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You Are Not Alone
If you have a mental illness, you are not alone. One in five adult
Americans will have a mental illness during their lifetime that is
severe enough to require treatment. Many more have problems that
prevent them from enjoying their lives.
Fortunately, effective treatments are now available for many mental
illnesses. Unfortunately, most people do not seek help. Many wrongly
believe their symptoms are their own fault or are caused by personal
weakness. They think if they try hard enough they can overcome their
problems by themselves, and they suffer unnecessarily.
In actuality, mental illnesses often involve biological dysfunctions
that require professional treatment. An individual with a mental
illness needs treatment and help in coping with everyday problems. In
contrast, individuals who do not have a mental illness can usually
deal with ordinary problems by themselves. At times of particular
stress, however, even mentally healthy persons will find professional
The following discussion of mental health and mental illnesses is
designed to provide information that can help people lead happier,
What Is Mental Health?
While mental health can mean many things to many people, self-esteem
and the capacity to care about others are universally important
components of mental health. Mentally healthy people understand that
they are not perfect nor can they be all things to all people. They
experience a full range of emotions including sadness, anger, and
frustration as well as joy, love, and satisfaction. While they
typically can handle life's challenges and changes, they can reach out
for help if they are having difficulty dealing with major traumas and
transitions--loss of loved ones, marriage difficulties, school or work
problems, the prospect of retirement.
Helping Yourself and Others About Mental Health
There are a number of steps you can take to help maintain good mental
health. When you reduce your own stress level, you put others at ease
too. When you are cooperative and outgoing, you bring out the
cooperative spirit in others. Here are some suggestions:
Take a realistic approach. If there's a job to do, get it done
without ruffling the feathers of other people. Accept a challenge.
Take command of the situation. Set goals. Keep them in perspective
and see them as part of a larger purpose. Compromise with others who
may not see eye-to-eye with you on every point. Remember, they also
have rights. Enlist cooperation rather than arouse antagonism.
Suggest a family or staff meeting to encourage cooperation and
Learn to recognize and express your feelings. Try not to label
feelings--yours or others--as "good" or "bad." It is human to
experience a wide range of feelings. It is generally healthy to
express feelings as soon as possible in a suitable way since, when
pent up, they can result in inappropriate responses. For example, if
you feel put down or ignored and suppress your feelings, you may later
vent your anger on someone else or you may turn it inward and feel
depressed. Know why you feel angry and express your feelings as
calmly as possible. Or talk matters over with a sensible, trustworthy
person--a wise friend, a clergyman, a physician, a relative, or a
professional counselor. This approach may help you to think more
clearly, handle your feelings appropriately, and better understand the
feelings of others as well.
Don't brood. Often a simple change of pace or a refocusing of
energies is a constructive way of "getting away from it all." Instead
of brooding, do something--no matter how small--positive and useful
about a problem. Try not to worry about the things you cannot change.
Proceed one step at a time. To escape the feeling that you're
trapped, evaluate your problem, consider each step necessary to solve
it, and work toward a solution. This "one-step-at-a-time" approach
will allow you to take pride in your ability to handle the situation.
By diverting your tensions and anger to worthwhile and reachable
goals, you will be amazed by how much control you can exert in
managing your life.
What to Watch For
Even when you try your best, you will still experience periods of
frustration and unhappiness. Usually, with time, you will overcome
your distress. But you should learn to recognize when your
problems--or those of your loved ones--are too much to handle alone.
You can help yourself, your family, and your friends by knowing when
to ask for professional help. Some of the warning signs include:
Undue prolonged anxiety. This is an anxiety out of proportion to any
identifiable reason or cause. Of course, everyone experiences
problems that make them tense and anxious. But a deep, continuing
anxiety--a state of almost constant tension and fear that may fasten
itself to one cause after another--is a signal that help is needed.
Unrelieved anxiety not only causes mental anguish but also can lead to
Prolonged or severe depression. Clinical depression--which is quite
different from normal depressed feelings or "the blues"-- strongly
affects thinking, feelings, and behavior. Persistent feelings of
inadequacy, sadness, helplessness, hopelessness, undue pessimism, and
loss of confidence are some of the symptoms of depression. Changes in
behavior patterns are a key sign that depression may be getting out of
hand and help should be sought.
Depressed individuals often withdraw from friends they normally enjoy,
from loved ones, and from the usual occupation and hobbies that give
pleasure. Their eating and sleeping habits change. Some suffer from
loss of appetite and insomnia, especially an inability to stay asleep;
others seek solace in overeating and excess sleeping.
Other symptoms of depression include low energy, chronic fatigue,
decreased effectiveness at school, work, or home, and loss of sexual
interest. Depressed individuals are those most likely to think of
suicide as a solution, although people with other mental and emotional
disturbances may also be suicidal. During periods of crisis, people
should be with others, avoiding isolation.
Abrupt changes in mood and behavior. These changes do not include
deliberate steps a person adopts for self-improvement. They refer to
changes in mood and behavior that reflect serious alterations in an
individual's normal habits or way of thinking. For example, the good
student whose grades abruptly drop or the frugal man or woman who
suddenly begins gambling away large sums of money is very likely to be
experiencing emotional problems. Also, frequent or regular mood
changes from highs to lows, whether gradual or abrupt, can signal a
Physical symptoms that may be related to tension. Some bodily
ailments and complaints--headaches (including migraines), nausea, or
unexplained pains--may have no identifiable physical cause. These
symptoms, including pain, are very real. But only a physician is
qualified to determine whether they are caused by medical illness.
Because medical tests may reveal an organic cause, any persistent
physical ailment should be checked by a doctor.
If any of the warning signs described above are severe or long
lasting, whether caused by a medical illness or not, professional help
may be needed.
"Kinds" Of Mental Illness*
Schizophrenic disorders. In any given year, approximately 1.8 million
people in this country, or 1 percent of the population, are affected
by a form of schizophrenia.** This complex and extremely puzzling
type of mental illness is particularly disabling, generally
interfering with the ability to work, relate to others, and take care
Generally, symptoms of schizophrenia become apparent during
adolescence or early adulthood, but can begin later in life. Symptoms
may include delusions (false beliefs, sometimes paranoid in nature,
whereby the individual wrongly feels persecuted or endangered),
hallucinations (hearing voices that are not present), disconnected or
incoherent speech, withdrawal from the outside world, grossly
inappropriate feelings, or abnormal psychomotor activity (rocking,
pacing, or immobility). While some who experience an apparent
schizophrenic episode will recover fully, schizophrenia is a chronic
or recurrent illness for most people.
In order to obtain the most appropriate treatment, accurate diagnosis
by a qualified psychiatrist is essential since other psychotic
conditions--those induced by such drugs as LSD or PCP, or by mania,
depression, or organic brain disturbances--may mimic symptoms of
Mood disorders. Depression, mania, and bipolar disorder (bipolar
disorder is also called manic-depressive illness and is characterized
by cycles of depression and mania) are referred to as mood disorders.
Mood disorders affect an estimated 11.6 million adults in the United
States, or 6.3 percent of the population, each year.
Depressive disorders change the way people think, feel, and behave.
Unlike the normal "down" mood that we all experience at one time or
another, major depression lingers on and becomes more pronounced than
warranted by the events of daily living. Depression interferes with
the ability to think, to concentrate, and to enjoy the normal
pleasures of life. Depressed people may brood about death and dying,
and may exhibit suicidal behavior. Some people experience depressive
episodes--onsets of symptoms that can be severe and disabling. Others
can continue to function, but feel depressed and "under the weather"
all the time, a condition called dysthymia.
Manic episodes, by contrast, are marked initially by elation,
hyperactivity, irritability, decreased need for sleep, inflated
self-esteem, and increased loud speech, with abrupt changes of topic.
As the episode progresses, the person with mania can, like those with
schizophrenia, become overtly psychotic, experiencing delusions,
hallucinations, and bizarre behavior.
Individuals suffering from bipolar disorder alternate between episodes
of excitement/mania and major depression. Symptoms can be severe and
disabling, or relatively mild, a condition called cyclothymia.
Anxiety disorders. Anxiety is a normal, necessary part of life that
everyone experiences at times. As a symptom, it is not uncommon in
the early stages of schizophrenia when the individual is experiencing
strange new sensations; and it often accompanies mood disorders. In
another group of disorders, however, anxiety is the core symptom.
Anxiety disorders affect approximately 10.1 percent of the general
population, or more than 18 million people, during any year. These
disorders can take several forms.
Generalized anxiety disorders are marked by jumpiness, irritability,
tension, sweating, racing or pounding heart, and a variety of other
symptoms associated with anxiety. The person is apprehensive, on
edge, and has problems getting to sleep. To be considered a disorder,
the symptoms should be persistent, generally continuing for more than
a few weeks.
People with panic disorder are subject to attacks of panic from out of
nowhere, with no obvious cause. They become extremely frightened and
often think they are going to die. They suffer heart palpitations,
dizziness, chest pains, a sense of unreality, and other symptoms. The
disorder can be limited to a period of a few weeks or months, but more
commonly it recurs over time. Although the attack itself generally
lasts only a few minutes, anticipating the feeling of helplessness or
loss of control that accompanies the panic can make the person
reluctant to be alone or to leave home.
The individual whose frequent attacks have increasingly constricted
normal activities is usually diagnosed as having agoraphobia. This is
the most disabling of all the phobias, which are also considered
anxiety disorders. The person with agoraphobia usually avoids
situations where escape would be difficult or impossible--crowds,
tunnels, stores, bridges, elevators, or public transportation. Some
people with agoraphobia become so fearful that they never leave their
homes for years at a time.
Other types of phobia include simple phobias, the persistent and
irrational fear of a specific object, activity, or situation, and
social phobias, the irrational fear of humiliating or embarrassing
oneself in public.
Yet another anxiety disorder is posttraumatic stress disorder, which
is an often recurrent reaction to a psychologically traumatic event
that is outside the range of usual human experience. Wartime combat,
bombing, rape, floods, or torture are examples of this type of
experience. Symptoms include reexperiencing the event,
nonresponsiveness to others, little interest in outside activities,
sleeplessness, memory problems, and loss of concentration.
Obsessive-compulsive disorder (OCD) is an anxiety disorder involving
repetitive thoughts and behaviors that are difficult if not impossible
to control. The intrusive and obsessive thoughts may revolve around a
fear of harming others or of being harmed. In response to obsessive
thoughts, OCD victims often feel obligated to perform certain
rituals--behaving in a specific way a specific number of times--to
ward off harm, even though they know that the behavior is illogical.
Two of the most common OCD rituals are handwashing and checking. For
example, persons who fear either being contaminated or contaminating
others will wash their hands numerous times for long periods of time
every day. Or persons who fear harming others, such as running over
them with a car, will stop their car repeatedly to check on whether
there is a victim lying dead on the road.
Some people with OCD are obsessed with self doubt and compulsively
check to see if they have locked doors or turned off equipment or
carried out other tasks for which they feel responsible.
Personality disorders. The individual with a personality disorder
demonstrates personality traits that are inflexible and cause him or
her either to adjust poorly in social relationships or to suffer
internal distress. Characteristic of these disorders are rigid and
deeply rooted dysfunctional patterns in relating, perceiving, and
thinking. Personality disorders typically become apparent in
adolescence or earlier and are often less obvious in middle and old
age. This age-related pattern is especially true of the individual
with an antisocial personality, usually a person in the late teens or
the twenties who is in continuous social or legal trouble and appears
to profit little from parental or social punishment.
The characteristics of borderline personality are manifested in sudden
changes in mood, unstable interpersonal relationships, and proneness
to unpredictable actions which could be self-damaging. Individuals
with this disorder may also have a mood disorder.
An individual with paranoid personality characteristically behaves
toward others with unwarranted suspicion, envy, jealousy, and
stubbornness. He is ready to believe that others have taken advantage
of him, even when evidence to the contrary is presented.
Mental Illnesses Can Be Treated
Thanks to research, many effective therapies are available for the
treatment of mental illnesses. Medications and different types of
psychosocial therapies have been used alone or in combination. The
treatment chosen for an individual depends on the diagnosis and
severity of the illness. For severe disorders, such as schizophrenia,
depression, and bipolar disorder, as well as some anxiety disorders, a
doctor usually prescribes medication and some form of psychosocial
therapy. These include individual psychotherapy, group and family
therapy, behavior therapy, marital counseling, recreational therapy,
occupational therapy, hypnotherapy, behavior modification, art
therapy, and psychodrama. With some other disorders, psychosocial
therapy may be all that is needed for a successful recovery.
At times, electroconvulsive therapy, often referred to as ECT or
"shock" therapy, can be life-saving for severely depressed and
suicidal individuals, some of whom may not respond to other therapies.
These People Can Help
Psychiatrists, psychiatric social workers, psychologists, psychiatric
nurses, mental health counselors and aides, or teachers who are
specially trained in the area of mental illnesses and their treatment
are among those who can be of assistance. It is beneficial to discuss
problems with a family doctor or clergyman who can offer referral
information. Self-help organizations can also be beneficial.
How To Find Help
There are many services available to persons experiencing mental and
Mental health associations, consumer organizations, and mutual
help groups can provide assistance and information about mental
health resources available in your community.
Professional associations usually have State or local chapters
that can help in finding an appropriate professional in the
community. These include the State psychiatric and
psychological associations or medical societies.
Family service agencies may also provide information, referrals,
and counseling for individuals and families.
State and local departments of social services, city or county
health departments, or county medical associations and others,
including Veterans' Administration hospitals, school counseling
programs, and private clinics, can also provide help.
State mental hospitals usually maintain special units for
intensive short-term treatment and specialized programs for
disorders of longer duration. Some private hospitals also have
short-term psychiatric, intensive-care units.
Community mental health centers provide a myriad of mental
health services including inpatient, outpatient, partial
hospitalization, and aftercare services. Also included are
services for children and the elderly.
To obtain the name and telephone number of mental health services in
your community, scan the front cover of your telephone book where
police and fire departments list their telephone numbers. Often
mental health programs are listed on this page. You can check the
Yellow Pages under "mental health," "health," "social services,"
"suicide prevention," "hospitals," or "physicians." For appropriate
numbers, you can also call directory assistance or the operator and
request the telephone number of your local mental health center.
Once you make contact with your local mental health clinic, you will
meet trained personnel who can answer your questions, provide
assistance, or direct you to a further source of help.
If an emergency exists--someone is threatening suicide or acting in a
violent or extremely bizarre manner--call the police or an ambulance.
You can also contact a mental health hotline or suicide prevention
Three Important Tips
How much you are helped depends on several factors: (1) Obtaining the
right diagnosis is important; some mental illnesses have one or more
symptoms in common, so careful evaluation is required; (2) Your
therapist should have the training and most up-to-date information
needed to treat your mental illness; (3) There should be a "fit"
between your personality and that of the therapist. It pays to seek
help from another if you feel dissatisfied or unaided by a particular
Most of us experience stress in the course of living. If you have a
mental or emotional problem from time to time, try not to be unduly
discouraged. But if the problem persists, or is severe, you should
seek help. Remember, you are not alone.
For further information on mental health and mental illness, write to:
Information Resources and Inquiries Branch
Office of Scientific Information
National Institute of Mental Health
5600 Fishers Lane, Room 7C-02
Rockville, MD 20857
National Mental Health Association, Inc.
1021 Prince Street
Alexandria, VA 22314-2971
National Alliance for the Mentally Ill
Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201
National Depressive and Manic Depressive Association
730 North Franklin, Suite 501
Chicago, IL 60601
Anxiety Disorders Association of America
6000 Executive Boulevard, Suite 200
Rockville, MD 20852-4004
* Definitions of mental illnesses in this section were derived
from the Diagnostic and Statistical Manual of Mental Disorders, Third
Edition-Revised, American Psychiatric Association, 1987.
** Rates are based on estimates of the U.S. 1989
population--184,000,000 persons aged 18 and over. Source is
unpublished data from the Epidemiology and Psychopathology Branch,
Division of Clinical Research, National Institute of Mental Health.
This brochure was revised by Margaret Strock, staff member in the
Information Resources and Inquiries Branch, Office of Scientific
Information, National Institute of Mental Health (NIMH).