Mental disorder#Stigma and discrimination

{{redirect|Nervous breakdown}}

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.{{cite journal | vauthors = Stein DJ | title = What is a mental disorder? A perspective from cognitive-affective science | journal = Canadian Journal of Psychiatry | volume = 58 | issue = 12 | pages = 656–62 | date = December 2013 | pmid = 24331284 | doi = 10.1177/070674371305801202 | doi-access = free }} 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.{{cite journal | vauthors = Stein DJ, Phillips KA, Bolton D, Fulford KW, Sadler JZ, Kendler KS | title = What is a mental/psychiatric disorder? From DSM-IV to DSM-V | publisher = Cambridge University Press | location = UK | issn = 0033-2917 | eissn =1469-8978 |oclc = 01588231 | journal = Psychological Medicine | volume = 40 | issue = 11 | pages = 1759–65 | date = November 2010 | pmid = 20624327 | pmc = 3101504 | doi = 10.1017/S0033291709992261 | quote = In DSM-IV, each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one. Whatever its original cause, it must currently be considered a manifestation of behavioral, psychological, or biological dysfunction in the individual. Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, as described above.}}

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.{{cite journal | vauthors = Stein DJ, Phillips KA, Bolton D, Fulford KW, Sadler JZ, Kendler KS | title = What is a mental/psychiatric disorder? From DSM-IV to DSM-V | publisher = Cambridge University Press | location = UK | issn = 0033-2917 | eissn =1469-8978 |oclc = 01588231 | journal = Psychological Medicine | volume = 40 | issue = 11 | pages = 1759–65 | date = November 2010 | pmid = 20624327 | pmc = 3101504 | doi = 10.1017/S0033291709992261 | quote = ... although this manual provides a classification of mental disorders, it must be admitted that no definition adequately specifies precise boundaries for the concept of 'mental disorder.' The concept of mental disorder, like many other concepts in medicine and science, lacks a consistent operational definition that covers all situations. All medical conditions are defined on various levels of abstraction—for example, structural pathology (e.g., ulcerative colitis), symptom presentation (e.g., migraine), deviance from a physiological norm (e.g., hypertension), and etiology (e.g., pneumococcal pneumonia). Mental disorders have also been defined by a variety of concepts (e.g., distress, dyscontrol, disadvantage, disability, inflexibility, irrationality, syndromal pattern, etiology, and statistical deviation). Each is a useful indicator for a mental disorder, but none is equivalent to the concept, and different situations call for different definitions. }}

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."{{cite book |chapter=Use of the Manual |title=Diagnostic and statistical manual of mental disorders |edition=5th |publisher=American Psychiatric Association |location=Arlington, VA |isbn=978-0-89042-554-1 |chapter-url=http://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596 |doi=10.1176/appi.books.9780890425596.UseofDSM5 |year=2013 |access-date=2 August 2017 |archive-date=19 September 2019 |archive-url=https://web.archive.org/web/20190919004915/https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596 |url-status=live }} The final draft of ICD-11 contains a very similar definition.{{Cite web|url=https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f334423054|title=Chapter 6 on mental, behavioural and neurodevelopmental disorders|website=ICD-11 for Mortality and Morbidity Statistics, 2018 version|access-date=2 November 2018|archive-date=1 August 2018|archive-url=https://archive.today/20180801205234/https://icd.who.int/browse11/l-m/en%23/http://id.who.int/icd/entity/294762853#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f334423054|url-status=live}}

The terms "mental breakdown" or "nervous breakdown" may be used by the general population to mean a mental disorder.{{cite book | vauthors = Pickering N |title=The Metaphor of Mental Illness |date=2006 |publisher=Oxford University Press |isbn=978-0-19-853087-9 |page=1 |url=https://books.google.com/books?id=9JnuZHxvHykC&pg=PA1 }} 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.{{cite journal | vauthors = Rapport LJ, Todd RM, Lumley MA, Fisicaro SA | title = The diagnostic meaning of "nervous breakdown" among lay populations | journal = Journal of Personality Assessment | volume = 71 | issue = 2 | pages = 242–52 | date = October 1998 | pmid = 9857496 | doi = 10.1207/s15327752jpa7102_11 }}Hall-Flavin, Daniel K. (26 October 2016). [http://www.mayoclinic.com/health/nervous-breakdown/AN00476 "Nervous Breakdown"] {{Webarchive|url=https://web.archive.org/web/20131108013817/http://www.mayoclinic.com/health/nervous-breakdown/AN00476 |date=8 November 2013 }} Mayo Clinic. [https://web.archive.org/web/20211102155753/https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/nervous-breakdown/faq-20057830 Archived copy], 2 November 2021. 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. Many health experts today refer to a nervous breakdown as a mental health crisis.{{Cite web|url=https://www.healthdirect.gov.au/nervous-breakdown|title=Nervous breakdown|author=Healthdirect Australia|date=14 February 2019|website=www.healthdirect.gov.au|language=en-AU|access-date=25 March 2019|archive-date=25 March 2019|archive-url=https://web.archive.org/web/20190325220525/https://www.healthdirect.gov.au/nervous-breakdown|url-status=live}}

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:

{{blockquote|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{{cite book | vauthors = Shorter E |title=How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown |date=2013 |publisher=Oxford University Press |isbn=978-0-19-997825-0 }}{{page needed|date=June 2022}}|title=|source=}}

{{blockquote|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, WalesDavid Healy (2013) Pharmageddon, University of California Press {{ISBN|978-0-520-27576-8}}{{page needed|date=June 2022}}|title=|source=}}

{{blockquote|"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|date=June 2022}}}}

{{blockquote|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, LondonPeter Tyrer (2013) Models for Mental Disorder, Wiley-Blackwell {{ISBN|978-1-118-54052-7}}{{page needed|date=June 2022}}|title=|source=}}

{{Main|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).{{Cite web |title=ICD-11 for Mortality and Morbidity Statistics |url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/334423054 |access-date=2022-08-13 |website=icd.who.int |archive-date=1 August 2018 |archive-url=https://archive.today/20180801205234/https://icd.who.int/browse11/l-m/en%23/http://id.who.int/icd/entity/294762853#/http://id.who.int/icd/entity/334423054 |url-status=live }}
• 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).{{cite journal | vauthors = Berrios GE | title = Classifications in psychiatry: a conceptual history | journal = The Australian and New Zealand Journal of Psychiatry | volume = 33 | issue = 2 | pages = 145–60 | date = April 1999 | pmid = 10336212 | doi = 10.1046/j.1440-1614.1999.00555.x | s2cid = 25866251 | url = https://www.revistas.usp.br/acp/article/view/17193 | access-date = 9 November 2022 | archive-date = 21 February 2024 | archive-url = https://web.archive.org/web/20240221121901/https://www.revistas.usp.br/acp/article/view/17193 | url-status = live }} 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.Perring, C. (2005) [http://plato.stanford.edu/entries/mental-illness/ Mental Illness] {{Webarchive|url=https://web.archive.org/web/20180611130635/https://plato.stanford.edu/entries/mental-illness/ |date=11 June 2018 }} Stanford Encyclopedia of Philosophy 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.{{cite journal | vauthors = Katschnig H | title = Are psychiatrists an endangered species? Observations on internal and external challenges to the profession | journal = World Psychiatry | volume = 9 | issue = 1 | pages = 21–8 | date = February 2010 | pmid = 20148149 | pmc = 2816922 | doi = 10.1002/j.2051-5545.2010.tb00257.x }}{{cite journal | vauthors = Kato T | title = A renovation of psychiatry is needed | journal = World Psychiatry | volume = 10 | issue = 3 | pages = 198–9 | date = October 2011 | pmid = 21991278 | pmc = 3188773 | doi = 10.1002/j.2051-5545.2011.tb00056.x }}

The DSM and ICD approach remains under attack both because of the implied causality model{{cite web |vauthors=Doward J |date=11 May 2013 |title=Medicine's big new battleground: does mental illness really exist? |url=https://www.theguardian.com/society/2013/may/12/medicine-dsm5-row-does-mental-illness-exist |website=The Guardian |access-date=15 December 2016 |archive-date=28 June 2021 |archive-url=https://web.archive.org/web/20210628184855/https://www.theguardian.com/society/2013/may/12/medicine-dsm5-row-does-mental-illness-exist |url-status=live }} and because some researchers believe it better to aim at underlying brain differences which can precede symptoms by many years.{{cite web|url=http://www.nimh.nih.gov/about/updates/2013/mental-disorders-as-brain-disorders-thomas-insel-at-tedxcaltech.shtml |title= Mental Disorders as Brain Disorders: Thomas Insel at TEDxCaltech |website=National Institute of Mental Health |date=23 April 2013 |publisher=U.S. Department of Health and Human Services |archive-url=https://web.archive.org/web/20130507060046/http://www.nimh.nih.gov/about/updates/2013/mental-disorders-as-brain-disorders-thomas-insel-at-tedxcaltech.shtml |archive-date=7 May 2013 }}

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.{{cite journal | vauthors = Hankin BL, Snyder HR, Gulley LD, Schweizer TH, Bijttebier P, Nelis S, Toh G, Vasey MW | title = Understanding comorbidity among internalizing problems: Integrating latent structural models of psychopathology and risk mechanisms | journal = Development and Psychopathology | issn = 0954-5794 | eissn = 1469-2198 | volume = 28 | issue = 4pt1 | pages = 987–1012 | date = November 2016 | pmid = 27739389 | pmc = 5119897 | doi = 10.1017/S0954579416000663 }} 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.{{cite journal | vauthors = Caspi A, Houts RM, Belsky DW, Goldman-Mellor SJ, Harrington H, Israel S, Meier MH, Ramrakha S, Shalev I, Poulton R, Moffitt TE | title = The p Factor: One General Psychopathology Factor in the Structure of Psychiatric Disorders? | journal = Clinical Psychological Science | volume = 2 | issue = 2 | pages = 119–137 | date = March 2014 | pmid = 25360393 | pmc = 4209412 | doi = 10.1177/2167702613497473 }} 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.{{cite journal | vauthors = Forbes MK, Tackett JL, Markon KE, Krueger RF | title = Beyond comorbidity: Toward a dimensional and hierarchical approach to understanding psychopathology across the life span | journal = Development and Psychopathology | issn = 0954-5794 | eissn = 1469-2198 | volume = 28 | issue = 4pt1 | pages = 971–986 | date = November 2016 | pmid = 27739384 | pmc = 5098269 | doi = 10.1017/S0954579416000651 }}{{cite journal | vauthors = Gizer IR | title = Molecular genetic approaches to understanding the comorbidity of psychiatric disorders | journal = Development and Psychopathology | issn = 0954-5794 | eissn = 1469-2198 | volume = 28 | issue = 4pt1 | pages = 1089–1101 | date = November 2016 | pmid = 27739393 | pmc = 5079621 | doi = 10.1017/S0954579416000717 }}{{cite journal | vauthors = Lahey BB, Krueger RF, Rathouz PJ, Waldman ID, Zald DH | title = A hierarchical causal taxonomy of psychopathology across the life span | journal = Psychological Bulletin | volume = 143 | issue = 2 | pages = 142–186 | date = February 2017 | pmid = 28004947 | pmc = 5269437 | doi = 10.1037/bul0000069 }} A leading dimensional model is the Hierarchical Taxonomy of Psychopathology.

{{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.Gazzaniga, M.S., & Heatherton, T.F. (2006). Psychological Science. New York: W.W. Norton & Company, Inc.{{page needed|date=May 2013}}{{cite book |author1=Office of the Surgeon General |author1-link=Surgeon General of the United States |author2=Center for Mental Health Services |author2-link=Substance Abuse and Mental Health Services Administration#Center for Mental Health Services |author3=National Institute of Mental Health |author3-link=National Institute of Mental Health |chapter-url=http://profiles.nlm.nih.gov/ps/access/NNBBHW.pdf |chapter=The Fundamentals of Mental Health and Mental Illness |date=1999 |isbn=978-0-16-050300-9 |pages=26–50 |publisher=National Institute of Mental Health |title=Mental Health: A Report of the Surgeon General |url=http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBBHS |access-date=28 May 2013 |archive-date=26 September 2019 |archive-url=https://web.archive.org/web/20190926235338/https://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBBHS |url-status=live }}[http://science-education.nih.gov/supplements/nih5/Mental/guide/info-mental-c.htm Teacher's Guide: Information about Mental Illness and the Brain] National Institute of Mental Health. 2005. {{webarchive|url=https://web.archive.org/web/20071012140052/http://science-education.nih.gov/supplements/nih5/Mental/guide/info-mental-c.htm |date=12 October 2007 }} Curriculum supplement from The NIH Curriculum Supplements Series

{{Main|Anxiety disorder}}

An anxiety disorder is anxiety or fear that interferes with normal functioning may be classified as an anxiety disorder.{{cite web |url=http://www.webmd.com/mental-health/mental-health-types-illness |title=Mental Health: Types of Mental Illness |access-date=29 September 2009 |website=WebMD |date=1 July 2005 |archive-date=9 March 2021 |archive-url=https://web.archive.org/web/20210309020545/https://www.webmd.com/mental-health/mental-health-types-illness |url-status=live }} Commonly recognized categories include specific phobias, generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, obsessive–compulsive disorder and post-traumatic stress disorder.

{{Main|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.{{cite journal | vauthors = Akiskal HS, Benazzi F | title = The DSM-IV and ICD-10 categories of recurrent [major] depressive and bipolar II disorders: evidence that they lie on a dimensional spectrum | journal = Journal of Affective Disorders | volume = 92 | issue = 1 | pages = 45–54 | date = May 2006 | pmid = 16488021 | doi = 10.1016/j.jad.2005.12.035 }}{{cite journal | vauthors = McIntyre RS | title = Mixed features and mixed states in psychiatry: from calculus to geometry | journal = CNS Spectrums | volume = 22 | issue = 2 | pages = 116–117 | date = April 2017 | pmid = 28264727 | doi = 10.1017/S1092852916000559 |publisher=Cambridge University Press }}

{{Main|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.

{{Main|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.{{cite journal | vauthors = Clark LA | title = Assessment and diagnosis of personality disorder: perennial issues and an emerging reconceptualization | journal = Annual Review of Psychology | volume = 58 | issue = 1 | pages = 227–57 | year = 2007 | pmid = 16903806 | doi = 10.1146/annurev.psych.57.102904.190200 | s2cid = 2728977 | url = https://zenodo.org/record/1134186 | access-date = 21 June 2022 | archive-date = 26 November 2022 | archive-url = https://web.archive.org/web/20221126090328/https://zenodo.org/record/1134186 | url-status = live }} 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.{{cite journal | author4-link = Andrew E. Skodol | vauthors = Morey LC, Hopwood CJ, Gunderson JG, Skodol AE, Shea MT, Yen S, Stout RL, Zanarini MC, Grilo CM, Sanislow CA, McGlashan TH | title = Comparison of alternative models for personality disorders | issn = 0033-2917 | eissn = 1469-8978 | oclc = 01588231 | journal = Psychological Medicine | volume = 37 | issue = 7 | pages = 983–94 | date = July 2007 | pmid = 17121690 | doi = 10.1017/S0033291706009482 | s2cid = 15568151 | url = https://digitalcollections.wesleyan.edu/object/phycfp-87 | access-date = 13 March 2023 | archive-date = 13 March 2023 | archive-url = https://web.archive.org/web/20230313183741/https://digitalcollections.wesleyan.edu/object/phycfp-87 }}{{Citation | vauthors = Fariba KA, Gupta V, Torrico TJ, Kass E |title=Personality Disorder |date=2025 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK556058/ |access-date=2025-01-28 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32310518 }}{{Primary source inline|date=October 2015|reason=Article is a comparative study.}}

{{Main articles|Neurodevelopmental disorder}}

Neurodevelopmental disorders is a group of mental disorder that affect the central nervous system, such as the brain and spinal cord.{{Cite web |title=GRIN2B-related neurodevelopmental disorder: MedlinePlus Genetics |url=https://medlineplus.gov/genetics/condition/grin2b-related-neurodevelopmental-disorder/#:~:text=Neurodevelopmental%20disorders%20result%20from%20impaired,associated%20with%20other%20neurological%20problems. |access-date=2024-12-27 |website=medlineplus.gov |language=en}} These disorders can appear in early childhood.{{cite journal | vauthors = Micai M, Fulceri F, Caruso A, Guzzetta A, Gila L, Scattoni ML | title = Early behavioral markers for neurodevelopmental disorders in the first 3 years of life: An overview of systematic reviews | journal = Neuroscience and Biobehavioral Reviews | volume = 116 | pages = 183–201 | date = September 2020 | pmid = 32610179 | doi = 10.1016/j.neubiorev.2020.06.027 | doi-access = free }} They can even persist into adulthood.{{cite journal | vauthors = Virtanen M, Lallukka T, Kivimäki M, Alexanderson K, Ervasti J, Mittendorfer-Rutz E | title = Neurodevelopmental disorders among young adults and the risk of sickness absence and disability pension: a nationwide register linkage study | journal = Scandinavian Journal of Work, Environment & Health | volume = 46 | issue = 4 | pages = 410–416 | date = July 2020 | pmid = 32076730 | pmc = 8506319 | doi = 10.5271/sjweh.3888 }} 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),{{cite journal | vauthors = Scattolin MA, Resegue RM, Rosário MC | title = The impact of the environment on neurodevelopmental disorders in early childhood | journal = Jornal de Pediatria | volume = 98 | issue = Suppl 1 | pages = S66–S72 | date = 2021 | pmid = 34914896 | pmc = 9510913 | doi = 10.1016/j.jped.2021.11.002 }} environmental factors (excessive stress, exposure to neurotoxins, pollution, viral infections, and bacterial infections),{{cite journal | vauthors = Love C, Sominsky L, O'Hely M, Berk M, Vuillermin P, Dawson SL | title = Prenatal environmental risk factors for autism spectrum disorder and their potential mechanisms | journal = BMC Medicine | volume = 22 | issue = 1 | page = 393 | date = September 2024 | pmid = 39278907 | pmc = 11404034 | doi = 10.1186/s12916-024-03617-3 | doi-access = free }}{{cite journal | vauthors = Ijomone OM, Olung NF, Akingbade GT, Okoh CO, Aschner M | title = Environmental influence on neurodevelopmental disorders: Potential association of heavy metal exposure and autism | journal = Journal of Trace Elements in Medicine and Biology | volume = 62 | page = 126638 | date = December 2020 | pmid = 32891009 | pmc = 7655547 | doi = 10.1016/j.jtemb.2020.126638 | bibcode = 2020JTEMB..6226638I }} physical factors (traumatic brain injury, illness),{{cite web |url=https://diamondrehabthailand.com/what-are-neurodevelopmental-disorders/#:~:text=While%20the%20exact%20cause%20of,drugs%2C%20or%20medications%20during%20pregnancy |title=Neurodevelopmental disorders: definition, types, causes, symptoms, and treatments |last=Zayed |first=Ahmed |work=The Diamond Rehab Thailand |publisher=The Diamond: Luxury Rehab in Thailand |date=28 May 2024 |access-date=17 February 2025}} and prenatal factors (birth defects, exposure to drugs during pregnancy, low birth weight).{{Cite web |title=Neurodevelopmental Disorders {{!}} Nevada Hospitals |url=https://www.dignityhealth.org/las-vegas/services/neurological-care/neurodevelopmental-disorders |archive-url=https://web.archive.org/web/20240717203234/https://www.dignityhealth.org/las-vegas/services/neurological-care/neurodevelopmental-disorders |archive-date=17 July 2024 |access-date=2024-12-27 |website=Dignity Health |url-status=live }} Neurodevelopmental disorders can be managed with behavioral therapy, applied behavior analysis (ABA), educational interventions, specific medications, and other such treatments.{{cite web |url=https://www.specialstrong.com/the-different-types-of-neurodevelopmental-disorders/#:~:text=What%20treatments%20are%20available%20for,of%20life%20and%20functional%20capabilities. |title=The Different Types of Neurodevelopmental Disorders |website=specialstrong.com |date=22 April 2024 |access-date=17 February 2025}}

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.{{cite web |title= Depression and autism |url= https://www.autistica.org.uk/what-is-autism/depression-and-autism |website= Autistica |date= 14 March 2024 |access-date= 23 January 2025}}{{cite web |title=Suicide and autism |url= https://www.autistica.org.uk/what-is-autism/suicide-and-autism |website= Autistica |date= 7 March 2024 |access-date= 23 January 2025}}{{cite journal | vauthors = Lever AG, Geurts HM | title = Psychiatric Co-occurring Symptoms and Disorders in Young, Middle-Aged, and Older Adults with Autism Spectrum Disorder | journal = Journal of Autism and Developmental Disorders | volume = 46 | issue = 6 | pages = 1916–1930 | date = June 2016 | pmid = 26861713 | pmc = 4860203 | doi = 10.1007/s10803-016-2722-8 }}

{{Main|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.{{cite journal | vauthors = Ackard DM, Croll JK, Kearney-Cooke A | title = Dieting frequency among college females: association with disordered eating, body image, and related psychological problems | journal = Journal of Psychosomatic Research | volume = 52 | issue = 3 | pages = 129–136 | date = March 2002 | pmid = 11897231 | doi = 10.1016/S0022-3999(01)00269-0 }} Eating disorders involve disproportionate concern in matters of food and weight. Categories of disorder in this area include anorexia nervosa, bulimia nervosa, exercise bulimia or binge eating disorder.{{Cite web|url=https://www.nami.org/Learn-More/Mental-Health-Conditions/Eating-Disorders|title=Eating Disorders |website=National Alliance on Mental Illness (NAMI) |archive-url = https://web.archive.org/web/20210814051612/https://nami.org/About-Mental-Illness/Mental-Health-Conditions/Eating-Disorders |archive-date = 14 August 2021 |date = 2021 |access-date=6 May 2019}}{{Cite web|url=https://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml|title= Eating Disorders|website= National Institute of Mental Health | publisher = U.S. Department of Health and Human Services|department =National Institutes of Health | archive-url = https://web.archive.org/web/20220607093817/https://www.nimh.nih.gov/health/topics/eating-disorders |archive-date = 7 June 2022 | date= December 2021 |access-date=6 May 2019}}

{{Main|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.{{Cite web |title=Narcolepsy - Diagnosis and treatment | website = Mayo Clinic |url=https://www.mayoclinic.org/diseases-conditions/narcolepsy/diagnosis-treatment/drc-20375503 | archive-url = https://web.archive.org/web/20220516195530/https://www.mayoclinic.org/diseases-conditions/narcolepsy/diagnosis-treatment/drc-20375503 | archive-date = 2022-05-16 | date = 2022-11-06 |access-date=2022-03-31 }} Doctors will do a multiple sleep latency test, which measures how long it takes a person to fall asleep.

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.{{Cite web |title=Sleep apnea - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631 |access-date=2022-03-31 |date = 2020-07-20 | archive-date =2020-12-29 | archive-url = https://web.archive.org/web/20201229222740/https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631|website=Mayo Clinic |language=en}} 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.

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. 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.{{cite journal | vauthors = Herder T, Spoelstra SK, Peters AW, Knegtering H | title = Sexual dysfunction related to psychiatric disorders: a systematic review | journal = The Journal of Sexual Medicine | volume = 20 | issue = 7 | pages = 965–976 | date = June 2023 | pmid = 37279603 | doi = 10.1093/jsxmed/qdad074 }}

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.{{cite journal | vauthors = Gamma A, Angst J, Ajdacic V, Eich D, Rössler W | title = The spectra of neurasthenia and depression: course, stability and transitions | issn = 0940-1334 | eissn = 1433-8491 | oclc = 613502930 | journal = European Archives of Psychiatry and Clinical Neuroscience | volume = 257 | issue = 2 | pages = 120–7 | date = March 2007 | pmid = 17131216 | doi = 10.1007/s00406-006-0699-6 | s2cid = 21221326 | url = http://doc.rero.ch/record/321668/files/406_2006_Article_699.pdf | access-date = 15 January 2019 | archive-date = 2 November 2021 | archive-url = https://web.archive.org/web/20211102015534/http://doc.rero.ch/record/321668/files/406_2006_Article_699.pdf | url-status = live }}{{Primary source inline|date=October 2015}}

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.{{cite journal |doi=10.1136/jnnp.73.2.211-c |title=Uncommon psychiatric syndromes, 4th edn |year=2002 | vauthors = Trimble M |journal=Journal of Neurology, Neurosurgery & Psychiatry |volume=73 |issue=2 |pages=211–c |pmc=1738003}}

The onset of psychiatric disorders usually occurs from childhood to early adulthood.{{cite journal | vauthors = Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustün TB | title = Age of onset of mental disorders: a review of recent literature | journal = Current Opinion in Psychiatry | volume = 20 | issue = 4 | pages = 359–64 | date = July 2007 | pmid = 17551351 | pmc = 1925038 | doi = 10.1097/YCO.0b013e32816ebc8c }} 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.{{cite journal | vauthors = Paus T, Keshavan M, Giedd JN | title = Why do many psychiatric disorders emerge during adolescence? | journal = Nature Reviews. Neuroscience | volume = 9 | issue = 12 | pages = 947–57 | date = December 2008 | pmid = 19002191 | pmc = 2762785 | doi = 10.1038/nrn2513 }} Symptoms of schizophrenia typically manifest from late adolescence to early twenties.{{cite journal | vauthors = van Os J, Kapur S | title = Schizophrenia | journal = Lancet | volume = 374 | issue = 9690 | pages = 635–45 | date = August 2009 | pmid = 19700006 | doi = 10.1016/S0140-6736(09)60995-8 | s2cid = 208792724 }}

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."{{cite journal | vauthors = Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J, Dube KC, Ganev K, Giel R, an der Heiden W, Holmberg SK, Janca A, Lee PW, León CA, Malhotra S, Marsella AJ, Nakane Y, Sartorius N, Shen Y, Skoda C, Thara R, Tsirkin SJ, Varma VK, Walsh D, Wiersma D | title = Recovery from psychotic illness: a 15- and 25-year international follow-up study | journal = The British Journal of Psychiatry | issn = 0007-1250 | eissn = 1472-1465 | lccn = 89649366 | oclc = 1537306 | volume = 178 | issue = 6 | pages = 506–17 | date = June 2001 | pmid = 11388966 | doi = 10.1192/bjp.178.6.506 | doi-access = free }}{{Primary source inline|date=October 2015}}{{cite journal | vauthors = Jobe TH, Harrow M | title = Long-term outcome of patients with schizophrenia: a review | journal = Canadian Journal of Psychiatry | volume = 50 | issue = 14 | pages = 892–900 | date = December 2005 | pmid = 16494258 | doi = 10.1177/070674370505001403 | doi-access = free }}

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.{{cite journal | vauthors = Tohen M, Zarate CA, Hennen J, Khalsa HM, Strakowski SM, Gebre-Medhin P, Salvatore P, Baldessarini RJ | title = The McLean-Harvard First-Episode Mania Study: prediction of recovery and first recurrence | journal = The American Journal of Psychiatry | volume = 160 | issue = 12 | pages = 2099–107 | date = December 2003 | pmid = 14638578 | doi = 10.1176/appi.ajp.160.12.2099 | s2cid = 30881311 }}{{Primary source inline|date=October 2015}}

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. 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.Center for Psychiatric Rehabilitation [http://www.bu.edu/cpr/reasaccom/whatis-psych.html What is Psychiatric Disability and Mental Illness?] {{webarchive|url=https://web.archive.org/web/20120104041024/http://www.bu.edu/cpr/reasaccom/whatis-psych.html |date=4 January 2012 }} Boston University, Retrieved January 2012

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.{{cite book | vauthors = Pilgrim D, Rogers A |title=A sociology of mental health and illness |publisher=Open University Press |location=Milton Keynes |year=2005 |isbn=978-0-335-21583-6 |edition= 3rd}}{{page needed|date=May 2013}} In addition, the public perception of the level of disability associated with mental disorders can change.Ferney, V. (2003) [http://www.nycvoices.org/article.php?article_id=585 The Hierarchy of Mental Illness: Which diagnosis is the least debilitating?] {{Webarchive|url=https://web.archive.org/web/20130117044557/http://www.nycvoices.org/article.php?article_id=585 |date=17 January 2013 }} New York City Voices Jan/March

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.{{cite journal | vauthors = Ormel J, Petukhova M, Chatterji S, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Bromet EJ, Burger H, Demyttenaere K, de Girolamo G, Haro JM, Hwang I, Karam E, Kawakami N, Lépine JP, Medina-Mora ME, Posada-Villa J, Sampson N, Scott K, Ustün TB, Von Korff M, Williams DR, Zhang M, Kessler RC | title = Disability and treatment of specific mental and physical disorders across the world | journal = The British Journal of Psychiatry | issn = 0007-1250 | eissn = 1472-1465 | lccn = 89649366 | oclc = 1537306 | volume = 192 | issue = 5 | pages = 368–75 | date = May 2008 | pmid = 18450663 | pmc = 2681238 | doi = 10.1192/bjp.bp.107.039107 }} 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%).{{cite journal | vauthors = Gore FM, Bloem PJ, Patton GC, Ferguson J, Joseph V, Coffey C, Sawyer SM, Mathers CD | title = Global burden of disease in young people aged 10–24 years: a systematic analysis | journal = Lancet | volume = 377 | issue = 9783 | pages = 2093–102 | date = June 2011 | pmid = 21652063 | doi = 10.1016/S0140-6736(11)60512-6 | s2cid = 205962371 }}

Suicide, which is often attributed to some underlying mental disorder, is a leading cause of death among teenagers and adults under 35.{{cite news |url=http://www.rferl.org/content/article/1071203.html |title=CIS: UN Body Takes On Rising Suicide Rates – Radio Free Europe / Radio Liberty 2006 |newspaper=Radio Free Europe/Radio Liberty |date=2 February 2012 | vauthors = Krastev N |access-date=2 April 2011 |archive-date=3 March 2016 |archive-url=https://web.archive.org/web/20160303225433/http://www.rferl.org/content/article/1071203.html |url-status=live }}{{Cite book |vauthors=O'Connor R, Sheehy N |title=Understanding suicidal behaviour |url=https://books.google.com/books?id=79hEYGdDA3oC |date=29 January 2000 |publisher=BPS Books |location=Leicester |isbn=978-1-85433-290-5 |pages=33–37 |access-date=24 August 2020 |archive-date=13 January 2023 |archive-url=https://web.archive.org/web/20230113005830/https://books.google.com/books?id=79hEYGdDA3oC |url-status=live }} There are an estimated 10 to 20 million non-fatal attempted suicides every year worldwide.{{cite journal | vauthors = Bertolote JM, Fleischmann A | title = Suicide and psychiatric diagnosis: a worldwide perspective | journal = World Psychiatry | volume = 1 | issue = 3 | pages = 181–5 | date = October 2002 | pmid = 16946849 | pmc = 1489848 }}

{{Main|Causes of mental disorders}}

The predominant view {{as of|2018|lc=y}} is that genetic, psychological, and environmental factors all contribute to the development or progression of mental disorders.{{cite journal | vauthors = Arango C, Díaz-Caneja CM, McGorry PD, Rapoport J, Sommer IE, Vorstman JA, McDaid D, Marín O, Serrano-Drozdowskyj E, Freedman R, Carpenter W | title = Preventive strategies for mental health | language = en | journal = The Lancet. Psychiatry | volume = 5 | issue = 7 | pages = 591–604 | date = July 2018 | pmid = 29773478 | doi = 10.1016/S2215-0366(18)30057-9 | hdl = 11370/92f1a79c-f53d-47ae-be92-7a4c8d4b4e25 | s2cid = 21703364 | url = https://research.rug.nl/en/publications/92f1a79c-f53d-47ae-be92-7a4c8d4b4e25 | hdl-access = free }} Different risk factors may be present at different ages, with risk occurring as early as during prenatal period.{{cite book |title=Risks to mental health |date=16 October 2012 |publisher=World Health Organization |url=https://www.who.int/publications/m/item/risks-to-mental-health |access-date=21 June 2022 |archive-date=23 May 2022 |archive-url=https://web.archive.org/web/20220523105832/https://www.who.int/publications/m/item/risks-to-mental-health |url-status=live }}

{{Main|Psychiatric genetics}}

A number of psychiatric disorders are linked to a family history (including depression, narcissistic personality disorder{{cite journal | vauthors = Torgersen S, Lygren S, Oien PA, Skre I, Onstad S, Edvardsen J, Tambs K, Kringlen E | title = A twin study of personality disorders | journal = Comprehensive Psychiatry | volume = 41 | issue = 6 | pages = 416–25 | date = December 2000 | pmid = 11086146 | doi = 10.1053/comp.2000.16560 }}{{cite journal | vauthors = Reichborn-Kjennerud T | title = The genetic epidemiology of personality disorders | journal = Dialogues in Clinical Neuroscience | volume = 12 | issue = 1 | pages = 103–14 | date = 1 March 2010 | doi = 10.31887/DCNS.2010.12.1/trkjennerud | pmid = 20373672 | pmc = 3181941 }} and anxiety).{{cite journal | vauthors = Bienvenu OJ, Ginsburg GS | title = Prevention of anxiety disorders | journal = International Review of Psychiatry | volume = 19 | issue = 6 | pages = 647–54 | date = December 2007 | pmid = 18092242 | doi = 10.1080/09540260701797837 | s2cid = 95140 }} Twin studies have also revealed a very high heritability for many mental disorders (especially autism and schizophrenia).{{cite journal | vauthors = Insel TR | title = Disruptive insights in psychiatry: transforming a clinical discipline | journal = The Journal of Clinical Investigation | volume = 119 | issue = 4 | pages = 700–5 | date = April 2009 | pmid = 19339761 | pmc = 2662575 | doi = 10.1172/jci38832 }} 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.{{Cite web |url=https://www.madinamerica.com/wp-content/uploads/2013/05/Statement-from-dsm-chair-david-kupfer-md.pdf |title=American Psychiatric Association 3 May 2013 Release Number 13-33 |access-date=22 April 2016 |archive-date=29 November 2020 |archive-url=https://web.archive.org/web/20201129172422/https://www.madinamerica.com/wp-content/uploads/2013/05/Statement-from-dsm-chair-david-kupfer-md.pdf |url-status=live }}

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.{{cite journal | vauthors = Nordsletten AE, Larsson H, Crowley JJ, Almqvist C, Lichtenstein P, Mataix-Cols D | title = Patterns of Nonrandom Mating Within and Across 11 Major Psychiatric Disorders | journal = JAMA Psychiatry | volume = 73 | issue = 4 | pages = 354–61 | date = April 2016 | pmid = 26913486 | pmc = 5082975 | doi = 10.1001/jamapsychiatry.2015.3192 }}

{{Main article|Brain health and pollution}}

File:The prevalence of mental illness is higher in more unequal rich countries.jpg 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. Maternal stress and birth complications including prematurity and infections have also been implicated in increasing susceptibility for mental illness.{{cite journal | vauthors = Fumagalli F, Molteni R, Racagni G, Riva MA | title = Stress during development: Impact on neuroplasticity and relevance to psychopathology | journal = Progress in Neurobiology | volume = 81 | issue = 4 | pages = 197–217 | date = March 2007 | pmid = 17350153 | doi = 10.1016/j.pneurobio.2007.01.002 | s2cid = 22224892 }} Infants neglected or not provided optimal nutrition have a higher risk of developing cognitive impairment.

Social influences have also been found to be important,{{cite journal | vauthors = Hiday VA | title = The social context of mental illness and violence | journal = Journal of Health and Social Behavior | volume = 36 | issue = 2 | pages = 122–37 | date = June 1995 | pmid = 9113138 | doi = 10.2307/2137220 | jstor = 2137220 }} including abuse, neglect, bullying, social stress, traumatic events, and other negative or overwhelming life experiences. Aspects of the wider community have also been implicated, 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.{{cite journal | vauthors = Sarris J, Logan AC, Akbaraly TN, Amminger GP, Balanzá-Martínez V, Freeman MP, Hibbeln J, Matsuoka Y, Mischoulon D, Mizoue T, Nanri A, Nishi D, Ramsey D, Rucklidge JJ, Sanchez-Villegas A, Scholey A, Su KP, Jacka FN | title = Nutritional medicine as mainstream in psychiatry | journal = The Lancet. Psychiatry | volume = 2 | issue = 3 | pages = 271–4 | date = March 2015 | pmid = 26359904 | doi = 10.1016/S2215-0366(14)00051-0 | type = Review }}

In schizophrenia and psychosis, risk factors include migration and discrimination, childhood trauma, bereavement or separation in families, recreational use of drugs,{{cite web|url=http://www.schizophreniacommission.org.uk/the-report/ |title=The Report |publisher=The Schizophrenia Commission |date=13 November 2012 |access-date=23 April 2013 |archive-url=https://web.archive.org/web/20130405104051/http://www.schizophreniacommission.org.uk/the-report/ |archive-date=5 April 2013 }} and urbanicity.{{cite journal | vauthors = Krabbendam L, van Os J | title = Schizophrenia and urbanicity: a major environmental influence—conditional on genetic risk | journal = Schizophrenia Bulletin | volume = 31 | issue = 4 | pages = 795–9 | date = October 2005 | pmid = 16150958 | doi = 10.1093/schbul/sbi060 | doi-access = free }}

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).{{cite book|vauthors= O'Connell ME, Boat T, Warner KE|title= Prevention of Mental Disorders, Substance Abuse, and Problem Behaviors: A Developmental Perspective|pages= 530–531|year= 2009|pmid= 20662125|doi= 10.17226/12480|chapter= Table E-4 Risk Factors for Anxiety|isbn= 978-0-309-12674-8|publisher= National Academies Press|s2cid= 142581788|chapter-url= http://books.nap.edu/openbook.php?record_id=12480&page=530|access-date= 17 March 2012|archive-date= 18 April 2014|archive-url= https://web.archive.org/web/20140418234307/http://books.nap.edu/openbook.php?record_id=12480&page=530|url-status= live}} Adults with imbalance work to life are at higher risk for developing anxiety.

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.{{cite journal | vauthors = Miklowitz DJ, Chang KD | title = Prevention of bipolar disorder in at-risk children: theoretical assumptions and empirical foundations | journal = Development and Psychopathology | issn = 0954-5794 | eissn = 1469-2198 | volume = 20 | issue = 3 | pages = 881–97 | year = 2008 | pmid = 18606036 | pmc = 2504732 | doi = 10.1017/S0954579408000424 }}

Mental disorders are associated with drug use including: cannabis,{{cite web|url=http://www.rcpsych.ac.uk/mentalhealthinfo/problems/alcoholanddrugs/cannabis.aspx|title=Cannabis and mental health|website=Royal College of Psychiatrists|access-date=23 April 2013|archive-date=1 July 2018|archive-url=https://web.archive.org/web/20180701085157/https://www.rcpsych.ac.uk/mentalhealthinfo/problems/alcoholanddrugs/cannabis.aspx|url-status=live}} alcohol{{cite journal | vauthors = Fergusson DM, Boden JM, Horwood LJ | title = Tests of causal links between alcohol abuse or dependence and major depression | journal = Archives of General Psychiatry | volume = 66 | issue = 3 | pages = 260–6 | date = March 2009 | pmid = 19255375 | doi = 10.1001/archgenpsychiatry.2008.543 | doi-access = free }} and caffeine,{{cite journal| vauthors = Winston AP, Hardwick E, Jaberi N |date=October 2005|title=Neuropsychiatric effects of caffeine|journal=Advances in Psychiatric Treatment|volume=11|issue=6|pages=432–39|doi=10.1192/apt.11.6.432|doi-access=free}} use of which appears to promote anxiety.{{cite journal | vauthors = Vilarim MM, Rocha Araujo DM, Nardi AE | title = Caffeine challenge test and panic disorder: a systematic literature review | journal = Expert Review of Neurotherapeutics | volume = 11 | issue = 8 | pages = 1185–95 | date = August 2011 | pmid = 21797659 | doi = 10.1586/ern.11.83 | s2cid = 5364016 }} For psychosis and schizophrenia, usage of a number of drugs has been associated with development of the disorder, including cannabis, cocaine, and amphetamines.{{cite journal | vauthors = Picchioni MM, Murray RM | title = Schizophrenia | journal = BMJ | volume = 335 | issue = 7610 | pages = 91–5 | date = July 2007 | pmid = 17626963 | pmc = 1914490 | doi = 10.1136/bmj.39227.616447.BE }} There has been debate regarding the relationship between usage of cannabis and bipolar disorder.{{cite journal | vauthors = Khan MA, Akella S | title = Cannabis-induced bipolar disorder with psychotic features: a case report | journal = Psychiatry | volume = 6 | issue = 12 | pages = 44–8 | date = December 2009 | pmid = 20104292 | pmc = 2811144 }} Cannabis has also been associated with depression. 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.

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.{{Cite web|url=https://ontario.cmha.ca/documents/the-relationship-between-mental-health-mental-illness-and-chronic-physical-conditions/|title=The Relationship between Mental Health, Mental Illness and Chronic Physical Conditions|website=Canadian Mental Health Association (CMHA), Ontario | archive-url=https://web.archive.org/web/20220716202319/https://ontario.cmha.ca/documents/the-relationship-between-mental-health-mental-illness-and-chronic-physical-conditions/ | archive-date=16 July 2022 |access-date=21 November 2019}}

Risk factors for mental illness include a propensity for high neuroticism{{cite journal | vauthors = Jeronimus BF, Kotov R, Riese H, Ormel J | title = Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants | journal = Psychological Medicine | issn = 0033-2917 | eissn = 1469-8978 | oclc = 01588231 | volume = 46 | issue = 14 | pages = 2883–2906 | date = October 2016 | pmid = 27523506 | doi = 10.1017/S0033291716001653 | s2cid = 23548727 | url = https://zenodo.org/record/895885 | access-date = 8 August 2019 | archive-date = 29 December 2019 | archive-url = https://web.archive.org/web/20191229175420/https://zenodo.org/record/895885 | url-status = live }}{{cite journal | vauthors = Ormel J, Jeronimus BF, Kotov R, Riese H, Bos EH, Hankin B, Rosmalen JG, Oldehinkel AJ | title = Neuroticism and common mental disorders: meaning and utility of a complex relationship | journal = Clinical Psychology Review | volume = 33 | issue = 5 | pages = 686–697 | date = July 2013 | pmid = 23702592 | pmc = 4382368 | doi = 10.1016/j.cpr.2013.04.003 }} or "emotional instability". In anxiety, risk factors may include temperament and attitudes (e.g. pessimism). 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).{{cite journal | vauthors = Kang W, Steffens F, Pineda S, Widuch K, Malvaso A | title = Personality traits and dimensions of mental health | journal = Scientific Reports | volume = 13 | issue = 1 | page = 7091 | date = May 2023 | pmid = 37127723 | pmc = 10151354 | doi = 10.1038/s41598-023-33996-1 | bibcode = 2023NatSR..13.7091K }} 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.{{cite journal | vauthors = Borchers A, Pieler T | title = Programming pluripotent precursor cells derived from Xenopus embryos to generate specific tissues and organs | journal = Genes | volume = 1 | issue = 3 | pages = 413–426 | date = November 2010 | pmid = 24710095 | doi = 10.3390/psycholint6040052 | doi-access = free | pmc = 3966229 }} 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.

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.{{cite journal | vauthors = Kendler KS | title = The dappled nature of causes of psychiatric illness: replacing the organic-functional/hardware-software dichotomy with empirically based pluralism | journal = Molecular Psychiatry | volume = 17 | issue = 4 | pages = 377–88 | date = April 2012 | pmid = 22230881 | pmc = 3312951 | doi = 10.1038/mp.2011.182 }} 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.{{cn|date=October 2024}}

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.{{cn|date=October 2024}}

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.{{cite journal | vauthors = Kinderman P, Lobban F |doi= 10.1017/S1352465800003118 |title=Evolving Formulations: Sharing Complex Information with Clients |year=2000 |journal=Behavioural and Cognitive Psychotherapy |volume=28 |issue=3 |pages=307–10|citeseerx=10.1.1.500.5290 |s2cid= 16787375 }} 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.Payne, Kattie. (2004). [http://health.yahoo.com/topic/mentalhealth/symptoms/medicaltest/healthwise/tp16780 Mental Health Assessment.] {{webarchive|url=https://web.archive.org/web/20060626070720/http://health.yahoo.com/topic/mentalhealth/symptoms/medicaltest/healthwise/tp16780 |date=26 June 2006 }} Yahoo! Health. Boise: Healthwise, Inc.{{cite journal | vauthors = Davies T | title = ABC of mental health. Mental health assessment | journal = BMJ | volume = 314 | issue = 7093 | pages = 1536–9 | date = May 1997 | pmid = 9183204 | pmc = 2126757 | doi = 10.1136/bmj.314.7093.1536 }}

Time and budgetary constraints often limit practicing psychiatrists from conducting more thorough diagnostic evaluations.{{cite journal | vauthors = Kashner TM, Rush AJ, Surís A, Biggs MM, Gajewski VL, Hooker DJ, Shoaf T, Altshuler KZ | title = Impact of structured clinical interviews on physicians' practices in community mental health settings | journal = Psychiatric Services | volume = 54 | issue = 5 | pages = 712–8 | date = May 2003 | pmid = 12719503 | doi = 10.1176/appi.ps.54.5.712 }} 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.{{cite journal | vauthors = Shear MK, Greeno C, Kang J, Ludewig D, Frank E, Swartz HA, Hanekamp M | title = Diagnosis of nonpsychotic patients in community clinics | journal = The American Journal of Psychiatry | volume = 157 | issue = 4 | pages = 581–7 | date = April 2000 | pmid = 10739417 | doi = 10.1176/appi.ajp.157.4.581 | doi-access = free }} 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.{{cite web |title=What is HoNOS? |url=http://www.rcpsych.ac.uk/traininpsychiatry/eventsandcourses/courses/honos/whatishonos.aspx |website=Royal College of Psychiatrists |access-date=13 May 2013 |archive-date=1 July 2017 |archive-url=https://web.archive.org/web/20170701113022/http://www.rcpsych.ac.uk/traininpsychiatry/eventsandcourses/courses/honos/whatishonos.aspx |url-status=live }} In HoNOS a score of 0–4 is given for each of 12 factors, based on functional living capacity.{{cite web |title=Introduction to HoNOS |url=http://www.rcpsych.ac.uk/traininpsychiatry/eventsandcourses/courses/honos/workingageadults/introduction.aspx |website=Royal College of Psychiatrists |access-date=13 May 2013 |archive-date=1 July 2017 |archive-url=https://web.archive.org/web/20170701120237/http://www.rcpsych.ac.uk/traininpsychiatry/eventsandcourses/courses/honos/workingageadults/introduction.aspx }} Research has been supportive of HoNOS,{{cite journal | vauthors = Pirkis JE, Burgess PM, Kirk PK, Dodson S, Coombs TJ, Williamson MK | title = A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures | journal = Health and Quality of Life Outcomes | volume = 3 | issue = 1 | page = 76 | date = November 2005 | pmid = 16313678 | pmc = 1315350 | doi = 10.1186/1477-7525-3-76 |doi-access=free}} 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.{{cite journal | vauthors = Audin K, Margison FR, Clark JM, Barkham M | title = Value of HoNOS in assessing patient change in NHS psychotherapy and psychological treatment services | journal = The British Journal of Psychiatry| issn = 0007-1250 | eissn = 1472-1465 | lccn = 89649366 | oclc = 1537306 | volume = 178 | issue = 6 | pages = 561–6 | date = June 2001 | pmid = 11388975 | doi = 10.1192/bjp.178.6.561 | doi-access = free }}

{{Primary sources section|find=criticism|find2=psychiatric diagnosis|date=July 2021}}

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.{{cite news |url=https://www.washingtonpost.com/opinions/psychiatrys-bible-the-dsm-is-doing-more-harm-than-good/2012/04/27/gIQAqy0WlT_story.html |title=Psychiatry's bible, the DSM, is doing more harm than good |vauthors=Caplan PJ |author-link=Paula Caplan |date=28 April 2012 |newspaper=Washington Post |department=Opinions |access-date=4 September 2017 |archive-date=3 June 2019 |archive-url=https://web.archive.org/web/20190603024110/https://www.washingtonpost.com/opinions/psychiatrys-bible-the-dsm-is-doing-more-harm-than-good/2012/04/27/gIQAqy0WlT_story.html |url-status=live }}

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".{{cite journal | vauthors = Frances A | title = The new crisis of confidence in psychiatric diagnosis | journal = Annals of Internal Medicine | volume = 159 | issue = 3 | pages = 221–2 | date = August 2013 | pmid = 23685989 | doi = 10.7326/0003-4819-159-3-201308060-00655 | quote = Unfortunately, the extensive research has had no effect on psychiatric diagnosis, which still relies exclusively on fallible subjective judgments rather than objective biological tests. … In the past 20 years, the rate of attention-deficit disorder tripled, the rate of bipolar disorder doubled, and the rate of autism increased more than 20-fold (4). The lesson should be clear that every change in the diagnostic system can lead to unpredictable overdiagnosis. | department = Ideas and Opinions | author1-link = Allen Frances | doi-access = free }} 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).{{cite book | vauthors = Kirk SA, Gomory T, Cohen D |author1-link=Stuart A. Kirk |title=Mad Science: Psychiatric Coercion, Diagnosis, and Drugs |year=2013 |publisher=Transaction Publishers |page=185}}{{ISBN needed}} 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.{{cite journal | vauthors = Moynihan R, Heath I, Henry D | title = Selling sickness: the pharmaceutical industry and disease mongering | journal = BMJ | volume = 324 | issue = 7342 | pages = 886–91 | date = April 2002 | pmid = 11950740 | pmc = 1122833 | doi = 10.1136/bmj.324.7342.886 | department = Education And Debate; Commentary }}

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.{{Cite book| vauthors = Greenberg G |url = https://archive.org/details/bookofwoedsmunma0000gree_t5n8 | isbn = 978-0-399-15853-7 | oclc = 827119919 |location = New York |publisher = Blue Rider Press|title=Book of Woe|year = 2013 }} 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.{{cite book | vauthors = Szasz T |title=The Medicalization of Everyday Life: Selected Essays |date=2007 |publisher=Syracuse University Press |isbn=978-0-8156-0867-7 }}{{page needed|date=June 2022}}

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:

1. "have a sensitivity of at least 80% for detecting a particular psychiatric disorder"
2. should "have a specificity of at least 80% for distinguishing this disorder from other psychiatric or medical disorders"
3. "should be reliable, reproducible, and ideally be noninvasive, simple to perform, and inexpensive"
4. 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.{{cite journal | vauthors = First MB, Drevets WC, Carter C, Dickstein DP, Kasoff L, Kim KL, McConathy J, Rauch S, Saad ZS, Savitz J, Seymour KE, Sheline YI, Zubieta JK | title = Clinical Applications of Neuroimaging in Psychiatric Disorders | journal = The American Journal of Psychiatry | volume = 175 | issue = 9 | pages = 915–916 | date = September 2018 | pmid = 30173550 | pmc = 6583905 | doi = 10.1176/appi.ajp.2018.1750701 }}

{{Main|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."{{cite book |department= Department of Mental Health and Substance Abuse |author2=Prevention Research Centre of the Universities of Nijmegen and Maastricht |date=2004 |title=Prevention of mental disorders: effective interventions and policy options: summary report |author1=World Health Organization |location=Geneva | publisher = World Health Organization |isbn=978-92-4-159215-4 | archive-url=https://web.archive.org/web/20040930104950/https://www.who.int/mental_health/evidence/en/prevention_of_mental_disorders_sr.pdf | archive-date=September 30, 2004 |url=https://www.who.int/mental_health/evidence/en/prevention_of_mental_disorders_sr.pdf }}

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."{{cite journal | vauthors = Campion J, Bhui K, Bhugra D | title = European Psychiatric Association (EPA) guidance on prevention of mental disorders | journal = European Psychiatry | volume = 27 | issue = 2 | pages = 68–80 | date = February 2012 | pmid = 22285092 | doi = 10.1016/j.eurpsy.2011.10.004 | s2cid = 15874608 }}

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".{{cite web |url=http://www2.lse.ac.uk/businessAndConsultancy/LSEEnterprise/news/2011/healthstrategy.aspx |title=Mental health promotion and mental illness prevention: The economic case | veditors = Knapp M, McDaid D, Parsonage M | quote=as of 2019, it is now the Care Policy and Evaluation Centre |department = Personal Social Services Research Unit |publisher = Department of Health, London |archive-url = https://web.archive.org/web/20120706233349/http://www2.lse.ac.uk/businessAndConsultancy/LSEEnterprise/pdf/PSSRUfeb2011.pdf |archive-date = 6 July 2012|website =London School of Economics and Political Science |date=2 February 2011 |access-date=27 May 2013}}

In 2016, the National Institute of Mental Health re-affirmed prevention as a research priority area.{{Cite web | url=https://www.nimh.nih.gov/about/strategic-planning-reports/strategic-research-priorities/srp-objective-3/index.shtml | archive-date = 4 April 2015 | archive-url = https://web.archive.org/web/20150404210448/https://www.nimh.nih.gov/about/strategic-planning-reports/strategic-research-priorities/srp-objective-3/index.shtml| title= Research Priorities for Strategic Objective 3 | location = Bethesda, MD | publisher = National Institutes of Health |website=National Institute of Mental Health}}

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.{{cite journal | vauthors = Wolicki SB, Bitsko RH, Cree RA, Danielson ML, Ko JY, Warner L, Robinson LR | title = Mental Health of Parents and Primary Caregivers by Sex and Associated Child Health Indicators | journal = Adversity and Resilience Science | volume = 2 | issue = 2 | pages = 125–139 | date = June 2021 | pmid = 36523952 | pmc = 9749862 | doi = 10.1007/s42844-021-00037-7 | s2cid = 234820994 }}{{cite journal | vauthors = Barth RP | title = Preventing child abuse and neglect with parent training: evidence and opportunities | journal = The Future of Children | volume = 19 | issue = 2 | pages = 95–118 | year = 2009 | pmid = 19719024 | doi = 10.1353/foc.0.0031 | s2cid = 2548960 | doi-access = free | jstor = 27795049 }}{{cite journal | vauthors = Stewart-Brown SL, Schrader-McMillan A | title = Parenting for mental health: what does the evidence say we need to do? Report of Workpackage 2 of the DataPrev project | journal = Health Promotion International | volume = 26 | issue = Suppl 1 | pages = i10–i28 | date = December 2011 | pmid = 22079931 | doi = 10.1093/heapro/dar056 | doi-access = free }}

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.{{cite journal | vauthors = Muñoz RF, Cuijpers P, Smit F, Barrera AZ, Leykin Y | title = Prevention of major depression | journal = Annual Review of Clinical Psychology | volume = 6 | pages = 181–212 | year = 2010 | pmid = 20192789 | doi = 10.1146/annurev-clinpsy-033109-132040 }}{{cite journal | vauthors = Cuijpers P | title = Examining the effects of prevention programs on the incidence of new cases of mental disorders: the lack of statistical power | journal = The American Journal of Psychiatry | volume = 160 | issue = 8 | pages = 1385–91 | date = August 2003 | pmid = 12900296 | doi = 10.1176/appi.ajp.160.8.1385 }}

{{Main|Treatment of mental disorders|Services for mental disorders|Mental health professional}}

File:Tornow Pritzhagen 10.jpg-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.{{cite journal | vauthors = Kisely SR, Campbell LA, O'Reilly R | title = Compulsory community and involuntary outpatient treatment for people with severe mental disorders | journal = The Cochrane Database of Systematic Reviews | volume = 3 | pages = CD004408 | date = March 2017 | issue = 6 | pmid = 28303578 | pmc = 4393705 | doi = 10.1002/14651858.CD004408.pub5 }}

Lifestyle strategies, including dietary changes, exercise and quitting smoking may be of benefit.{{cite journal | vauthors = Jacka FN | title = Nutritional Psychiatry: Where to Next? | journal = eBioMedicine | volume = 17 | issue = 17 | pages = 24–29 | date = March 2017 | pmid = 28242200 | pmc = 5360575 | doi = 10.1016/j.ebiom.2017.02.020 | doi-access = free | type = Review }}{{cite journal | vauthors = Marx W, Moseley G, Berk M, Jacka F | title = Nutritional psychiatry: the present state of the evidence | journal = The Proceedings of the Nutrition Society | volume = 76 | issue = 4 | pages = 427–436 | date = November 2017 | pmid = 28942748 | doi = 10.1017/S0029665117002026 | type = Review | doi-access = free | hdl = 10536/DRO/DU:30108896 | hdl-access = free }}

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.{{cite journal | vauthors = Marx W, Moseley G, Berk M, Jacka F | title = Nutritional psychiatry: the present state of the evidence | journal = The Proceedings of the Nutrition Society | volume = 76 | issue = 4 | pages = 427–436 | date = November 2017 | pmid = 28942748 | doi = 10.1017/S0029665117002026 | hdl = 10536/DRO/DU:30108896 | hdl-access = free }}

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.{{cite journal | vauthors = Goldstrom ID, Campbell J, Rogers JA, Lambert DB, Blacklow B, Henderson MJ, Manderscheid RW | title = National estimates for mental health mutual support groups, self-help organizations, and consumer-operated services | journal = Administration and Policy in Mental Health | volume = 33 | issue = 1 | pages = 92–103 | date = January 2006 | pmid = 16240075 | doi = 10.1007/s10488-005-0019-x | url = http://www.psychodyssey.net/wp-content/uploads/2012/02/National-estimates-for-mental-health-mutual-support-groups-self-help-organizations-and-consumer-operated-services.pdf | citeseerx = 10.1.1.476.1948 | s2cid = 27310867 | access-date = 25 October 2017 | archive-date = 3 August 2020 | archive-url = https://web.archive.org/web/20200803210238/http://www.psychodyssey.net/wp-content/uploads/2012/02/National-estimates-for-mental-health-mutual-support-groups-self-help-organizations-and-consumer-operated-services.pdf }}The Joseph Rowntree Foundation (1998) [http://www.jrf.org.uk/knowledge/findings/socialcare/SCR488.asp The experiences of mental health service users as mental health professionals] {{webarchive|url=https://web.archive.org/web/20070928073754/http://www.jrf.org.uk/knowledge/findings/socialcare/SCR488.asp |date=28 September 2007 }}{{cite journal | vauthors = Chamberlin J | title = User/consumer involvement in mental health service delivery | journal = Epidemiologia e Psichiatria Sociale | volume = 14 | issue = 1 | pages = 10–4 | year = 2011 | pmid = 15792289 | doi = 10.1017/S1121189X00001871 | s2cid = 22521457 }}{{cite journal | vauthors = McCann TV, Baird J, Clark E, Lu S | title = Beliefs about using consumer consultants in inpatient psychiatric units | journal = International Journal of Mental Health Nursing | volume = 15 | issue = 4 | pages = 258–65 | date = December 2006 | pmid = 17064322 | doi = 10.1111/j.1447-0349.2006.00432.x }}

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.

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.{{Cite web|url=https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml|title=Mental Health Medications|website=National Institute of Mental Health|access-date=6 May 2019|archive-date=6 April 2019|archive-url=https://web.archive.org/web/20190406082433/https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml|url-status=live}}

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.Mind Disorders Encyclopedia [http://www.minddisorders.com/Ob-Ps/Psychosurgery.html Psychosurgery] {{Webarchive|url=https://web.archive.org/web/20170701161714/http://www.minddisorders.com/Ob-Ps/Psychosurgery.html |date=1 July 2017 }} [Retrieved on 5 August 2008]{{cite journal | vauthors = Mashour GA, Walker EE, Martuza RL | title = Psychosurgery: past, present, and future | journal = Brain Research. Brain Research Reviews | volume = 48 | issue = 3 | pages = 409–19 | date = June 2005 | pmid = 15914249 | doi = 10.1016/j.brainresrev.2004.09.002 | s2cid = 10303872 }}

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.{{cite journal | vauthors = Lakhan SE, Vieira KF | title = Nutritional therapies for mental disorders | journal = Nutrition Journal | volume = 7 | issue = 1 | page = 2 | date = January 2008 | pmid = 18208598 | pmc = 2248201 | doi = 10.1186/1475-2891-7-2 | doi-access = free }}

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.{{cite journal | vauthors = Black N, Stockings E, Campbell G, Tran LT, Zagic D, Hall WD, Farrell M, Degenhardt L | title = Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis | journal = The Lancet. Psychiatry | volume = 6 | issue = 12 | pages = 995–1010 | date = December 2019 | pmid = 31672337 | pmc = 6949116 | doi = 10.1016/S2215-0366(19)30401-8 }}

{{Main|Prevalence of mental disorders}}

File:Mental and behavioral disorders world map-Deaths per million persons-WHO2012.svg

File:Neuropsychiatric conditions world map - DALY - WHO2004.svg for neuropsychiatric conditions per 100,000 inhabitants in 2004

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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. In the United States, 46% qualify for a mental illness at some point.{{cite journal | vauthors = Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE | title = Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication | journal = Archives of General Psychiatry | volume = 62 | issue = 6 | pages = 593–602 | date = June 2005 | pmid = 15939837 | doi = 10.1001/archpsyc.62.6.593 | doi-access = free }} 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.{{cite web |url=http://www.hcp.med.harvard.edu/wmh/index.php |title=The World Mental Health Survey Initiative |year=2005 |publisher=Harvard School of Medicine |access-date=1 May 2007 |archive-date=20 April 2020 |archive-url=https://web.archive.org/web/20200420000335/https://www.hcp.med.harvard.edu/wmh/index.php |url-status=live }} Rates varied by region.{{cite journal | vauthors = Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, Angermeyer MC, Bernert S, de Girolamo G, Morosini P, Polidori G, Kikkawa T, Kawakami N, Ono Y, Takeshima T, Uda H, Karam EG, Fayyad JA, Karam AN, Mneimneh ZN, Medina-Mora ME, Borges G, Lara C, de Graaf R, Ormel J, Gureje O, Shen Y, Huang Y, Zhang M, Alonso J, Haro JM, Vilagut G, Bromet EJ, Gluzman S, Webb C, Kessler RC, Merikangas KR, Anthony JC, Von Korff MR, Wang PS, Brugha TS, Aguilar-Gaxiola S, Lee S, Heeringa S, Pennell BE, Zaslavsky AM, Ustun TB, Chatterji S | title = Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys | journal = JAMA | volume = 291 | issue = 21 | pages = 2581–90 | date = June 2004 | pmid = 15173149 | doi = 10.1001/jama.291.21.2581 | doi-access = free }}

A review of anxiety disorder surveys in different countries found average lifetime prevalence estimates of 16.6%, with women having higher rates on average.{{cite journal | vauthors = Somers JM, Goldner EM, Waraich P, Hsu L | title = Prevalence and incidence studies of anxiety disorders: a systematic review of the literature | journal = Canadian Journal of Psychiatry | volume = 51 | issue = 2 | pages = 100–13 | date = February 2006 | pmid = 16989109 | doi = 10.1177/070674370605100206 | url = http://ww1.cpa-apc.org/Publications/Archives/CJP/2006/february/sommers-RP.asp | doi-access = free | access-date = 28 May 2013 | archive-date = 18 February 2019 | archive-url = https://web.archive.org/web/20190218034947/http://ww1.cpa-apc.org/Publications/Archives/CJP/2006/february/sommers-RP.asp | url-status = live }} 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.{{cite journal | vauthors = Waraich P, Goldner EM, Somers JM, Hsu L | title = Prevalence and incidence studies of mood disorders: a systematic review of the literature | journal = Canadian Journal of Psychiatry | volume = 49 | issue = 2 | pages = 124–38 | date = February 2004 | pmid = 15065747 | doi = 10.1177/070674370404900208 | url = http://ww1.cpa-apc.org/Publications/Archives/CJP/2004/february/waraich.asp | doi-access = free | access-date = 28 May 2013 | archive-date = 5 June 2019 | archive-url = https://web.archive.org/web/20190605101837/http://ww1.cpa-apc.org/Publications/Archives/CJP/2004/february/waraich.asp | url-status = live }}

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%).{{cite journal | vauthors = Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE | title = Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication | journal = Archives of General Psychiatry | volume = 62 | issue = 6 | pages = 617–27 | date = June 2005 | pmid = 15939839 | pmc = 2847357 | doi = 10.1001/archpsyc.62.6.617 }}{{cite web |publisher=National Institute of Mental Health |url=http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml |title=The Numbers Count: Mental Disorders in America |date=24 May 2013 |access-date=27 May 2013|archive-url=https://web.archive.org/web/20130524181701/http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml |archive-date=24 May 2013}}

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.{{cite journal | vauthors = Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC, Kovess V, Lépine JP, Ormel J, Polidori G, Russo LJ, Vilagut G, Almansa J, Arbabzadeh-Bouchez S, Autonell J, Bernal M, Buist-Bouwman MA, Codony M, Domingo-Salvany A, Ferrer M, Joo SS, Martínez-Alonso M, Matschinger H, Mazzi F, Morgan Z, Morosini P, Palacín C, Romera B, Taub N, Vollebergh WA | title = Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project | journal = Acta Psychiatrica Scandinavica. Supplementum | volume = 109 | issue = 420 | pages = 21–7 | year = 2004 | pmid = 15128384 | doi = 10.1111/j.1600-0047.2004.00327.x | s2cid = 24499847 }} 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.{{cite journal | vauthors = Wittchen HU, Jacobi F | title = Size and burden of mental disorders in Europe—a critical review and appraisal of 27 studies | journal = European Neuropsychopharmacology | volume = 15 | issue = 4 | pages = 357–76 | date = August 2005 | pmid = 15961293 | doi = 10.1016/j.euroneuro.2005.04.012 | s2cid = 26089761 | url = http://www.qucosa.de/fileadmin/data/qucosa/documents/11261/797_PP.pdf | access-date = 20 April 2018 | archive-date = 9 August 2017 | archive-url = https://web.archive.org/web/20170809095220/http://www.qucosa.de/fileadmin/data/qucosa/documents/11261/797_PP.pdf }}

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.{{cite journal | vauthors = Saha S, Chant D, Welham J, McGrath J | title = A systematic review of the prevalence of schizophrenia | journal = PLOS Medicine | volume = 2 | issue = 5 | pages = e141 | date = May 2005 | pmid = 15916472 | pmc = 1140952 | doi = 10.1371/journal.pmed.0020141 | doi-access = free }}

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.{{cite journal | vauthors = Torgersen S, Kringlen E, Cramer V | title = The prevalence of personality disorders in a community sample | journal = Archives of General Psychiatry | volume = 58 | issue = 6 | pages = 590–6 | date = June 2001 | pmid = 11386989 | doi = 10.1001/archpsyc.58.6.590 | url = https://polipapers.upv.es/index.php/reinad/article/view/3333 | doi-access = free | access-date = 25 May 2019 | archive-date = 20 January 2022 | archive-url = https://web.archive.org/web/20220120194739/https://polipapers.upv.es/index.php/reinad/article/view/3333 | url-status = live }} A US survey that incidentally screened for personality disorder found a rate of 14.79%.{{cite journal | vauthors = Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan WJ, Pickering RP | title = Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions | journal = The Journal of Clinical Psychiatry | volume = 65 | issue = 7 | pages = 948–58 | date = July 2004 | pmid = 15291684 | doi = 10.4088/JCP.v65n0711 | s2cid = 29235629 }}

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.{{cite journal | vauthors = Carter AS, Briggs-Gowan MJ, Davis NO | title = Assessment of young children's social-emotional development and psychopathology: recent advances and recommendations for practice | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 45 | issue = 1 | pages = 109–34 | date = January 2004 | pmid = 14959805 | doi = 10.1046/j.0021-9630.2003.00316.x }}

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.{{cite web |publisher=World Health Organization |url=https://www.who.int/mental_health/prevention/genderwomen/en/ |title=Gender disparities and mental health: The Facts |access-date=12 January 2012 |archive-date=26 May 2019 |archive-url=https://web.archive.org/web/20190526064750/https://www.who.int/mental_health/prevention/genderwomen/en/ |url-status=live }}

{{Main|History of mental disorders}}

Ancient civilizations described and treated a number of mental disorders. Mental illnesses were well known in ancient Mesopotamia,{{cite book| vauthors = Nemet-Nejat KR |author-link=Karen Rhea Nemet-Nejat |date=1998 |title=Daily Life in Ancient Mesopotamia |url=https://archive.org/details/dailylifeinancie00neme |url-access=registration|location=Santa Barbara, California |publisher=Greenwood |isbn=978-0-313-29497-6 |pages=[https://archive.org/details/dailylifeinancie00neme/page/80 80]–81 }} where diseases and mental disorders were believed to be caused by specific deities.{{cite book| vauthors = Black J, Green A |title=Gods, Demons and Symbols of Ancient Mesopotamia: An Illustrated Dictionary |url=https://books.google.com/books?id=05LXAAAAMAAJ|publisher=The British Museum Press|year=1992|isbn=978-0-7141-1705-8|page=102}} Because hands symbolized control over a person, mental illnesses were known as "hands" of certain deities. One psychological illness was known as Qāt Ištar, meaning "Hand of Ishtar". Others were known as "Hand of Shamash", "Hand of the Ghost", and "Hand of the God". Descriptions of these illnesses, however, are so vague that it is usually impossible to determine which illnesses they correspond to in modern terminology. Mesopotamian doctors kept detailed record of their patients' hallucinations and assigned spiritual meanings to them. The royal family of Elam was notorious for its members often being insane. 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.

Conceptions of madness in the Middle Ages in Christian Europe were a mixture of the divine, diabolical, magical and humoral, and transcendental.{{Cite book|title=The SAGE encyclopedia of abnormal and clinical psychology|publisher=Sage Publishing| vauthors = Wenzel A |year=2017|isbn=978-1-4833-6583-1|location=Thousand Oaks, CA|oclc=982958263}} 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.{{cite journal | vauthors = Schoeneman TJ | title = The role of mental illness in the European witch hunts of the sixteenth and seventeenth centuries: an assessment | journal = Journal of the History of the Behavioral Sciences | volume = 13 | issue = 4 | pages = 337–51 | date = October 1977 | pmid = 336681 | doi = 10.1002/1520-6696(197710)13:4<337::aid-jhbs2300130406>3.0.co;2-g }} Many terms for mental disorders that found their way into everyday use first became popular in the 16th and 17th centuries.

File:Gautier - Salpetriere.JPG, 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.{{cn|date=October 2024}}

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.{{cn|date=October 2024}}

File:A mentally ill patient in a strait-jacket attached to the wa Wellcome V0016643ER.jpg

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.

File:Insulin shock therapy.jpg, 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.Bangen, Hans: Geschichte der medikamentösen Therapie der Schizophrenie. Berlin 1992, {{ISBN|3-927408-82-4}} 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.{{cite journal |url=http://www.academyanalyticarts.org/kirk&kutchins.htm | vauthors = Kirk SA, Kutchins H |date=1994 |title=The Myth of the Reliability of DSM |journal=Journal of Mind and Behavior |volume=15 |issue=1&2 |archive-url=https://web.archive.org/web/20080307115815/http://www.academyanalyticarts.org/kirk%26kutchins.htm |archive-date=7 March 2008 }}

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.

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.{{Cite web |date=2016-11-25 |title=Mental illness: Invisible but devastating |url=https://www.un.org/africarenewal/magazine/december-2016-march-2017/mental-illness-invisible-devastating |access-date=2022-07-02 |website=Africa Renewal |language=en |archive-date=15 February 2022 |archive-url=https://web.archive.org/web/20220215162249/https://www.un.org/africarenewal/magazine/december-2016-march-2017/mental-illness-invisible-devastating |url-status=live }}

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.{{Cite web |title=In West Africa, traditional or religious practices are often the preferred method of treating mental disorders |url=https://www.dandc.eu/en/article/west-africa-traditional-or-religious-practices-are-often-preferred-method-treating-mental |access-date=2022-07-02 |website=D+C |date=12 June 2019 |language=en |archive-date=5 January 2021 |archive-url=https://web.archive.org/web/20210105103057/https://www.dandc.eu/en/article/west-africa-traditional-or-religious-practices-are-often-preferred-method-treating-mental |url-status=live }}

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{{Cite web |date=2021-10-10 |title=Why accessible, affordable treatment is vital to curbing rising mental health |url=https://guardian.ng/sunday-magazine/newsfeature/why-accessible-affordable-treatment-is-vital-to-curbing-rising-mental-health-challenge/ |access-date=2022-07-02 |website=The Guardian Nigeria News - Nigeria and World News |language=en-US |archive-date=2 July 2022 |archive-url=https://web.archive.org/web/20220702110252/https://guardian.ng/sunday-magazine/newsfeature/why-accessible-affordable-treatment-is-vital-to-curbing-rising-mental-health-challenge/ |url-status=live }}{{Cite web |date=2021-05-25 |title=Mental health: Most Nigerians patronise traditional, spiritual healers – Expert |url=https://dailytrust.com/mental-health-most-nigerians-patronise-traditional-spiritual-healers-expert |access-date=2022-07-02 |website=Daily Trust |language=en |archive-date=2 July 2022 |archive-url=https://web.archive.org/web/20220702105728/https://dailytrust.com/mental-health-most-nigerians-patronise-traditional-spiritual-healers-expert |url-status=live }}

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.{{Cite journal |last1=Liu |first1=Jin |last2=Ma |first2=Hong |last3=He |first3=Yan Ling |last4=Xie |first4=Bin |last5=Xu |first5=Yi Feng |last6=Tang |first6=Hong Yu |last7=Li |first7=Ming |last8=Hao |first8=Wei |last9=Wang |first9=Xiang Dong |last10=Zhang |first10=Ming Yuan |last11=Ng |first11=Chee H. |last12=Goding |first12=Margaret |last13=Fraser |first13=Julia |last14=Herrman |first14=Helen |last15=Chiu |first15=Helen F.K. |date=2011 |title=Mental health system in China: history, recent service reform and future challenges |journal=World Psychiatry |language=en |volume=10 |issue=3 |pages=210–216 |doi=10.1002/j.2051-5545.2011.tb00059.x |pmid=21991281 |issn=1723-8617|pmc=3188776 }}

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.

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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.{{cite journal | vauthors = Heinimaa M | title = Incomprehensibility: the role of the concept in DSM-IV definition of schizophrenic delusions | journal = Medicine, Health Care and Philosophy | volume = 5 | issue = 3 | pages = 291–5 | year = 2002 | pmid = 12517037 | doi = 10.1023/A:1021164602485 | s2cid = 28266198 }} 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.

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.{{cite web |title=Latinx/Hispanic Communities and Mental Health |url=https://www.mhanational.org/issues/latinxhispanic-communities-and-mental-health |website=Mental Health America |language=en |access-date=14 July 2022 |archive-date=14 July 2022 |archive-url=https://web.archive.org/web/20220714183549/https://www.mhanational.org/issues/latinxhispanic-communities-and-mental-health |url-status=live }}

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.{{cite web | vauthors = Ramos-Olazagasti M, Conway CA |title=The Prevalence of Mental Health Disorders Among Latino Parents |url=https://www.hispanicresearchcenter.org/research-resources/the-prevalence-of-mental-health-disorders-among-latino-parents/ |website=Hispanic Research Center |access-date=14 July 2022 |archive-date=3 July 2022 |archive-url=https://web.archive.org/web/20220703214654/https://www.hispanicresearchcenter.org/research-resources/the-prevalence-of-mental-health-disorders-among-latino-parents/ |url-status=live }}

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.{{cite journal | vauthors = Pro G, Brown C, Rojo M, Patel J, Flax C, Haynes T | title = Downward National Trends in Mental Health Treatment Offered in Spanish: State Differences by Proportion of Hispanic Residents | journal = Psychiatric Services | volume = 73 | issue = 11 | pages = 1232–1238 | date = November 2022 | pmid = 35502519 | doi = 10.1176/appi.ps.202100614 | url = https://ps.psychiatryonline.org/doi/10.1176/appi.ps.202100614 | access-date = 17 July 2022 | url-status = live | s2cid = 248503963 | archive-url = https://web.archive.org/web/20220612003548/https://ps.psychiatryonline.org/doi/10.1176/appi.ps.202100614 | archive-date = 12 June 2022 }} "Disparities in behavioral health risk factors in the past decade have also grown and closely parallel the overall growth in the Latin American population (11–13). From 2015 to 2018, rates of serious mental illness in Latin American populations increased by 60% (from 4.0% to 6.4%) among those ages 18–25 years and by 77% (from 2.2% to 3.9%) among those ages 26–49 years (14). This report was based on analysis of the National Survey on Drug Use and Health and used the Substance Abuse and Mental Health Services Administration's (SAMHSA's) definition of serious mental illness as a diagnosable mental, behavior, or emotional disorder that causes serious functional impairment that substantially interferes with one or more major life activities (15). A similar trend between 2015 and 2018 has been observed for the prevalence of major depressive episodes among Latin Americans ages 12–49 years, which increased from 8.4% to 11.3% (14). In a study based on data from the Behavioral Risk Factor Surveillance System, more than one-third (34%) of Latin American respondents reported at least one poor mental health day in the past month (mean=3.6 days), and 11% reported frequent mental distress (16)." 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.{{cite web |title=Mental and Behavioral Health - Hispanics - The Office of Minority Health |url=https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=69 |website=minorityhealth.hhs.gov |access-date=17 July 2022 |archive-date=17 July 2022 |archive-url=https://web.archive.org/web/20220717072008/https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=69 |url-status=live }} "However, the suicide rate for [Latin Americans] is less than half that of the non-[Latin American] white population.

In 2019, suicide was the second leading cause of death for Latin Americans, ages 15 to 34.1" However, Latin American suicide rates rose steadily after 2020 in relation to the COVID-19 pandemic, even as the national rate declined.{{cite news | vauthors = Pattani A |title=Pandemic unveils growing suicide crisis for communities of color |url=https://www.inquirer.com/health/coronavirus/suicide-rates-increasing-black-hispanic-20210831.html |language=en |access-date=17 July 2022 |archive-date=17 July 2022 |archive-url=https://web.archive.org/web/20220717072008/https://www.inquirer.com/health/coronavirus/suicide-rates-increasing-black-hispanic-20210831.html |url-status=live }}{{cite web | vauthors = Despres C |title=More Latino Men Are Dying by Suicide, Even as the National Rate Declines |url=https://salud-america.org/more-latino-men-are-dying-by-suicide-even-as-the-national-rate-declines/ |website=Salud America |date=9 March 2022 |access-date=17 July 2022 |archive-date=29 June 2022 |archive-url=https://web.archive.org/web/20220629104418/https://salud-america.org/more-latino-men-are-dying-by-suicide-even-as-the-national-rate-declines/ |url-status=live }}

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,{{cite journal | vauthors = Villatoro AP, Morales ES, Mays VM | title = Family culture in mental health help-seeking and utilization in a nationally representative sample of Latinos in the United States: The NLAAS | journal = The American Journal of Orthopsychiatry | volume = 84 | issue = 4 | pages = 353–363 | date = July 2014 | pmid = 24999521 | pmc = 4194077 | doi = 10.1037/h0099844 }} 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.{{cite web |title=Mental Health Stigma, Fueled by Religious Belief, May Prevent Many Latinos from Seeking Help |url=https://www.rutgers.edu/news/mental-health-stigma-fueled-religious-belief-may-prevent-many-latinos-seeking-help |website=www.rutgers.edu |language=en |access-date=17 July 2022 |archive-date=5 December 2022 |archive-url=https://web.archive.org/web/20221205175557/https://www.rutgers.edu/news/mental-health-stigma-fueled-religious-belief-may-prevent-many-latinos-seeking-help |url-status=live }}

{{See also|Psychology of religion}}

Religious, spiritual, or transpersonal experiences and beliefs meet many criteria of delusional or psychotic disorders.{{cite journal | vauthors = Pierre JM | title = Faith or delusion? At the crossroads of religion and psychosis | journal = Journal of Psychiatric Practice | volume = 7 | issue = 3 | pages = 163–72 | date = May 2001 | pmid = 15990520 | doi = 10.1097/00131746-200105000-00004 | s2cid = 22897500 }}{{cite journal |doi=10.1177/0022167808314174 |title=Enlightened or Delusional?: Differentiating Religious, Spiritual, and Transpersonal Experiences from Psychopathology |year=2008 | vauthors = Johnson CV, Friedman HL |journal=Journal of Humanistic Psychology |volume=48 |issue=4 |pages=505–27|hdl=11244/24872 |s2cid=145541617 |hdl-access=free }} A belief or experience can sometimes be shown to produce distress or disability—the ordinary standard for judging mental disorders.{{cite book |title=Psychosis and Spirituality: Consolidating the New Paradigm | vauthors = Clarke I |publisher=John Wiley & Sons |year=2010 |isbn=978-0-470-97029-4 |page=240}} There is a link between religion and schizophrenia,{{cite journal | vauthors = Siddle R, Haddock G, Tarrier N, Faragher EB | title = Religious delusions in patients admitted to hospital with schizophrenia | journal = Social Psychiatry and Psychiatric Epidemiology | volume = 37 | issue = 3 | pages = 130–8 | date = March 2002 | pmid = 11990010 | doi = 10.1007/s001270200005 | s2cid = 8949296 }} 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,{{cite journal | vauthors = Mohr S, Borras L, Betrisey C, Pierre-Yves B, Gilliéron C, Huguelet P | title = Delusions with religious content in patients with psychosis: how they interact with spiritual coping | journal = Psychiatry | volume = 73 | issue = 2 | pages = 158–72 | date = 1 June 2010 | pmid = 20557227 | doi = 10.1521/psyc.2010.73.2.158 | s2cid = 207509518 }}{{cite journal | vauthors = Suhail K, Ghauri S |title=Phenomenology of delusions and hallucinations in schizophrenia by religious convictions |journal=Mental Health, Religion & Culture |date=1 April 2010 |volume=13 |issue=3 |pages=245–59 |doi=10.1080/13674670903313722|s2cid=145793759 }} and religion itself may be a trigger for schizophrenia.{{cite journal | vauthors = Mohr S, Borras L, Rieben I, Betrisey C, Gillieron C, Brandt PY, Perroud N, Huguelet P | title = Evolution of spirituality and religiousness in chronic schizophrenia or schizo-affective disorders: a 3-years follow-up study | journal = Social Psychiatry and Psychiatric Epidemiology | volume = 45 | issue = 11 | pages = 1095–103 | date = November 2010 | pmid = 19821066 | doi = 10.1007/s00127-009-0151-0 | s2cid = 13042932 | url = http://doc.rero.ch/record/314252/files/127_2009_Article_151.pdf | access-date = 15 January 2019 | archive-date = 29 October 2021 | archive-url = https://web.archive.org/web/20211029102413/http://doc.rero.ch/record/314252/files/127_2009_Article_151.pdf | url-status = live }}

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File:Dr Thomas S Szasz.jpg

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. 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.{{cite book |url=https://books.google.com/books?id=MFf5jD8-J10C|title=Psychiatry:A Very Short Introduction |author=Tom Burns |year=2006 |publisher=Oxford University Press|isbn=978-0-19-157939-4}} 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.{{cite journal |vauthors=Everett B |title=Something is happening: the contemporary consumer and psychiatric survivor movement in historical context |journal=Journal of Mind and Behavior |volume=15 |issue=1–2 |pages=55–70 |year=1994 |url=http://www.brown.uk.com/brownlibrary/EVERETT.htm |access-date=12 January 2012 |archive-date=8 December 2021 |archive-url=https://web.archive.org/web/20211208194317/http://www.brown.uk.com/brownlibrary/EVERETT.htm |url-status=live }}{{cite journal | vauthors = Rissmiller DJ, Rissmiller JH | title = Evolution of the antipsychiatry movement into mental health consumerism | journal = Psychiatric Services | volume = 57 | issue = 6 | pages = 863–6 | date = June 2006 | pmid = 16754765 | doi = 10.1176/appi.ps.57.6.863 | s2cid = 19635873 }}{{cite journal | vauthors = Oaks D | title = The evolution of the consumer movement | journal = Psychiatric Services | volume = 57 | issue = 8 | pages = 1212; author reply 1216 | date = August 2006 | pmid = 16870979 | doi = 10.1176/appi.ps.57.8.1212 }} 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.The Antipsychiatry Coalition. (26 November 2005). The Antipsychiatry Coalition. Retrieved 19 April 2007, from antipsychiatry.org{{verify source|date=May 2013}}{{unreliable source?|date=May 2013}}{{cite journal | vauthors = O'Brien AP, Woods M, Palmer C | title = The emancipation of nursing practice: applying anti-psychiatry to the therapeutic community | journal = The Australian and New Zealand Journal of Mental Health Nursing | volume = 10 | issue = 1 | pages = 3–9 | date = March 2001 | pmid = 11421968 | doi = 10.1046/j.1440-0979.2001.00183.x }}{{cite journal | vauthors = Weitz D | title = Call me antipsychiatry activist--not "consumer" | journal = Ethical Human Sciences and Services | volume = 5 | issue = 1 | pages = 71–2 | year = 2003 | pmid = 15279009 | url = http://openurl.ingenta.com/content?genre=article&issn=1523-150X&volume=5&issue=1&spage=71&epage=72 }}{{Dead link|date=July 2023 |bot=InternetArchiveBot |fix-attempted=yes }} Republished from {{cite journal | vauthors = Weitz D | title = Call me antipsychiatry activist—not "consumer" | journal = Ethical Human Sciences and Services | volume = 5 | issue = 1 | pages = 71–2 | date = Spring 2002 | pmid = 15279009 | url = http://radicalpsychology.org/vol3-1/don.html | archive-url = https://web.archive.org/web/20140103084519/http://radicalpsychology.org/vol3-1/don.html | archive-date = 3 January 2014 }}

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'.{{cite journal | vauthors = Patel V, Prince M | title = Global mental health: a new global health field comes of age | journal = JAMA | volume = 303 | issue = 19 | pages = 1976–7 | date = May 2010 | pmid = 20483977 | pmc = 3432444 | doi = 10.1001/jama.2010.616 }}

{{See also|Depression and culture|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.{{cite journal | vauthors = Widiger TA, Sankis LM | title = Adult psychopathology: issues and controversies | journal = Annual Review of Psychology | volume = 51 | issue = 1 | pages = 377–404 | year = 2000 | pmid = 10751976 | doi = 10.1146/annurev.psych.51.1.377 }} 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.{{cite news |vauthors=Vedantam S |url=https://www.washingtonpost.com/wp-dyn/content/article/2005/06/25/AR2005062500982.html |title=Psychiatry's Missing Diagnosis: Patients' Diversity Is Often Discounted |newspaper=The Washington Post |date=26 June 2005 |access-date=4 September 2017 |archive-date=7 August 2017 |archive-url=https://web.archive.org/web/20170807094158/http://www.washingtonpost.com/wp-dyn/content/article/2005/06/25/AR2005062500982.html |url-status=live }}

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.{{cite journal | vauthors = Kleinman A | title = Triumph or pyrrhic victory? The inclusion of culture in DSM-IV | journal = Harvard Review of Psychiatry | volume = 4 | issue = 6 | pages = 343–4 | year = 1997 | pmid = 9385013 | doi = 10.3109/10673229709030563 | s2cid = 43256486 }} 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.{{cite book | vauthors = Bhugra D, Munro A |year=1997 |title=Troublesome Disguises: Underdiagnosed Psychiatric Syndromes | url = https://archive.org/details/troublesomedisgu0000unse | url-access = registration |publisher=Blackwell Science|isbn=978-0-86542-674-0 }}{{page needed|date=May 2013}}

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.

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.{{cite journal |doi=10.1521/pedi.2006.20.2.184 |title=The Role of Moral Judgment in Personality Disorder Diagnosis |year=2006 | vauthors = Clark LA |journal=Journal of Personality Disorders |volume=20 |issue=2 |pages=184–85}} 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.{{cite journal | vauthors = Karasz A | title = Cultural differences in conceptual models of depression | journal = Social Science & Medicine | volume = 60 | issue = 7 | pages = 1625–35 | date = April 2005 | pmid = 15652693 | doi = 10.1016/j.socscimed.2004.08.011 }}{{cite journal |doi=10.5172/hesr.13.1.54 |title='There are orphans in Africa still looking for my hands': African women refugees and the sources of emotional distress |year=2004 | vauthors = Tilbury F, Rapley M |journal=Health Sociology Review |volume=13 |pages=54–64|s2cid=145545714 }} This dichotomy has led some academics and clinicians to advocate a postmodernist conceptualization of mental distress and well-being.{{cite journal | vauthors = Bracken P, Thomas P | title = Postpsychiatry: a new direction for mental health | journal = BMJ | volume = 322 | issue = 7288 | pages = 724–7 | date = March 2001 | pmid = 11264215 | pmc = 1119907 | doi = 10.1136/bmj.322.7288.724 }}{{cite journal |doi=10.1023/A:1009018429802 |year=2000 | vauthors = Lewis B |journal=Journal of Medical Humanities |volume=21 |issue=2 |pages=71–84 |title=Psychiatry and Postmodern Theory|s2cid=53444644 }}

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.{{cite journal | vauthors = Kwate NO | title = The heresy of African-centered psychology | journal = The Journal of Medical Humanities | volume = 26 | issue = 4 | pages = 215–35 | year = 2005 | pmid = 16333686 | doi = 10.1007/s10912-005-7698-x | s2cid = 20638428 }} In many countries there are attempts to challenge perceived prejudice against minority groups, including alleged institutional racism within psychiatric services.{{cite journal |doi=10.1192/pb.bp.107.017137 |title=Institutional racism in mental health services does not imply racism in individual psychiatrists: Commentary on... Institutional racism in psychiatry |year=2007 | vauthors = Patel K, Heginbotham C |journal=Psychiatric Bulletin |volume=31 |issue=10 |pages=367–68|doi-access=free }} There are also ongoing attempts to improve professional cross cultural sensitivity.{{Cite web |title=TIP 59: Improving Cultural Competence {{!}} SAMHSA Publications and Digital Products |url=https://store.samhsa.gov/product/TIP-59-Improving-Cultural-Competence/SMA15-4849 |access-date=2022-07-01 |website=store.samhsa.gov |archive-date=25 May 2022 |archive-url=https://web.archive.org/web/20220525071344/https://store.samhsa.gov/product/TIP-59-Improving-Cultural-Competence/SMA15-4849 |url-status=live }}

{{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.{{cite book|publisher=World Health Organization |year=2005 |url=https://www.who.int/mental_health/policy/who_rb_mnh_hr_leg_FINAL_11_07_05.pdf |title= Resource Book on Mental Health: Human rights and legislation |isbn=978-92-4-156282-9 |archive-url=https://web.archive.org/web/20131025235045/http://www.who.int/mental_health/policy/who_rb_mnh_hr_leg_FINAL_11_07_05.pdf |archive-date=25 October 2013 }}{{page needed|date=May 2013}} 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. 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.{{cite journal | vauthors = Sklar R | title = Starson v. Swayze: the Supreme Court speaks out (not all that clearly) on the question of "capacity" | journal = Canadian Journal of Psychiatry | volume = 52 | issue = 6 | pages = 390–6 | date = June 2007 | pmid = 17696026 | doi = 10.1177/070674370705200609 | doi-access = free }}

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. 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.Manitoba Family Services and Housing. The Vulnerable Persons Living with a Mental Disability Act, 1996{{primary source inline|date=May 2013}} 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. 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.{{Cite web |url=https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html |title=Department of Economic and Social Affairs Disability |access-date=15 July 2022 |archive-date=2 October 2016 |archive-url=https://web.archive.org/web/20161002201518/https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html |url-status=live }}

The term insanity, sometimes used colloquially as a synonym for mental illness, is often used technically as a legal term.

{{anchor|Stigma and discrimination}}

{{Further|Schizophrenogenic parents|Refrigerator mother|Mentalism (discrimination)}}

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."{{cite book |author1=Office of the Surgeon General |author1-link=Surgeon General of the United States |author2=Center for Mental Health Services |author2-link=Substance Abuse and Mental Health Services Administration#Center for Mental Health Services |author3=National Institute of Mental Health |author3-link=National Institute of Mental Health |chapter=A Vision for the Future |chapter-url=http://profiles.nlm.nih.gov/ps/access/NNBBJR.pdf |date=1999 |pages=451–58 |url=http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBBHS |title=Mental Health: A Report of the Surgeon General |publisher=National Institute of Mental Health |isbn=978-0-16-050300-9 |access-date=28 May 2013 |archive-date=26 September 2019 |archive-url=https://web.archive.org/web/20190926235338/https://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBBHS |url-status=live }} Additionally, researcher Wulf Rössler in 2016, in his article, "The Stigma of Mental Disorders" stated:

{{blockquote|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.{{cite journal | vauthors = Rössler W | title = The stigma of mental disorders: A millennia-long history of social exclusion and prejudices | journal = EMBO Reports | volume = 17 | issue = 9 | pages = 1250–1253 | date = September 2016 | pmid = 27470237 | pmc = 5007563 | doi = 10.15252/embr.201643041 }}}}

In the United States, racial and ethnic minorities are more likely to experience mental health disorders often due to low socioeconomic status, and discrimination.{{cite journal | vauthors = Williams DR | title = Stress and the Mental Health of Populations of Color: Advancing Our Understanding of Race-related Stressors | journal = Journal of Health and Social Behavior | volume = 59 | issue = 4 | pages = 466–485 | date = December 2018 | pmid = 30484715 | pmc = 6532404 | doi = 10.1177/0022146518814251 }}{{Cite web|url=https://www.samhsa.gov/specific-populations/racial-ethnic-minority|title=Racial and Ethnic Minority Populations|vauthors=Lynsen A|date=24 September 2014|website=www.samhsa.gov|access-date=18 December 2018|archive-date=18 December 2018|archive-url=https://web.archive.org/web/20181218054506/https://www.samhsa.gov/specific-populations/racial-ethnic-minority|url-status=live}}{{cite journal | vauthors = Gary FA | title = Stigma: barrier to mental health care among ethnic minorities | journal = Issues in Mental Health Nursing | volume = 26 | issue = 10 | pages = 979–999 | date = December 2005 | pmid = 16283995 | doi = 10.1080/01612840500280638 | s2cid = 26075592 }} 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.{{cite web | author=MedPartner Taiwan | title=別再說「想太多」！一張表看懂憂鬱症身心症狀 | website=健康遠見 | date=22 May 2019 | url=https://health.gvm.com.tw/article.html?id=66420 | archive-url=https://web.archive.org/web/20190831101637/https://health.gvm.com.tw/article.html?id=66420 | archive-date=31 August 2019 |access-date=9 July 2019 | language=zh-tw }}

Employment discrimination is reported to play a significant part in the high rate of unemployment among those with a diagnosis of mental illness.{{cite journal | vauthors = Stuart H | title = Mental illness and employment discrimination | journal = Current Opinion in Psychiatry | volume = 19 | issue = 5 | pages = 522–6 | date = September 2006 | pmid = 16874128 | doi = 10.1097/01.yco.0000238482.27270.5d | s2cid = 45821626 }} An Australian study found that having a psychiatric disability is a bigger barrier to employment than a physical disability.{{cite web |url=http://www.smh.com.au/national/health/stigma-hurts-job-prospects-20121007-277c3.html |title=Stigma hurts job prospects | vauthors = Lucas C |work=Sydney Morning Herald |access-date=13 October 2012 |archive-url=https://web.archive.org/web/20130120171340/http://www.smh.com.au/national/health/stigma-hurts-job-prospects-20121007-277c3.html |archive-date=20 January 2013}}{{Better source needed|reason=This article might be an appropriate lay summary for the study it describes.|date=October 2015}} The mentally ill are stigmatized in Chinese society and can not legally marry.{{cite news|title=China relaxes laws on love and marriage|url=https://www.telegraph.co.uk/news/worldnews/asia/china/1439403/China-relaxes-laws-on-love-and-marriage.html |archive-url=https://ghostarchive.org/archive/20220110/https://www.telegraph.co.uk/news/worldnews/asia/china/1439403/China-relaxes-laws-on-love-and-marriage.html |page=20 | id={{Gale|A106746772}}|archive-date=10 January 2022 |url-access=subscription |url-status=live|access-date=24 October 2013|newspaper=The Telegraph |publisher=Hollinger International |location=London England|issn=0307-1235 |oclc=49632006 |date=21 August 2003|author=Spencer, Richard }}{{cbignore}}

Efforts are being undertaken worldwide to eliminate the stigma of mental illness,{{cite web|url=http://bipolarworld-net.canadawebhosting.com/Disability/Stigma/stop_stigma.htm |title=Stop Stigma |publisher=Bipolarworld-net.canadawebhosting.com |date=29 April 2002 |access-date=23 April 2013 |archive-url=https://web.archive.org/web/20130117044557/http://bipolarworld-net.canadawebhosting.com/Disability/Stigma/stop_stigma.htm |archive-date=17 January 2013 }} although the methods and outcomes used have sometimes been criticized.{{cite journal | vauthors = Read J, Haslam N, Sayce L, Davies E | title = Prejudice and schizophrenia: a review of the 'mental illness is an illness like any other' approach | journal = Acta Psychiatrica Scandinavica | volume = 114 | issue = 5 | pages = 303–18 | date = November 2006 | pmid = 17022790 | doi = 10.1111/j.1600-0447.2006.00824.x | s2cid = 27738025 }}

{{Main|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.{{cite journal|author1-link=John H. Coverdale | vauthors = Coverdale J, Nairn R, Claasen D | title = Depictions of mental illness in print media: a prospective national sample | journal = The Australian and New Zealand Journal of Psychiatry | volume = 36 | issue = 5 | pages = 697–700 | date = October 2002 | pmid = 12225457 | doi = 10.1046/j.1440-1614.2002.00998.x | s2cid = 19862722 }}Edney, RD. (2004) [http://www.ontario.cmha.ca/content/about_mental_illness/mass_media.asp Mass Media and Mental Illness: A Literature Review] {{webarchive|url=https://web.archive.org/web/20050912181527/http://www.ontario.cmha.ca/content/about_mental_illness/mass_media.asp |date=12 September 2005 }} Canadian Mental Health Association{{cite journal |doi=10.1002/(SICI)1520-6629(199705)25:3<289::AID-JCOP5>3.0.CO;2-R |title=The portrayal of mental illness on prime-time television |year=1997 | vauthors = Diefenbach DL |journal=Journal of Community Psychology |volume=25 |issue=3 |pages=289–302}} 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.{{cite journal |doi=10.1080/0963823031000118249 |title=Media frames of mental illnesses: The potential impact of negative frames |year=2003 | vauthors = Sieff E |journal=Journal of Mental Health |volume=12 |issue=3 |pages=259–69|s2cid=145291023 }}{{cite journal |doi=10.1177/0002764203254615 |title=News Media Portrayal of Mental Illness: Implications for Public Policy |year=2003 | vauthors = Wahl OF |journal=American Behavioral Scientist |volume=46 |issue=12 |pages=1594–600|s2cid=145696394 }}

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.{{cite press release |publisher=The Carter Center |title=The Carter Center Awards 2008–2009 Rosalynn Carter Fellowships for Mental Health Journalism |date=18 July 2008 |url=http://www.cartercenter.org/news/pr/mental_health_fellows_2008_2009.html |access-date=28 May 2013 |archive-date=3 January 2014 |archive-url=https://web.archive.org/web/20140103071447/http://www.cartercenter.org/news/pr/mental_health_fellows_2008_2009.html |url-status=live }} 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.{{cite web |publisher=The Carter Center |title=The Rosalynn Carter Fellowships For Mental Health Journalism |url=http://www.cartercenter.org/health/mental_health/fellowships/index.html |access-date=28 May 2013 |year=2013 |archive-date=15 March 2013 |archive-url=https://web.archive.org/web/20130315053141/http://cartercenter.org/health/mental_health/fellowships/index.html |url-status=live }}{{cite web |date=19 July 2016 |website=The Carter Center |title=Rosalynn Carter's Leadership in Mental Health |url=https://www.cartercenter.org/health/mental_health/rosalynn-carter-mental-health-leadership.html |url-status=live |archive-date=8 July 2017 |archive-url=https://web.archive.org/web/20170708180048/https://www.cartercenter.org/health/mental_health/rosalynn-carter-mental-health-leadership.html }} 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.{{cite journal | vauthors = Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA | title = Public conceptions of mental illness: labels, causes, dangerousness, and social distance | journal = American Journal of Public Health | volume = 89 | issue = 9 | pages = 1328–1333 | date = September 1999 | pmid = 10474548 | pmc = 1508784 | doi = 10.2105/AJPH.89.9.1328 }} 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.{{cite journal | vauthors = Pescosolido BA, Monahan J, Link BG, Stueve A, Kikuzawa S | title = The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems | journal = American Journal of Public Health | volume = 89 | issue = 9 | pages = 1339–1345 | date = September 1999 | pmid = 10474550 | pmc = 1508769 | doi = 10.2105/AJPH.89.9.1339 }} 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."{{cite journal | vauthors = Hamilton S, Lewis-Holmes E, Pinfold V, Henderson C, Rose D, Thornicroft G | title = Discrimination against people with a mental health diagnosis: qualitative analysis of reported experiences | journal = Journal of Mental Health | volume = 23 | issue = 2 | pages = 88–93 | date = April 2014 | pmid = 24660972 | doi = 10.3109/09638237.2014.880408 | s2cid = 19652980 }} 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."{{cite journal | vauthors = Schomerus G, Angermeyer MC | title = Stigma and its impact on help-seeking for mental disorders: what do we know? | journal = Epidemiologia e Psichiatria Sociale | volume = 17 | issue = 1 | pages = 31–37 | date = 18 May 2011 | pmid = 18444456 | doi = 10.1017/S1121189X00002669 | s2cid = 34916201 }}

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).{{cite news |vauthors=Mitchell J |title=How 'Homeland' became a pioneer in the portrayal of mental illness |website=SBS |date=23 February 2018 |url=https://www.sbs.com.au/guide/article/2018/02/12/how-homeland-became-pioneer-portrayal-mental-illness |location=Australia |access-date=4 July 2022 |archive-date=4 July 2022 |archive-url=https://web.archive.org/web/20220704014934/https://www.sbs.com.au/guide/article/2018/02/12/how-homeland-became-pioneer-portrayal-mental-illness |url-status=live }}{{cite journal |vauthors=Langley T |title=Does Iron Man 3's Hero Suffer Posttraumatic Stress Disorder? |journal=Psychology Today |date=4 May 2013 |url=https://www.psychologytoday.com/us/blog/beyond-heroes-and-villains/201305/does-iron-man-3s-hero-suffer-posttraumatic-stress-disorder |access-date=4 July 2022 |publisher=Sussex Publishers |archive-date=3 June 2021 |archive-url=https://archive.today/20210603211857/https://www.psychologytoday.com/us/blog/beyond-heroes-and-villains/201305/does-iron-man-3s-hero-suffer-posttraumatic-stress-disorder |url-status=live }}{{Original research inline|date=May 2013}}

The insanity defense may be used in a legal trial as an legal excuse for crime.

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.{{cite journal | vauthors = Elbogen EB, Johnson SC | title = The intricate link between violence and mental disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions | journal = Archives of General Psychiatry | volume = 66 | issue = 2 | pages = 152–61 | date = February 2009 | pmid = 19188537 | doi = 10.1001/archgenpsychiatry.2008.537 | doi-access = free }} A 2015 review found that in the United States, about 4% of violence is attributable to people diagnosed with mental illness,{{cite journal | vauthors = Metzl JM, MacLeish KT | title = Mental illness, mass shootings, and the politics of American firearms | journal = American Journal of Public Health | volume = 105 | issue = 2 | pages = 240–9 | date = February 2015 | pmid = 25496006 | pmc = 4318286 | doi = 10.2105/AJPH.2014.302242 }} 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.{{cite journal | vauthors = Peterson JK, Skeem J, Kennealy P, Bray B, Zvonkovic A | title = How often and how consistently do symptoms directly precede criminal behavior among offenders with mental illness? | journal = Law and Human Behavior | volume = 38 | issue = 5 | pages = 439–49 | date = October 2014 | pmid = 24730388 | doi = 10.1037/lhb0000075 | s2cid = 2228512 }} The majority of people with serious mental illness are never violent.{{cite journal | vauthors = Swanson JW, McGinty EE, Fazel S, Mays VM | title = Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy | journal = Annals of Epidemiology | volume = 25 | issue = 5 | pages = 366–76 | date = May 2015 | pmid = 24861430 | pmc = 4211925 | doi = 10.1016/j.annepidem.2014.03.004 }}

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.{{cite journal | vauthors = Brekke JS, Prindle C, Bae SW, Long JD | title = Risks for individuals with schizophrenia who are living in the community | journal = Psychiatric Services | volume = 52 | issue = 10 | pages = 1358–66 | date = October 2001 | pmid = 11585953 | doi = 10.1176/appi.ps.52.10.1358 }} 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.{{cite journal | vauthors = Teplin LA, McClelland GM, Abram KM, Weiner DA | title = Crime victimization in adults with severe mental illness: comparison with the National Crime Victimization Survey | journal = Archives of General Psychiatry | volume = 62 | issue = 8 | pages = 911–21 | date = August 2005 | pmid = 16061769 | pmc = 1389236 | doi = 10.1001/archpsyc.62.8.911 }} People with a diagnosis may find it more difficult to secure prosecutions, however, due in part to prejudice and being seen as less credible.{{cite journal |doi=10.1177/009385480102800601 |title=Crime Victims with Developmental Disabilities: A Review Essay |year=2001 | vauthors = Petersilia JR |journal=Criminal Justice and Behavior |volume=28 |issue=6 |pages=655–94 |s2cid=145599816 }}

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.{{cite journal | vauthors = Stuart H | title = Violence and mental illness: an overview | journal = World Psychiatry | volume = 2 | issue = 2 | pages = 121–4 | date = June 2003 | pmid = 16946914 | pmc = 1525086 }}{{cite journal | vauthors = Steadman HJ, Mulvey EP, Monahan J, Robbins PC, Appelbaum PS, Grisso T, Roth LH, Silver E | title = Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods | journal = Archives of General Psychiatry | volume = 55 | issue = 5 | pages = 393–401 | date = May 1998 | pmid = 9596041 | doi = 10.1001/archpsyc.55.5.393 | doi-access = free }}{{cite journal | vauthors = Fazel S, Gulati G, Linsell L, Geddes JR, Grann M | title = Schizophrenia and violence: systematic review and meta-analysis | journal = PLOS Medicine | volume = 6 | issue = 8 | pages = e1000120 | date = August 2009 | pmid = 19668362 | pmc = 2718581 | doi = 10.1371/journal.pmed.1000120 | veditors = McGrath J | doi-access = free }}

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.{{cite journal | vauthors = Taylor PJ, Gunn J | title = Homicides by people with mental illness: myth and reality | journal = The British Journal of Psychiatry | issn = 0007-1250 | eissn = 1472-1465 | lccn = 89649366 | oclc = 1537306 | volume = 174 | issue = 1 | pages = 9–14 | date = January 1999 | pmid = 10211145 | doi = 10.1192/bjp.174.1.9 | s2cid = 24432329 }} 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.{{cite journal | vauthors = Solomon PL, Cavanaugh MM, Gelles RJ | title = Family violence among adults with severe mental illness: a neglected area of research | journal = Trauma, Violence & Abuse | volume = 6 | issue = 1 | pages = 40–54 | date = January 2005 | pmid = 15574672 | doi = 10.1177/1524838004272464 | s2cid = 20067766 }} It is also an issue in health care settings{{cite journal | vauthors = Chou KR, Lu RB, Chang M | title = Assaultive behavior by psychiatric in-patients and its related factors | journal = The Journal of Nursing Research | volume = 9 | issue = 5 | pages = 139–51 | date = December 2001 | pmid = 11779087 | doi = 10.1097/01.JNR.0000347572.60800.00 }} and the wider community.{{cite journal | vauthors = Lögdberg B, Nilsson LL, Levander MT, Levander S | title = Schizophrenia, neighbourhood, and crime | journal = Acta Psychiatrica Scandinavica | volume = 110 | issue = 2 | pages = 92–7 | date = August 2004 | pmid = 15233709 | doi = 10.1111/j.1600-0047.2004.00322.x | s2cid = 12605241 }}

{{Main|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.{{rp|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.{{cite journal | vauthors = | title = Cross-national comparisons of the prevalences and correlates of mental disorders. WHO International Consortium in Psychiatric Epidemiology | journal = Bulletin of the World Health Organization | volume = 78 | issue = 4 | pages = 413–426 | year = 2000 | pmid = 10885160 | pmc = 2560724 | hdl = 10665/57240 }} 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.{{cite journal | vauthors = Westerhof GJ, Keyes CL | title = Mental Illness and Mental Health: The Two Continua Model Across the Lifespan | journal = Journal of Adult Development | volume = 17 | issue = 2 | pages = 110–119 | date = June 2010 | pmid = 20502508 | pmc = 2866965 | doi = 10.1007/s10804-009-9082-y }} 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.{{cite web |title=What is Mental Health and Mental Illness? {{!}} Workplace Mental Health Promotion |department = Health Communication Unit | publisher = Dalla Lana School of Public Health| location = University of Toronto| date = 12 April 2010 | archive-url = https://web.archive.org/web/20100801232011/http://wmhp.cmhaontario.ca/workplace-mental-health-core-concepts-issues/what-is-mental-health-and-mental-illness | archive-date = 1 August 2010 | url=http://wmhp.cmhaontario.ca/workplace-mental-health-core-concepts-issues/what-is-mental-health-and-mental-illness | website=Workplace Mental Health Promotion }}

{{main|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.{{cite journal | vauthors = Brüne M, Brüne-Cohrs U, McGrew WC, Preuschoft S | title = Psychopathology in great apes: concepts, treatment options and possible homologies to human psychiatric disorders | journal =Neuroscience & Biobehavioral Reviews | issn = 0149-7634 | eissn = 1873-7528 | lccn =78-643607 | oclc = 3552135| volume = 30 | issue = 8 | pages = 1246–59 | year = 2006 | pmid = 17141312 | doi = 10.1016/j.neubiorev.2006.09.002 | s2cid = 10101196 }}{{cite journal | vauthors = Ferdowsian HR, Durham DL, Kimwele C, Kranendonk G, Otali E, Akugizibwe T, Mulcahy JB, Ajarova L, Johnson CM | title = Signs of mood and anxiety disorders in chimpanzees | journal = PLOS ONE | volume = 6 | issue = 6 | pages = e19855 | year = 2011 | pmid = 21698223 | pmc = 3116818 | doi = 10.1371/journal.pone.0019855 | veditors = Callaerts P | bibcode = 2011PLoSO...619855F | doi-access = free }}

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.{{cite journal | vauthors = Fabrega H | title = Making sense of behavioral irregularities of great apes | journal = Neuroscience & Biobehavioral Reviews | issn = 0149-7634 | eissn = 1873-7528 | lccn =78-643607 | oclc = 3552135| volume = 30 | issue = 8 | pages = 1260–73; discussion 1274–7 | year = 2006 | pmid = 17079015 | doi = 10.1016/j.neubiorev.2006.09.004 | s2cid = 20587935 }}

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.{{cite journal | vauthors = Lilienfeld SO, Gershon J, Duke M, Marino L, de Waal FB | title = A preliminary investigation of the construct of psychopathic personality (psychopathy) in chimpanzees (Pan troglodytes) | journal = Journal of Comparative Psychology | issn = 0735-7036 | eissn = 1939-2087 | lccn = 83648068 | oclc = 08997203 | volume = 113 | issue = 4 | pages = 365–75 | date = December 1999 | pmid = 10608560 | doi = 10.1037/0735-7036.113.4.365 | url = https://animalstudiesrepository.org/acwp_asie/49 | access-date = 8 August 2019 | archive-date = 8 August 2019 | archive-url = https://web.archive.org/web/20190808195546/https://animalstudiesrepository.org/acwp_asie/49/ | url-status = live }}

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,{{cite journal |author=Moran M |title=Animals Can Model Psychiatric Symptoms |journal=Psychiatric News |volume=38 |issue=12 |pages=20–30 |date=20 June 2003 |doi=10.1176/pn.38.12.0020}}{{cite journal | vauthors = Sánchez MM, Ladd CO, Plotsky PM | title = Early adverse experience as a developmental risk factor for later psychopathology: evidence from rodent and primate models | journal = Development and Psychopathology | issn = 0954-5794 | eissn = 1469-2198 | volume = 13 | issue = 3 | pages = 419–49 | year = 2001 | pmid = 11523842 | doi = 10.1017/S0954579401003029 | s2cid = 25469071 }} but this has been criticized on empirical grounds{{cite journal | vauthors = Matthews K, Christmas D, Swan J, Sorrell E | title = Animal models of depression: navigating through the clinical fog | journal = Neuroscience & Biobehavioral Reviews | issn = 0149-7634 | eissn = 1873-7528 | lccn = 78-643607 | oclc = 3552135| volume = 29 | issue = 4–5 | pages = 503–13 | year = 2005 | pmid = 15925695 | doi = 10.1016/j.neubiorev.2005.03.005 | s2cid = 23468566 }} and opposed on animal rights grounds.

{{Portal|Philosophy|Psychiatry|Psychology|Society}}

• 50 Signs of Mental Illness
• List of mental disorders
• Mental disorders and LGBTQ
• Mental illness portrayed in media
• Mental disorders in film
• Mental illness in fiction
• Neurotherapy
• Parity of esteem
• Psychological evaluation
• Youth mental health crisis

{{Clear}}

{{Reflist}}

{{refbegin|30em}}

• {{cite book |vauthors=Atkinson J |date=2006 |title=Private and Public Protection: Civil Mental Health Legislation |location=Edinburgh |publisher=Dunedin Academic Press |url=https://archive.org/details/privatepublicpro0000atki/page/n1/mode/2up |lccn=2007367763 |oclc=475785132 |isbn=978-1-903765-61-6 }}
• {{Cite book | vauthors = Fried Y, Agassi J |title=Paranoia: A Study in Diagnosis |series=Boston Studies in the Philosophy of Science |volume=50 |year=1976 | doi = 10.1007/978-94-010-1506-6 | publisher = Springer Dordrecht |issn = 2214-7942 |isbn=978-90-277-0704-8 }}{{publisher missing|date=August 2017}}
• {{Cite book |vauthors=Fried Y, Agassi J |title=Psychiatry as Medicine |url=https://archive.org/details/psychiatryasmedi0000frie |location=The Hague |publisher=Nijhoff |year=1983 |lccn=83004224 |isbn=978-90-247-2837-4 }}
• {{Cite book | vauthors = Hicks JW |title=50 Signs of Mental Illness: A Guide to Understanding Mental Health |publisher=Yale University Press |year=2005 |isbn=978-0-300-10657-2}}
• {{Cite book | vauthors=Hockenbury D, Hockenbury S | title=Discovering Psychology | url=https://archive.org/details/studyguidetoacco00corn | url-access=registration | publisher=Worth Publishers | year=2004 | isbn=978-0-7167-5704-7 }}
• {{cite book|author=((National Academies of Sciences, Engineering, and Medicine))|author-link=National Academies of Sciences, Engineering, and Medicine|title=Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change|date=2016|publisher=National Academies Press|location=Washington, DC|isbn=978-0-309-43912-1|url=http://www.nap.edu/download/23442|doi=10.17226/23442|pmid=27631043|doi-access=free|access-date=8 August 2016|archive-date=28 January 2022|archive-url=https://web.archive.org/web/20220128171620/https://www.nap.edu/login.php?record_id=23442|url-status=live}}
• {{Cite book |vauthors=Porter R |author-link=Roy Porter |title=Madness: a brief history |publisher=Oxford University Press |archive-url=https://archive.org/details/madnessbriefhist0000port_w7r4/mode/2up |archive-date=2022-03-18 |location=Oxford |year=2002 |isbn=0-19-280267-4 |url-access=registration |url=https://archive.org/details/madnessbriefhist0000port }}
• {{cite encyclopedia |title=Mental Disorder (Illness) | url = https://plato.stanford.edu/entries/mental-disorder/ | vauthors = Radden J | issn = 1095-5054 |

oclc = 643092515 | archive-url = https://web.archive.org/web/20220404132044/https://plato.stanford.edu/entries/mental-disorder/| archive-date = 4 April 2022 |date=20 February 2019 }} [https://archive.org/search.php?query=stanford%20Encyclopedia%20of%20Philosophy Stanford Encyclopedia of Philosophy]

• {{cite book |veditors=Weller MP, Eysenck M |title=The Scientific Basis of Psychiatry |edition=2nd |url=https://archive.org/details/scientificbasiso0000unse_l5x6/mode/2up |publisher=W. B. Saunders |location=London |isbn=0-7020-1448-6 |date=1992 }}
• {{cite book |title=Management of physical health conditions in adults with severe mental disorders |date=2018 | publisher = World Health Organization |isbn=978-92-4-155038-3 |archive-date=12 November 2020 |department=Department of Mental Health and Substance Abuse |location=Geneva |format=Guidelines |archive-url=https://web.archive.org/web/20201112024825/http://apps.who.int/iris/bitstream/handle/10665/275718/9789241550383-eng.pdf |url=http://apps.who.int/iris/bitstream/handle/10665/275718/9789241550383-eng.pdf?ua=1 }}
• {{cite book | vauthors = Wiencke M |date=2006 |chapter=Schizophrenie als Ergebnis von Wechselwirkungen: Georg Simmels Individualitätskonzept in der Klinischen Psychologie | veditors = Kim D |title=Georg Simmel in Translation: Interdisciplinary Border-Crossings in Culture and Modernity |pages=123–55 |publisher=Cambridge Scholars Press |location=Cambridge |isbn=978-1-84718-060-5 }}

{{refend}}

{{Medical resources

| DiseasesDB = 28852

| ICD11 = {{ICD11|6E8Z}}

| ICD10 = {{ICD10|F99}}

| ICD9 = {{ICD9|290}}–{{ICD9|319}}

| MeshID = D001523

}}

{{Spoken Wikipedia|Mental_illness.ogg|date=20 August 2005}}

{{commons category|Mental and behavioural diseases and disorders}}

{{Wikivoyage|Travelling with a mental health condition}}

• [https://direct.mit.edu/books/oa-edited-volume/5015/Defining-Mental-DisorderJerome-Wakefield-and-His Defining Mental Disorder: Jerome Wakefield and His Critics]
• [http://www.nimh.nih.gov National Institute of Mental Health] {{Webarchive|url=https://web.archive.org/web/20090529190231/http://www.nimh.nih.gov/ |date=29 May 2009 }}
• [http://www.cartercenter.com/health/mental_health/intl_women.html International Committee of Women Leaders on Mental Health] {{Webarchive|url=https://web.archive.org/web/20081030045640/http://www.cartercenter.com/health/mental_health/intl_women.html |date=30 October 2008 }}

{{Library resources box

|by=no

|onlinebooks=no

|about=yes

|label=Mental illness}}

{{Mental and behavioural disorders}}

{{Disease groups}}

{{Authority control}}

Category:Disability by type

Category:Abnormal psychology

Category:Psychopathology

Category:Psychiatric assessment

Category:Suffering