address mental health needs.[130][131][132] Universal prevention (aimed at a population that has no increased risk for developing a mental disorder, such as school programs or mass media campaigns) need very high numbers of people to show effect (sometimes known as the "power" problem). Approaches to overcome this are (1) focus on high-incidence groups (e.g. by targeting groups with high risk factors), (2) use multiple interventions to achieve greater, and thus more statistically valid, effects, (3) use cumulative meta-analyses of many trials, and (4) run very large trials.[133][134] Management Main articles: Treatment of mental disorders, Services for mental disorders, and Mental health professional The "Haus Tornow am See" (former manor house) in Germany from 1912 is today separated into a special education school and a hotel with integrated work/job- and rehabilitation-training for people with mental disorders. Treatment and support for mental disorders are provided in psychiatric hospitals, clinics or a range of community mental health services. In some countries services are increasingly based on a recovery approach, intended to support individual's personal journey to gain the kind of life they want. There is a range of different types of treatment and what is most suitable depends on the disorder and the individual. Many things have been found to help at least some people, and a placebo effect may play a role in any intervention or medication. In a minority of cases, individuals may be treated against their will, which can cause particular difficulties depending on how it is carried out and perceived. Compulsory treatment while in the community versus non-compulsory treatment does not appear to make much of a difference except by maybe decreasing victimization.[135] Lifestyle Lifestyle strategies, including dietary changes, exercise and quitting smoking may be of benefit.[13][94][136] Dietary patterns can influence the risk and management of mental disorders. Observational studies have shown that nutrient-dense, whole-food diets - such as the Mediterranean diet, which is rich in fruits, vegetables, whole grains, legumes, nuts, fish, and healthy fats like olive oil - are associated with a lower risk of depression and anxiety. In contrast, Western diets high in ultra-processed foods, refined sugars, and saturated fats are linked to a greater incidence of mental health disorders, potentially due to their impact on neuroinflammation, oxidative stress, gut microbiota, and neuroplasticity.[137] Therapy There is also a wide range of psychotherapists (including family therapy), counselors, and public health professionals. In addition, there are peer support roles where personal experience of similar issues is the primary source of expertise.[138][139][140][141] A major option for many mental disorders is psychotherapy. There are several main types. Cognitive behavioral therapy (CBT) is widely used and is based on modifying the patterns of thought and behavior associated with a particular disorder. Other psychotherapies include dialectic behavioral therapy (DBT) and interpersonal psychotherapy (IPT). Psychoanalysis, addressing underlying psychic conflicts and defenses, has been a dominant school of psychotherapy and is still in use. Systemic therapy or family therapy is sometimes used, addressing a network of significant others as well as an individual. Some psychotherapies are based on a humanistic approach. There are many specific therapies used for particular disorders, which may be offshoots or hybrids of the above types. Mental health professionals often employ an eclectic or integrative approach. Much may depend on the therapeutic relationship, and there may be problems with trust, confidentiality and engagement. Medication A major option for many mental disorders is psychiatric medication and there are several main groups. Antidepressants are used for the treatment of clinical depression, as well as often for anxiety and a range of other disorders. Anxiolytics (including sedatives) are used for anxiety disorders and related problems such as insomnia. Mood stabilizers are used primarily in bipolar disorder. Antipsychotics are used for psychotic disorders, notably for positive symptoms in schizophrenia, and also increasingly for a range of other disorders. Stimulants are commonly used, notably for ADHD.[142] Other Electroconvulsive therapy (ECT) is sometimes used in severe cases when other interventions for severe intractable depression have failed. ECT is usually indicated for treatment resistant depression, severe vegetative symptoms, psychotic depression, intense suicidal ideation, depression during pregnancy, and catatonia. Psychosurgery is considered experimental but is advocated by some neurologists in certain rare cases.[143][144] Counseling (professional) and co-counseling (between peers) may be used. Psychoeducation programs may provide people with the information to understand and manage their problems. Creative therapies are sometimes used, including music therapy, art therapy or drama therapy. Lifestyle adjustments and supportive measures are often used, including peer support, self-help groups for mental health and supported housing or supported employment (including social firms). Some advocate dietary supplements.[145] Reasonable accommodations (adjustments and supports) might be put in place to help an individual cope and succeed in environments despite potential disability related to mental health problems. This could include an emotional support animal or specifically trained psychiatric service dog. As of 2019 cannabis is specifically not recommended as a treatment.[146] Epidemiology Main article: Prevalence of mental disorders Deaths from mental and behavioral disorders per million persons in 2012 0–6 7–9 10–15 16–24 25–31 32–39 40–53 54–70 71–99 100–356 Disability-adjusted life year for neuropsychiatric conditions per 100,000 inhabitants in 2004 <2,200 2,200–2,400 2,400–2,600 2,600–2,800 2,800–3,000 3,000–3,200 3,200–3,400 3,400–3,600 3,600–3,800 3,800–4,000 4,000–4,200 >4,200 Mental disorders are common. Worldwide, more than one in three people in most countries report sufficient criteria for at least one at some point in their life.[147] In the United States, 46% qualify for a mental illness at some point.[148] An ongoing survey indicates that anxiety disorders are the most common in all but one country, followed by mood disorders in all but two countries, while substance disorders and impulse-control disorders were consistently less prevalent.[149] Rates varied by region.[150] A review of anxiety disorder surveys in different countries found average lifetime prevalence estimates of 16.6%, with women having higher rates on average.[151] A review of mood disorder surveys in different countries found lifetime rates of 6.7% for major depressive disorder (higher in some studies, and in women) and 0.8% for Bipolar I disorder.[152] In the United States the frequency of disorder is: anxiety disorder (28.8%), mood disorder (20.8%), impulse-control disorder (24.8%) or substance use disorder (14.6%).[148][153][154] A 2004 cross-Europe study found that approximately one in four people reported meeting criteria at some point in their life for at least one of the DSM-IV disorders assessed, which included mood disorders (13.9%), anxiety disorders (13.6%), or alcohol disorder (5.2%). Approximately one in ten met the criteria within a 12-month period. Women and younger people of either gender showed more cases of the disorder.[155] A 2005 review of surveys in 16 European countries found that 27% of adult Europeans are affected by at least one mental disorder in a 12-month period.[156] An international review of studies on the prevalence of schizophrenia found an average (median) figure of 0.4% for lifetime prevalence; it was consistently lower in poorer countries.[157] Studies of the prevalence of personality disorders (PDs) have been fewer and smaller-scale, but one broad Norwegian survey found a five-year prevalence of almost 1 in 7 (13.4%). Rates for specific disorders ranged from 0.8% to 2.8%, differing across countries, and by gender, educational level and other factors.[158] A US survey that incidentally screened for personality disorder found a rate of 14.79%.[159] Approximately 7% of a preschool pediatric sample were given a psychiatric diagnosis in one clinical study, and approximately 10% of 1- and 2-year-olds receiving developmental screening have been assessed as having significant emotional/behavioral problems based on parent and pediatrician reports.[160] While rates of psychological disorders are often the same for men and women, women tend to have a higher rate of depression. Each year 73 million women are affected by major depression, and suicide is ranked 7th as the cause of death for women between the ages of 20–59. Depressive disorders account for close to 41.9% of the psychiatric disabilities among women compared to 29.3% among men.[161] History Main article: History of mental disorders Ancient civilizations Ancient civilizations described and treated a number of mental disorders. Mental illnesses were well known in ancient Mesopotamia,[162] where diseases and mental disorders were believed to be caused by specific deities.[163] Because hands symbolized control over a person, mental illnesses were known as "hands" of certain deities.[163] One psychological illness was known as Qāt Ištar, meaning "Hand of Ishtar".[163] Others were known as "Hand of Shamash", "Hand of the Ghost", and "Hand of the God".[163] Descriptions of these illnesses, however, are so vague that it is usually impossible to determine which illnesses they correspond to in modern terminology.[163] Mesopotamian doctors kept detailed record of their patients' hallucinations and assigned spiritual meanings to them.[162] The royal family of Elam was notorious for its members often being insane.[162] The Greeks coined terms for melancholy, hysteria and phobia and developed the humorism theory. Mental disorders were described, and treatments developed, in Persia, Arabia and in the medieval Islamic world. Europe Middle Ages Conceptions of madness in the Middle Ages in Christian Europe were a mixture of the divine, diabolical, magical and humoral, and transcendental.[164] In the early modern period, some people with mental disorders may have been victims of the witch-hunts. While not every witch and sorcerer accused were mentally ill, all mentally ill were considered to be witches or sorcerers.[165] Many terms for mental disorders that found their way into everyday use first became popular in the 16th and 17th centuries. Eighteenth century Eight patients representing mental diagnoses as of the 19th century at the Salpêtrière, Paris By the end of the 17th century and into the Enlightenment, madness was increasingly seen as an organic physical phenomenon with no connection to the soul or moral responsibility. Asylum care was often harsh and treated people like wild animals, but towards the end of the 18th century a moral treatment movement gradually developed. Clear descriptions of some syndromes may be rare before the 19th century.[citation needed] Nineteenth century Industrialization and population growth led to a massive expansion of the number and size of insane asylums in every Western country in the 19th century. Numerous different classification schemes and diagnostic terms were developed by different authorities, and the term psychiatry was coined (1808), though medical superintendents were still known as alienists.[citation needed] Twentieth century A patient in a strait-jacket and barrel contraption, 1908 The turn of the 20th century saw the development of psychoanalysis, which would later come to the fore, along with Kraepelin's classification scheme. Asylum "inmates" were increasingly referred to as "patients", and asylums were renamed as hospitals. Europe and the United States Insulin shock procedure, 1950s Early in the 20th century in the United States, a mental hygiene movement developed, aiming to prevent mental disorders. Clinical psychology and social work developed as professions. World War I saw a massive increase of conditions that came to be termed "shell shock". World War II saw the development in the U.S. of a new psychiatric manual for categorizing mental disorders, which along with existing systems for collecting census and hospital statistics led to the first Diagnostic and Statistical Manual of Mental Disorders. The International Classification of Diseases (ICD) also developed a section on mental disorders. The term stress, having emerged from endocrinology work in the 1930s, was increasingly applied to mental disorders. Electroconvulsive therapy, insulin shock therapy, lobotomies and the neuroleptic chlorpromazine came to be used by mid-century.[166] In the 1960s there were many challenges to the concept of mental illness itself. These challenges came from psychiatrists like Thomas Szasz who argued that mental illness was a myth used to disguise moral conflicts; from sociologists such as Erving Goffman who said that mental illness was merely another example of how society labels and controls non-conformists; from behavioral psychologists who challenged psychiatry's fundamental reliance on unobservable phenomena; and from gay rights activists who criticised the APA's listing of homosexuality as a mental disorder. A study published in Science by Rosenhan received much publicity and was viewed as an attack on the efficacy of psychiatric diagnosis.[167] Deinstitutionalization gradually occurred in the West, with isolated psychiatric hospitals being closed down in favor of community mental health services. A consumer/survivor movement gained momentum. Other kinds of psychiatric medication gradually came into use, such as "psychic energizers" (later antidepressants) and lithium. Benzodiazepines gained widespread use in the 1970s for anxiety and depression, until dependency problems curtailed their popularity. Advances in neuroscience, genetics, and psychology led to new research agendas. Cognitive behavioral therapy and other psychotherapies developed. The DSM and then ICD adopted new criteria-based classifications, and the number of "official" diagnoses saw a large expansion. Through the 1990s, new SSRI-type antidepressants became some of the most widely prescribed drugs in the world, as later did antipsychotics. Also during the 1990s, a recovery approach developed. Africa and Nigeria Most Africans view mental disturbances as external spiritual attack on the person. Those who have a mental illness are thought to be under a spell or bewitched. Often than usual, People view a mentally ill person as possessed of an evil spirit and is seen as more of sociological perspective than a psychological order.[168] The WHO estimated that fewer than 10% of mentally ill Nigerians have access to a psychiatrist or health worker, because there is a low ratio of mental-health specialists available in a country of 200 million people. WHO estimates that the number of mentally ill Nigerians ranges from 40 million to 60 million. Disorders such as depression, anxiety, schizophrenia, personality disorder, old age-related disorder, and substance-abuse disorder are common in Nigeria, as in other countries in Africa.[169] Nigeria is still nowhere near being equipped to solve prevailing mental health challenges. With little scientific research carried out, coupled with insufficient mental-health hospitals in the country, traditional healers provide specialized psychotherapy care to those that require their services and pharmacotherapy[170][171] China The history of mental illness management in China dates back to the Tang Dynasty (618-907 AD), when the Bei Tian Fang, a charity facility run by monks, provided care for homeless widows, orphans, and individuals with mental illness. This early approach laid the foundation for structured mental health care. The first Western-style psychiatric hospital was established in 1898 by American missionary John Kerr in what is now the Guangzhou Brain Hospital. However, psychiatric hospital development was slow over the next 50 years, with only a handful of facilities emerging in major cities. By mid-20th century, China had approximately 100 psychiatrists and 1,000 psychiatric beds.[172] Following the establishment of the People's Republic of China in 1949, psychiatric hospitals were introduced in every province, primarily aimed at maintaining social stability. The first National Mental Health Meeting in 1958 initiated community mental health programs in key regions like Beijing, Shanghai, Hunan, Sichuan, and Jiangsu. These programs focused on professional training, early intervention, and relapse prevention. However, during the Cultural Revolution (1966-1976), most community mental health initiatives ceased, although localized rehabilitation centers and community care networks persisted in places like Shanghai and Beijing. Society and culture Different societies or cultures, even different individuals in a subculture, can disagree as to what constitutes optimal versus pathological biological and psychological functioning. Research has demonstrated that cultures vary in the relative importance placed on, for example, happiness, autonomy, or social relationships for pleasure. Likewise, the fact that a behavior pattern is valued, accepted, encouraged, or even statistically normative in a culture does not necessarily mean that it is conducive to optimal psychological functioning. People in all cultures find some behaviors bizarre or even incomprehensible. But just what they feel is bizarre or incomprehensible is ambiguous and subjective.[173] These differences in determination can become highly contentious. The process by which conditions and difficulties come to be defined and treated as medical conditions and problems, and thus come under the authority of doctors and other health professionals, is known as medicalization or pathologization. Mental illness in the Latin American community There is a perception in Latin American communities, especially among older people, that discussing problems with mental health can create embarrassment and shame for the family. This results in fewer people seeking treatment.[174] Latin Americans from the US are slightly more likely to have a mental health disorder than first-generation Latin American immigrants, although differences between ethnic groups were found to disappear after adjustment for place of birth.[175] From 2015 to 2018, rates of serious mental illness in young adult Latin Americans increased by 60%, from 4% to 6.4%. The prevalence of major depressive episodes in young and adult Latin Americans increased from 8.4% to 11.3%. More than a third of Latin Americans reported more than one bad mental health day in the last three months.[176] The rate of suicide among Latin Americans was about half the rate of non-Latin American white Americans in 2018, and this was the second-leading cause of death among Latin Americans ages 15 to 34.[177] However, Latin American suicide rates rose steadily after 2020 in relation to the COVID-19 pandemic, even as the national rate declined.[178][179] Family relations are an integral part of the Latin American community. Some research has shown that Latin Americans are more likely rely on family bonds, or familismo, as a source of therapy while struggling with mental health issues. Because Latin Americans have a high rate of religiosity, and because there is less stigma associated with religion than with psychiatric services,[180] religion may play a more important therapeutic role for the mentally ill in Latin American communities. However, research has also suggested that religion may also play a role in stigmatizing mental illness in Latin American communities, which can discourage community members from seeking professional help.[181] Religion See also: Psychology of religion Religious, spiritual, or transpersonal experiences and beliefs meet many criteria of delusional or psychotic disorders.[182][183] A belief or experience can sometimes be shown to produce distress or disability—the ordinary standard for judging mental disorders.[184] There is a link between religion and schizophrenia,[185] a complex mental disorder characterized by a difficulty in recognizing reality, regulating emotional responses, and thinking in a clear and logical manner. Those with schizophrenia commonly report some type of religious delusion,[185][186][187] and religion itself may be a trigger for schizophrenia.[188] Movements Giorgio Antonucci Thomas Szasz Controversy has often surrounded psychiatry, and the term anti-psychiatry was coined by the psychiatrist David Cooper in 1967. The anti-psychiatry message is that psychiatric treatments are ultimately more damaging than helpful to patients, and psychiatry's history involves what may now be seen as dangerous treatments.[189] Electroconvulsive therapy was one of these, which was used widely between the 1930s and 1960s. Lobotomy was another practice that was ultimately seen as too invasive and brutal. Diazepam and other sedatives were sometimes over-prescribed, which led to an epidemic of dependence. There was also concern about the large increase in prescribing psychiatric drugs for children. Some charismatic psychiatrists came to personify the movement against psychiatry. The most influential of these was R.D. Laing who wrote a series of best-selling books, including The Divided Self. Thomas Szasz wrote The Myth of Mental Illness. Some ex-patient groups have become militantly anti-psychiatric, often referring to themselves as survivors.[189] Giorgio Antonucci has questioned the basis of psychiatry through his work on the dismantling of two psychiatric hospitals (in the city of Imola), carried out from 1973 to 1996. The consumer/survivor movement (also known as user/survivor movement) is made up of individuals (and organizations representing them) who are clients of mental health services or who consider themselves survivors of psychiatric interventions. Activists campaign for improved mental health services and for more involvement and empowerment within mental health services, policies and wider society.[190][191][192] Patient advocacy organizations have expanded with increasing deinstitutionalization in developed countries, working to challenge the stereotypes, stigma and exclusion associated with psychiatric conditions. There is also a carers rights movement of people who help and support people with mental health conditions, who may be relatives, and who often work in difficult and time-consuming circumstances with little acknowledgement and without pay. An anti-psychiatry movement fundamentally challenges mainstream psychiatric theory and practice, including in some cases asserting that psychiatric concepts and diagnoses of 'mental illness' are neither real nor useful.[193][unreliable source?][194][195] Alternatively, a movement for global mental health has emerged, defined as 'the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide'.[196] Cultural bias See also: Depression and culture and Cultural competence in healthcare Diagnostic guidelines of the 2000s, namely the DSM and to some extent the ICD, have been criticized as having a fundamentally Euro-American outlook. Opponents argue that even when diagnostic criteria are used across different cultures, it does not mean that the underlying constructs have validity within those cultures, as even reliable application can prove only consistency, not legitimacy.[197] Advocating a more culturally sensitive approach, critics such as Carl Bell and Marcello Maviglia contend that the cultural and ethnic diversity of individuals is often discounted by researchers and service providers.[198] Cross-cultural psychiatrist Arthur Kleinman contends that the Western bias is ironically illustrated in the introduction of cultural factors to the DSM-IV. Disorders or concepts from non-Western or non-mainstream cultures are described as "culture-bound", whereas standard psychiatric diagnoses are given no cultural qualification whatsoever, revealing to Kleinman an underlying assumption that Western cultural phenomena are universal.[199] Kleinman's negative view towards the culture-bound syndrome is largely shared by other cross-cultural critics. Common responses included both disappointment over the large number of documented non-Western mental disorders still left out and frustration that even those included are often misinterpreted or misrepresented.[200] Many mainstream psychiatrists are dissatisfied with the new culture-bound diagnoses, although for partly different reasons. Robert Spitzer, a lead architect of the DSM-III, has argued that adding cultural formulations was an attempt to appease cultural critics, and has stated that they lack any scientific rationale or support. Spitzer also posits that the new culture-bound diagnoses are rarely used, maintaining that the standard diagnoses apply regardless of the culture involved. In general, mainstream psychiatric opinion remains that if a diagnostic category is valid, cross-cultural factors are either irrelevant or are significant only to specific symptom presentations.[197] Clinical conceptions of mental illness also overlap with personal and cultural values in the domain of morality, so much so that it is sometimes argued that separating the two is impossible without fundamentally redefining the essence of being a particular person in a society.[201] In clinical psychiatry, persistent distress and disability indicate an internal disorder requiring treatment; but in another context, that same distress and disability can be seen as an indicator of emotional struggle and the need to address social and structural problems.[202][203] This dichotomy has led some academics and clinicians to advocate a postmodernist conceptualization of mental distress and well-being.[204][205] Such approaches, along with cross-cultural and "heretical" psychologies centered on alternative cultural and ethnic and race-based identities and experiences, stand in contrast to the mainstream psychiatric community's alleged avoidance of any explicit involvement with either morality or culture.[206] In many countries there are attempts to challenge perceived prejudice against minority groups, including alleged institutional racism within psychiatric services.[207] There are also ongoing attempts to improve professional cross cultural sensitivity.[208] Laws and policies See also: Mental health law Three-quarters of countries around the world have mental health legislation. Compulsory admission to mental health facilities (also known as involuntary commitment) is a controversial topic. It can impinge on personal liberty and the right to choose, and carry the risk of abuse for political, social, and other reasons; yet it can potentially prevent harm to self and others, and assist some people in attaining their right to healthcare when they may be unable to decide in their own interests.[209] Because of this it is a concern of medical ethics. All human rights oriented mental health laws require proof of the presence of a mental disorder as defined by internationally accepted standards, but the type and severity of disorder that counts can vary in different jurisdictions. The two most often used grounds for involuntary admission are said to be serious likelihood of immediate or imminent danger to self or others, and the need for treatment. Applications for someone to be involuntarily admitted usually come from a mental health practitioner, a family member, a close relative, or a guardian. Human-rights-oriented laws usually stipulate that independent medical practitioners or other accredited mental health practitioners must examine the patient separately and that there should be regular, time-bound review by an independent review body.[209] The individual should also have personal access to independent advocacy. For involuntary treatment to be administered (by force if necessary), it should be shown that an individual lacks the mental capacity for informed consent (i.e. to understand treatment information and its implications, and therefore be able to make an informed choice to either accept or refuse). Legal challenges in some areas have resulted in supreme court decisions that a person does not have to agree with a psychiatrist's characterization of the issues as constituting an "illness", nor agree with a psychiatrist's conviction in medication, but only recognize the issues and the information about treatment options.[210] Proxy consent (also known as surrogate or substituted decision-making) may be transferred to a personal representative, a family member, or a legally appointed guardian. Moreover, patients may be able to make, when they are considered well, an advance directive stipulating how they wish to be treated should they be deemed to lack mental capacity in the future.[209] The right to supported decision-making, where a person is helped to understand and choose treatment options before they can be declared to lack capacity, may also be included in the legislation.[211] There should at the very least be shared decision-making as far as possible. Involuntary treatment laws are increasingly extended to those living in the community, for example outpatient commitment laws (known by different names) are used in New Zealand, Australia, the United Kingdom, and most of the United States. The World Health Organization reports that in many instances national mental health legislation takes away the rights of persons with mental disorders rather than protecting rights, and is often outdated.[209] In 1991, the United Nations adopted the Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, which established minimum human rights standards of practice in the mental health field. In 2006, the UN formally agreed the Convention on the Rights of Persons with Disabilities to protect and enhance the rights and opportunities of disabled people, including those with psychiatric disabilities.[212] The term insanity, sometimes used colloquially as a synonym for mental illness, is often used technically as a legal term. The insanity defense may be used in a legal trial (known as the mental disorder defence in some countries). Perception and discrimination Further information: Schizophrenogenic parents, Refrigerator mother, and Mentalism (discrimination) Stigma The social stigma associated with mental disorders is a widespread problem. The US Surgeon General stated in 1999 that: "Powerful and pervasive, stigma prevents people from acknowledging their own mental health problems, much less disclosing them to others."[213] Additionally, researcher Wulf Rössler in 2016, in his article, "The Stigma of Mental Disorders" stated: For millennia, society did not treat persons suffering from depression, autism, schizophrenia and other mental illnesses much better than slaves or criminals: they were imprisoned, tortured or killed.[214] In the United States, racial and ethnic minorities are more likely to experience mental health disorders often due to low socioeconomic status, and discrimination.[215][216][217] In Taiwan, people with mental disorders often face misconceptions from the general public. These misconceptions include the belief that mental health issues stem from excessive worry, having too much free time, a lack of progress or ambition, not taking life seriously, neglecting real-life responsibilities, mental weakness, unwillingness to be resilient, perfectionism, or a lack of courage.[218] Employment discrimination is reported to play a significant part in the high rate of unemployment among those with a diagnosis of mental illness.[219] An Australian study found that having a psychiatric disability is a bigger barrier to employment than a physical disability.[220][better source needed] The mentally ill are stigmatized in Chinese society and can not legally marry.[221] Efforts are being undertaken worldwide to eliminate the stigma of mental illness,[222] although the methods and outcomes used have sometimes been criticized.[223] Media and general public Main article: Mental disorders in fiction Media coverage of mental illness comprises predominantly negative and pejorative depictions, for example, of incompetence, violence or criminality, with far less coverage of positive issues such as accomplishments or human rights issues.[224][225][226] Such negative depictions, including in children's cartoons, are thought to contribute to stigma and negative attitudes in the public and in those with mental health problems themselves, although more sensitive or serious cinematic portrayals have increased in prevalence.[227][228] In the United States, the Carter Center has created fellowships for journalists in South Africa, the U.S., and Romania, to enable reporters to research and write stories on mental health topics.[229] Former US First Lady Rosalynn Carter began the fellowships not only to train reporters in how to sensitively and accurately discuss mental health and mental illness, but also to increase the number of stories on these topics in the news media.[230][231] There is also a World Mental Health Day, which in the United States and Canada falls within a Mental Illness Awareness Week. The general public have been found to hold a strong stereotype of dangerousness and desire for social distance from individuals described as mentally ill.[232] A US national survey found that a higher percentage of people rate individuals described as displaying the characteristics of a mental disorder as "likely to do something violent to others", compared to the percentage of people who are rating individuals described as being troubled.[233] In the article, "Discrimination Against People with a Mental Health Diagnosis: Qualitative Analysis of Reported Experiences", an individual who has a mental disorder, revealed that, "If people don't know me and don't know about the problems, they'll talk to me quite happily. Once they've seen the problems or someone's told them about me, they tend to be a bit more wary."[234] In addition, in the article, "Stigma and its Impact on Help-Seeking for Mental Disorders: What Do We Know?" by George Schomerus and Matthias Angermeyer, it is affirmed that "Family doctors and psychiatrists have more pessimistic views about the outcomes for mental illnesses than the general public (Jorm et al., 1999), and mental health professionals hold more negative stereotypes about mentally ill patients, but, reassuringly, they are less accepting of restrictions towards them."[235] Recent depictions in media have included leading characters successfully living with and managing a mental illness, including in bipolar disorder in Homeland (2011) and post-traumatic stress disorder in Iron Man 3 (2013).[236][237][original research?] Violence Despite public or media opinion, national studies have indicated that severe mental illness does not independently predict future violent behavior, on average, and is not a leading cause of violence in society. There is a statistical association with various factors that do relate to violence (in anyone), such as substance use and various personal, social, and economic factors.[238] A 2015 review found that in the United States, about 4% of violence is attributable to people diagnosed with mental illness,[239] and a 2014 study found that 7.5% of crimes committed by mentally ill people were directly related to the symptoms of their mental illness.[240] The majority of people with serious mental illness are never violent.[241] In fact, findings consistently indicate that it is many times more likely that people diagnosed with a serious mental illness living in the community will be the victims rather than the perpetrators of violence.[242][243] In a study of individuals diagnosed with "severe mental illness" living in a US inner-city area, a quarter were found to have been victims of at least one violent crime over the course of a year, a proportion eleven times higher than the inner-city average, and higher in every category of crime including violent assaults and theft.[244] People with a diagnosis may find it more difficult to secure prosecutions, however, due in part to prejudice and being seen as less credible.[245] However, there are some specific diagnoses, such as childhood conduct disorder or adult antisocial personality disorder or psychopathy, which are defined by, or are inherently associated with, conduct problems and violence. There are conflicting findings about the extent to which certain specific symptoms, notably some kinds of psychosis (hallucinations or delusions) that can occur in disorders such as schizophrenia, delusional disorder or mood disorder, are linked to an increased risk of serious violence on average. The mediating factors of violent acts, however, are most consistently found to be mainly socio-demographic and socio-economic factors such as being young, male, of lower socioeconomic status and, in particular, substance use (including alcohol use) to which some people may be particularly vulnerable.[76][242][246][247] High-profile cases have led to fears that serious crimes, such as homicide, have increased due to deinstitutionalization, but the evidence does not support this conclusion.[247][248] Violence that does occur in relation to mental disorder (against the mentally ill or by the mentally ill) typically occurs in the context of complex social interactions, often in a family setting rather than between strangers.[249] It is also an issue in health care settings[250] and the wider community.[251] Mental health Main article: Mental health The recognition and understanding of mental health conditions have changed over time and across cultures and there are still variations in definition, assessment, and classification, although standard guideline criteria are widely used. In many cases, there appears to be a continuum between mental health and mental illness, making diagnosis complex.[41]: 39  According to the World Health Organization, over a third of people in most countries report problems at some time in their life which meet the criteria for diagnosis of one or more of the common types of mental disorder.[147] Corey M Keyes has created a two continua model of mental illness and health which holds that both are related, but distinct dimensions: one continuum indicates the presence or absence of mental health, the other the presence or absence of mental illness.[252] For example, people with optimal mental health can also have a mental illness, and people who have no mental illness can also have poor mental health.[253] Other animals Main article: Animal psychopathology Psychopathology in non-human primates has been studied since the mid-20th century. Over 20 behavioral patterns in captive chimpanzees have been documented as (statistically) abnormal for frequency, severity or oddness—some of which have also been observed in the wild. Captive great apes show gross behavioral abnormalities such as stereotypy of movements, self-mutilation, disturbed emotional reactions (mainly fear or aggression) towards companions, lack of species-typical communications, and generalized learned helplessness. In some cases such behaviors are hypothesized to be equivalent to symptoms associated with psychiatric disorders in humans such as depression, anxiety disorders, eating disorders and post-traumatic stress disorder. Concepts of antisocial, borderline and schizoid personality disorders have also been applied to non-human great apes.[254][255] The risk of anthropomorphism is often raised concerning such comparisons, and assessment of non-human animals cannot incorporate evidence from linguistic communication. However, available evidence may range from nonverbal behaviors—including physiological responses and homologous facial displays and acoustic utterances—to neurochemical studies. It is pointed out that human psychiatric classification is often based on statistical description and judgment of behaviors (especially when speech or language is impaired) and that the use of verbal self-report is itself problematic and unreliable.[254][256] Psychopathology has generally been traced, at least in captivity, to adverse rearing conditions such as early separation of infants from mothers; early sensory deprivation; and extended periods of social isolation. Studies have also indicated individual variation in temperament, such as sociability or impulsiveness. Particular causes of problems in captivity have included integration of strangers into existing groups and a lack of individual space, in which context some pathological behaviors have also been seen as coping mechanisms. Remedial interventions have included careful individually tailored re-socialization programs, behavior therapy, environment enrichment, and on rare occasions psychiatric drugs. Socialization has been found to work 90% of the time in disturbed chimpanzees, although restoration of functional sexuality and caregiving is often not achieved.[254][257] Laboratory researchers sometimes try to develop animal models of human mental disorders, including by inducing or treating symptoms in animals through genetic, neurological, chemical or behavioral manipulation,[258][259] but this has been criticized on empirical grounds[260] and opposed on animal rights grounds.

How to Recognize the Signs and Symptoms of a Mental Disorder

A mental disorder, also referred to as a mental illness,[6] a mental health condition,[7] or a psychiatric disability,[2] is a behavioral or mental pattern that causes significant distress or impairment of personal functioning.[8] A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context.[9][10] Such disturbances may occur as single episodes, may be persistent, or may be relapsing–rem

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An addictive personality refers to a hypothesized set of personality traits that make an individual predisposed to developing addictions. This hypothesis states that there may be common personality traits observable in people suffering from addiction; however, the lack of a universally agreed upon definition has marked the research surrounding addictive personality. Addiction is a fairly broad term; it is most often associated with substance use disorders, but it can also be extended to cover a number of other compulsive behaviors, including sex, internet, television, gambling, food, and shopping. Within these categories of addiction a common diagnostic scale involves tolerance, withdrawal, and cravings.[1] This is a fairly contentious topic, with many experts suggesting the term be retired due to a lack of cumulative evidence supporting the existence of addictive personality.[2] It has been claimed that characteristics of personality attributed to addictive personality do not predict addiction, but rather can be the result of addiction.[3] However, different personality traits have been linked to various types of addictive behaviors, suggesting that individual addictions may be associated with different personality profiles.[4] The strongest consensus is that genetic factors play the largest role in determining a predisposition for addictive behaviors.[5] Even then, however, genes play different roles in different types of addictions. Forty to seventy percent of the population variance in the expression of addictions can be explained by genetic factors.[6] Etiology The following factors are believed to influence addiction susceptibility. Psychological factors Impulsivity Sensation seeking[7][8] Nonconformity combined with weak commitment to socially valued goals for achievement Social alienation and tolerance for deviance Heightened stress coupled with lack of coping skills. Some claim the existence of "addictive beliefs" in people more likely to develop addictions, such as "I cannot make an impact on my world" or "I am not good enough", which may lead to developing traits associated with addiction, such as depression and emotional insecurity.[9] People who strongly believe that they control their own lives and are mostly self-reliant in learning information (rather than relying on others) are less likely to become addicted.[10] However, it is unclear whether these traits are causes, results or merely associated coincidentally. For example, depression due to physical disease[11] can cause feelings of hopelessness that are mitigated after successful treatment of the underlying condition, and addiction can increase dependence on others. Certain psychological disorders such as panic attacks, depressive disorders, and generalized anxiety disorder have been related to addiction. The addicted person, who struggles with reality and feels negative feelings, such as anxiety and depression, will seek out ways to help them avoid such feelings.[1] A study based on social cognitive theories, included a personality-targeted intervention that was shown to help treat substance addiction. It is feasible that by changing certain elements of one's personality, one can gain a step in the right direction towards changing their addictive personality.[12] Food addiction Overeating due to food addiction has not yet been recognized as a medical disorder under the Diagnostic and Statistical Manual of Mental Disorders despite its prevalence in the general population. While food addiction is not considered to be a medical disorder, there is still controversy as to whether food can be addictive as it is necessary for survival. Research has shown that foods can have the same chemical reactions in the brain as addictive chemicals or drugs (e.g. brain reward pathways). Furthermore, certain foods that have a higher level of sweeteners or fats have been found to demonstrate a higher addictive potential. More research is needed to determine the relation between food and addiction. Recent studies have attempted to find correlations between humans and animals, but no general consensus has been reached.[13] Genetic factors According to David Goldman, a prominent alcoholism researcher,[14] addiction is one of the behavioral disorders most strongly correlated with genetic makeup.[15] Individual traits can share common underlying factors or interact. For example, depression, poor self-control, and compulsive behavior are linked to neurotransmitter abnormalities, i.e., biological mechanisms.[16] In laboratory studies with rats, only some rats develop a pattern of self-administration of stimulant drugs, supporting the existence of some inherent propensity for addictive tendencies. In these rats, a positive correlation was found between locomotor response to novel stimuli and the amount of amphetamine self-administered during the first few days of testing.[17] Twin and adoption studies have shown genetic factors account for 50–60% of the risk for alcoholism. In early adolescence, social and familial factors play a more important role in the initiation of drug use, but their importance fades with progression into adulthood.[18] The gene CHRNA5 has been heavily linked to the addictions of cigarettes. Researchers discovered that the CHRNA5 variant creates a less nauseating experience for a first time smoker. The gene is active in the region of the brain called the habenula. Research showed that frequent smoking might damage the neurons within the habenula that inhibit its role in aversion and avoidance, which might cause the smoker to then use more nicotine to feel relief from resulting distressful and negative feelings.[19] Environmental factors Studies have found numerous environmental factors that correlate with addiction. Exposure to sustained stress in childhood, such as physical or sexual abuse, especially accompanied by unpredictable parental behavior strongly correlates with drug addiction and overeating in adulthood.[20] Children who tend to react to distress in a more rash way have been linked to becoming more likely to drink and smoke in their adolescence. Results from this research found that this was because the reaction to distress affected psychosocial learning, which led to increased expectancy to drink or smoke.[21] A lack of social interaction has also been shown to correlate with addictive tendencies; rats reared in isolation were quicker to develop a pattern of cocaine self-administration than rats reared in groups.[17] There is a gene/environment connection in that individuals with particular personality traits may self-select into different environments, e.g., they may seek out work environments where addictive substances are more readily available.[22] Description Addiction can be defined as an excessive amount of time and resources spent in engaging in an activity or an experience that somehow affects the person's quality of life.[23] An addictive personality is when those addictive behaviors progress and change as the individual seeks to produce the desired mood.[24] People that face this issue are currently defined to have a brain disease as promoted by the National Institute on Drug Abuse and other authorities.[25] People who experience addictive personality disorders typically act on impulses and cannot deal with delayed gratification.[26] At the same time, people with this type of personality tend to believe that they do not fit into societal norms and therefore, acting on impulses, deviate from conformity to rebel.[27] People with addictive personalities are very sensitive to emotional stress. They have trouble handling situations that they deem frustrating, even if the event is for a very short duration. The combination of low self-esteem, impulsivity and low tolerance for stress causes these individuals to have frequent mood swings and often suffer from some sort of depression.[26] A coping mechanism to deal with their conflicting personality becomes their addiction and the addiction acts as something that the person can control when they find it difficult to control their personality traits.[26] People with addictive personalities typically switch from one addiction to the next.[3] These individuals may show impulsive behavior such as excessive caffeine consumption, Internet use, eating chocolate or other sugar-laden foods, television watching, or even running.[28] Extraversion, self-monitoring, and loneliness are also common characteristics found in those who suffer from addiction.[29][30] Individuals who score high on self-monitoring are more prone to developing an addiction.[29][30] High self-monitors are sensitive to social situations;[29][30] they act how they think others expect them to act. They wish to fit in, hence they are very easily influenced by others. Likewise, those who have low self-esteem also seek peer approval; therefore, they participate in "attractive" activities such as smoking or drinking to try to fit in.[29][30] People with addictive personalities find it difficult to manage their stress levels. In fact, lack of stress tolerance is a telltale sign of the disorder.[26] They find it difficult to face stressful situations and fight hard to get out of such conditions. Long-term goals prove difficult to achieve because people with addictive personalities usually focus on the stress that comes with getting through the short-term goals.[26] Such personalities will often switch to other enjoyable activities the moment that they are deprived of enjoyment in their previous addiction.[26] Addictive individuals feel highly insecure when it comes to relationships. They may often find it difficult to make commitments in relationships or trust their beloved because of the difficulty they find in achieving long-term goals.[28] They constantly seek approval of others and as a result, these misunderstandings may contribute to the destruction of relationships. People suffering from addictive personality disorder usually undergo depression and anxiety, managing their emotions by developing addiction to alcohol, other types of drugs, or other pleasurable activities.[28] An addict is more prone to depression, anxiety, and anger.[30] Both the addict's environment, genetics and biological tendency contribute to their addiction.[30] People with very severe personality disorders are more likely to become addicts. Addictive substances usually stop primary and secondary neuroses, meaning people with personality disorders like the relief from their pain.[30] Personality traits and addiction Addiction is defined by scholars as "a biopsychosocial disorder characterized by persistent use of drugs (including alcohol) despite substantial harm and adverse consequences".[31] Substance-based addictions are those based upon the release of dopamine in the brain, upon which the range of sensations produced by the euphoric event in the brain changes the brain's immediate behavior, causing more susceptibility for future addictions. Behavior-based addictions, on the other hand, are those that are not linked to neurological behavior as much and are thus thought to be linked to personality traits; it is this type of addiction that combines a behavior with a mental state and the repeated routine is therefore associated with the mental state.[32] Drug addiction A group of British forensic psychologists and data scientists analysed a new large database of users of psychoactive substances.[33] To analyse the predisposition to drug use, they utilized 7 psychological traits, the Five Factor Model supplemented by Impulsivity and Sensation seeking: N Neuroticism is a long-term tendency to experience negative emotions such as nervousness, tension, anxiety and depression (associated adjectives: anxious, self-pitying, tense, touchy, unstable, and worrying);[34] E Extraversion is manifested in outgoing, warm, active, assertive, talkative, cheerful characters, often in search of stimulation (associated adjectives: active, assertive, energetic, enthusiastic, outgoing, and talkative);[34] O Openness to experience is a general appreciation for art, unusual ideas, and imaginative, creative, unconventional, and wide interests (associated adjectives: artistic, curious, imaginative, insightful, original, and wide interest);[34] A Agreeableness is a dimension of interpersonal relations, characterized by altruism, trust, modesty, kindness, compassion and cooperativeness (associated adjectives: appreciative, forgiving, generous, kind, sympathetic, and trusting);[34] C Conscientiousness is a tendency to be organized and dependable, strong-willed, persistent, reliable, and efficient (associated adjectives: efficient, organized, reliable, responsible, and thorough);[34] Imp Impulsivity is defined as a tendency to act without adequate forethought;[34] SS Sensation Seeking is defined by the search for experiences and feelings, that are varied, novel, complex and intense, and by the readiness to take risks for the sake of such experiences.[34] These factors are not statistically independent but the condition number of the correlation matrix is less than 10 and the multicollinearity effects are not expected to be strong.[33] The results of the detailed analysis of modern data support partially the hypothesis about psychological predisposition to addiction. The group of users of illicit drugs differs from the group of non-users for N, O, A, C, Imp, and SS. Symbolically, this difference can be illustrated as follows: N ⇑ , O ⇑ , A ⇓ , C ⇓ , I m p ⇑ , S S ⇑ {\displaystyle {\rm {N}}\Uparrow ,{\rm {O}}\Uparrow ,{\rm {A}}\Downarrow ,{\rm {C}}\Downarrow ,{\rm {Imp}}\Uparrow ,{\rm {SS}}\Uparrow } (N, O, Imp, and SS scores are higher for users; A and C scores are lower for users). The hypothesis about importance of E for addiction was not supported by this aggregated analysis of use of all illicit drugs. Analysis of consumption of different drugs separately demonstrated that predisposition to use of different drugs is different. For all illicit drugs groups of their users have the following common properties: O ⇑ , C ⇓ , I m p ⇑ , S S ⇑ {\displaystyle {\rm {O}}\Uparrow ,{\rm {C}}\Downarrow ,{\rm {Imp}}\Uparrow ,{\rm {SS}}\Uparrow } (O, Imp, and SS scores are higher for users and C score is lower for users). Deviation of N, E, and A scores for users of different drugs can be different. For example, heroin users have average profile N ⇑ , E ⇓ , O ⇑ , A ⇓ , C ⇓ , I m p ⇑ , S S ⇑ , {\displaystyle {\rm {N}}\Uparrow ,{\rm {E}}\Downarrow ,{\rm {O}}\Uparrow ,{\rm {A}}\Downarrow ,{\rm {C}}\Downarrow ,{\rm {Imp}}\Uparrow ,{\rm {SS}}\Uparrow ,} whereas for LSD and Ecstasy (the latter being a so-called "Party drug") users N has no significant deviation from the population level and E can be higher.[33] Several personality profiles of risky behaviour were identified by various researchers, for example N ⇑ , C ⇓ {\displaystyle {\rm {N}}\Uparrow ,{\rm {C}}\Downarrow } (Insecures) and E ⇑ , C ⇓ {\displaystyle {\rm {E}}\Uparrow ,{\rm {C}}\Downarrow }(Impulsives, Hedonists).[35] Various types of addictive personality have in common low C. Internet addiction Internet addiction is associated with higher scores in neuroticism and lower scores in extraversion and conscientiousness.[36] One explanation for the association with high neuroticism is that virtual environments may be regarded as more safe and comfortable by individuals with lower self-esteem and increased negative emotion (traits associated with high neuroticism) compared to real-life environments. Similarly, individuals with low extraversion that desire social interaction but are averse to face-to-face interaction may find the opportunity for online communication attractive.[36] Social media addiction is currently not recognized as a formal psychiatric disorder, however with over 5 billion people spending an average of 2 hours and 29 minutes a day on social media in 2024, there are many concerns about the impact that social media has on mental health and the daily lives of people.[37] Several mental health consequences of heavy social media use have been identified, with increased social media usage being linked to increased levels of stress, insomnia, and suicide-related outcomes.[37] Personality theories of addiction This section is an excerpt from Personality theories of addiction.[edit] Personality theories of addiction are psychological models that associate personality traits or modes of thinking (i.e., affective states) with an individual's proclivity for developing an addiction. Models of addiction risk that have been proposed in psychology literature include an affect dysregulation model of positive and negative psychological affects, the reinforcement sensitivity theory model of impulsiveness and behavioral inhibition, and an impulsivity model of reward sensitization and impulsiveness.[38][42][43] Controversy There is an ongoing debate about the question of whether an addictive personality really exists. The assumption that personality might be to blame for an addicted person, who is in need of rehabilitation due to drug and alcohol addictions, can have great negative impacts from its supporting a homogeneous answer to a heterogeneous issue in question. These people run the risk of being labeled as stigmas and become incorrectly marginalized, and these misjudgments of personality may then lead to poor mental, medical, and social health practices.[23] There are two sides of this argument, each with many levels and variations. One side believes that there are certain traits and dimensions of personality that, if existent in a person, cause the person to be more prone to developing addictions throughout their life. The other side argues that addiction is in chemistry, as in how the brain's synapses respond to neurotransmitters and is therefore not affected by personality. A major argument in favor of defining and labeling an addictive personality has to do with the human ability to make decisions and the notion of free will.[44] This argument suggests human beings are aware of their actions and what the consequences of their own actions are and many choose against certain things because of this. This can be seen in that people are not forced to drink excessively or smoke every day, but it is within the reach of their own free will that some may choose to do so.[44] Therefore, those with addictive personalities are high in neuroticism and hence choose to engage in riskier behaviors. The theory of addictive personalities agrees that there are two types of people: risk-takers and risk-averse. Risk-takers enjoy challenges, new experiences and want instant gratification. These people enjoy the excitement of danger and trying new things.[44] On the other hand, risk-averse are those who are by nature cautious in what they do and the activities they involve themselves in.[44] It is the personality traits of individuals that combine to create either a risk-taker or risk-averse person. Another important concern is the lack of evidence supporting the addictive personality label and the possibility of stigma.[2] While there is a medical consensus surrounding the genetic components of addiction,[5] there is no such consensus supporting the idea that specific personality types have a tendency towards addictive behaviors.[2] In fact, continued use of this term in the absence of clear evidence could be damaging to the people who believe they have an addictive personality.[2]

Exploring the Traits and Triggers of an Addictive Personality

An addictive personality refers to a hypothesized set of personality traits that make an individual predisposed to developing addictions. This hypothesis states that there may be common personality traits observable in people suffering from addiction; however, the lack of a universally agreed upon definition has marked the research surrounding addictive personality. Addiction is a fairly broad term; it is most often associated with substance use disorders, but it can also be extended to cover a

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Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal.[15] Problematic use of alcohol has been mentioned in the earliest historical records. The World Health Organization (WHO) estimated there were 283 million people with alcohol use disorders worldwide as of 2016.[12][13] The term alcoholism was first coined in 1852,[16] but alcoholism and alcoholic are considered stigmatizing and likely to discourage seeking treatment, so diagnostic terms such as "alcohol use disorder" and "alcohol dependence" are often used instead in a clinical context.[17][18][19] Alcohol is addictive, and heavy long-term alcohol use results in many negative health and social consequences. It can damage all the organ systems, but especially affects the brain, heart, liver, pancreas and immune system.[4][5] Heavy alcohol usage can result in trouble sleeping, and severe cognitive issues like dementia, brain damage, or Wernicke–Korsakoff syndrome. Physical effects include irregular heartbeat, an impaired immune response, liver cirrhosis, increased cancer risk, and severe withdrawal symptoms if stopped suddenly.[4][5][20] These health effects can reduce life expectancy by 10 years.[21] Drinking during pregnancy may harm the child's health,[3] and drunk driving increases the risk of traffic accidents. Alcoholism is also associated with increases in violent and non-violent crime.[22] While alcoholism directly resulted in 139,000 deaths worldwide in 2013,[23] in 2012 3.3 million deaths may be attributable globally to alcohol.[14] The development of alcoholism is attributed to both environment and genetics equally.[4] The use of alcohol to self-medicate stress or anxiety can turn into alcoholism.[24] Someone with a parent or sibling with an alcohol use disorder is three to four times more likely to develop an alcohol use disorder themselves, but only a minority of them do.[4] Environmental factors include social, cultural and behavioral influences.[25] High stress levels and anxiety, as well as alcohol's inexpensive cost and easy accessibility, increase the risk.[4][7] People may continue to drink partly to prevent or improve symptoms of withdrawal.[4] After a person stops drinking alcohol, they may experience a low level of withdrawal lasting for months.[4] Medically, alcoholism is considered both a physical and mental illness.[26][27] Questionnaires are usually used to detect possible alcoholism.[4][28] Further information is then collected to confirm the diagnosis.[4] Treatment of alcoholism may take several forms.[9] Due to medical problems that can occur during withdrawal, alcohol cessation should be controlled carefully.[9] One common method involves the use of benzodiazepine medications, such as diazepam.[9] These can be taken while admitted to a health care institution or individually.[9] The medications acamprosate or disulfiram may also be used to help prevent further drinking.[10] Mental illness or other addictions may complicate treatment.[29] Various individual or group therapy or support groups are used to attempt to keep a person from returning to alcoholism.[8][30] Among them is the abstinence based mutual aid fellowship Alcoholics Anonymous (AA). A 2020 scientific review found that clinical interventions encouraging increased participation in AA (AA/twelve step facilitation (AA/TSF))—resulted in higher abstinence rates over other clinical interventions, and most studies in the review found that AA/TSF led to lower health costs.[a][32][33][34] Many terms, some slurs and some informal, have been used to refer to people affected by alcoholism such as tippler, sot, drunk, drunkard, piss ant, dipsomaniac and souse.[35] Signs and symptoms The risk of alcohol dependence begins at low levels of drinking and increases directly with both the volume of alcohol consumed and a pattern of drinking larger amounts on an occasion, to the point of intoxication, which is sometimes called binge drinking. Binge drinking is the most common pattern of alcoholism. It has different definitions and one of this defines it as a pattern of drinking when a male has five or more drinks on an occasion or a female has at least four drinks on an occasion.[36] Long-term misuse Some of the possible long-term effects of ethanol an individual may develop. Additionally, in pregnant women, alcohol can cause fetal alcohol syndrome. Alcoholism is characterized by an increased tolerance to alcohol – which means that an individual can consume more alcohol – and physical dependence on alcohol, which makes it hard for an individual to control their consumption. The physical dependency caused by alcohol can lead to an affected individual having a very strong urge to drink alcohol. These characteristics play a role in decreasing the ability to stop drinking of an individual with an alcohol use disorder.[37] Alcoholism can have adverse effects on mental health, contributing to psychiatric disorders and increasing the risk of suicide. A depressed mood is a common symptom of heavy alcohol drinkers.[38][39] Warning signs Warning signs of alcoholism include the consumption of increasing amounts of alcohol and frequent intoxication, preoccupation with drinking to the exclusion of other activities, promises to quit drinking and failure to keep those promises, the inability to remember what was said or done while drinking (colloquially known as "blackouts"), personality changes associated with drinking, denial or the making of excuses for drinking, the refusal to admit excessive drinking, dysfunction or other problems at work or school, the loss of interest in personal appearance or hygiene, marital and economic problems, and the complaint of poor health, with loss of appetite, respiratory infections, or increased anxiety.[40] Physical Short-term effects Main article: Short-term effects of alcohol consumption Drinking enough to cause a blood alcohol concentration (BAC) of 0.03–0.12% typically causes an overall improvement in mood and possible euphoria (intense feelings of well-being and happiness), increased self-confidence and sociability, decreased anxiety, a flushed, red appearance in the face and impaired judgment and fine muscle coordination. A BAC of 0.09% to 0.25% causes lethargy, sedation, balance problems and blurred vision. A BAC of 0.18% to 0.30% causes profound confusion, impaired speech (e.g. slurred speech), staggering, dizziness and vomiting. A BAC from 0.25% to 0.40% causes stupor, unconsciousness, anterograde amnesia, vomiting (death may occur due to inhalation of vomit while unconscious) and respiratory depression (potentially life-threatening). A BAC from 0.35% to 0.80% causes a coma (unconsciousness), life-threatening respiratory depression and possibly fatal alcohol poisoning. With all alcoholic beverages, drinking while driving, operating an aircraft or heavy machinery increases the risk of an accident; many countries have penalties for drunk driving. Long-term effects See also: Long-term effects of alcohol consumption Having more than one drink a day for women or two drinks for men increases the risk of heart disease, high blood pressure, atrial fibrillation, and stroke.[41] Risk is greater with binge drinking, which may also result in violence or accidents. About 3.3 million deaths (5.9% of all deaths) are believed to be due to alcohol each year.[14] Alcoholism reduces a person's life expectancy by around ten years[21] and alcohol use is the third leading cause of early death in the United States.[41] Long-term alcohol misuse can cause a number of physical symptoms, including cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional deficiencies, peptic ulcers[42] and sexual dysfunction, and can eventually be fatal. Other physical effects include an increased risk of developing cardiovascular disease, malabsorption, alcoholic liver disease, and several cancers such as breast cancer and head and neck cancer.[43] Damage to the central nervous system and peripheral nervous system can occur from sustained alcohol consumption.[44][45] A wide range of immunologic defects can result and there may be a generalized skeletal fragility, in addition to a recognized tendency to accidental injury, resulting in a propensity for bone fractures.[46] Women develop long-term complications of alcohol dependence more rapidly than do men; women also have a higher mortality rate from alcoholism than men.[47] Examples of long-term complications include brain, heart, and liver damage[48] and an increased risk of breast cancer. Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. This results in reproductive dysfunction such as anovulation, decreased ovarian mass, problems or irregularity of the menstrual cycle, and early menopause.[47] Alcoholic ketoacidosis can occur in individuals who chronically misuse alcohol and have a recent history of binge drinking.[49][50] The amount of alcohol that can be biologically processed and its effects differ between sexes. Equal dosages of alcohol consumed by men and women generally result in women having higher blood alcohol concentrations (BACs), since women generally have a lower weight and higher percentage of body fat and therefore a lower volume of distribution for alcohol than men.[51] Psychiatric Long-term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive problems are common; approximately 10% of all dementia cases are related to alcohol consumption, making it the second leading cause of dementia.[52] Excessive alcohol use causes damage to brain function, and psychological health can be increasingly affected over time.[53] Social skills are significantly impaired in people with alcoholism due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain. The social skills that are impaired by alcohol use disorder include impairments in perceiving facial emotions, prosody, perception problems, and theory of mind deficits; the ability to understand humor is also impaired in people who misuse alcohol.[54] Psychiatric disorders are common in people with alcohol use disorders, with as many as 25% also having severe psychiatric disturbances. The most prevalent psychiatric symptoms are anxiety and depression disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence.[55] Psychosis, confusion, and organic brain syndrome may be caused by alcohol misuse, which can lead to a misdiagnosis such as schizophrenia.[56] Panic disorder can develop or worsen as a direct result of long-term alcohol misuse.[57][58] The co-occurrence of major depressive disorder and alcoholism is well documented.[59][60][61] Among those with comorbid occurrences, a distinction is commonly made between depressive episodes that remit with alcohol abstinence ("substance-induced"), and depressive episodes that are primary and do not remit with abstinence ("independent" episodes).[62][63][64] Additional use of other drugs may increase the risk of depression.[65] Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often have a co-occurring psychiatric diagnosis such as major depression, anxiety, panic disorder, bulimia, post-traumatic stress disorder (PTSD), or borderline personality disorder. Men with alcohol-use disorders more often have a co-occurring diagnosis of narcissistic or antisocial personality disorder, bipolar disorder, schizophrenia, impulse disorders or attention deficit/hyperactivity disorder (ADHD).[66] Women with alcohol use disorder are more likely to experience physical or sexual assault, abuse, and domestic violence than women in the general population,[66] which can lead to higher instances of psychiatric disorders and greater dependence on alcohol. Social effects See also: Drug-related crime Serious social problems arise from alcohol use disorder; these dilemmas are caused by the pathological changes in the brain and the intoxicating effects of alcohol.[52][67] Alcohol misuse is associated with an increased risk of committing criminal offences, including child abuse, domestic violence, rape, burglary and assault.[68] Alcoholism is associated with loss of employment,[69] which can lead to financial problems. Drinking at inappropriate times and behavior caused by reduced judgment can lead to legal consequences, such as criminal charges for drunk driving[70] or public disorder, or civil penalties for tortious behavior. An alcoholic's behavior and mental impairment while drunk can profoundly affect those surrounding him and lead to isolation from family and friends. This isolation can lead to marital conflict and divorce, or contribute to domestic violence. Alcoholism can also lead to child neglect, with subsequent lasting damage to the emotional development of children of people with alcohol use disorders.[71] For this reason, children of people with alcohol use disorders can develop a number of emotional problems. For example, they can become afraid of their parents, because of their unstable mood behaviors. They may develop shame over their inadequacy to liberate their parents from alcoholism and, as a result of this, may develop self-image problems, which can lead to depression.[72] Alcohol withdrawal Main article: Alcohol withdrawal syndrome See also: Kindling (sedative-hypnotic withdrawal) "The bottle has done its work". Reproduction of an etching by G. Cruikshank, 1847. As with similar substances with a sedative-hypnotic mechanism, such as barbiturates and benzodiazepines, withdrawal from alcohol dependence can be fatal if it is not properly managed.[67][73] Alcohol's primary effect is the increase in stimulation of the GABAA receptor, promoting central nervous system depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and physical dependence. When alcohol consumption is stopped too abruptly, the person's nervous system experiences uncontrolled synapse firing. This can result in symptoms that include anxiety, life-threatening seizures, delirium tremens, hallucinations, shakes and possible heart failure.[74][75] Other neurotransmitter systems are also involved, especially dopamine, NMDA and glutamate.[37][76] Severe acute withdrawal symptoms such as delirium tremens and seizures rarely occur after 1-week post cessation of alcohol. The acute withdrawal phase can be defined as lasting between one and three weeks. In the period of 3–6 weeks following cessation, anxiety, depression, fatigue, and sleep disturbance are common.[77] Similar post-acute withdrawal symptoms have also been observed in animal models of alcohol dependence and withdrawal.[78] A kindling effect also occurs in people with alcohol use disorders whereby each subsequent withdrawal syndrome is more severe than the previous withdrawal episode; this is due to neuroadaptations which occur as a result of periods of abstinence followed by re-exposure to alcohol. Individuals who have had multiple withdrawal episodes are more likely to develop seizures and experience more severe anxiety during withdrawal from alcohol than alcohol-dependent individuals without a history of past alcohol withdrawal episodes. The kindling effect leads to persistent functional changes in brain neural circuits as well as to gene expression.[79] Kindling also results in the intensification of psychological symptoms of alcohol withdrawal.[77] There are decision tools and questionnaires that help guide physicians in evaluating alcohol withdrawal. For example, the CIWA-Ar objectifies alcohol withdrawal symptoms in order to guide therapy decisions which allows for an efficient interview while at the same time retaining clinical usefulness, validity, and reliability, ensuring proper care for withdrawal patients, who can be in danger of death.[80] Causes Mental health as a risk factor for alcohol dependence or abuse William Hogarth's Gin Lane, 1751 A complex combination of genetic and environmental factors influences the risk of the development of alcoholism.[81] Genes that influence the metabolism of alcohol also influence the risk of alcoholism, as can a family history of alcoholism.[82] There is compelling evidence that alcohol use at an early age may influence the expression of genes which increase the risk of alcohol dependence. These genetic and epigenetic results are regarded as consistent with large longitudinal population studies finding that the younger the age of drinking onset, the greater the prevalence of lifetime alcohol dependence.[83][84] Severe childhood trauma is also associated with a general increase in the risk of drug dependency.[81] Lack of peer and family support is associated with an increased risk of alcoholism developing.[81] Genetics and adolescence are associated with an increased sensitivity to the neurotoxic effects of chronic alcohol misuse. Cortical degeneration due to the neurotoxic effects increases impulsive behaviour, which may contribute to the development, persistence and severity of alcohol use disorders. There is evidence that with abstinence, there is a reversal of at least some of the alcohol induced central nervous system damage.[85] The use of cannabis was associated with later problems with alcohol use.[86] Alcohol use was associated with an increased probability of later use of tobacco and illegal drugs such as cannabis.[87] Availability Alcohol is the most available, widely consumed, and widely misused recreational drug. Beer alone is the world's most widely consumed[88] alcoholic beverage; it is the third-most popular drink overall, after water and tea.[89] It is thought by some to be the oldest fermented beverage.[90][91][92][93] Gender difference Comparison of prevalence of alcohol use disorders by gender and country (top image: female, bottom image: male) Map of alcohol use disorders by females only Map of alcohol use disorders by males only World map colored by alcohol use disorders (15+), 12 month prevalence (%), data: WHO (2016) 0.0–3.6 3.7–7.3 7.4–11.0 11.1–14.7 14.8–18.1 19.9–21.2 22.2–23.5 28.8–28.8 33.9–36.9 Based on combined data in the US from SAMHSA's 2004–2005 National Surveys on Drug Use & Health, the rate of past-year alcohol dependence or misuse among persons aged 12 or older varied by level of alcohol use: 44.7% of past month heavy drinkers, 18.5% binge drinkers, 3.8% past month non-binge drinkers, and 1.3% of those who did not drink alcohol in the past month met the criteria for alcohol dependence or misuse in the past year. Males had higher rates than females for all measures of drinking in the past month: any alcohol use (57.5% vs. 45%), binge drinking (30.8% vs. 15.1%), and heavy alcohol use (10.5% vs. 3.3%), and males were twice as likely as females to have met the criteria for alcohol dependence or misuse in the past year (10.5% vs. 5.1%).[94] However, because females generally weigh less than males, have more fat and less water in their bodies, and metabolize less alcohol in their esophagus and stomach, they are likely to develop higher blood alcohol levels per drink. Women may also be more vulnerable to liver disease.[95] Genetic variation See also: Addiction § Genetic factors There are genetic variations that affect the risk for alcoholism.[82][81][96][97] Some of these variations are more common in individuals with ancestry from certain areas; for example, Africa, East Asia, the Middle East and Europe. The variants with strongest effect are in genes that encode the main enzymes of alcohol metabolism, ADH1B and ALDH2.[82][96][97] These genetic factors influence the rate at which alcohol and its initial metabolic product, acetaldehyde, are metabolized.[82] They are found at different frequencies in people from different parts of the world.[98][82][99] The alcohol dehydrogenase allele ADH1B*2 causes a more rapid metabolism of alcohol to acetaldehyde, and reduces risk for alcoholism;[82] it is most common in individuals from East Asia and the Middle East. The alcohol dehydrogenase allele ADH1B*3 also causes a more rapid metabolism of alcohol. The allele ADH1B*3 is only found in some individuals of African descent and certain Native American tribes. African Americans and Native Americans with this allele have a reduced risk of developing alcoholism.[82][99][100] Native Americans, however, have a significantly higher rate of alcoholism than average; risk factors such as cultural environmental effects (e.g. trauma) have been proposed to explain the higher rates.[101][102] The aldehyde dehydrogenase allele ALDH2*2 greatly reduces the rate at which acetaldehyde, the initial product of alcohol metabolism, is removed by conversion to acetate; it greatly reduces the risk for alcoholism.[82][98] A genome-wide association study (GWAS) of more than 100,000 human individuals identified variants of the gene KLB, which encodes the transmembrane protein β-Klotho, as highly associated with alcohol consumption. The protein β-Klotho is an essential element in cell surface receptors for hormones involved in modulation of appetites for simple sugars and alcohol.[103] Several large GWAS have found differences in the genetics of alcohol consumption and alcohol dependence, although the two are to some degree related.[96][97][104] DNA damage Alcohol-induced DNA damage, when not properly repaired, may have a key role in the neurotoxicity induced by alcohol.[105] Metabolic conversion of ethanol to acetaldehyde can occur in the brain and the neurotoxic effects of ethanol appear to be associated with acetaldehyde induced DNA damages including DNA adducts and crosslinks.[105] In addition to acetaldehyde, alcohol metabolism produces potentially genotoxic reactive oxygen species, which have been demonstrated to cause oxidative DNA damage.[105] Diagnosis Definition A man drinking from a bottle of liquor while sitting on a boardwalk, c. 1905–1914. Picture by Austrian photographer Emil Mayer. Because there is disagreement on the definition of the word alcoholism, it is not a recognized diagnosis, and the use of the term alcoholism is discouraged due to its heavily stigmatized connotations.[17][18] It is classified as alcohol use disorder[2] in the DSM-5[4] or alcohol dependence in the ICD-11.[106] In 1979, the World Health Organization discouraged the use of alcoholism due to its inexact meaning, preferring alcohol dependence syndrome.[107] Misuse, problem use, abuse, and heavy use of alcohol refer to improper use of alcohol, which may cause physical, social, or moral harm to the drinker.[108] The Dietary Guidelines for Americans, issued by the United States Department of Agriculture (USDA) in 2005, defines "moderate use" as no more than two alcoholic beverages a day for men and no more than one alcoholic beverage a day for women.[109] The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as the amount of alcohol leading to a blood alcohol content (BAC) of 0.08, which, for most adults, would be reached by consuming five drinks for men or four for women over a two-hour period. According to the NIAAA, men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 standard drinks per week or 4 drinks per day, and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day. It defines a standard drink as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits.[110] Despite this risk, a 2014 report in the National Survey on Drug Use and Health found that only 10% of either "heavy drinkers" or "binge drinkers" defined according to the above criteria also met the criteria for alcohol dependence, while only 1.3% of non-binge drinkers met the criteria. An inference drawn from this study is that evidence-based policy strategies and clinical preventive services may effectively reduce binge drinking without requiring addiction treatment in most cases.[111] Alcoholism The term alcoholism is commonly used amongst laypeople, but the word is poorly defined. Despite the imprecision inherent in the term, there have been attempts to define how the word alcoholism should be interpreted when encountered. In 1992, it was defined by the National Council on Alcoholism and Drug Dependence (NCADD) and ASAM as "a primary, chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking."[112] MeSH has had an entry for alcoholism since 1999, and references the 1992 definition.[113] The WHO calls alcoholism "a term of long-standing use and variable meaning", and use of the term was disfavored by a 1979 WHO expert committee. In professional and research contexts, the term alcoholism is not currently favored, but rather alcohol abuse, alcohol dependence, or alcohol use disorder are used.[4][2] Talbot (1989) observes that alcoholism in the classical disease model follows a progressive course: if people continue to drink, their condition will worsen. This will lead to harmful consequences in their lives, physically, mentally, emotionally, and socially.[114] Johnson (1980) proposed that the emotional progression of the addicted people's response to alcohol has four phases. The first two are considered "normal" drinking and the last two are viewed as "typical" alcoholic drinking.[114] Johnson's four phases consist of: Learning the mood swing. People are introduced to alcohol (in some cultures this can happen at a relatively young age), and they enjoy the happy feeling it produces. At this stage, there is no emotional cost. Seeking the mood swing. People will drink to regain that happy feeling in phase 1; the drinking will increase as more alcohol is required to achieve the same effect. Again at this stage, there are no significant consequences. At the third stage there are physical and social consequences such as hangovers, family problems, and work problems. People will continue to drink excessively, disregarding the problems. The fourth stage can be detrimental with a risk for premature death. People in this phase now drink to feel normal and block out the feelings of overwhelming guilt, remorse, anxiety, and shame they experience when sober.[114] DSM and ICD In the United States, the Diagnostic and Statistical Manual of Mental Disorders (DSM) is the most common diagnostic guide for substance use disorders, whereas most countries use the International Classification of Diseases (ICD) for diagnostic (and other) purposes. The two manuals use similar but not identical nomenclature to classify alcohol problems. Manual Nomenclature Definition DSM-IV Alcohol abuse, or Alcohol dependence Alcohol abuse – repeated use despite recurrent adverse consequences.[115] Alcohol dependence – alcohol abuse combined with tolerance, withdrawal, and an uncontrollable drive to drink.[115] The term "alcoholism" was split into "alcohol abuse" and "alcohol dependence" in 1980's DSM-III, and in 1987's DSM-III-R behavioral symptoms were moved from "abuse" to "dependence".[116] Some scholars suggested that DSM-5 merges alcohol abuse and alcohol dependence into a single new entry,[117] named "alcohol-use disorder".[118] DSM-5 Alcohol use disorder "A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by [two or more symptoms out of a total of 12], occurring within a 12-month period ...."[119] ICD-10 Alcohol harmful use, or Alcohol dependence syndrome Definitions are similar to that of the DSM-IV. The World Health Organization uses the term "alcohol dependence syndrome" rather than alcoholism.[107] The concept of "harmful use" (as opposed to "abuse") was introduced in 1992's ICD-10 to minimize underreporting of damage in the absence of dependence.[116] The term "alcoholism" was removed from ICD between ICD-8/ICDA-8 and ICD-9.[120] ICD-11 Episode of harmful use of alcohol, Harmful pattern of use of alcohol, or Alcohol dependence Episode of harmful use of alcohol – "A single episode of use of alcohol that has caused damage to a person's physical or mental health or has resulted in behaviour leading to harm to the health of others ..."[121] Harmful pattern of use of alcohol – "A pattern of alcohol use that has caused damage to a person's physical or mental health or has resulted in behaviour leading to harm to the health of others ..."[122] Alcohol dependence – "Alcohol dependence is a disorder of regulation of alcohol use arising from repeated or continuous use of alcohol. The characteristic feature is a strong internal drive to use alcohol. ... The features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if alcohol use is continuous (daily or almost daily) for at least 1 month."[123] Social barriers Attitudes and social stereotypes can create barriers to the detection and treatment of alcohol use disorder. This is more of a barrier for women than men.[why?] Fear of stigmatization may lead women to deny that they have a medical condition, to hide their drinking, and to drink alone. This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a woman they know has alcohol use disorder.[47] In contrast, reduced fear of stigma may lead men to admit that they are having a medical condition, to display their drinking publicly, and to drink in groups. This pattern, in turn, leads family, physicians, and others to be more likely to suspect that a man they know is someone with an alcohol use disorder.[66] Screening Screening is recommended among those over the age of 18.[124] Several tools may be used to detect a loss of control of alcohol use. These tools are mostly self-reports in questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use.[125] The CAGE questionnaire, named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office. Two "yes" responses indicate that the respondent should be investigated further. The questionnaire asks the following questions: Have you ever felt you needed to cut down on your drinking? Have people annoyed you by criticizing your drinking? Have you ever felt guilty about drinking? Have you ever felt you needed a drink first thing in the morning (eye-opener) to steady your nerves or to get rid of a hangover?[126][127] The CAGE questionnaire has demonstrated a high effectiveness in detecting alcohol-related problems; however, it has limitations in people with less severe alcohol-related problems, white women and college students.[128] Other tests are sometimes used for the detection of alcohol dependence, such as the Alcohol Dependence Data Questionnaire, which is a more sensitive diagnostic test than the CAGE questionnaire. It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use.[129] The Michigan Alcohol Screening Test (MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses,[130] driving under the influence being the most common. The Alcohol Use Disorders Identification Test (AUDIT), a screening questionnaire developed by the World Health Organization, is unique in that it has been validated in six countries and is used internationally. Like the CAGE questionnaire, it uses a simple set of questions – a high score earning a deeper investigation.[131] The Paddington Alcohol Test (PAT) was designed to screen for alcohol-related problems amongst those attending Accident and Emergency departments. It concords well with the AUDIT questionnaire but is administered in a fifth of the time.[132] Urine and blood tests There are biological markers for the use of alcohol, one common test being that of blood alcohol content (BAC).[133] Monitoring levels of gamma-glutamyl transpeptidase (GGT) is sometimes used to assess continued alcohol intake. But levels of GGT are elevated in only half of men with alcohol use disorder, and it is less commonly elevated in women and younger people.[134] GGT levels remain persistently elevated for many weeks with continued drinking, with a half life of 2–3 weeks, making the GGT level a useful assessment of continued and chronic alcohol use.[134] However, elevated levels of GGT may also be seen in non-alcohol related liver diseases, diabetes, obesity or overweight, heart failure, hyperthyroidism and some medications.[134] Phosphatidylethanol is a biomarker that is present in the red blood cells for several weeks after drinking, with its levels grossly corresponding to amount of alcohol consumed, and a detection limit as long as 5 weeks, making it a useful test to assess continued alcohol use.[134] Ethyl glucuronide may be measured to assess recent alcohol intake, with levels being detected in urine up to 48 hours after alcohol intake. However, it is a poor measure of the amount of alcohol consumed.[134] Measurement of ethanol levels in the blood, urine and breath are also used to assess recent alcohol intake, often in the emergency setting.[134] Other laboratory markers of chronic alcohol misuse include:[135] Macrocytosis (enlarged MCV) Moderate elevation of AST and ALT and an AST: ALT ratio of 2:1 High carbohydrate deficient transferrin (CDT) With regard to alcoholism, BAC is useful to judge alcohol tolerance, which in turn is a sign of alcoholism.[4] Electrolyte and acid-base abnormalities including hypokalemia, hypomagnesemia, hyponatremia, hyperuricemia, metabolic acidosis, and respiratory alkalosis are common in people with alcohol use disorders.[5] However, none of these blood tests for biological markers are as sensitive as screening questionnaires. Prevention Further information: Alcohol education The World Health Organization, the European Union and other regional bodies, national governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism.[136][137] Increasing the age at which alcohol can be purchased, and banning or restricting alcohol beverage advertising are common methods to reduce alcohol use among adolescents and young adults in particular, see Alcoholism in adolescence. Another common method of alcoholism prevention is taxation of alcohol products – increasing price of alcohol by 10% is linked with reduction of consumption of up to 10%.[138] Credible, evidence-based educational campaigns in the mass media about the consequences of alcohol misuse have been recommended. Guidelines for parents to prevent alcohol misuse amongst adolescents, and for helping young people with mental health problems have also been suggested.[139] Because alcohol is often used for self-medication of conditions like anxiety temporarily, prevention of alcoholism may be attempted by reducing the severity or prevalence of stress and anxiety in individuals.[4][7] Management Treatments are varied because there are multiple perspectives of alcoholism. Those who approach alcoholism as a medical condition or disease recommend differing treatments from, for instance, those who approach the condition as one of social choice. Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social support to help them resist a return to alcohol use. Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed to successfully prevent a relapse. An example of this kind of treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. Much of the treatment community for alcoholism supports an abstinence-based zero tolerance approach popularized by the 12 step program of Alcoholics Anonymous; however, some prefer a harm-reduction approach.[140] Cessation of alcohol intake Main article: Alcohol detoxification Medical treatment for alcohol detoxification usually involves administration of a benzodiazepine, in order to ameliorate alcohol withdrawal syndrome's adverse impact.[141][142] The addition of phenobarbital improves outcomes if benzodiazepine administration lacks the usual efficacy, and phenobarbital alone might be an effective treatment.[143] Propofol also might enhance treatment for individuals showing limited therapeutic response to a benzodiazepine.[144][145] Individuals who are only at risk of mild to moderate withdrawal symptoms can be treated as outpatients. Individuals at risk of a severe withdrawal syndrome as well as those who have significant or acute comorbid conditions can be treated as inpatients. Direct treatment can be followed by a treatment program for alcohol dependence or alcohol use disorder to attempt to reduce the risk of relapse.[9] Experiences following alcohol withdrawal, such as depressed mood and anxiety, can take weeks or months to abate while other symptoms persist longer due to persisting neuroadaptations.[77] Psychological A regional service center for Alcoholics Anonymous Various forms of group therapy or psychotherapy are sometimes used to encourage and support abstinence from alcohol, or to reduce alcohol consumption to levels that are not associated with adverse outcomes. Mutual-aid group-counseling is an approach used to facilitate relapse prevention.[8] Alcoholics Anonymous was one of the earliest organizations formed to provide mutual peer support and non-professional counseling, however the effectiveness of Alcoholics Anonymous is disputed.[146] A 2020 Cochrane review concluded that Twelve-Step Facilitation (TSF) probably achieves outcomes such as fewer drinks per drinking day, however evidence for such a conclusion comes from low to moderate certainty evidence "so should be regarded with caution".[147] Others include LifeRing Secular Recovery, SMART Recovery, Women for Sobriety, and Secular Organizations for Sobriety.[148] Manualized[149] Twelve Step Facilitation (TSF) interventions (i.e. therapy which encourages active, long-term Alcoholics Anonymous participation) for Alcohol Use Disorder lead to higher abstinence rates, compared to other clinical interventions and to wait-list control groups.[150] Moderate drinking See also: Managed alcohol program Moderate drinking amongst people with alcohol dependence—often termed 'controlled drinking'—has been subject to significant controversy.[151] Indeed, much of the skepticism toward the viability of moderate drinking goals stems from historical ideas about 'alcoholism', now replaced with 'alcohol use disorder' or alcohol dependence in most scientific contexts. A 2021 meta-analysis and systematic review of controlled drinking covering 22 studies concluded controlled drinking was a 'non-inferior' outcome to abstinence for many drinkers.[152] Rationing and moderation programs such as Moderation Management and DrinkWise do not mandate complete abstinence. While most people with alcohol use disorders are unable to limit their drinking in this way, some return to moderate drinking. A 2002 US study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7% of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. This group, however, showed fewer initial symptoms of dependency.[153] A follow-up study, using the same subjects that were judged to be in remission in 2001–2002, examined the rates of return to problem drinking in 2004–2005. The study found abstinence from alcohol was the most stable form of remission for recovering alcoholics.[154] There was also a 1973 study showing chronic alcoholics drinking moderately again,[155] but a 1982 follow-up showed that 95% of subjects were not able to maintain drinking in moderation over the long term.[156][157] Another study was a long-term (60 year) follow-up of two groups of alcoholic men which concluded that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence."[158] Internet based measures appear to be useful at least in the short term.[159] Medications In the United States there are four approved medications for alcoholism: acamprosate, two methods of using naltrexone and disulfiram.[160] Acamprosate may stabilise the brain chemistry that is altered due to alcohol dependence via antagonising the actions of glutamate, a neurotransmitter which is hyperactive in the post-withdrawal phase.[161] By reducing excessive NMDA activity which occurs at the onset of alcohol withdrawal, acamprosate can reduce or prevent alcohol withdrawal related neurotoxicity.[162] Acamprosate reduces the risk of relapse amongst alcohol-dependent persons.[163][164] Acamprosate is not recommended in those with advanced, decompensated liver cirrhosis due to the risk of liver toxicity.[134] Naltrexone is a competitive antagonist for opioid receptors, effectively blocking the effects of endorphins and opioids. Naltrexone may be given as a daily oral tablet or as a monthly intramuscular injection.[134] Naltrexone is used to decrease cravings for alcohol and encourage abstinence. Alcohol causes the body to release endorphins, which in turn release dopamine and activate the reward pathways; hence in the body Naltrexone reduces the pleasurable effects from consuming alcohol.[165] Evidence supports a reduced risk of relapse among alcohol-dependent persons and a decrease in excessive drinking.[164] Naltrexone should not be used in those with advanced liver disease due to the risk of liver toxicity.[134] Nalmefene also appears effective and works in a similar manner.[164] Disulfiram prevents the elimination of acetaldehyde by inhibiting the enzyme acetaldehyde dehydrogenase. Acetaldehyde is a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hangover symptoms from alcohol use. The overall effect is acute discomfort when alcohol is ingested characterized by flushing, nausea, a rapid heart rate and low blood pressure.[134] Disulfiram should not be used in those with advanced liver disease due to the risk of life-threatening liver toxicity.[134] Several other drugs are also used and many are under investigation. Benzodiazepines are a first line medication in the management of acute alcohol withdrawal, however their use outside of the acute withdrawal period is not recommended.[134] Benzodiazepines with a shorter half life, such as lorazepam or oxazepam are preferred in the treatment of alcohol withdrawal as their shorter half lives and less active metabolites have a lower risk of confusion in those with liver disease.[134] If used long-term, they can cause a worse outcome in alcoholism. Alcoholics on chronic benzodiazepines have a lower rate of achieving abstinence from alcohol than those not taking benzodiazepines. Initiating prescriptions of benzodiazepines or sedative-hypnotics in individuals in recovery has a high rate of relapse with one author reporting more than a quarter of people relapsed after being prescribed sedative-hypnotics. Those who are long-term users of benzodiazepines should not be withdrawn rapidly, as severe anxiety and panic may develop, which are known risk factors for alcohol use disorder relapse. Taper regimes of 6–12 months have been found to be the most successful, with reduced intensity of withdrawal.[166][167] Calcium carbimide works in the same way as disulfiram; it has an advantage in that the occasional adverse effects of disulfiram, hepatotoxicity and drowsiness, do not occur with calcium carbimide.[168] Ondansetron and topiramate are supported by tentative evidence in people with certain genetic patterns.[169][170] Evidence for ondansetron is stronger in people who have recently started to abuse alcohol.[169] Topiramate is a derivative of the naturally occurring sugar monosaccharide D-fructose. Review articles characterize topiramate as showing "encouraging",[169] "promising",[169] "efficacious",[171] and "insufficient"[172] results in the treatment of alcohol use disorders. Evidence does not support the use of selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), antipsychotics, or gabapentin.[164] Research Topiramate, a derivative of the naturally occurring sugar monosaccharide D-fructose, has been found effective in helping alcoholics quit or cut back on the amount they drink. Evidence suggests that topiramate antagonizes excitatory glutamate receptors, inhibits dopamine release, and enhances inhibitory gamma-aminobutyric acid function. A 2008 review of the effectiveness of topiramate concluded that the results of published trials are promising, however as of 2008, data was insufficient to support using topiramate in conjunction with brief weekly compliance counseling as a first-line agent for alcohol dependence.[173] A 2010 review found that topiramate may be superior to existing alcohol pharmacotherapeutic options. Topiramate effectively reduces craving and alcohol withdrawal severity as well as improving quality-of-life-ratings.[174] Baclofen, a GABAB receptor agonist, is under study for the treatment of alcoholism.[175] According to a 2017 Cochrane Systematic Review, there is insufficient evidence to determine the effectiveness or safety for the use of baclofen for withdrawal symptoms in alcoholism.[176] Psilocybin-assisted psychotherapy is under study for the treatment of patients with alcohol use disorder.[177][178] Dual addictions and dependencies Alcoholics may also require treatment for other psychotropic drug addictions and drug dependencies. The most common dual dependence syndrome with alcohol dependence is benzodiazepine dependence, with studies showing 10–20% of alcohol-dependent individuals had problems of dependence and/or misuse problems of benzodiazepine drugs such as diazepam or clonazepam. These drugs are, like alcohol, depressants. Benzodiazepines may be used legally, if they are prescribed by doctors for anxiety problems or other mood disorders, or they may be purchased as illegal drugs. Benzodiazepine use increases cravings for alcohol and the volume of alcohol consumed by problem drinkers.[179] Benzodiazepine dependency requires careful reduction in dosage to avoid benzodiazepine withdrawal syndrome and other health consequences. Dependence on other sedative-hypnotics such as zolpidem and zopiclone as well as opiates and illegal drugs is common in alcoholics. Alcohol itself is a sedative-hypnotic and is cross-tolerant with other sedative-hypnotics such as barbiturates, benzodiazepines and nonbenzodiazepines. Dependence upon and withdrawal from sedative-hypnotics can be medically severe and, as with alcohol withdrawal, there is a risk of psychosis or seizures if not properly managed.[180] Epidemiology Disability-adjusted life year for alcohol use disorders per million inhabitants in 2012 234–806 814–1,501 1,551–2,585 2,838 2,898–3,935 3,953–5,069 5,168 5,173–5,802 5,861–8,838 9,122–25,165 Alcohol consumption per person 2016[181] The World Health Organization estimates that as of 2016 there are about 380 million people with alcoholism worldwide (5.1% of the population over 15 years of age),[12][13] with it being most common among males and young adults.[4] Geographically, it is least common in Africa (1.1% of the population) and has the highest rates in Eastern Europe (11%).[4] As of 2015 in the United States, about 17 million (7%) of adults and 0.7 million (2.8%) of those age 12 to 17 years of age are affected.[14] About 12% of American adults have had an alcohol dependence problem at some time in their life.[182] In the United States and Western Europe, 10–20% of men and 5–10% of women at some point in their lives will meet criteria for alcoholism.[183] In England, the number of "dependent drinkers" was calculated as over 600,000 in 2019.[184] Estonia had the highest death rate from alcohol in Europe in 2015 at 8.8 per 100,000 population.[185] In the United States, 30% of people admitted to hospital have a problem related to alcohol.[186] Within the medical and scientific communities, there is a broad consensus regarding alcoholism as a disease state. For example, the American Medical Association considers alcohol a drug and states that "drug addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences. It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity)."[187] Alcoholism has a higher prevalence among men, though, in recent decades, the proportion of female alcoholics has increased.[48] Current evidence indicates that in both men and women, alcoholism is 50–60% genetically determined, leaving 40–50% for environmental influences.[188] Most alcoholics develop alcoholism during adolescence or young adulthood.[81] Prognosis Alcohol use disorders deaths per million persons in 2012 0 1–3 4–6 7–13 14–20 21–37 38–52 53–255 Alcoholism often reduces a person's life expectancy by around ten years.[21] The most common cause of death in alcoholics is from cardiovascular complications.[189] There is a high rate of suicide in chronic alcoholics, which increases the longer a person drinks. Approximately 3–15% of alcoholics die by suicide,[190] and research has found that over 50% of all suicides are associated with alcohol or drug dependence. This is believed to be due to alcohol causing physiological distortion of brain chemistry, as well as social isolation. Suicide is also common in adolescent alcohol abusers. Research in 2000 found that 25% of suicides in adolescents were related to alcohol abuse.[191] Among those with alcohol dependence after one year, some met the criteria for low-risk drinking, even though only 26% of the group received any treatment, with the breakdown as follows: 25% were found to be still dependent, 27% were in partial remission (some symptoms persist), 12% asymptomatic drinkers (consumption increases chances of relapse) and 36% were fully recovered – made up of 18% low-risk drinkers plus 18% abstainers.[192] In contrast, however, the results of a long-term (60-year) follow-up of two groups of alcoholic men indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence....return-to-controlled drinking, as reported in short-term studies, is often a mirage."[158] History Adriaen Brouwer, Inn with Drunken Peasants, 1620s 1904 advertisement describing alcoholism as a disease Historically the name dipsomania was coined by German physician C. W. Hufeland in 1819 before it was superseded by alcoholism.[193][194] That term now has a more specific meaning.[195] The term alcoholism was first used by Swedish physician Magnus Huss in an 1852 publication to describe the systemic adverse effects of alcohol.[16] Alcohol has a long history of use and misuse throughout recorded history. Biblical, Egyptian and Babylonian sources record the history of abuse and dependence on alcohol. In some ancient cultures alcohol was worshiped and in others, its misuse was condemned. Excessive alcohol misuse and drunkenness were recognized as causing social problems even thousands of years ago. However, the defining of habitual drunkenness as it was then known as and its adverse consequences were not well established medically until the 18th century. In 1647 a Greek monk named Agapios was the first to document that chronic alcohol misuse was associated with toxicity to the nervous system and body which resulted in a range of medical disorders such as seizures, paralysis, and internal bleeding. In the 1910s and 1920s, the effects of alcohol misuse and chronic drunkenness boosted membership of the temperance movement and led to the prohibition of alcohol in many countries in North America and the Nordic countries, nationwide bans on the production, importation, transportation, and sale of alcoholic beverages that generally remained in place until the late 1920s or early 1930s; these policies resulted in the decline of death rates from cirrhosis and alcoholism.[196] In 2005, alcohol dependence and misuse was estimated to cost the US economy approximately 220 billion dollars per year, more than cancer and obesity.[197] Society and culture See also: List of deaths through alcohol The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society; for example, money due to lost labor-hours, medical costs due to injuries due to drunkenness and organ damage from long-term use, and secondary treatment costs, such as the costs of rehabilitation facilities and detoxification centers. Alcohol use is a major contributing factor for head injuries, motor vehicle injuries (27%), interpersonal violence (18%), suicides (18%), and epilepsy (13%).[198] Beyond the financial costs that alcohol consumption imposes, there are also significant social costs to both the alcoholic and their family and friends.[67] For instance, alcohol consumption by a pregnant woman can lead to an incurable and damaging condition known as fetal alcohol syndrome, which often results in cognitive deficits, mental health problems, an inability to live independently and an increased risk of criminal behaviour, all of which can cause emotional stress for parents and caregivers.[199][200] Estimates of the economic costs of alcohol misuse, collected by the World Health Organization, vary from 1–6% of a country's GDP.[201] One Australian estimate pegged alcohol's social costs at 24% of all drug misuse costs; a similar Canadian study concluded alcohol's share was 41%.[202] One study quantified the cost to the UK of all forms of alcohol misuse in 2001 as £18.5–20 billion.[184][203] All economic costs in the United States in 2006 have been estimated at $223.5 billion.[204] The idea of hitting rock bottom refers to an experience of stress that can be attributed to alcohol misuse.[205] There is no single definition for this idea, and people may identify their own lowest points in terms of lost jobs, lost relationships, health problems, legal problems, or other consequences of alcohol misuse.[206] The concept is promoted by 12-step recovery groups and researchers using the transtheoretical model of motivation for behavior change.[206] The first use of this slang phrase in the formal medical literature appeared in a 1965 review in the British Medical Journal,[206] which said that some men refused treatment until they "hit rock bottom", but that treatment was generally more successful for "the alcohol addict who has friends and family to support him" than for impoverished and homeless addicts.[207] Stereotypes of alcoholics are often found in fiction and popular culture. The "town drunk" is a stock character in Western popular culture. Stereotypes of drunkenness may be based on racism or xenophobia, as in the fictional depiction of the Irish as heavy drinkers.[208] Studies by social psychologists Stivers and Greeley attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America.[209] Alcohol consumption is relatively similar between many European cultures, the United States, and Australia. In Asian countries that have a high gross domestic product, there is heightened drinking compared to other Asian countries, but it is nowhere near as high as it is in other countries like the United States. It is also inversely seen, with countries that have very low gross domestic product showing high alcohol consumption.[210] In a study done on Korean immigrants in Canada, they reported alcohol was typically an integral part of their meal but is the only time solo drinking should occur. They also generally believe alcohol is necessary at any social event, as it helps conversations start.[211] Peyote, a psychoactive agent, has even shown promise in treating alcoholism. Alcohol had actually replaced peyote as Native Americans' psychoactive agent of choice in rituals when peyote was outlawed.[212]

- Overcoming Alcoholism: A Journey to Sobriety

Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal.[15] Problematic use of alcohol has been mentioned in the earliest historical records. The World Health Organization (WHO) estimated there were 283 million people with alcohol use disorders worldwide as of 2016.[12][13] The term alcoholism was first coined in 1852,[16] but alcoholism and alcoholic are considered stigmatizing and likely to discourage seeking

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A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a name for community personnel who worked in the new community mental health agencies begun in the 1970s to assist individuals moving from state hospitals, to prevent admissions, and to provide support in homes, jobs, education, and community. These individuals (i.e., state office personnel, private sector personnel, and non-profit, now voluntary sector personnel) were the forefront brigade to develop the community programs, which today may be referred to by names such as supported housing, psychiatric rehabilitation, supported or transitional employment, sheltered workshops, supported education, daily living skills, affirmative industries, dual diagnosis treatment,[1] individual and family psychoeducation, adult day care, foster care, family services and mental health counseling. Psychiatrists - physicians who use the biomedical model to treat mental health problems - may prescribe medication. The term counselors often refers to office-based professionals who offer therapy sessions to their clients, operated by organizations such as pastoral counseling (which may or may not work with long-term services clients) and family counselors. Mental health counselors may refer to counselors working in residential services in the field of mental health in community programs.

Mental Health Professional

A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of impr

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Definition and Historical Context Alcoholism is defined as continued drinking of alcohol despite causing problems. Historical records indicate that problematic alcohol use has been recognized for centuries. The World Health Organization estimated 283 million individuals worldwide had alcohol use disorders by 2016. The term "alcoholism" was coined in 1852, but terms like "alcohol use disorder" are preferred in clinical contexts due to stigma. Health Consequences of Alcohol Use Alcohol addiction leads to severe negative health and social consequences. - Damage to vital organ systems, most prominently the brain, heart, and liver. - Cognitive issues like dementia and Wernicke–Korsakoff syndrome result from heavy usage. - Long-term use increases cancer risk and leads to physical health complications. Withdrawal symptoms can be severe if alcohol intake is abruptly stopped, necessitating medical supervision during cessation. Understanding Alcoholism Alcoholism, also known as alcohol use disorder (AUD), is a chronic disease characterized by an inability to control or stop drinking despite the negative consequences it may cause. It affects individuals physically, psychologically, and socially. Causes of Alcoholism Genetic Factors: Family history can increase the risk of developing alcoholism. Environmental Influences: Exposure to alcohol at a young age or societal norms can contribute to the risk. Psychological Factors: Mental health issues such as depression or anxiety often accompany alcoholism. Signs and Symptoms Inability to limit drinking Experiencing withdrawal symptoms when not drinking Neglecting responsibilities at work, school, or home Continuing to drink despite health problems Developing a tolerance to alcohol Treatment Options Detoxification: A supervised process to safely manage withdrawal symptoms. Counseling: Behavioral therapies to address the psychological aspects of addiction. Medications: Certain medications can help reduce cravings or make drinking less pleasurable. Support Groups: Groups like Alcoholics Anonymous (AA) provide community support. Conclusion Alcoholism is a serious condition that requires understanding and comprehensive treatment. If you or someone you know is struggling with alcohol use, seeking help from a healthcare professional is crucial. Life expectancy can be reduced by up to 10 years due to heavy alcohol use. Drinking during pregnancy can lead to fetal alcohol syndrome, risking the child's health as well. Societal Impact of Alcoholism Alcoholism is linked with increased rates of crime, both violent and non-violent. In 2012, alcohol was attributed to approximately 3.3 million global deaths. Alcohol misuse has significant social implications, leading to issues like marital problems and child neglect, affecting family dynamics. Development and Genetics of Alcoholism Both genetic predisposition and environmental factors contribute to the development of alcohol dependency. - Individuals with a family history of alcohol use disorder are at a higher risk. - Environmental stressors and easy access to alcohol can exacerbate the problem. Diagnosis and Screening Alcoholism is diagnosed using various questionnaires, assessing for signs of dependence and problematic use. Tools like the CAGE questionnaire and AUDIT help in screening patients effectively. Treatment and Management Approaches Treatment varies widely and can include medications, therapy, and support groups. - Benzodiazepines are often used for managing alcohol withdrawal. - Medications like acamprosate and disulfiram may help in preventing relapse. Programs such as Alcoholics Anonymous provide community support and structure for recovery. Comprehensive management often includes addressing dual dependencies and comorbid mental health issues. Warning Signs and Symptoms Key indicators of alcohol misuse include increased tolerance, failed attempts to quit, and neglect of responsibilities. Behavioral changes and health problems associated with alcohol use can escalate over time. Gender Differences in Alcoholism The prevalence of alcohol use disorders differs between genders, with men historically showing higher rates. Women may experience health effects more rapidly than men and could be more vulnerable to liver disease. Conclusion Alcoholism is a complex interplay of genetic, environmental, and societal factors. Recognition and understanding of the symptoms and treatment options can lead to improved outcomes for those affected. Ongoing education and awareness efforts are vital for preventing alcohol use disorders and supporting those in recovery.

Understanding Alcoholism: A Comprehensive Overview

Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal.[15] Problematic use of alcohol has been mentioned in the earliest historical records. The World Health Organization (WHO) estimated there were 283 million people with alcohol use disorders worldwide as of 2016.[12][13] The term alcoholism was first coined in 1852,[16] but alcoholism and alcoholic are considered stigmatizing and likely to discourage seeking

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Black nationalism is a nationalist movement which seeks representation for Black people as a distinct national identity, especially in racialized, colonial and postcolonial societies.[1][2][3][4][5] Its earliest proponents saw it as a way to advocate for democratic representation in culturally plural societies or to establish self-governing independent nation-states for Black people.[3] Modern Black nationalism often aims for the social, political, and economic empowerment of Black communities within white majority societies, either as an alternative to assimilation or as a way to ensure greater representation and equality within predominantly Eurocentric cultures.[1][6][7][8] As an ideology, Black nationalism encompasses a diverse range of beliefs which have variously included forms of economic, political and cultural nationalism, or pan-nationalism.[7][9][10] It often overlaps with, but is distinguished from, similar concepts and movements such as Pan-Africanism, Ethiopianism, the back-to-Africa movement, Afrocentrism, Black Zionism, and Garveyism.[5] Critics of Black nationalism compare it to white nationalism and white supremacy, and say it promotes racial and ethnic nationalism, separatism and Black supremacy. Most experts distinguish between these movements, saying that while white nationalism ultimately seeks to maintain or deepen inequality between racial and ethnic groups, most forms of Black nationalism instead aim to increase equality in response to pre-existing forms of white dominance.[11][12][13] Concepts Black nationalism reflects the idea that, in racialized societies, people of diverse African descent are often treated as a single racial, ethnic and cultural group (such as African Americans in the US or Black Britons in the UK).[14][15] Because of a shared history of oppression and a distinct culture shaped by that history, Black nationalism argues that Black people in the African diaspora therefore form a distinct nation (or multiple distinct nations) and so have a right to representation or self-governance.[16][17][18][19] Black nationalists therefore seek to acquire political and economic power to improve the quality of life and freedoms of Black people collectively.[1][10] Black nationalists tend to believe in self-reliance and self-sufficiency for Black people, solidarity among Black people as a nation, and pride in Black achievement and culture, in order to overcome the effects of institutionalized inequality, self-hate and internalized racism.[20] The roots of Black nationalism extend back to the time of the transatlantic trade in enslaved Africans, when some enslaved Africans revolted or formed independent Black settlements (such as the Maroons), free of European control. By the 19th century, African Americans such as Paul Cuffe and Martin Delany called for free and fugitive Black people to emigrate to Africa to help establish independent nations.[21] In the early 20th century, Jamaican activist Marcus Garvey moved to the US and, inspired by Zionism and Irish independence, promoted Black nationalist and Pan-African ideas, which collectively became known as Garveyism.[22][21] Modern Black nationalist ideas coalesced as a distinct movement during the era of racial segregation in America, as a response to centuries of institutionalized white supremacy, the discrimination African Americans experienced as a result, and the perceived failures of the nonviolent civil rights movement of the time.[1][21][11][5] After the assassination of Malcolm X in 1965, the Black nationalism movement gained increased traction in various African American communities. A focus on returning to Africa became less popular, giving way to the idea that Black people constituted a "nation within a nation," and therefore should seek better rights and political power within a multicultural US.[23] Black nationalists often fought racism, colonialism, and imperialism,[23] and influenced the Organization of Afro-American Unity, Black Panther Party, Black Islam, and the Black Power movement.[21][1] Black nationalism, Black separatism and Black supremacy There are similarities between Black separatism and Black nationalism, since they both advocate for the civil rights of Black people. While Black separatists believe that Black people should be physically separated from other races, primarily whites, Black nationalism focuses primarily on civil rights, self-determination, and democratic representation.[10] These two ideologies can also overlap as "separatist nationalism", which typically manifests in the belief in a literal or metaphorical secession from white American society, and is especially popular among those who have become disillusioned with "deferred American racial equality". In this schema, Black nationalism without Black separatism is called "cultural nationalism". Separatist nationalism often rejects integration into white society—which may extend into rejection of existing political systems—preferring to organise alternative structures. Black nationalism, however, often focuses on engagement with societal and political structures to enact change, such as by attempting to elect Black representatives at the local and national level. Black cultural nationalism has broader support among African-Americans than separatist nationalism; the latter is more popular among young men and people of lower economic status. Examples of Black separatist organizations include the Nation of Islam and the New Black Panther Party.[10] Black nationalists often reject conflation with Black supremacy, as well as comparisons with white supremacists, characterizing their movement as an anti-racist reaction to white supremacy and color-blind white liberalism as racist.[24][25][5] Additionally, while white nationalism often seeks to maintain or re-establish systems of white majority dominance, Black nationalism instead aims to challenge white supremacy through increased civil rights and representation (or independence) for black people as an oppressed minority.[3][6][8] According to the Southern Poverty Law Center, Black nationalist groups have "little or no impact on mainstream politics and no defenders in high office", unlike white supremacists.[11] Revolutionary Black nationalism Black nationalism may also be divided into revolutionary or reactionary Black nationalism. Revolutionary Black nationalism combines cultural nationalism with scientific socialism in order to achieve Black self-determination. Proponents of revolutionary Black nationalism say it rejects all forms of oppression, including class-based exploitation under capitalism.[26] Revolutionary Black nationalist organizations such as the Black Panther Party and the Revolutionary Action Movement also adopted a set of anti-colonialist politics inspired by the writings of notable revolutionary theorists including Frantz Fanon, Mao Zedong, and Kwame Nkrumah.[27] In the words of Ahmad Muhammad (formerly known as Max Stanford) the national field chairman of the Revolutionary Action Movement: We are revolutionary black nationalist[s], not based on ideas of national superiority, but striving for justice and liberation of all the oppressed peoples of the world. ... There can be no liberty as long as black people are oppressed and the peoples of Africa, Asia, and Latin America are oppressed by Yankee imperialism and neo-colonialism. After four hundred years of oppression, we realize that slavery, racism and imperialism are all interrelated and that liberty and justice for all cannot exist peacefully with imperialism."[28] Professor and author Harold Cruse said revolutionary Black nationalism was a necessary and logical progression from other leftist ideologies, as non-Black leftists could not properly assess the particular material conditions of the Black community and other colonized people: Revolutionary nationalism has not waited for Western Marxian thought to catch up with the realities of the "underdeveloped" world...The liberation of the colonies before the socialist revolution in the West is not orthodox Marxism (although it might be called Maoism or Castroism). As long as American Marxists cannot deal with the implications of revolutionary nationalism, both abroad and at home, they will continue to play the role of revolutionaries by proxy.[29] History Overview Historian Wilson Jeremiah Moses suggests the development of Black nationalism can be examined over three different periods, giving rise to the various ideological perspectives within today's Black nationalism.[30] The first period of pre-classical Black nationalism began when the first Africans were brought to the Americas as slaves through the American Revolutionary period.[31] Many of these slaves rebelled against their captors or formed independent Black societies, beyond the reach of Europeans.[32][33] The second period of Black nationalism began after the Revolutionary War, when educated Africans within the colonies became disgusted with the social conditions of Black people, and sought to create organizations that would unite Black people and improve their situation.[34] The third period of Black nationalism arose during the post-Reconstruction era, as community leaders began to articulate the need to separate Blacks from non-Blacks for safety and to collectivize resources. The new ideology of this third period informed the philosophy of groups like the Moorish Science Temple and the Nation of Islam.[30] First period In the New World, as early as 1512, African slaves escaped from Spanish captors and either joined indigenous peoples or eked out a living on their own.[35] The first recorded slave rebellion in the region occurred in what is today the Dominican Republic, on the sugar plantations owned by Admiral Diego Columbus, on 26 December 1522.[36] Especially in the Caribbean, escaped slaves began to form independent Black communities either in exile or with Indigenous American groups, becoming known as maroons. Maroons armed themselves to survive attacks by hostile colonists while also obtaining food for subsistence living and setting up their own communities.[37][38] Others enslaved Africans were freed or bought their freedom, and began to seek their own independence, away from white society. This often included calls to emigrate to Africa and help build independent Black nations there.[31][32][33] Maroon communities On some of the larger Caribbean islands, maroon communities were able to grow crops and hunt for food. As more slaves escaped from plantations, their numbers could grow. Seeking to separate themselves from colonisers, the maroons gained in power amid increasing hostility. They raided and pillaged plantations until the planters began to fear a massive slave revolt.[39] As early as 1655, escaped Africans had formed communities in inland Jamaica, and by the 18th century, Nanny Town and other Jamaican maroon villages began to fight for independent recognition.[40] Jamaican Maroons consistently fought British colonists, leading to the First Maroon War (1728–1740). By 1740, the British governor of the Colony of Jamaica, Edward Trelawny had signed two treaties promising them 2,500 acres (1,012 ha) in Cudjoe's Town (Trelawny Town) and Crawford's Town, bringing an end to the warfare between the communities and effectively freeing the Maroons a century before the Slavery Abolition Act came into effect in 1838.[41] In Cuba, maroon communities formed in the mountains when escaped African slaves joined the indigenous Taínos. Before roads were built into the mountains of Puerto Rico, heavy brush kept many escaped maroons hidden in the southwestern hills where many also intermarried with the natives. Escaped slaves sought refuge away from the coastal plantations of Ponce.[42] In the plantation colony of Suriname, escaped slaves revolted and started to build their own villages. On October 10, 1760, the Ndyuka signed a treaty with the Dutch recognising their territorial autonomy; it was drafted by Adyáko Benti Basiton of Boston, a formerly enslaved African from Jamaica.[43][44] Second period In the mid-to-late 18th century, Methodist and Baptist evangelists during the period of the First Great Awakening (c. 1730–1755) encouraged slave owners to free their slaves, in their belief that all men were equal before God. They converted many slaves to Christianity and approved Black leaders as preachers; Blacks developed their own churches.[45] After the Revolutionary War, educated Africans within the colonies (specifically within New England and Pennsylvania) had become disgusted with the social conditions of Black people. Individuals such as Prince Hall, Richard Allen, Absalom Jones, James Forten, Cyrus Bustill and William Gray sought to create organizations that would unite Black people, who had been excluded from white society, and improve their situation collectively. Institutions such as Black Masonic lodges, the Free African Society, and the African Episcopal Church of St. Thomas lay the groundwork for the independent Black organizations and communities that would follow.[34] Meanwhile, Black people were relocated from the Americas and Britain to new colonies in Sierra Leone and Liberia, paving the way for Black-led nations in those countries. Back in the Caribbean, the Haitian Revolution proved to disparate Black communities across the Americas that they could achieve independence or equality in the law, if they cooperated and worked together.[46][47][48][49][50] First Great Awakening The First Great Awakening (c. 1730–1755) was a series of Christian revivals that swept Britain and its thirteen North American colonies. The revival movement permanently affected Protestantism as adherents strove to renew individual piety and religious devotion. Northern Baptist and Methodist preachers converted both white and Black people, whether the latter were free or not.[45] The message of spiritual equality appealed to many enslaved people and, as African religious traditions continued to decline in North America, Black people accepted Christianity in large numbers for the first time. Black people even began to take active roles in these mixed churches, sometimes even preaching.[51][45] Many leaders of the revivals also proclaimed that enslaved people should be educated so that they could read and study the Bible. This helped establish a new class of educated black people in America.[52] Revolutionary War Before the American Revolutionary War of 1775–1783, few slaves were manumitted. On the eve of the American Revolution, there was an estimated 30,000 free African Americans in Colonial America which accounts for about 5% of the total African American population. The Revolutionary War greatly disrupted slave societies and showed Bl With the 1775 proclamation of Lord Dunmore, governor of Virginia, the British began recruiting the slaves of American revolutionaries and promised them freedom in return.[53] Free Blacks like Prince Hall proposed that Blacks be allowed to join the American side, believing if they were involved in founding the new nation, it would aid in attaining freedom for all Black people.[54] The Continental Army gradually began to allow Blacks to fight in exchange for their freedom.[53] Nova Scotia and Sierra Leone Between 1713 and 1758, the Fortress of Louisbourg on Île-Royale (now Cape Breton Island) became the first Black community in Nova Scotia. During this early period, 381 Black people, some free and others enslaved, escaped or were brought to the Fortress, mostly from the Francophone Caribbean colonies.[55] It was home to a mix of freed and unfree enslaved Africans, who undertook a variety of trades and professions, such as gardeners, bakers, stonemasons, musicians, soldiers, sailors, fishermen, hospital workers, and more.[56][55] After the Revolutionary War, General Washington urged the British to return the Black Loyalists as stolen property, under the Treaty of Paris (1783). The British attempted to keep their promise to the Loyalists by relocating them outside the US.[57] The British transported more than 3,000 Black Loyalists and Jamaican Maroons to resettle in Nova Scotia (part of present-day Ontario). Between 1749 and 1816, approximately 10,000 Black people settled in Nova Scotia.[58] Those settlers who remained in Nova Scotia would go on to found large communities of freed Black people, forming 52 black settlements in total, and would develop their own national identity as Black Nova Scotians.[59][60][61][62] Meanwhile, in 1786, the Committee for the Relief of the Black Poor, a British organization with government support, launched its efforts to establish the Sierra Leone Province of Freedom, a colony in West Africa for London's "Black poor". After Nova Scotia proved a hostile environment for many of the new settlers, with extreme weather as well as racism from the white Nova Scotians, about a third of the Loyalists, and nearly all of the Jamaican Maroons, petitioned the British for passage to Sierra Leone as well, eventually leading to the founding of Freetown in 1792. Their descendants are known as the Sierra Leone Creole people.[63] Black Mutual Aid Societies and Black Churches Main articles: Free African Society, Free African Union Society, and African Episcopal Church of St. Thomas Since most sources of welfare at the time were controlled by whites, free blacks across the early United States created their own mutual aid societies. These societies offered cultural centers, spiritual assistance, and financial resources to their members.[64] The Free African Union Society, founded in 1780 in Newport, Rhode Island, was America's first African benevolent society. Founders and early members included Prince Amy, Lincoln Elliot, Bristol Yamma, Zingo Stevens and Newport Gardner. It became the model for multiple similar organizations across the Northeast.[65] In 1787, Richard Allen and Absalom Jones formed the Free African Society (FAS) of Pennsylvania. It became famous for its members' work as nurses and aides during the Yellow Fever Epidemic of 1793, when many other residents abandoned the city.[66] Notable members included African-American abolitionists such as Cyrus Bustill, James Forten, and William Gray, as well as survivors of the Haitian Revolution in Saint-Domingue, as well as fugitive slaves escaping from the South.[67] The FAS provided guidance, medical care, and financial advice. The last became particularly important, and would establish a model for later African American banks. It operated ten private schools for Blacks across Pennsylvania, performed burials and weddings, and recorded births and marriages. Its activity and open doors served as motivator for growth for the city, inspiring many other Black mutual aid societies to pop up. In 1793, Jones and several other FAS members also founded the St. Thomas African Episcopal Church, a nondenominational church specifically for Black people. This in turn paved the way for the first independent Black churches in the United States.[68][69] The church and its members played a key role in the abolition/anti-slavery and equal rights movement of the 1800s and it would later be involved in the civil rights movement.[70][71] Mutual aid became a foundation of social welfare in the United States until the early 20th century.[citation needed] Liberia See also: Liberia Following the American Revolutionary War, the population of free people of color in the US had grown from 60,000 in 1790 to 300,000 by 1830. The prevailing view of white people was that free people of color could not integrate into U.S. society and slaveowners feared these free Blacks might help their slaves to escape or rebel.[72] In addition, many White Americans believed that African Americans were inherently inferior and should be relocated.[73] In Boston, Black Quaker and activist Paul Cuffe advocated settling freed American slaves in Africa. He was a successful ship owner and in 1815, he attempted a settlement for freedmen on Sherbro Island.[74] By 1811, he had transported some members of the Free African Society to Liberia. He also gained broad political support to take emigrants to Sierra Leone, and in 1816, Cuffe took 38 American Black people to Freetown.[75] He died in 1817 before undertaking other voyages.[76] By 1821, his Sherbro Island settlement had failed and the survivors also fled to Sierra Leone.[74] In 1816, modeled after Cuffe's work and the British resettlement of Black people in Sierra Leone,[76] Robert Finley founded the American Colonization Society (ACS). The ACS and organizations like it aimed to encourage and support the migration of freeborn people of color and emancipated slaves to the continent of Africa.[77] The African American community, who wanted to keep their homes, overwhelmingly opposed the ACS, as did the abolitionist movement.[78][79] Many African Americans, both free and enslaved, were pressured into emigrating anyway.[80][81][82][83][84][85] By 1833, the Society had transported only 2,769 individuals out of the U.S. and close to half the arrivals in Liberia died from tropical diseases. During the early years, 22% of the settlers in Liberia died within one year.[86][81] According to Benjamin Quarles, however, the colonization movement "originated abolitionism" by arousing the free Black people and other opponents of slavery.[87] Between 1822 and the outbreak of the American Civil War in 1861, more than 15,000 freed and free-born African Americans, along with 3,198 Afro-Caribbeans, relocated to Liberia.[88] The settlers carried their culture and tradition with them, gradually developing a Black national identity as Americo-Liberians.[89] Liberia declared independence on July 26, 1847, becoming the first African republic to proclaim its independence and Africa's first and oldest modern republic.[90] The U.S. did not recognize Liberia's independence until February 5, 1862.[89] Haitian Revolution Main article: Haitian Revolution The Haitian Revolution was a successful insurrection by self-liberated slaves against French colonial rule in Saint-Domingue (now the sovereign state of Haiti). The revolt began on 22 August 1791,[91] and ended in 1804 with the former colony's independence. From the revolt, the ex-slave Toussaint Louverture emerged as Haiti's most prominent general. The revolution was the only slave uprising that led to the founding of a state which was both free from slavery (though not from forced labour)[92] and ruled by non-whites and former captives.[93] The successful revolution was a defining moment in the history of the Atlantic World[49][50] and the revolution's effects on the institution of slavery were felt throughout the Americas. Independence and the abolition of slavery in the former colony was followed by a successful defense of the freedoms the former slaves had won, and with the collaboration of already free people of color, of their independence from white Europeans. This had the effect of encouraging other Black communities suffering under slavery or colonialism to imagine independence and self-rule.[46][47][48] Third period The third period of Black nationalism arose during the post-Reconstruction era, particularly among various African-American clergy circles. Separated circles were already established and accepted because African-Americans had long endured the oppression of slavery and Jim Crowism in the United States since its inception. The clerical phenomenon led to the birth of a modern form of Black nationalism that stressed the need to separate Blacks from non-Blacks and build separate communities that would promote racial pride and collectivize resources.[citation needed] Scientific racism In the immediate aftermath of the European Revolutions of 1848, French aristocrat Count Arthur de Gobineau wrote the pseudoscientific An Essay on the Inequality of the Human Races (Essai sur l'inégalité des Races Humaines), legitimizing scientific racism and decrying race-mixing as the doom of civilization.[94][95][96][97] Gobineau's writings were quickly praised by white supremacist, pro-slavery Americans like Josiah C. Nott and Henry Hotze, who translated his book into English, but omitted around 1,000 pages, including parts that negatively described Americans as a racially mixed population.[95][94] He inspired a racist social movement in Germany, named Gobinism, and his works were influential on prominent antisemites like Richard Wagner, Houston Stewart Chamberlain, A. C. Cuza, and the Nazi Party.[95] In 1885, Haitian anthropologist and barrister Anténor Firmin published De l'égalité des races humaines (On the Equality of Human Races) as a rebuttal to Count Arthur de Gobineau's work, challenging the idea that brain size was a measure of human intelligence and noting the presence of Black Africans in Pharaonic Egypt.[98][99] Firmin then explored the significance of the Haitian Revolution of 1804 and the ensuing achievements of Haitians such as Léon Audain, Isaïe Jeanty and Edmond Paul. (Both Audain and Jeanty had obtained prizes from the Académie Nationale de Médecine.)[100] Though marginalized for his belief in the equality of all races, his work influenced Pan-African and Black nationalist thought, and the négritude movement.[101] Firmin influenced Jean Price-Mars, the initiator of Haitian ethnology and developer of the concept of Indigenism, and 20th-century American anthropologist Melville Herskovits.[101] Africa for Africans Martin Delany (1812–1885), an African American abolitionist, was arguably the first proponent of Black nationalism as we understand it today.[102][103] Delany is credited with the Pan-African slogan of "Africa for Africans."[104] Born as a free person of color in what is now West Virginia, and raised in Pennsylvania, Delany trained as a physician's assistant. In 1850, Delany was one of the first three Black men admitted to Harvard Medical School, but all were dismissed after a few weeks because of widespread protests by white students.[105][106] During the cholera epidemics of 1833 and 1854 in Pittsburgh, Delany treated patients, even though many doctors and residents fled the city out of fear of contamination.[107] Beginning in 1847, Delany worked alongside Frederick Douglass in Rochester, New York to publish the anti-slavery newspaper The North Star.[108] Delany dreamed of establishing a settlement in West Africa. He visited Liberia, a United States colony founded by the American Colonization Society, and lived in Canada for several years, but when the American Civil War began, he returned to the United States. When the United States Colored Troops were created in 1863, he recruited for them. Commissioned as a major in February 1865, Delany became the first African American field grade officer in the United States Army. After the Civil War, Delany went to the South, settling in South Carolina, where he worked for the Freedmen's Bureau and became politically active, including in the Colored Conventions Movement. Delany ran unsuccessfully for Lieutenant Governor as an Independent Republican. He was appointed as a trial judge, but he was removed following a scandal. Delany later switched his party affiliation. He worked for the campaign of Democrat Wade Hampton III, who won the 1876 election for governor in a season marked by violent suppression of Black Republican voters by Red Shirts and fraud in balloting.[citation needed] After Emancipation, the back-to-Africa movement eventually began to decline. In 1877, at the end of the Reconstruction era, it would experience a revival as many Black people in the American South faced violence from groups such as the Ku Klux Klan.[109] Interest among the South's Black population in African emigration peaked during the 1890s, a time when racism reached its peak and the greatest number of lynchings in American history took place.[110] New Imperialism and the Scramble for Africa During the period known as New Imperialism (1833 to 1914), European nations colonized and occupied Africa in the "Scramble for Africa". This mobilized Black people in the diaspora to activism in their home nations. Ethiopia and Liberia were the only African countries to maintain their sovereignty and independence during this time.[111][112] The African Times and Orient Review would later encourage others to emigrate to Ethiopia as part of the back-to-Africa movement.[113] In 1919, Marcus Garvey became President of the Black Star Line, designed to forge a link between North America and Africa and facilitate African-American migration to Liberia.[114][115] During World War II, Liberia supported the United States war effort against Nazi Germany, and in turn received considerable American investment in infrastructure, which aided the country's wealth and development. President William Tubman encouraged economic and political changes that heightened the country's prosperity and international profile; Liberia was a founding member of the League of Nations, United Nations, and the Organisation of African Unity.[90] Marcus Garvey Main article: Marcus Garvey 1924 photograph of Marcus Garvey In 1914, Jamaican activist Marcus Garvey established the Universal Negro Improvement Association with his then-wife, Amy Ashwood Garvey, in Kingston. He moved to New York in 1916, and founded the first American UNIA chapter in Harlem in 1918. The UNIA is often considered one of the most powerful Black nationalist movements to date, claiming around a thousand chapters worldwide.[116][117] Marcus Garvey encouraged African people around the world to be proud of their race and see beauty in their own kind. Garvey used his own personal magnetism and understanding of Black psychology to create a movement that appealed to working class African Americans. Garvey's movement, known as Garveyism, was opposed by mainstream Black leaders, and crushed by government action. However, its many alumni remembered its inspiring rhetoric.[116] A central idea to Garveyism was that African people in every part of the world were one people and that, to advance, they should put aside their cultural and ethnic differences to unite under their shared history. He was heavily influenced by the earlier works of Booker T. Washington, Martin Delany, and Henry McNeal Turner.[118] By the 1910s, Alexander Bedward became convinced that God had intended for him to be Aaron to Garvey's Moses — paving the way for the younger man to deliver his people into the Promised Land. Bedward led his followers into Garveyism by finding the charismatic metaphor: one the high priest, the other the prophet, both leading the children of Israel out of exile.[119][120] Frantz Fanon Writer Frantz Fanon fought on the side of the Allies during WWII, and spent several years in France, where his experiences of racism led him to write his first book, Black Skin, White Masks. An analysis of the impact of colonial subjugation on the African psyche, it changed the way people thought of Blackness more generally. While in North Africa, Fanon produced The Wretched of the Earth, where he analyzes the role of class, race, national culture and violence in the struggle for decolonization. Fanon expounded upon his views on the liberating role of violence for the colonized, as well as the general necessity of violence in the anti-colonial struggle. Fanon's books established him as one of the leading anti-colonial thinkers of the 20th century, influencing Black nationalist and decolonial movements worldwide.[121] Black power Ignited by the 1965 assassination of Malcolm X, and the urban riots of 1964 and 1965, the Black power movement emerged from the civil rights movement of the United States.[122] Seen as a reaction to the mainstream civil rights movement's more moderate tendencies and motivated by a desire for safety, the movement was partially inspired by ideologies and individuals from outside the United States, such as American expatriates in newly independent Ghana,[123] but it also impacted others outside of the United States, such as the Black Power Revolution in Trinidad and Tobago.[124] Black power organizations such as the Black Panther Party (BPP) emerged, supporting philosophies ranging from socialism to Black nationalism.[124] Black power activists founded black-owned bookstores,[125] food cooperatives,[126] farms,[127] media,[127] printing presses,[127] schools,[127][128] clinics and ambulance services.[129][130][131] In 1967, Stokely Carmichael and political scientist Charles V. Hamilton wrote Black Power: The Politics of Liberation, drawing on Black nationalist ideas to define the concept of Black power. Stokely Carmichael stated that white supremacy, colonialism, and systemic racism were drivers of disenfranchisement and racism.[132] The authors believed Black power not only lay in dismantling white supremacy, but also in establishing camaraderie within the African American community. The authors disavowed liberal, conformist politics, instead emphasizing sovereignty for the Black community, similar to the goals of Black nationalism.[133] 21st-century Black nationalism Modern Black nationalism encompasses multiple different movements, organizations and philosophies. In America, Black nationalists began to "do what other 'ethnic' groups had done" — i.e., "pursue their interests in a pluralistic political system, subsumed by a capitalistic economic one".[8] In Black Nationalism in America, John H. Bracey Jr., August Meier and Elliott Rudwick argue, "In the arena of politics, black nationalism at its mildest is bourgeois reformism, a view which assumes that the United States is politically pluralistic and that liberal values concerning democracy and the political process are operative."[134] Dean E. Robinson, meanwhile, argues that "modern black nationalism drew upon strategies for political and economic empowerment that had analogies in the wider political landscape."[8] According to the SPLC, Black nationalist groups face a "categorically different" environment than white nationalist groups in the United States; while white supremacy has been championed by influential figures within the Donald Trump administration, for example, Black nationalists have "little or no impact on mainstream politics and no defenders in high office".[11] Patrisse Cullors, a co-founder of the Black Lives Matter Global Network Foundation, has called for reparations for slavery and historic racism in the form of "financial restitution, land redistribution, political self-determination, culturally relevant education programs, language recuperation, and the right to return (or repatriation)," and cited Frantz Fanon's work for "understanding the current global context for Black individuals on the African continent and in our multiple diasporas."[135] The Not Fucking Around Coalition (NFAC) is a Black nationalist and Black separatist organization in the United States. The group advocates for Black liberation, and has been described by some news outlets as a "Black militia", though they have avoided violence.[136][137] The NFAC gained prominence during the 2020–2021 United States racial unrest, making its first reported appearance at a protest near Brunswick, Georgia, over the February 2020 murder of Ahmaud Arbery,[138] though they were identified by local media as "Black Panthers".[139] Historian Thomas Mockaitis said that, "In one sense it (NFAC) echoes the Black Panthers but they are more heavily armed and more disciplined... So far, they've coordinated with police and avoided engaging with violence."[140] John Fitzgerald Johnson, also known as Grand Master Jay and John Jay Fitzgerald Johnson, claims leadership of the NFAC[140][141] and has stated that it is composed of "ex military shooters".[138] In 2019 Grand Master Jay told the Atlanta Black Star that the organization was formed to prevent another Greensboro Massacre.[142][143] Johnson expressed early third period Black nationalist views, putting forth the view that the United States should either hand over Texas to African-Americans so they may form an independent country, or allow African-Americans to depart the United States to another country that would provide land upon which to form an independent nation.[144] Black nationalism around the world Africa Main articles: Pan-Africanism, Ethiopian movement, and Back-to-Africa movement Black nationalism in Africa largely refers to the ideology of black nationalism brought by black communities who have migrated to Africa from the diaspora. It should not be confused with indigenous African nationalism, which is an umbrella term for a group of political ideologies in sub-Saharan Africa, based on the idea of national self-determination and the creation of African nation states.[145] Differences between black nationalism and African nationalism Main article: African nationalism African nationalism emerged during the mid-19th century among the emerging black middle classes in West Africa. Early nationalists hoped to overcome ethnic fragmentation by creating nation-states.[145] In its earliest period, it was inspired by African-American and Afro-Caribbean intellectuals from the Back-to-Africa movement who imported nationalist ideals current in Europe and the Americas at the time.[146] The early African nationalists were elitist and believed in the supremacy of Western culture but sought a greater role for themselves in political decision-making.[146] They rejected African traditional religions and tribalism as "primitive" and embraced western ideas of Christianity, modernity, and the nation state.[146] One of the challenges faced by nationalists in unifying their nation after European rule were the divisions of tribes and the formation of ethnicism. Repatriation and emigration Ex-slave repatriation or the emigration of African-American, Caribbean, and Black British former slaves to Africa occurred mainly during the late 18th century to mid-19th century. In the cases of Sierra Leone and Liberia, both were established by former slaves who were repatriated to Africa within a 28-year period.[147][148][149] Americo-Liberian people See also: Americo-Liberian people Americo-Liberian people are a Liberian ethnic group descended from African Americans, Afro-Caribbeans, and liberated Africans. Americo-Liberians trace their ancestry to free-born and formerly enslaved African Americans who emigrated in the 19th century and became the founders of the state of Liberia, often as part of early black nationalist and back-to-Africa movements. Rastafari See also: Rastafari § Africa Many Rastafari believe that Ethiopia is the Promised Land of the black people. While some take this to mean Africa in the figurative sense, others take it literally and seek to join or establish independent black nations in Africa. In the 1960s, a Rasta settlement was established in Shashamane, Ethiopia, on land made available by Haile Selassie's Ethiopian World Federation.[150] The community faced many problems; 500 acres were confiscated by the Marxist government of Mengistu Haile Mariam.[150] There were also conflicts with local Ethiopians, who largely regarded the incoming Rastas, and their Ethiopian-born children, as foreigners.[150] The Shashamane community peaked at a population of 2,000, although subsequently declined to around 200.[150] Some Rastas have settled in Ghana, Nigeria, Gambia and Senegal.[150][151] Sierra Leone Creole people See also: Sierra Leone Creole people Sierra Leone Creole people are an ethnic group of Sierra Leone descended from freed African-American, Afro-Caribbean, Black British, and Liberated African slaves who settled in the Western Area of Sierra Leone between 1787 and about 1885.[147] Many of the black people who migrated to Sierra Leone did so as part of the early black nationalist and back-to-Africa movements. The colony was established by the British, supported by abolitionists, under the Sierra Leone Company, as a place for freedmen.[152] The settlers called their new settlement Freetown. Today, the Sierra Leone Creoles are 1.2 percent of the population of Sierra Leone.[153] Caribbean Bedwardism See also: Bedwardism Born in 1848 in Saint Andrew Parish, north of Kingston, Jamaica, Alexander Bedward was one of the most successful preachers of Jamaican Revivalism in the 1880s, and would become the central figure of the Jamaica Native Baptist Free Church, or "Bedwardism".[154] Bedward's version of Revivalism was motivated by the inequality he saw between Black and white workers while in Panama, and incorporated African influences.[155] Bedward drew large groups of followers by conducting services which included reports of mass healings. He identified himself with Paul Bogle, the Baptist leader of the Morant Bay rebellion, and he stressed the need for changes to the inequalities in race relations in Jamaican society.[156] In 1889, Harrison "Shakespeare" Woods, an African-American immigrant, officially founded Bedwardism as a new religion in August Town, Saint Andrew Parish, with Bedward as its prophet—referred to as "That Prophet" and "Shepherd."[157][158][159] Bedwardian literature described it as the successor to Christianity and Judaism, though its teachings differed little from those of most Christian denominations. Even so, because the movement likened the ruling classes to the Pharisees, it met with disapproval and even suppression. Bedwardism originated the belief that August Town, Jamaica corresponds to Jerusalem for the Western world, which would influence Rastafari beliefs.[160] Bedward also variously claimed to be the reincarnation of prophets such as Moses, Jonah and John the Baptist, and was twice ruled insane by the colonial Jamaican courts.[161] Bedwardism later drew inspiration from the rise of Marcus Garvey and his Universal Negro Improvement Association (UNIA).[160][161] The movement lost steam in 1921 after Bedward and hundreds of his followers marched into Kingston, where he failed to deliver on his claim to ascend into Heaven, and many were arrested. In 1930, Bedward died in his cell of natural causes.[162][163] Many of his followers became Garveyites and Rastafarians, and brought with them the experience of resisting systems of colonial and white supremacist oppression. While some Rastafari cast Marcus Garvey as a Messiah, Bedward sometimes takes the role of John the Baptist.[164][162] Rastafari See also: Rastafari Rastafari emerged from early Black nationalism and shaped the Black nationalism that followed.[165][166] It was influenced by the Great Revival of 1860–61, which converted large numbers of Black preachers in Jamaica;[166][167][168] and the Ethiopian movement within Black churches,[169][168] which regarded the biblical "Ethiopia" as a synonym for Africa as a whole.[168] By 1916, some Garveyists, Ethiopianists and Pan-Africanists believed Africa was poised for a great event, prophesied in Psalm 68:31 of the Bible: "Princes shall come of Egypt; Ethiopia shall soon stretch forth its hands unto God".[170][171][172][173] Black Christians saw this as a promise of God's plan to lift Black people from oppression, as with the Israelites and early Christians before them, while early Black nationalists saw it as a call to action.[172] By the 1920s, some Black Christian groups had begun to develop their own canon of Afrocentric religious texts in opposition to the Eurocentrism of mainstream Christian churches.[174] Between 1924 and 1928, Anguillan preacher Robert Athlyi Rogers, inspired Marcus Garvey, wrote the Holy Piby, also known as the Black Man's Bible. It was intended for an Afrocentric Abrahamic religion, known as the Afro-Athlican Constructive Gaathly.[175] Rogers declared Garvey an "apostle of God" and dedicated the seventh chapter of the Holy Piby to him. His theology described Black people as God's chosen people, and preached self-reliance and self-determination.[176] Around 1926, Jamaican preacher Fitz Balintine Pettersburg wrote The Royal Parchment Scroll of Black Supremacy, which decried white colonialism and the oppression of Black people.[177] In the book, Pettersburg declared himself "King Alpha" and his wife as "Queen Omega", suggesting a fulfillment of the Ethiopianist promise of Psalm 68.[178][177] In August 1930, Marcus Garvey's play Coronation of an African King was performed in Kingston. Inspired by the coronation of Haile Selassie that same year, and drawing on Psalm 68, it featured the coronation of a fictional Sudanese prince.[115] When Haile Selassie was crowned Emperor of Ethiopia in November, his Ethiopian title was Nəgusä Nägäst (literally "King of Kings", a common epithet for Jesus). He was the first sovereign monarch crowned in crowned in Sub-Saharan Africa since 1891.[168][179][180] According to Ethiopian tradition, Haile Selassie was descended from King David, King Solomon, and the Queen of Sheba. Some Jamaican preachers, such as Archibald Dunkley and Joseph Hibbert, saw Selassie's coronation as proof he was the Black messiah they saw prophesied in the Book of Revelation, the Book of Daniel, and the Psalms.[168][179][180] That year, Dunkley proclaimed Rastafari was the name of God, after Haile Selassie's pre-regnal title and name: Ras Tafari Makonnen. In 1933, he founded the King of Kings Ethiopian Mission in Kingston.[181] In 1931, Hibbert, a former member of the Ancient Order of Ethiopia masonic lodge, concluded that Haile Selassie was divine after studying the Ethiopian Bible. He left the Ethiopian Baptist Church, founded by the 18th-century Jamaican Baptist George Lisle, and formed the Ethiopian Coptic Faith ministry, in St. Andrew Parish. When he later transferred his ministry to Kingston, he found Leonard Howell was already teaching similar doctrines.[182][183] From 1933, Howell had begun preaching that Selassie was the "Messiah returned to earth"—an important symbol for the African diaspora.[184][185][186][166] Under his Hindu pen name G. G. Maragh (for Gangung Guru), Howell published The Promised Key, which synthesized material from the Royal Parchment Scroll of Black Supremacy and the Holy Piby.[187] Most significantly, the identities of "King Alpha and Queen Omega" were changed from Pettersburg and his wife to Selassie and Empress Menen Asfaw, solidifying the prophecy of Psalm 68. This Howellite innovation became an article of faith for many Rastafari.[187] Howell later formed the Pinnacle settlement in Saint Catherine Parish that became associated with Rastafari.[188][189] Rastafari's new Black religious canon—with its anti-colonial message, and promotion of a positive Black identity—threatened colonial authorities who attempted to quell the growing movement with the arrest, trial for sedition, and imprisonment of these early Black preachers.[166][181] In 1937, the Ethiopian World Federation (EWF) was founded in New York City by Dr. Malaku Bayen and Dorothy E. Bayen, under the advice of Haile Selassie.[186] Dr. Bayen was the cousin and personal physician of the Emperor, and a prince.[190][191] Dunkley, Hibbert and Howell would also join the organization,[181] which aimed to mobilize African American support for the Ethiopians during the Italian invasion of 1935-41, and to embody the unity of Black people worldwide.[186][192] Ethiopia's resistance against European imperialism made it a source of pride and inspiration among Black people in the diaspora.[111][112][181] Europe Black Liberation Front The Black Liberation Front (BLF) formed in London in 1971 and ceased activities in 1993.[193] Much more secretive than the British Black Panthers, most of their members remained anonymous,[194] but it was nevertheless considered one of the most effective Black Power organizations in the UK, despite threats and attacks from the National Front, the media and the police, as well as state surveillance.[193] The BLF's politics were informed by Pan-African socialism and black nationalism.[194] The BLF had links with Pan-African groups worldwide, often sending money back to Africa, and helped organize the Africa Liberation Day celebrations in the 1970s and 1980s. They also published the Grassroots Newspaper, which often featured creative work, alongside news on anti-colonial movements back in Africa and the Caribbean.[193] BLF was especially concerned with educational inequalities in the UK. Because black-authored books were extremely difficult to source in London at the time, the BLF established three book shops filled with black history, black politics and black literature. The Grassroots store front on Ladbroke Grove was one of these book shops, and became a community hub. The Headstart bookshop provided information for young people and at the weekends, volunteers ran math, English and black history classes there.[193] BLF ran prisoner welfare schemes, and schemes to support black women. Ujima Housing Association was established by the BLF to address issues around discrimination in housing. Young people and mothers were especially welcome. By 2008, when Ujima was merged into London and Quadrant, its assets were valued at £2 billion.[193] British Black Panther Movement Main article: British Black Panthers The British Black Panthers emerged after a 1967 visit by Stokey Carmichael and Malcolm X to London. The British chapter was officially formed the following year by Obi Egbuna and Darcus Howe. Egbuna had ambitions for the BBPM to be a militant, underground revolutionary organization. When Althea Jones-LeCointe later came to lead the organization, she wanted it to remain a grassroots organization, focused on the plight of workers, the unemployed, and young people. The BBPM also published a newspaper, Black Peoples News Service, and focused on injustice in education, policing, and government. The chapter was dissolved in 1972, but famous members included Neil Kenlock, Linton Kwesi Johnson, Olive Morris, Barbara Beese, Liz Obi and Beverley Bryan.[194] North America Black Panther Party Main article: Black Panther Party The Black Panther Party (originally the Black Panther Party for Self-Defense) was a Marxist–Leninist and black power political organization founded by college students Bobby Seale and Huey P. Newton in October 1966 in Oakland, California.[195][196] Originally, the party organized in an emergent black nationalist tradition inspired by Malcolm X and others.[197] Upon its inception, the party's core practice was its open carry patrols ("copwatching") designed to challenge the excessive force and misconduct of the Oakland Police Department. From 1969 onward, the party created social programs, including the Free Breakfast for Children Programs, education programs, and community health clinics. The Black Panther Party advocated for class struggle, claiming to represent the proletarian vanguard.[198] The party was active in the United States between 1966 and 1982, with chapters in many major American cities, including San Francisco, New York City, Chicago, Los Angeles, Seattle, and Philadelphia.[199] They were also active in many prisons and had international chapters in the United Kingdom and Algeria.[200] Malcolm X Main article: Malcolm X Between 1953 and 1964, while most African leaders worked in the civil rights movement to integrate African-American people into mainstream American life, Malcolm X was an avid advocate of Black independence and the reclaiming of Black pride and masculinity.[201] He initially maintained that Black people were better served by separatism—with control of politics and economics within their own communities—than the tactics of civil rights leader Rev. Martin Luther King Jr. and mainstream civil rights groups such as the SCLC, SNCC, NAACP, and CORE. Malcolm X believed that to achieve anything, African Americans would have to reclaim their national identity, embrace the rights covered by the Second Amendment, and defend themselves from white hegemony and extrajudicial violence.[202] In April 1964, Malcolm X participated in a Hajj (pilgrimage to Mecca); Malcolm subsequently shifted to mainstream Islam and recanted many of his earlier opinions, including his prior commitment to Black separatism.[203] He still supported Black cultural nationalism and advocated for African Americans to proactively campaign for equal human rights, instead of relying on white citizens to change the laws. Malcolm X articulated his new philosophy in the charter of his Organization of Afro-American Unity (which he patterned after the Organization of African Unity), and he inspired some aspects of the future Black Panther Party.[204] 1964 photograph of Malcolm X In 1965, Malcolm X expressed reservations about Black nationalism, saying, "I was alienating people who were true revolutionaries dedicated to overturning the system of exploitation that exists on this earth by any means necessary. So I had to do a lot of thinking and reappraising of my definition of black nationalism. Can we sum up the solution to the problems confronting our people as black nationalism? And if you notice, I haven't been using the expression for several months."[205] Nation of Islam Main article: Nation of Islam Like Rastafari, Nation of Islam was partly influenced by Garveyism.[206] Wallace D. Fard founded the Nation of Islam in the 1930s as a reaction to the perceived white supremacy of Christianity.[207][208][206] Since 1977, it has been under Louis Farrakhan's leadership. High-profile members included the Black nationalist activist Malcolm X and the boxer Muhammad Ali. The group believed Christianity had been forced on Black people during slavery, that Islam was the original religion of Black people, and that Black identity could be reclaimed through Islam.[206] Deviating significantly from mainstream Islam, Muhammad also taught that Fard was a Messiah and that he himself was sent by God to prepare Black people for global supremacy and destruction of "the white devil".[209] The Nation promoted economic self-sufficiency for Black people, and talked of establishing a separate Black nation in Georgia, Alabama, or Mississippi.[210] Black nationalism in popular culture Political hip hop As hip hop is a music genre originally created and dominated by African-Americans, political rappers often reference and discuss black liberation, black nationalism and the black power movement. Numerous hip hop songs express anti-racist views, such as the popular The Black Eyed Peas song "Where Is the Love?". Artists who advocate more radical black liberationist views have remained controversial. Artists such as Public Enemy, Tupac Shakur, Ice Cube, Game, and Kendrick Lamar have advocated black liberation in their lyrics and poetry. In Tupac Shakur's poem, "How Can We Be Free", Shakur discusses the sacrifices of black political prisoners and the rejection of patriotic symbols.[citation needed] In the 2010s, artists such as Killer Mike and Kendrick Lamar have released songs criticizing the War on Drugs and the prison industrial complex from an anti-racist perspective. Hip hop music continues to draw attention to the struggles of black people and attracts a young demographic of activists. Kendrick Lamar and many other rappers have been credited with creating discussions regarding "blackness" through their music.[211] Criticism General criticism In his Letter from Birmingham Jail, Martin Luther King Jr. characterized black nationalism with "hatred and despair", writing that support for black nationalism "would inevitably lead to a frightening racial nightmare."[212] Norm R. Allen Jr., former director of African Americans for Humanism, calls black nationalism a "strange mixture of profound thought and patent nonsense": On the one hand, Reactionary Black Nationalists (RBNs) advocate self-love, self-respect, self-acceptance, self-help, pride, unity, and so forth—much like the right-wingers who promote 'traditional family values.' But—also like the holier-than-thou right-wingers—RBNs promote bigotry, intolerance, hatred, sexism, homophobia, anti-Semitism, pseudo-science, irrationality, dogmatic historical revisionism, violence, and so forth.[213] Tunde Adeleke, Nigerian-born professor of History and Director of the African American Studies program at the University of Montana, argues in his book UnAfrican Americans: Nineteenth-Century Black Nationalists and the Civilizing Mission that 19th-century African American nationalism embodied the racist and paternalistic values of Euro-American culture and that black nationalist plans were not designed for the immediate benefit of Africans but to enhance their own fortunes.[214] In Black Nationalism in America, John H. Bracey Jr., August Meier and Elliott Rudwick argue, "In the arena of politics, black nationalism at its mildest is bourgeois reformism, a view which assumes that the United States is politically pluralistic and that liberal values concerning democracy and the political process are operative."[134] Dean E. Robinson, meanwhile, argues that "modern black nationalism drew upon strategies for political and economic empowerment that had analogies in the wider political landscape" and that, shaped by circumstances in America, black nationalists merely began to "do what other 'ethnic' groups had done" — i.e., "pursue their interests in a pluralistic political system, subsumed by a capitalistic economic one".[8] Criticism by black feminist activists Black feminists in the U.S., such as Barbara Smith, Toni Cade Bambara, and Frances Beal, have also lodged sustained criticism of certain strands of black nationalism, particularly the political programs which are advocated by cultural nationalists. Black cultural nationalists envisioned black women only in the traditional heteronormative role of the idealized wife-mother figure. Patricia Hill Collins criticizes the limited imagining of black women in cultural nationalist projects, writing that black women "assumed a particular place in Black cultural nationalist efforts to reconstruct authentic Black culture, reconstitute Black identity, foster racial solidarity, and institute an ethic of service to the Black community."[215] A major example of black women as only the heterosexual wife and mother can be found in the philosophy and practice called Kawaida exercised by the US Organization. Maulana Karenga established the political philosophy of Kawaida in 1965. Its doctrine prescribed distinct roles between black men and women. Specifically, the role of the black woman as "African Woman" was to "inspire her man, educate her children, and participate in social development."[216] Historian of black women's history and radical politics Ashley Farmer records a more comprehensive history of black women's resistance to sexism and patriarchy within black nationalist organizations, leading many Black Power era associations to support gender equality.[217] Black nationalist hate groups Black nationalism and antisemitism Further information: African American–Jewish relations and Nation of Islam and antisemitism Due to the high-profile nature of changing African American–Jewish relations,[218][219][220][221][222][223] there is much research on antisemitism among black nationalist groups and individuals.[224][225][226] In the late 1950s, both Muslim and non-Muslim black nationalists engaged in antisemitism.[224] Some activists argued that American Jews, as well as Israel, were "the central obstacle to black progress"[224] and that Jews were "the most racist whites",[225] or they portrayed Jews as "parasitic intruders who accumulated wealth by exploiting the toil of black people in America's ghettos and South Africa".[225] Some black nationalists have alleged that black people "are the original Semites",[227] have engaged in Holocaust trivialization,[225] or may even be Holocaust deniers.[228][226] Notable black nationalist leaders who have professed antisemitic sentiments include Amiri Baraka, Louis Farrakhan, Kwame Ture, Leonard Jeffries and Tamika Mallory among others.[229] Black nationalism and the Southern Poverty Law Center Main article: List of organizations designated by the Southern Poverty Law Center as hate groups § Black separatist and black nationalist The Southern Poverty Law Center (SPLC) said that while black nationalist and black separatist hate groups exist, "The black nationalist movement is a reaction to centuries of institutionalized white supremacy in America," and it also notes that there is a lack of high-level political support for black nationalist and black separatist groups as opposed to white supremacist groups.[11] According to the SPLC, black nationalist groups face a "categorically different" environment than white hate groups in the United States; while white supremacy has been championed by influential figures within the Donald Trump administration, black nationalists have "little or no impact on mainstream politics and no defenders in high office".[11] The SPLC has designated a number of black nationalist groups as hate groups, including the Black Riders Liberation Party, The Israelite Church of God in Jesus Christ, the Israelite School of Universal Practical Knowledge, the New Black Panther Party, the Revolutionary Black Panther Party and The United Nuwaupians Worldwide. The Southern Poverty Law Center has previously been criticized for conflating black nationalism with hate more generally.[230] It later clarified that "black nationalists are assessed as a loose-knit network of various hate groups, charismatic leaders, as well as unaffiliated individuals who may identify as black nationalists, but [who] do not associate with black nationalist groups," and reiterated that "violent black nationalists" were distinct from other forms of black activism.[231] They also challenged the notion that black activists of diverse ideologies should be grouped as "black identity extremists" by the FBI.[231] In October 2020, the SPLC announced that it would no longer use the category "black separatism", in order to foster a more accurate understanding of violent extremism and avoid creating a false equivalency between black separatism and white supremacist extremism. This change in the terminology which is used by the SPLC also includes the removal of "black nationalism" as a category of hate groups from the SPLC's website.[232][233]

What are the key principles of Black Nationalism as a nationalist movement?

Black nationalism is a nationalist movement which seeks representation for Black people as a distinct national identity, especially in racialized, colonial and postcolonial societies.[1][2][3][4][5] Its earliest proponents saw it as a way to advocate for democratic representation in culturally plural societies or to establish self-governing independent nation-states for Black people.[3] Modern Black nationalism often aims for the social, political, and economic empowerment of Black communities w

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A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a name for community personnel who worked in the new community mental health agencies begun in the 1970s to assist individuals moving from state hospitals, to prevent admissions, and to provide support in homes, jobs, education, and community. These individuals (i.e., state office personnel, private sector personnel, and non-profit, now voluntary sector personnel) were the forefront brigade to develop the community programs, which today may be referred to by names such as supported housing, psychiatric rehabilitation, supported or transitional employment, sheltered workshops, supported education, daily living skills, affirmative industries, dual diagnosis treatment,[1] individual and family psychoeducation, adult day care, foster care, family services and mental health counseling.