the Beginnings of Mental Illness

Mental illnesses and mental wellness are all around us and it is said that 1 in 5 people will suffer with a mental illness at some point in their life. There are varying categories of mental illness, with different severities of symptoms, coping mechanisms and treatment options. Most mental illness do not respond to a one-size-fits-all approach, despite the common theme in treatment: talk therapy, pills, inpatient or outpatient centres. Neuroscience, psychiatry and attachment theory have all made some significant impacts in the world of mental health and illness and how one can go about looking at how to dealing with, coping and healing while having a mental illness. Some diagnoses begin in early life, through trauma or genetic factors, while others appear in full force in young adulthood, some happen because of the way the brain is structured and others happen through habitual coping mechanisms and not acknowledging feelings and emotions.

Adverse Childhood Experiences

The Adverse Childhood Experiences study first occurred between 1995-1997 through the Centre for Disease Control and Prevention (CDC) at Kaiser Permenente (a Californian Medical Group). Their study determined that childhood negative experiences and trauma typically lead to adverse health, mental and social outcomes in life. Though there is increasing research stating the adolescent brain does not fully develop until one’s mid-twenties, the Adverse Childhood Experiences questionnaires states whether these instances happened prior to one’s 18th Birthday.

One’s ACE Score is determined by 10 yes or no questions; each yes gives a score of 1 and each no gives a score of 0. There have been discussions were individuals have point 0.5 for scores for when the instance can be applied, but could be considered mild rather than severe or detrimental. Personal scores higher than 4 increases the likelihood of negative outcomes dramatically.

ACE Questionnaire

Below are the ACE Questions. More information can be found at the ACEs Too High link below.

  1. Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?
  2. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?
  3. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?
  4. Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?
  5. Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
  6. Were your parents ever separated or divorced?
  7. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
  8. Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
  9. Was a household member depressed or mentally ill, or did a household member attempt suicide?
  10. Did a household member go to prison?

Do the test yourself here: https://acestoohigh.com/got-your-ace-score/

Vulnerability and Resilience

Through Adverse Childhood Experiences, children and adolescents thrive and suffer through two main factors: being vulnerable and having resilience. Through appropriate stress, attachment relationships and emotion regulation, children and youth are able to gain skills within the body and through behaviours that allow them to build their resiliency and allow them to gain healthy and natural coping mechanisms. However, when children and youth are put through toxic and/or chronic stress, the body’s ability to cope diminishes greatly, impacting one’s behavioural and conscious ability to cope.

the 9 Things Young People Need

Michael Ungar, Ph.D. is an author, professor at Dalhousie University at their School of Social Work and well known voice in the academic world on Resilience. Through his research, experience and career, he has established that there are 9 Things Young People Need to Thrive.

  1. Structure
  2. Consequences
  3. Parent-Child Connections
  4. Lots and Lots of Strong Relationships
  5. A Powerful Identity
  6. A Sense of Control
  7. A Sense of Belonging/Spirituality/Life Purpose
  8. Rights and Responsibilities
  9. Safety and Support

You can view his PowerPoint titled 9 Things Young People Need to Thrive from a Conference in Seattle with the Foundation for Healthy Generations here.

 

Vulnerability

Brené Brown describes vulnerability as the core of shame and fear and our struggle for worthiness but it appears that it’s also the birthplace of joy, of creativity, of belonging, of love… we live in a vulnerable world… and one of the ways we deal with it is [to] numb vulnerability.

Brené’s Ted Talk on The Power of Vulnerability

Throughout childhood and adolescence, adverse experiences impact many factors of life, and that impact is controlled through one’s state of vulnerability and one’s ability to learn and hold resilience.

 

Coping Mechanisms

There are a variety of definitions for coping mechanism, for this purpose I will be using a psychological reference point. Coping Mechanisms are expressed as our behavioural response to situations and stress, short-term and chronic, that we are either aware of or not. In the case of awareness, this can be an action that one is aware of physically, but not necessarily cognizant of the potential issues it is arising from. Take self-injury for example, one is coping physically without having an understanding that their emotions are dis-regulated and thus impacting their thoughts and behaviours.

Comorbidity and Concurrent Disorders

Comorbid disorders are typically diagnoses of two disorders at the same time. typically two mental health conditions or a mental health condition and a substance use problem. Concurrent Disorders are considered a mental health disorder and an addiction concern. The focus will be on comorbid disorders, typically involving mental illnesses, substance use and disordered eating. These all intertwine and each one alone and together, impact the brain, a person’s habits and coping mechanisms and one’s ability to function in daily life in an ideal way – not to diminish one’s strength in surviving day to day when all else seems that hopeless.

 

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V)

The first edition of the DSM derived from the Second World War and the introduction of the International Statistical Classification of Diseases in 1949 and was published in 1952 via the American Psychiatric Association. The latest edition of the DSM was approved in May of 2013 with a variety of adaptations and understanding to complexity of what leads to a mental health diagnosis. The DSM-V does not the Five Axis System of Diagnosis that the DSM-IV did; however, the DSM-V combines Axis 1-3 and addresses 4 and 5 similarly (DSM-V pg 58).

 

The Diagnosed Disorders

Listed below is a look into the world of one person’s struggle with their mental health, coping mechanisms and perceptions of their self-worth. There are brief introductions of the disorders and the DSM-V criteria.

Persistent Depressive Disorder (Dysthymia)

The DSM revised their diagnostic definition of Dysthymia in the fifth edition, stating a consolidation of the previous diagnoses of Chronic Major Depression and Dysthymia. Dysthymia is a more persistent, lasting years versus weeks, and is sometimes considered a milder version of Major Depressive Disorder. Dysthymia is a continuing feeling of low energy and self worth, challenging sleep patterns, and a consistent lingering feeling of pointlessness. Dysthymia ebbs and flows – some days one can handle more while other days are spent in bed with no energy or emotion to be able to cope.

Anxiety Related Disorders: Panic Attack Specifier and Generalized Anxiety Disorder

Panic attacks can be described as one of the worst feelings in the world: the area is closing in on you, your chest is tight, your breathing is short and rabid, your stomach hurts, you cannot think and your heart is about to beat out of your chest. Panic attacks can be attributed to certain situations or experiences, and/or particular, reoccurring thought patterns; thus panic attacks can be expected or unexpected.

General Anxiety is something that follows one around for an extended period of time, at least six months. There is a lingering feeling that something is just not quite right, and as a result, one is moody, exhausted, tense and having issues sleeping and concentrating. It is more than just needing to “think positive” or “to not worry about it”. Anxiety, Dysthymia and Panic Attacks can be experienced at the same time, during similar situations. Comorbidity can be challenging to cope with on a regular basis, and as well to treat.

Obsessive Compulsive Disorders: Excoriation (Skin-Picking) Disorder

Skin picking is something that most people may find uncomfortable to talk about or to hear about. It is a disorder that results from a compulsion to pick the skin, healthy or irritated, typically around the face, arms and hands (but it can be any or multiple areas). Though the criteria requires recurrent skin picking and attempts to stop, but states that these habits may last months or years.

Eating Disorders and Disordered Eating: Bulimia Nervosa and Atypical Anorexia Nervosa

It appears that disordered eating is becoming more prevalent; they vary in their severity and how is being limited or utilized to maintain one’s weight – including one’s perceived weight and body image. Restricting food intake, bingeing on particular food and using typically unhealthy measures to counteract ingestion.

Bulimia Nervosa in it’s varying severities entails one to binge or eat large quantities of food in a relatively short period of time; then one will engage in behaviours such as self-induced vomiting and/or use of laxatives and the like. Many eating disorders or disordered eating behaviours overlap.

Other Specific Feeing or Eating Disorder – Atypical Anorexia Nervosa
Due to the nature of eating disorders, some of the criteria for a diagnosis is based off a weight (or even worse, the Body Mass Index scale of height and weight), though one may have all of the diagnostic criteria for Anorexia Nervosa, due to weight, someone with a relatively normal weight or BMI would be diagnosed as Atypical Anorexia Nervosa. Anorexia is a significantly reduced intake of nutrients (calories, fats, carbohydrates, proteins, vitamins) leading to a significant reduction in one’s weight. People with Anorexia have a great fear and preoccupation with gaining weight, specifically fat, and may have a distorted body image, while relying on their weight for their self worth.

Nonsuicidal Self-Injury

Self-injury is some behaviour or action that one does to oneself in order to feel relief from emotional, mental or spiritual distress. As the name implies, these acts of self-harming are not to result in death – just a form of release. There are cases where self-injury is due to inebriation, psychotic like mental states (ie delusions and/or hallucinations), or other psychological diagnosis and not to relieve psychological pain. Self-injury and other diagnosis can be very common – like those with depression or eating disorders. Some theorize that those who self-injure have little to no self worth and thus acting on the urges and thoughts do not come with the sense of the aftermath or the danger involved (scars, stitches, infections).

Sleep-Wake Disorders – Insomnia Disorder

Insomnia Disorder
Sleeping is a major factor in one’s daily functioning; some can function off less sleep while others require more. Interrupted sleep, and/or an inability to fall asleep are common problems that people face; however, when it is persistent it can have debilitating effects on the mind and body.

Other Conditions That May be a Focus of Clinical Attention – Relational Problems

Diagnostic and Statistical Manual of Mental Disorders-V pg715-717, 2013
Abuse and Neglect: 717-722 (family, child, spouse, nonrelated)

With the increases advances in medical science, researchers and experts are discovering so much more about brain development, toddler to preschool brain developments, what happens throughout childhood in the brain and the major reconstruction and renovations that happen in the teenage or adolescent brain. Besides genetics and neurochemistry, healthy attachments will determine how the brain develops and whether it is within a state of stress or a state of pleasure and stability. The DSM-V states that “the parent-child relational problem is associated with… functioning in behavioural, cognitive, or affective domains”; meaning that the better the relationship, the better mental health outcomes can be – whether that is reducing the chance of a mental illness or increasing the ability to cope and treat mental illness together.

This is just brief introduction into attachment and the impact on the brain (behaviours, thoughts and emotions); for more check out Dr. Bruce Perry, Dr. Gordon Neufeld and Dr. Karen MacNamara, Dr. Gabor Maté and the work of many others.

  • Gordon Neufeld’s Institute where you can find lectures, courses, books and more!
  • Deborah MacNamara’s Website is a wonderful resource and her book Rest, Play, Grow: Making Sense of Preschoolers (or Anyone Who Acts Like One) is highly recommended.
  • Bruce Perry’s NMT Model gives a fantastic and in depth looks at the impacts of trauma on the developing brain and how to intervene and heal.
  • Gabor Maté’s research looks at development through the lens of science and compassion.

 

Urie Bronfenbrenner’s Ecological Model

The basis of the Ecological Model is that Bronfenbrenner not only gave meaning to the person, but their social situation; that is the who, what, where, when and why in particular situations. It helps to explain why there are patterns or inconsistencies with behaviours, thoughts and emotions. It can help assess where someone is thriving and where someone is struggling. The Ecological Model can also determine where one is learning coping mechanisms and if emotional intelligence and emotion regulation is being taught and implemented.

There are several elements to Bronfenbrenner’s Ecological Model; they start closest to the person of interest and move further away:

  • Microsystem: includes home, school, peer group etc; in which the developing person spends a good deal of time engaging in activities and interaction
  • Mesosystem: is not a particular place or person, but the interactions and interrelationships between the person of interest and other people.
  • Exosystem: contexts in which the person of interest is being considered are not actually apart of, but they have influences on their development/life; such as a child and their parent’s work.
  • Macrosystem: defined as a context encompassing any group whose members share or value beliefs systems; this include cultural values, social communication, lifestyle choices etc
  • Chronosystem: this is like a time-line of what did and/or is happening in the person of interest’s life.

Tudge, Mokrova, Hatfield, Karnik, 2009, p 6 .

The Impacts of Mental Health – the Illness and the Healing 

A lot of factors play into someone’s mental, physical and emotional health, especially factors that the DSM-V addresses. Poverty, neglect, abuse, isolation are all prevalent issues that impact one’s ability to function happily and optimally. How one learns to cope with their emotional reactions and their ability to soothe and regulate will determine a lot in one’s mental health and coping capabilities. That is not to say that people with nurturing homes where they could excel at whatever they wanted do not suffer from negative coping mechanisms, low sense of self worth or chemical imbalances in their brain. New research is showing the importance of positive relationships for child and adolescent development, especially in their brain and emotional development. Having a meaningful, safe connection with someone who provide for one’s needs is necessary for healthy, happy functioning people. One’s perceptions of their life, their relationships, their thoughts and behaviours, is also beneficial for one to examine – consistently being in a negative, upset mindset, it is easier to stay there, to be content with the misery; while on the other hand, being optimistic, loving and curious will prove a better outlook and mindset. Sometimes medication is necessary as those neurochemicals are not working the best they could be, and for the person to regain some stability and understanding of their life. Medication is fickle and there are many precautions, and it could several months trying several difference doses to get something that feels right.