H is for Health
H = Happiness and Health, Medical, Mental and Spiritual Well-being.
Happiness is a mental or emotional state of well-being characterized by positive or pleasant emotions ranging from contentment to intense joy. A variety of biological, psychological, religious, and philosophical approaches have striven to define happiness and identify its sources.
Philosophers and religious thinkers often define happiness in terms of living a good life, or flourishing, rather than simply as an emotion. Happiness in this sense was used to translate the Greek Eudaimonia, and is still used in virtue ethics.
Happiness economics suggests that measures of public happiness should be used to supplement more traditional economic measures when evaluating the success of public policy.
Happiness is a fuzzy concept and can mean many things to many people. Part of the challenge of a science of happiness is to identify different concepts of happiness, and where applicable, split them into their components.
In the 2nd Edition of the Handbook of Emotions (2000), evolutionary psychologists Leda Cosmides and John Tooby say that happiness comes from “encountering unexpected positive events”. In the 3rd Edition of the Handbook of Emotions (2008), Michael Lewis says “happiness can be elicited by seeing a significant other”. According to Mark Leary, as reported in a November 1995 issue of Psychology Today, “we are happiest when basking in the acceptance and praise of others”. In a March 2009 edition ofThe Journal of Positive Psychology, Sara Algoe and Jonathan Haidt say that “happiness” may be the label for a family of related emotional states, such as joy, amusement, satisfaction, gratification, euphoria, and triumph.
According to a review in Boston.com on August 23, 2009, money doesn’t buy much happiness unless it’s used in certain ways. “Beyond the point at which people have enough to comfortably feed, clothe, and house themselves, having more money – even a lot more money – makes them only a little bit happier.” However we can sometimes get more happiness bang for our buck by spending it in prosocial ways. A Harvard Business School study found that “spending money on others actually makes us happier than spending it on ourselves” .
There are various factors that have been correlated with happiness, but no validated method has been found to substantially improve long-term happiness in a meaningful way for most people.
Psychologist Martin Seligman provides the acronym PERMA to summarize Positive Psychology’s correlational findings: humans seem happiest when they have
- Pleasure (tasty foods, warm baths, etc.),
- Engagement (or flow, the absorption of an enjoyed yet challenging activity),
- Relationships (social ties have turned out to be extremely reliable indicator of happiness),
- Meaning (a perceived quest or belonging to something bigger), and
- Accomplishments (having realized tangible goals).
There have also been some studies of how religion relates to happiness. Causal relationships remain unclear, but more religion is seen in happier people. This correlation may be the result of community membership and not necessarily belief in religion itself. Another component may have to do with ritual, according to a 2009 article in Frontiers in Evolutionary Neuroscience.
Abraham Harold Maslow (April 1, 1908–June 8, 1970), an American professor of psychology, founded humanistic psychology. A visual aid he created to explain his theory, which he called the hierarchy of needs, is a pyramid depicting the levels of human needs, psychological, and physical. When a human being ascends the steps of the pyramid, he reaches self-actualization. Beyond the routine of needs fulfillment, Maslow envisioned moments of extraordinary experience, known as peak experiences, profound moments of love, understanding, happiness, or rapture, during which a person feels more whole, alive, self-sufficient, and yet a part of the world.
See also: Religion and happiness
Happiness forms a central theme of Buddhist teachings[dubious – discuss]. For ultimate freedom from suffering, the Noble Eightfold Path leads its practitioner to Nirvana, a state of everlasting peace. Ultimate happiness is only achieved by overcoming craving in all forms. More mundane forms of happiness, such as acquiring wealth and maintaining good friendships, are also recognized as worthy goals for lay people (see sukha). Buddhism also encourages the generation of loving kindness and compassion, the desire for the happiness and welfare of all beings.[unreliable source?]
The primary meaning of “happiness” in various European languages involves good fortune, chance or happening. The meaning in Greek philosophy, however, refers primarily to ethics. In Catholicism, the ultimate end of human existence consists in felicity, Latin equivalent to the Greek eudaimonia, or “blessed happiness”, described by the 13th-century philosopher-theologian Thomas Aquinas as a Beatific Vision of God’s essence in the next life. Human complexities, like reason and cognition, can produce well-being or happiness, but such form is limited and transitory. In temporal life, the contemplation of God, the infinitely Beautiful, is the supreme delight of the will. Beatitudo, or perfect happiness, as complete well-being, is to be attained not in this life, but the next.
Main article: Philosophy of happiness
The Chinese Confucian thinker Mencius, who 2300 years ago sought to give advice to the ruthless political leaders of the warring states period, was convinced that the mind played a mediating role between the “lesser self” (the physiological self) and the “greater self” (the moral self) and that getting the priorities right between these two would lead to sage-hood. He argued that if we did not feel satisfaction or pleasure in nourishing one’s “vital force” with “righteous deeds”, that force would shrivel up (Mencius,6A:15 2A:2). More specifically, he mentions the experience of intoxicating joy if one celebrates the practice of the great virtues, especially through music.
Al-Ghazali (1058–1111) the Muslim Sufi thinker wrote the Alchemy of Happiness, a manual of spiritual instruction throughout the Muslim world and widely practiced today.
In the Nicomachean Ethics, written in 350 BCE, Aristotle stated that happiness (also being well and doing well) is the only thing that humans desire for its own sake, unlike riches, honor, health or friendship. He observed that men sought riches, or honor, or health not only for their own sake but also in order to be happy. Note that eudaimonia, the term we translate as “happiness”, is for Aristotle an activity rather than an emotion or a state. Happiness is characteristic of a good life, that is, a life in which a person fulfills human nature in an excellent way. People have a set of purposes which are typically human: these belong to our nature. The happy person is virtuous, meaning they have outstanding abilities and emotional tendencies which allow him or her to fulfill our common human ends. For Aristotle, then, happiness is “the virtuous activity of the soul in accordance with reason”: happiness is the practice of virtue.
Many ethicists make arguments for how humans should behave, either individually or collectively, based on the resulting happiness of such behavior. Utilitarians, such as John Stuart Mill and Jeremy Bentham, advocated the greatest happiness principle as a guide for ethical behavior.
Main article: Happiness economics
Common market health measures such as GDP and GNP have been used as a measure of successful policy. On average richer nations tend to be happier than poorer nations, but this effect seems to diminish with wealth. This has been explained by the fact that the dependency is not linear but logarithmic, i.e., the same percentual increase in the GNP produces the same increase in happiness for wealthy countries as for poor countries.
Libertarian think tank Cato Institute claims that economic freedom correlates strongly with happiness preferably within the context of a western mixed economy, with free press and a democracy. East European countries (ruled by Communist parties) were less happy than Western ones, even less happy than other equally poor countries.
It has been argued that happiness measures could be used not as a replacement for more traditional measures, but as a supplement. According to professor Edward Glaeser, people constantly make choices that decrease their happiness, because they have also more important aims. Therefore, the government should not decrease the alternatives available for the citizen by patronizing them but let the citizen keep a maximal freedom of choice.
Measures of happiness
- The Subjective Happiness Scale (SHS) is a four-item scale, measuring global subjective happiness. The scale requires participants to use absolute ratings to characterize themselves as happy or unhappy individuals, as well as it asks to what extend they identify themselves with description of happy and unhappy individuals.
- The Positive and Negative Affect Schedule (PANAS) is used to detect relation between personality traits and positive or negative affects at this moment, today, the past few days, the past week, the past few weeks, the past year, and generally (on average). PANAS is a 20-item questionnaire, which uses a five-point Likert scale (1 = very slightly or not at all, 5 = extremely).
- The Satisfaction with Life Scale (SWLS) is a global cognitive assessment of life satisfaction. The SWLS requires a person to use seven-item scale to state her agreement or disagreement (1 = strongly disagree, 4 = neither agree nor disagree, 7 = strongly agree) with five statements about one’s life.
health (hĕlth) noun
1. The overall condition of an organism at a given time.
2. Soundness, especially of body or mind; freedom from disease or abnormality.
3. A condition of optimal well-being: concerned about the ecological health of the area.
4. A wish for someone’s good health, often expressed as a toast.
[Middle English helthe, from Old English hǣlth.]
well·ness (wĕlʹnĭs) noun
The condition of good physical and mental health, especially when maintained by proper diet, exercise, and habits.
Often used to modify another noun: wellness programs; a wellness clinic.
Usage Note: It can be argued that wellness serves a useful function as a means of describing a state that includes not just physical health but fitness and emotional well-being. The word is first recorded in 1654 but has never been given the acceptance of its antonym illness. In the most recent survey 68 percent of the Usage Panel found the word unacceptable in the sentence A number of corporations have implemented employee wellness programs, aimed at enhancing spiritual values, emotional stability, fitness, and nutrition.
ill·ness (ĭlʹnĭs) noun
1. a. Disease of body or mind; poor health; sickness. b. A disease.
2. Obsolete. Evil; wickedness.
dis·ease (dĭ-zēzʹ) noun
1. A pathological condition of a part, an organ, or a system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms.
2. A condition or tendency, as of society, regarded as abnormal and harmful.
3. Obsolete. Lack of ease; trouble.
[Middle English disese, from Old French : des-, dis- + aise, ease. See ease.]
Disease, any state in which health is impaired. All diseases involve a breakdown of the body’s natural defense or regulatory systems.
Understanding disease depends on a clear delineation of symptoms, which can range from subjective reports of pain to visible conditions, such as a swelling or a rash. Common symptoms include fever, fatigue, loss or gain of weight, and pain in muscles or internal organs. Examination can reveal the presence of infectious organisms, broken bones, changes in the blood cells, or cancerous growths. The development and increased use of laboratory tests in routine physical examinations have improved the ability of doctors to diagnose diseases before symptoms become noticeable. For example, high blood pressure can be detected in its early stages before it damages the heart and blood vessels.
Diseases can be classified by their site (bone, heart); by their natural history (acute or chronic); by their course (progressive or intermittent); or by other schemes. Two useful classifications are by cause and by biological process disturbed. Examples of diseases classified by cause include pneumonia and cholera, caused by bacteria, and measles and hepatitis, caused by viruses. Noninfectious causes can lead to disease, as in the respiratory black lung disease, caused by long-term exposure to coal dust.
Many diseases are classified according to the biological system affected, as in diseases of the immune system. In many of these illnesses, called autoimmune diseases, the immune system makes antibodies against normal tissues in the body, destroying their operation. Disease can also result from abnormal cell receptors. Receptors are substances on the surface of cells that allow chemicals outside the cell, such as hormones and nutrients, to enter the cell. The neurological disability called Parkinson’s disease results from an abnormal receptor for a chemical necessary for brain function.
ANATOMY & PHYSIOLOGY
Immune System, group of cells, molecules, and organs that defend the body against invaders causing disease.
Immunity: Innate and Adaptive
There are two types of immunity: innate and adaptive. Innate, or nonspecific, immunity is furnished by barriers such as skin, tears, saliva, and mucus. These barriers hinder the entrance of disease but can rarely prevent it. Adaptive, or specific, immunity occurs when an invader does attack the body. Adaptive immunity has four distinguishing qualities: it responds only after the invader is present, it is specific, it displays memory, and it does not usually attack normal body components.
Adaptive immune responses are reactions to antigens, structures on the surface of the invader. The two types of adaptive immune responses are humoral and cell-mediated. In humoral immune responses, proteins called antibodies, which can destroy antigens, appear in the body fluids to resist invaders that act outside cells, such as bacteria and toxins. In cell-mediated responses, cells that can destroy the antigen become active to resist invaders that reproduce within other cells, such as viruses.
Components of the Immune System
White blood cells are the mainstay of the immune system. Some white blood cells, known as macrophages, work by surrounding, absorbing, and destroying invaders, or by delivering them elsewhere to be destroyed. Lymphocytes are specialized white blood cells that identify and destroy antigens. B lymphocytes, or B cells, make antibodies. T lymphocytes, or T cells, recognize specific antigens and directly destroy cells. Helper T lymphocytes control the strength and quality of immune responses. Most contact between antigens and lymphocytes occurs in the lymph nodes, spleen, and tonsils, as well as in specialized areas of the intestine and lungs.
In adaptive immunity each response is tailored to a specific invading antigen, and each lymphocyte is specific to a certain antigen. When an antigen enters a body cell, transport molecules within the cell attach themselves to the antigen and transport it to the surface of the cell, where they present the antigen to T lymphocytes.
Humoral Immune Response
In the humoral immune response, macrophages take up some of the antigen and attach it to transport molecules, which then present it to T helper cells. The T helper cells bind the antigen and produce molecules called interleukins, which activate B lymphocytes that have also bound the antigen. The activated B cells then produce antibodies, which destroy the antigen in various ways. Antibodies work best in the circulatory system, but they can also exit the bloodstream and appear in other body fluids.
Cell-Mediated Immune Response
In cell-mediated immune response, some of the antigen taken up by macrophages is presented to T helper cells, which bind the antigen and produce interleukins. The interleukins activate killer T cells, which kill any cells displaying the antigen.
The first, or primary, immune response to a new antigen is a slow response that cannot prevent disease. However, should the same antigen invade again, the secondary immune response is usually quick, detecting, attacking, and destroying the recognized antigen before symptoms appear. This resistance is called immunity and may be achieved through either active or passive immunization.
Active immunization occurs when a person’s immune system is activated by natural immunization or by vaccination that generates a primary immune response. In natural immunization, the body contracts a disease and develops the disease-preventing secondary immune response capability for that disease. Vaccination is immunization against a particular disease by the use of vaccines, which contain either a chemically killed disease-causing organism or a weakened living form of the organism unable to produce disease.
Passive immunization does not engage a person’s own immune system. Instead, a person receives antibodies that were created in another person or animal. This process provides only temporary immunity, and if used repeatedly can produce side effects.
Immune System Disorders
Disorders of the immune system range from mild allergy to immune deficiencies, transplant rejection, and autoimmune diseases. Immune system deficiencies may be either inherited or acquired, and people affected by these diseases are susceptible to opportunistic infections, normally harmless organisms that can flourish in a person with a weakened immune system. Acquired immune deficiencies can be caused by infections or other factors. An infectious agent resulting in fatal immune deficiency is the human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS) by destroying helper T cells. Environmental and lifestyle factors, such as poor nutrition or stress, can impair the immune system. Because the immune system recognizes and attacks anything different from the substances normally present within a person, it rejects transplanted tissues and organs (see Transplantation, Medical). In autoimmune diseases, the immune system attacks the body’s own cells and tissues.
Medicine, science and art concerned with curing and preventing disease and preserving health.
Early human beings recognized two categories of diseases: those attributed to the influence of evil demons or spirits, and those involving physical disability. Magic was a large part of treatment, but so were cleaning and treating wounds by burning, poultices, and stitching; resetting and splinting dislocations and fractures; purges, diuretics, laxatives, emetics, and enemas. The use of plant extracts as medical treatments was especially important.
As humans formed distinct cultures, the two trends in primitive medicine each became more institutionalized. Sorcerers and priests took up the magico-religious approach. The empirico-rational trend, based on experience and observation and lacking in mystical features, was practiced at first by priests but was taken up increasingly by nonreligious physicians. Modern medicine arose primarily from the empirico-rational trend, as the human body and its functions became better known and as science led medical practice away from superstition and the spiritual realm.
Ancient Medical Practice
In ancient Egypt, by the 3rd Dynasty, the physician emerged as an early form of scientist. The Egyptians practiced embalming but their anatomical knowledge remained at a low level, and they attempted only minor surgical procedures. In Assyria and Babylonia, the liver was considered the seat of the soul and was studied to determine the intentions of the gods. Hebrew medicine was influenced by the Old Testament and emphasized hygienic regulations, midwifery, feminine hygiene, separation of the sick, and disinfection of materials capable of harboring and transmitting germs. Ancient Hindu medicine became quite sophisticated, especially in the field of operative surgery. Ancient Chinese medicine utilized acupuncture and a wide array of drugs, including opium.
By the 500s BC, Greek medicine had become thoroughly nonreligious, stressing clinical observation. Greek physicians based their doctrine on experience gained by trial and error. The Greeks eventually identified the brain as the physiological seat of the senses. Greece was the home of Hippocrates, the father of Western medicine, and Aristotle, the founder of comparative anatomy.
Greek medicine influenced conquering Rome. Galen, a Greek, was the most important physician of the Roman period and influenced medicine well into the Middle Ages. The Romans made important contributions in the fields of public health and hygiene with their organization of street sanitation, water supply, and public hospitals.
Medicine in the Middle Ages
Medical practice reverted to magic during much of the Middle Ages. Classical learning was maintained by only a few Greek physicians. The Arabs, who conquered much of the world in the 7th century AD, learned and revived Greek medicine and became the keepers of the tradition through the Middle Ages. In Europe, medicine became the realm of religious orders such as the Benedictines and was practiced in monasteries, although sometimes shunned in favor of prayer. Eventually, nonreligious medicine became acceptable and began to be taught at universities. The ideas taught there differed little from the ancient Greek teachings taken from Arab manuscripts. Early medical scientists such as English philosopher Roger Bacon made valuable contributions based on experiment and careful observation but did not sway the established traditions.
No abrupt change in medical thought occurred in the Renaissance, but criticism directed against Galen and the Arabists increased, and the doctrines of Hippocrates were revived. Leonardo da Vinci and others of his time made major advances in anatomy, the practice of chemotherapy was founded, and important insights were gained into the nature of contagious diseases. See Bacteriology.
The Dawn of Modern Medicine
In the 17th century English physician and anatomist William Harvey demonstrated the method of blood circulation, and a new medical epoch began. Detailed studies of the organs, diseases, and processes such as physiology and respiration quickly followed, conducted by eminent physicians and scientists. Medical debates focused on minute features of the body, how to treat particular diseases, and the nature of life itself, whether physical or chemical. Vitalists believed that the soul is the vital principle (see Vitalism), but mechanists saw the body as a machine and life as a mechanical process. Important advances were made in the 18th century: Italian naturalist and biologist Lazzaro Spallanzani refuted the doctrine of spontaneous generation; Swedish botanist and taxonomist Carolus Linnaeus devised the modern binomial system of biological nomenclature (see Classification); and British physician Edward Jenner discovered the principle of vaccination as a preventive measure against smallpox and established the science of immunization.
In the 19th century great advances occurred in diagnosis and treatment of disease and in surgical methods. European researchers established the sciences of embryology and histology and the central concept of the cell as the seat of disease. British scientist Charles Darwin advanced his theory of evolution. Austrian biologist Gregor Johann Mendel laid out the basis of classical genetics. Studies of fermentation by French chemist and microbiologist Louis Pasteur revived interest in the contagion theory of disease. Pasteur and German physician and bacteriologist Robert Koch founded the field of bacteriology, considered the greatest single advance in the history of medicine; many bacterial diseases became preventable or controllable.
Bacteriology allowed important discoveries, including the role of white blood cells in destroying microbes, the way in which bacteria are carried, and the necessity of sterilization to prevent wound infection (see Antiseptics). Other advances during this time took place in physiology (including understanding of various glands and the nervous system), organic chemistry and metabolism, optics and ophthalmology, and psychology. The X ray was discovered by German physicist Wilhelm Conrad Roentgen; French physicists Pierre and Marie Curie discovered radium. American physicians developed the field of gynecology and identified mosquitoes as carriers of yellow fever.
The most important medical finding of the 20th century was the discovery by American biologist James Dewey Watson and English physicist Francis Harry Compton Crick of the structure of the genetic material, deoxyribonucleic acid, or DNA (see Nucleic Acids). By 1970 the first gene had been synthesized; by the mid-1980s genetic techniques were being used medically, and genetic engineering was producing large quantities of pure human substances such as hormones and interferon. Surgery advanced with the development of operating microscopes and other techniques that allow delicate procedures such as reattachment of severed limbs. Medical milestones were reached with the successful transplantation of organs and the development of the artificial heart and kidney. Plastic replacements for joints relieved some patients from crippling arthritis, and lasers were developed for medical use, especially in eye surgery.
Many infectious diseases have been conquered in the 20th century by improved sanitation, antibiotics, and vaccines. Especially important were the developments of the sulfonamide antibiotics and penicillin, which immediately saved many lives in World War II (1939-1945). Streptomycin, another drug, was used to defeat tuberculosis. Vaccines are widely used against viral diseases, including poliomyelitis, diphtheria, tetanus, yellow fever, measles, mumps, rubella (German measles), hepatitis B, influenza, herpes simplex, and chicken pox. Vaccine production was aided by new techniques such as tissue culture production and genetic engineering. In the latter part of the 20th century many microorganisms became resistant to antibiotics, and new diseases emerged, such as Legionnaires’ disease and acquired immune deficiency syndrome (AIDS).
In the 20th century the brain was carefully explored. Using chemical dyes and sophisticated imaging devices, scientists discovered the specific parts of the brain that control hearing, speech, and movement of the limbs; they showed that the right and left halves of the brain were functionally different. The discovery of the chemical/electrical method of nerve impulse transmission was an important finding, as were the complex way in which the brain regulates body function by hormones and the complex connection between emotions and biochemistry. Treatments became available for neurological diseases such as epilepsy and Parkinson’s disease.
Scientific insight into the workings of the immune system and the structure of antibody molecules has allowed better treatment of immune disorders, even temporary disabling of the immune system to prevent rejection of transplanted organs (see Transplantation, Medical). One form of antibody molecule proved to be associated with allergy, now viewed as an immune system disorder. The typing of blood by immune specificity has made transfusion safe and widely applicable (see Blood Type; Blood Transfusion).
In recent years, new and better methods of seeing inside the human body have revolutionized medical diagnosis. The computerized axial tomography (CAT) scanner is a computer-assisted X-ray device (see X Ray; Radiology). Nuclear magnetic resonance imaging employs radio waves to identify molecular structure. Ultrasound produces images from sound waves, and positron emission tomography scans the body with antimatter.
The treatment of mental illnesss first became scientific and successful in the 20th century. Austrian physician and neurologist Sigmund Freud pioneered the methods of psychoanalysis. Treatment of psychosis by lobotomy and electroconvulsive therapy began in the 1930s, although these are now seldom used. Drug therapy for mental illness became possible in the 1950s. The first drugs widely used to treat schizophrenia, the phenothiazines, have since been joined by lithium for manic depressive disease and tricyclic antidepressants for depression. Despite these successes, physicians now realize that some patients are not helped by drugs, and that supportive psychological therapy must be provided as well. Heart disease, the number one killer in Western countries, has declined dramatically because of recent medical advances such as cardiac catheterization, angiography, nerve-blocking drugs, heart valve replacement, arterial bypass surgery, and heart transplants. Increased awareness of the risks of smoking, stress, obesity, high blood pressure, and elevated blood cholesterol have also helped reduce heart disease. Cancer has become more prevalent in the 20th century. Research has linked some cancers with exposure to certain chemicals; smoking is known to cause lung cancer and other cancers. Surgery and radiation were primary means of treatment until the 1960s, when drug therapy also became effective against cancer.
The discovery of vitamins and their importance to the body produced important advances in nutritional medicine. An example is the discovery of vitamin B12 and its use to treat pernicious anemia. Similarly, improved understanding of the hormones led to better control of conditions such as hypothyroidism or cretinism, treated with thyroid extract (see Thyroid Gland), diabetes mellitus, treated with insulin, and various reproductive disorders, treated with synthetic testosterone and estrogen.
Advances have been made in birth control with the improvement of interuterine devices and the development of oral contraceptives. Solutions to some fertility problems have been provided by in vitro fertilization (“test-tube” babies) and transplantation of fertilized ova from one womb to another. Diagnosis of some birth defects can now be made through amniocentesis.
Complex medical ethics problems have gained increasing attention, especially the question of abortion and the decision whether to remove life support systems from terminally ill patients. Medical treatments became increasingly expensive in the 20th century, and many people came to distrust the orthodox medical establishment. This situation led in the United States to the consumer medical movement, in which people attempted to take control of their own health, largely through preventive medical practices, and to understand more about normal and diseased bodily function. Outgrowths of the movement included many popular medical reference books and development of the field of holistic medicine, which promotes good nutrition, physical exercise, and “self-regulation” techniques, such as biofeedback and relaxation.
Mental Health, condition of psychological well-being and self-acceptance. In a clinical sense, mental health is the absence of mental illness.
The Mental Health Movement
Concern for the mentally ill has waxed and waned through the centuries, but the development of modern-day approaches to the subject dates from the mid-18th century, when reformers such as French physician Philippe Pinel and American physician Benjamin Rush introduced humane moral treatment in place of the often cruel treatment that then prevailed. In 1841 American reformer Dorothea Dix campaigned to place the mentally ill in hospitals for special treatment.
The modern mental health movement can be traced to the publication in 1908 of A Mind That Found Itself, an account of the experience of its author, Clifford Whittingham Beers, as a mental patient. Increased public awareness led to passage of the National Mental Health Act in 1946, legislation that authorized the establishment of the National Institute of Mental Health to be operated as a part of the United States Public Health Service. In 1950 the National Association for Mental Health, better known as the Mental Health Association, was formed. Based on the findings of a Joint Commission on Mental Illness and Health survey, legislation was passed in 1963 authorizing funds for construction of facilities for community-based treatment centers.
Scope of the Problem and Prevention
According to a common estimate, at any one time 10 percent of Americans have mental health problems sufficiently serious to deserve care; recent evidence suggests that this figure may be closer to 15 percent (see Mental Disorders). Public health authorities customarily distinguish three ways of preventing mental illnesss. Primary prevention involves attempts to prevent the occurrence of mental illness and to promote positive mental health. Secondary prevention is the early detection and treatment of a disorder, and tertiary prevention refers to rehabilitative efforts directed at preventing complications.
Care of the mentally ill has changed dramatically in recent decades with the introduction of new drugs, as well as changes in approaches to mental illness. Psychiatric wards of community general hospitals have assumed some of the responsibility for caring for the mentally ill during the acute phases of illness. Treatment of patients with less severe mental illnesss has also shifted, from individual psychotherapy to such approaches as group or family psychotherapy and to behavior therapy, which focuses on changing behavior rather than on the underlying causes of a disorder.
In addition to outpatient clinics, rehabilitation services for people diagnosed with a mental illness, but not living in a community facility, include sheltered workshops, which provide vocational guidance and training; day-treatment programs; and social clubs. In day-treatment programs, patients return home at night and on weekends; during weekdays, the programs offer a range of rehabilitative services, such as vocational training, group activities, and help in the practical problems of living. Ex-patient social clubs provide social contacts, group activities, and an opportunity for recently discharged patients to develop self-confidence in normal situations. Another important rehabilitative facility is the halfway house, which serves as a temporary residence for ex-patients who are ready to form outside community ties.
Many different sciences contribute to knowledge about mental health and illness. In recent decades, these sciences have begun to clarify basic biological, psychological, and social processes, and they have refined the application of such knowledge to mental health problems.
Mental Illness, psychological and behavioral patterns significantly unlike those typical of human beings. In general, a mental illness involves distress or impairment in important areas of functioning. Through most of history, mental illnesss have been considered supernaturally or unnaturally caused. Mental science, which eventually developed into psychiatry, acquired respectability in the 1790s, when Parisian physician Philippe Pinel abolished physical restraints, introduced psychological treatment, and began objective clinical studies.
The division of mental illnesss into classes is still inexact, and classification varies from country to country. For record-keeping purposes, most countries follow the International Classification of Diseases of the World Health Organization (WHO). For clinical purposes in the United States, the Diagnostic and Statistical Manual, third edition, revised (DSM-III-R), published by the American Psychiatric Association, is used. Most classification systems recognize childhood disorders as separate categories from adult disorders. Most distinguish between organic disorders, caused by bodily problems, and nonorganic, or functional, disorders. Psychotic disorders are also commonly separated from neurotic ones, which are relatively less severe. Personality disorders are lifelong conditions in which inflexible personality traits cause social and occupational impairments.
Several mental illnesss are first evident in infancy, childhood, and adolescence, including mental retardation; attention-deficit hyperactivity disorder-involving inappropriate lack of attention, impulsiveness, and hyperactivity-anxiety disorders; and pervasive developmental illnesss, involving distortions in several psychological functions, as in infantile autism.
Schizophrenia and Affective Disorders
Schizophrenia is a group of serious disorders that usually begin in adolescence or young adulthood. Symptoms include disturbances in thought, perception, emotion, and interpersonal relationships. Affective disorders are those in which the main symptom is a disturbance in mood, such as depression. Paranoid disorders focus on delusions (firmly held false beliefs), often of persecution. These disorders usually start in middle or late adult life. Organic mental illnesss are associated with temporary or permanent impairments in brain function.
Anxiety and Neurotic Disorders
Anxiety is the predominant symptom in two conditions: panic disorder and generalized anxiety disorders, such as phobias or obsessive-compulsive disorders. Obsessions are repetitive thoughts, images, or impulses that make no sense to the person. Compulsions are repetitive behaviors performed dutifully to try to ward off some future event.
In addition to neurotic depression and anxiety disorders, other conditions that have been considered neurotic include somatization disorder (hysteria), conversion reactions, psychogenic pain, hypochondrias, and dissociative disorders. The rare conversion disorders (hysterical neurosis) commonly mimic a neurological disease such as paralysis. Psychogenic pain is pain for which no physical cause is apparent. In hypochondriasis, the patient is preoccupied with the fear of having a serious disease, for which no physical cause can be found. Included in the dissociative disorders are multiple personality-a rare condition in which two or more separate personalities exist in the same person-and amnesia that apparently stems from psychological causes.