Understanding and Evaluating Emotional and Behavioral Impairment

Author(s):  
James C. Harris

In English property law, intellectual disability and mental illness were differentiated in the thirteenth century. By 1690, John Locke’s An Essay Concerning Human Understanding had clarified differences between intellectual disability and mental illness. Locke wrote: . . . The defect in [intellectual disability] seems to proceed from want of quickness, activity, and motion in the intellectual faculties, whereby they are deprived of reason; whereas mad men seem to suffer by the other extreme. For they do not appear to me to have lost the faculty of reasoning: but having joined together some ideas very wrongly . . . they argue right from wrong principles. . . . But there are degrees of madness as folly; the disorderly jumbling of ideas together is in some more, and some less. In short, herein seems to lie the difference between [intellectually disabled] and mad men, that mad men put wrong ideas together, and so make wrong propositions, but argue and reason right from them: but [those with intellectual disability] make very few or no propositions, but argue and reason scarce at all. (Scheerenberger, 1983, p. 41) . . . Thus, Locke is often credited with establishing the dichotomy between mental illness and intellectual disability that influenced social policy for people with intellectual disability. But he did not appreciate the capacity persons with intellectual disability do have to reason with adequate supports, nor did he consider that persons with intellectual disability are also at risk for mental illness and behavior disorders. Historically, intellectual disability and mental illness were regarded to be mutually exclusive conditions. Affective and behavioral disturbances in individuals with intellectual disability generally were regarded as manifestations of maladaptive learning and adverse psychosocial experiences rather than as indications of a psychiatric disorder. This view has been shared by both intellectual disability and mental health professionals. Health professionals typically fail to consider the diagnosis of a psychiatric disorder among persons with intellectual disability despite the presence of signs and symptoms that would be readily ascribed as psychiatric disturbance among typically developing persons within the general population. This diagnostic bias may be an outgrowth of several factors.

2001 ◽  
Vol 178 (5) ◽  
pp. 420-426 ◽  
Author(s):  
Mary Cannon ◽  
Elizabeth Walsh ◽  
Christopher Hollis ◽  
Maresc Kargin ◽  
Eric Taylor ◽  
...  

BackgroundSchizophrenia has been linked with psychological problems in childhood but there is little information on precursors of affective psychosis.AimsTo compare childhood psychological antecedents of adult schizophrenia and affective psychosis.MethodChildhood item sheets, which give standardised information on signs and symptoms of mental illness in the year preceding assessment are completed for all attendees at the children's department of the Maudsley and Bethlem Royal Hospital. We examined item sheet data on individuals with an adult diagnosis of schizophrenia (n=59) or affective psychosis (n=27) and a comparison group with no adult mental illness (n=86) (all had attended the department).ResultsAbnormal suspiciousness or sensitivity and relationship difficulties with peers are associated with later schizophrenia. In contrast, affective psychosis is associated with childhood hysterical symptoms and disturbances in eating.ConclusionsChildhood psychological precursors for schizophrenia and affective psychosis differ and do not simply reflect non-specific psychiatric disturbance in adolescence.


2011 ◽  
Vol 35 (11) ◽  
pp. 404-408 ◽  
Author(s):  
Sabu John Varughese ◽  
Vania Mendes ◽  
Jason Luty

Aims and methodTackling discrimination, stigma and inequalities in mental health is a major UK government objective yet people with intellectual disability (also known as learning disability in UK health services) continue to suffer serious stigma and discrimination. We examine the effect of viewing pictures of a person with intellectual disability on stigmatised attitudes. The 20-point Attitude to Mental Illness Questionnaire (AMIQ) was used to assess stigmatised attitudes. Members of the general public were randomised to complete the questionnaire having looked at a good (attractive) or bad (unattractive) photograph of a person with intellectual disability.ResultsQuestionnaires were received from 187 participants (response rate 74%). The mean AMIQ stigma score for the bad photo group was 1.3 (s.e. = 0.3, median 1, interquartile range (IQR) = 0–3,n= 82). The mean AMIQ score for the good photo group was 2.8 (s.e. = 0.3, median 3, IQR = 1–5,n= 105). The difference in AMIQ stigma score was highly significant (two-sidedP= 0.0001, median difference 2, Mann–WhitneyU-test).Clinical implicationsLooking at a good (attractive) picture of a person with intellectual disability significantly reduces reported stigmatised attitudes, whereas a bad (unattractive) picture has no effect.


2017 ◽  
Vol 24 (6) ◽  
pp. 434-439 ◽  
Author(s):  
Julie P Gentile ◽  
Allison E Cowan ◽  
Beth Harper ◽  
Ryan Mast ◽  
Brian Merrill

Individuals with intellectual disability experience higher rates of mental illness when compared with the general population, and there is a lack of medical and mental health professionals in rural and under-served areas. With the increase in discharge of individuals from institutional settings back to their home communities into the least restrictive environments, there are more patients with complex needs being added to the schedules of physicians in the outpatient delivery care system. Patients with disabilities may not travel well or tolerate changes in routine so may not have access to psychiatry. Utilization of telepsychiatry is well suited to this specialized patient population because it allows a highly traumatized group to meet with a psychiatrist and other mental health professionals from a location of their choice. Ohio’s Telepsychiatry Project for Intellectual Disability was initiated in 2012 to serve outlying communities with a lack of infrastructure and resources, to provide specialized mental health services to individuals with co-occurring mental illness and intellectual disability. After five years, over 900 patients with intellectual disability from 64 of Ohio’s 88 counties receive specialized mental health treatment through this statewide grant-funded project.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 94-94
Author(s):  
Deborah Finkel ◽  
Per Bulöw ◽  
Pia Bulöw ◽  
Monika Wilińska ◽  
Cristina Joy Torgé ◽  
...  

Abstract As part of the process of de-institutionalizing the Swedish mental health care system, a reform was implemented in 1995 moving responsibility for social support for people with severe mental illness (SMI) from the county to social services in the municipalities. In many ways, older people with SMI were neglected in this changing landscape of psychiatric care. To investigate possible generational differences in support experiences, two nonoverlapping cohorts were created from surveys conducted every fifth year between 1996 and 2011 in one middle-sized municipality in the south of Sweden, aiming to detect the needs for social support. Cohort 1 includes everyone detected at the 1996 survey aged 65 and 79 years (N = 92). Cohort 2 includes individuals first detected at the 2011 survey who were aged 65 to 79 (N = 104). Results indicates significant differences between the two cohorts in diagnosis, reflecting changes over time in diagnostic tendencies. Cohort 1 was on average 10 years older than Cohort 2, even within the restricted age range. After correcting for age, there were no differences between the two cohorts in education, functioning (CAN and GAF), or marital status. Although Cohort 1 experienced more days of institutionalization than Cohort 2 (median = 424.5 days vs. 382 days), the difference was not statistically significant. Cohort 2 had significantly higher additional subsidies and disposable income, as well as significantly higher income from other sources after retirement. Results indicate the changing demands that older adults with SMI will place on care systems.


2021 ◽  
pp. 095269512098224
Author(s):  
Chakravarthi Ram-Prasad

The Caraka Saṃhitā (ca. first century BCE–third century CE), the first classical Indian medical compendium, covers a wide variety of pharmacological and therapeutic treatment, while also sketching out a philosophical anthropology of the human subject who is the patient of the physicians for whom this text was composed. In this article, I outline some of the relevant aspects of this anthropology – in particular, its understanding of ‘mind’ and other elements that constitute the subject – before exploring two ways in which it approaches ‘psychiatric’ disorder: one as ‘mental illness’ ( mānasa-roga), the other as ‘madness’ ( unmāda). I focus on two aspects of this approach. One concerns the moral relationship between the virtuous and the well life, or the moral and the medical dimensions of a patient’s subjectivity. The other is about the phenomenological relationship between the patient and the ecology within which the patient’s disturbance occurs. The aetiology of and responses to such disturbances helps us think more carefully about the very contours of subjectivity, about who we are and how we should understand ourselves. I locate this interpretation within a larger programme on the interpretation of the whole human being, which I have elsewhere called ‘ecological phenomenology’.


2009 ◽  
Vol 15 (4) ◽  
pp. 263-270 ◽  
Author(s):  
Clare Oakley ◽  
Fiona Hynes ◽  
Tom Clark

SummaryViolent behaviour in people with a psychiatric disorder causes great public concern and leads to stigma for people with mental illness. There is good evidence for a correlation between schizophrenia and increased rates of violence but any association between mood disorders and violence has been comparatively overlooked. It appears that there may be more evidence relating mood disorders and violence than many clinicians realise. This article highlights the difficulties in assessing this, summarises what is known and discusses what this means for clinical practice.


1997 ◽  
Vol 3 (5) ◽  
pp. 259-266 ◽  
Author(s):  
Michael F. Myers

Studies of utilisation of psychiatric services have shown that between 4 and 18% of medical students annually identify themselves as ‘impaired’ (Dickstein et al, 1990). An unknown number of students may be ill but do not seek help – they soldier on through classes and clinics not realising that their sleep disturbance, worry, vague pains, flagging spirits, failing grades or increasing use of alcohol represent symptoms of strain and possible psychiatric disorder. Some suspect or know that they are ill but the stigma of accepting mental illness or seeking professional help is so profound that they suffer silently.


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