In this video I provide a brief overview of some of the general issues surrounding the treatment of mental illness. These include the goal of treatment, who provides treatment, who receives treatment, and ethical considerations related to treatment. Disclaimer: This channel is for educational purposes only and is not intended as medical advice for the diagnosis or treatment of psychological disorders.

Video Transcript

Hi, I’m Michael Corayer and this is Psych Exam Review. In this video we’re going to start the unit looking at the treatment of mental illness. So in the previous unit we looked at a number of psychological disorders and the symptoms associated with those disorders and now we’ll start thinking about how these disorders can be treated.

Now in this video I’m going to provide a basic overview of some of the main issues surrounding treatment and the first of these is what the purpose of treatment is. We can say that regardless of the particular treatment in question, the goal of treatment is always to change thoughts, behaviors, or emotions. So people who are suffering from mental illness have certain thoughts, behaviors, or emotions that are distressful and we want to try to change these. And that means we have to have the underlying belief that change is possible; that it is possible for people who are suffering to change their thinking or change their behavior or change their emotional state, in order to reduce the distress that those symptoms are causing. And unfortunately this view that people suffering from mental illness can change has not always been the case. In the past, throughout history, unfortunately people suffering from mental illness have often also had to suffer from persecution or from cruel practices that we can only describe as tortures. And fortunately today the view that change is possible is much more common and for this we owe a debt of gratitude to some of the early reformers like Philippe Pinel, who encouraged the use of exercise and fresh air for people suffering from mental illness rather than the use of chains and shackles. And Dorothea Dix, who helped to establish mental health institutions in the United States and also helped to push for more humane treatments of people suffering from mental illness.

So the next general issue we can look at is who provides treatment. So often students taking introductory psychology classes might not be totally familiar with some of the different approaches to providing treatment and the different career paths that might be available. First we can talk about psychiatrists, and so psychiatrists hold an MD or a DO, that’s a doctor of Osteopathic Medicine, and they are physicians – licensed physicians, and they specialize in mental health issues. And because they are licensed physicians that means they are able to prescribe medications for people who are suffering from mental illness.

Now other physicians involved in mental health issues are neurologists, and so these also hold an MD or a DO, and they specialize in the brain and the nervous system, which of course is going to be relevant for a number of mental health issues.

Next we have clinical psychologists and they hold a PhD or a PsyD and they specialize in psychotherapy; so that means they’re using treatments other than medications for treating mental illness, and in most cases they’re not able to prescribe medication to patients. This is changing in a few places and there are some cases where clinical psychologists are able to prescribe things like antidepressants, but generally they’re not able to prescribe medication to their patients.

Next we have counseling psychologists and these usually have a Masters or a PhD and they specialize in mild to moderate mental health issues. So when we’re talking about counseling we’re often talking about things that are not so severe and so things like family or couples therapy things like grief counseling or career counseling, where a person may be suffering from some distress or they may have some dysfunction related to their occupation or some social dysfunction but it’s not severe enough that they might need to see a psychiatrist. So they could go to see a counseling psychologist who might be able to provide them with the help that they need.

And lastly we have clinical social workers and so clinical social workers have a two-year Master’s degree in social work and they may also have some additional training in particular types of counseling that they specialize in. And you’d find clinical social workers working in a range of different places; they might be working at mental health facilities, they could also be working at substance abuse clinics, or Veterans Affairs centers, or child welfare services.

Okay so those are some of the people who provide treatment for mental illness and the next general issue we have is, why do we treat mental illness? Now this seems like a stupid question because, of course, mental illness involves suffering and it’s distressful to people who are suffering from mental illness and it’s not just that their symptoms cause distress but they also have suffering in other areas. So they suffer consequences and costs related to their social lives, to their financial lives, and they have occupational costs as well. They might not be able to hold certain jobs, or they may have difficulty completing their work and so there’s a number of costs that people suffering from mental illness have to deal with. But we should also remember that there are costs to society as well and so when we talk about treatment we’re not only focused on getting rid of these costs to the actual sufferers but we also can think about how this improves society as a whole. Because having people who are suffering from mental illness means lost productivity and absenteeism at work, so there are people who, if they were treated, they might be able to work more productively or more often. And we can also think about the costs of treatments and institutions that provide those treatments. Those are costs to society and so we want those treatments to be as effective as possible. The more effective our institutions are, the more effective our treatments are, then the better our society can function and this benefits everyone, not just the people who have mental illnesses.

So who receives treatment? Well, unfortunately many people who are suffering don’t receive treatment and there’s a number of reasons why somebody who’s suffering from a mental illness might not receive treat. And so the first reason is they might not recognize that they need treatment. They may have misconceptions about mental health or about their symptoms and so they might not realize that they need to seek help or treatment or they might not understand the severity of the symptoms that they’re suffering from. So they may not be able to have the insight into their own symptoms to recognize that this is something that needs to be treated. And even if they do recognize the need and even if they’re willing and able to receive the help, it doesn’t necessarily mean that they’ll get treatment.

And part of this might have to do with the availability of professionals in their area. So they might be suffering from particular symptoms of a particular disorder and there simply might not be people around available to help them. And even if there are people around it could be the case that a person would be willing to receive help but they’re not well informed of the options that are available to them. So they might think “yes I would get help if it were available” but they think it’s not an option for them they don’t know what sorts of options are available.

And then even people who are willing and able to receive help; they have professionals in their area and they’re well informed of those options, even all of these people don’t necessarily get treatment. And so this brings us to other barriers that can get the way. One of these is stigmatization and this can come from any number of places; it could be their family environment or their their social group where there’s stigma associated with certain mental illnesses or with getting treatment, you know, there may be pressures that, you know, one has to learn to deal with their own problems independently. And this stigmatization could reduce the chance that the person goes to get help. There also could be bureaucratic hurdles involved in preventing someone from getting treatment. One might be just being put onto a waitlist. So the person might be willing to get treatment and know about the options but they might not have that treatment available for the person at that time.

There’s also financial difficulties that could get in the way of paying for treatments and again depending on the disorder the person suffering from or the type of treatment that they’re seeking, these costs could be substantial and the person simply might not be able to afford this. And this brings us to the possibility of insurance coverage being involved. So people might have a disorder they need treatment for, but it might not be covered by their insurance and that means they might not actually seek out the treatment even though it’s fairly clear that they might need it or they would benefit from it.

And we also have linguistic and cultural barriers they can get in the way so people who but might benefit greatly from something like psychotherapy, which is going to involve a very deep communication with another person, if there’s not a therapist in their area who has the fluency in the language that the patient needs then they might not be able to have this treatment option. Or there could be cultural barriers where certain cultural views related to either stigmatization or what sort of treatments are acceptable to the patient those might not be available.

It’s also the case that the best treatments might not be available so somebody might have a disorder they recognize they need treatment but the best treatment for that particular disorder and that particular patient might not be available in their area. And so they may either settle for a less effective treatment or decide that they don’t want any treatment at all, if they if they can’t get this particular treatment that would be suited for them. So all of these can help to explain why it is that some people aren’t getting treatment that they would benefit from.

And lastly we can consider some of the ethics associated with treatment. In the ideal world, everybody who had some mental illness would recognize the need for treatment and they would then freely choose to get the best possible treatment for what they were suffering from. But that’s the ideal world, unfortunately that’s not how things really are. There are cases where people either don’t recognize the need or they choose not to get treatment and that brings us to this ethical question of whether we can force people to get treatment. We’ve already talked about how treatment is beneficial, not just to those people but to society in general, and so we should wonder is it possible that we should be forcing certain people with certain disorders that they have to get certain treatments.

And this brings us to a point that was brought up by Thomas Szasz in his Myth of Mental Illness that psychiatrists aren’t just the agents of the ill. Ideally they would be; they would always be on the side of the person who’s suffering and they’re trying their best to help that person. But unfortunately psychiatrists often have to act as agents of others and in some cases these might be the family or friends of the person who’s suffering, either because the person doesn’t realize that treatment is available, or they resist getting treatment and family and friends may try to coerce that person and try to get the psychiatrist on their side to convince this person that they need to get treatment. Or psychiatrists might need to act as the agents of other organizations like law enforcement, or the court system, or for private organizations and that brings us to the next ethical issue which is the role of private organizations in defining mental illness or in defining what sorts of symptoms should require treatment.

One of the main criticisms of classification systems like the DSM is that it can represent a “medicalization of daily life” and what that means is that some types of suffering might be seen as normal aspects of the human condition. And yet the DSM lists hundreds of possible disorders and so if you look through the DSM, you’ll see there are certain things that you probably experience, there are things that are distressful that would fall into some symptom category in the DSM somewhere. We might wonder whether these are things that are just normal parts of life or if these actually represent illnesses that therefore need treatment. And if we were being critical of certain organizations like pharmaceutical companies we might wonder how much they’re pushing for a larger customer based by expanding our definition of what mental illness is or by expanding what we see as symptomatic of mental health issues, rather than just saying those are just the difficulties of life, those are the problems in living.

One particular example of this is if we look at the DSM-5 we see that the in the case of major depressive disorder the bereavement exclusion, it used to be the case in earlier editions of the DSM that if you were suffering from symptoms of depression but these were occurring after the loss of a loved one or some other type of you were, you know, bereavement then your symptoms wouldn’t be seen as symptomatic of major depressive disorder. We’d say yes you’re suffering, yes, you have depressed mood but because it’s in response to this life event that was you know causing a lot of grief. Therefore this means that you don’t have major depression even though you are suffering.

But controversially in the DSM-5 this bereavement exclusion was removed and so now even if you are suffering the loss of a loved one recently and you go to a psychiatrist and they see these symptoms of depression, now they can give you this diagnosis of major depressive disorder and that means you could then receive something like an antidepressant medication in order to help you cope with these symptoms.

And we might wonder if we’re medicating away negative emotions, whether this is always ethically appropriate. Are there times when we should suffer negative emotions? Where it’s okay to experience them despite the suffering? We recognize that it’s it’s part of life and we might actually want the suffering? Maybe it tells us about the relationship we had with this person who was lost or or something like that. So that brings the question what kinds of suffering should be treated and what what kinds should just be dealt with on their own? What kinds are just part of life and we shouldn’t be trying to chemically excise them from our brains or bodies?

And then the question of well, who gets to decide this? And how do we incorporate that into whether or not somebody should be getting treatment for some kind of suffering that they’re experiencing or not? Of course I don’t have the answers to these ethical questions and I’m raising them in this video just to get you to think about the role of these possible ethical issues in how we determine who gets treated and when they get treated or why they are treated. I hope you found this helpful if so please like the video and subscribe to the channel for more. Thanks for watching!