Mental Illness - Mood disorders
Mood disorders cause a disturbance in mood (state of mind) and include depression and bipolar disorders. Mood disorders can be devastating as, depending on their severity, they can emotionally paralyze people, rendering them unable to work or attend classes or even enjoy the most basic things. Mood disorders can also disrupt appetite and sleep patterns and an individual's sense of well-being. It is not known why some people suffer from mood disorders while others do not.
BED-WETTING
For many children, nighttime enuresis, or bed-wetting, is an embarrassing and painful problem. The inability to control one's bladder while sleeping is stressful and, unfortunately, still something of a mystery. Enuresis will not be diagnosed until after a child is at least five years old (the age by which most children have been toilet-trained). At age five, the DSM estimates that approximately seven percent of boys and three percent of girls are enuretic. Furthermore, the majority of enuretics have always had problems with bladder control during the night (they are called primary enuretics); secondary enuretics, in the minority, were once able to control their bladders but have lost that ability.
A variety of factors have been blamed for bedwetting. There is a strong genetic link for bedwetting (if a parent wet the bed, the child is much more likely to do so). Certain medical conditions cause enuresis, such as urinary tract infections and kidney disease. Some psychoanalytic therapists have suggested that bed-wetting is an act that can indicate anger toward parents. Still other schools of therapists have proposed that children encounter enuresis when they have been toilet-trained at too early an age.
Whatever the cause, enuresis is treatable. Using principles of classical conditioning (see Chapter 15: Mental Health Therapies), Drs. O.H. Mowrer and W.M Mowrer developed the bell-and-pad apparatus, which involves a pad that, when moisture hits it, sounds a bell, waking the child and prompting him to go to the bathroom to finish urinating. Prescription medicine is also effective in ending episodes of bed-wetting but is only effective when it is being used; when enuretics stop taking the drugs, the bed-wetting returns. Many enuretics simply outgrow the problem as they approach puberty.
Major Depression
Major depression, the condition of feeling deep and constant sadness, is one of the most common mental disorders. It strikes almost one in five people at some point. More common in women than in men, depression tends to recur, making it a lifelong battle for some people. Depression, too, has become more common over the last few decades. This may be attributable to social changes that have occurred simultaneously (society moving at a faster pace, individuals bearing more stress as life becomes increasingly urbanized, and many institutions—church, family, cultural customs—that once acted as support systems no longer as common). It may also be that people are more aware of the symptoms of depression and are more willing to seek treatment than in the past.
SYMPTOMS. There are several possible symptoms of depression, whether it be a major depressive episode (which lasts approximately up to two weeks) or major depressive disorder (of longer duration and higher rate of return of the depression). Symptoms can include: constant feelings of sadness, emptiness, or irritability; a lack of pleasure in activities, even those that once brought enormous pleasure; a noticeable drop or increase in weight; the inability to sleep; extreme exhaustion; feelings of worthlessness; an inability to make decisions or concentrate on performing tasks; and thoughts of death and suicide. In order for a diagnosis of depression to be made, none of these symptoms can be caused by drugs or a medical disorder (there are separate categories of depression that are caused by illness or substance abuse) and a diagnosis should not be made if an individual is mourning the very recent loss of a loved one.
CAUSES. Many different theories account for the development of depression, depending upon the therapist's school of thought. Psychoanalysts (see Chapter 15: Mental Health Therapies) believe that the seeds of depression are sown in early childhood when something goes wrong with one stage of development or another. Cognitive therapists, such as Aaron Beck, believe that an individual battling depression has a faulty perception of the world, tending to view things negatively, and this impacts the person and his or her
reactions to different situations later in life, increasing susceptibility to developing depression. Behavioral therapists believe that depression may strike individuals who do not have strong social support and whose depression further deepens their isolation from others. There are also those who attribute depression to biological causes, including the possibility that it is inherited or caused by a chemical imbalance in the brain.
TREATMENTS. Depression has been treated with success with cognitive therapy and interpersonal therapy (a therapy that focuses on how a person interacts with others and which instructs him or her how to interact more
effectively). Drug therapies have also worked well in treating depression. Antidepressants, such as Tofranil and Elavil, as well as Prozac, have been effective in alleviating the symptoms of depression. Drug therapies are most beneficial when they are accompanied by sessions with a therapist who can help an individual better understand depression and how he or she is reacting to the medication.
Bipolar Disorder
Bipolar disorders are marked by extreme highs and extreme lows in mood. Similar to depression in that they include the occurrence of major depressive episodes, bipolar disorders are also accompanied by manic episodes or hypomanic episodes. A manic episode is when a person is in an intense emotional state of elation (extreme happiness) and overactivity in which he or she is abnormally energetic and talks in an almost stream-of-consciousness way, with ideas and grandiose plans being shared (however implausible they may seem). Examples of other symptoms of a manic episode include an inflated sense of self, a reduced need for sleep, and engaging in reckless activities (for example, irresponsible sexual behavior or excessive spending). A hypomanic episode is similar to a manic episode though not as extreme.
Bipolar I disorder is marked by manic episodes accompanied by major depressive episodes. Bipolar II disorder has major depressive episodes at its center which are accompanied by at least one hypomanic episode.
Bipolar depression also differs from major depression, which is also known as unipolar depression, in that it strikes males and females at the same rate. Typically, bipolar depression is treated with drugs and counseling. As with major depression, there exists a genetic correlation.
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