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Mental disorders are part of our human condition. We have many names for these conditions. We speak of people with mental illness. For over a century, psychologists have studied these conditions in terms of abnormal psychology, which is the study of abnormal behavior. Others have used the term psychopathology. This is in contrast with pathophysiology, or pathology of our physiology. Slang words such as crazy or nuts have been around for hundreds of years. One of the oldest terms is insanity, or insane, which comes from the Latin meaning “not healthy.”

Mental disorders have been with us throughout our human history. Since the time that written language became a part of our experience, humans have included descriptions of mental disorders. We find such descriptions in Egyptian, Greek, Chinese, Indian, and other texts throughout world history. Today, our films, novels, plays, and television programs often portray problems experienced by those with mental disorders.

abnormal psychology: the study of psychological dysfunctions that the person experiences in terms of distress or impairment in functioning; a complete definition of abnormal behavior includes behaviors and experiences accepted in the person’s culture

psychopathology: the scientific study of mental illness and its causes

The experiences of the individuals described in the chapter opening give us insights into the nature of mental illness. Terri Cheney told how she experienced great energy, which lasted for 4 days. She described the experience of mental illness as something happening to her. In this sense, Terri Cheney and John Nash did not feel they had an alternative way of acting. Thus, one important characteristic of mental illness is the lack of control over one’s experience. This can also be described as a loss of freedom or an inability to consider alternative ways of thinking, feeling, or doing. Some individuals show this loss mainly in terms of emotional experiences, as in the case of Terri Cheney with bipolar disorder. Others show the loss in terms of cognitive processes, such as the experiences of John Nash. At the beginning of many of the chapters of this book, you will read first-person accounts from individuals with particular disorders.

Another common theme seen in psychopathology is the loss of genuine personal contact. Individuals with depression or schizophrenia often find it difficult to have social interactions as experienced by other people. Just having a simple conversation or talking to clerks in stores may seem impossible. Mental illness not only affects individuals’ interpersonal relationships but also their relationship with themselves, their intrapersonal relationship. When individuals with schizophrenia or depression talk to themselves, they often think negative thoughts about who they are and what will happen in the future.

In addition, in most cases, the experience of a mental disorder results in personal distress. Not being able to get out of bed, or feeling that a voice in your head is telling you that you are evil, or worrying that even a rice cake or an apple will make you fat all represent different degrees of distress. Thus, we can consider four important personal components in psychopathology.

These are first, a loss of freedom or ability to consider alternatives; second, a loss of genuine personal contact; third, a loss of connection with one’s self and the ability to live in a productive manner; and fourth, personal distress. As you will see with the disorders presented in this book, personal distress over time is one of the criteria required for a diagnosis to be made. There is also a more global component in which the person’s behavior and experiences are considered to be deviant in terms of cultural and statistical norms.

Table 1.1

Today, the National Institute of Mental Health (NIMH) estimates that at least 18.1% of the U.S. population experiences a diagnosable mental disorder during a given year (http://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-us-adults.shtml). This represents almost 48 million people in the United States (see Figure 1.1).

Having a mental disorder results in lost productivity, lost personal enjoyment, and potentially even premature death. The World Health Organization (WHO) estimated that in the United States and Canada, mental disorders cause a greater loss in what they refer to as disability-adjusted life years (DALYs) than cardiovascular disease or cancer. DALYs represent the total number of years lost due to illness, disability, or premature death (http://www.nimh.nih.gov/health/statistics/disability/file_148328.pdf).

With mental illness being so common, you might think that we as humans would have a complete understanding of the factors involved. However, this is not the case. We are not even sure how to refer to individuals with mental disorders. Are they abnormal? Depending on the reference group one uses, one can be normal or abnormal. Many famous artists such as the Impressionists of the nineteenth century had their work initially rejected because it did not fit into the standards of what was considered good art at the time. However, today we appreciate that these artists showed us another way of viewing the world. Likewise, many movies and YouTube videos today would be rejected as not representing mainstream values at a previous time. Further, what would be acceptable in one culture might be seen as completely “crazy” in another.