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R. Lanier Britsch and Terrance
D. Olson, eds., Counseling: A Guide to Helping Others, 2 vols. [Salt Lake
City: Deseret Book Co., 1983-1985], Volume 2 © 2001, Deseret Book, GospeLink
2001, Used by permission
2 Recognizing Mental
Disorders
David G. Weight
All societies have been faced with the problem of how to help those with
mental disorders. In our society about 15 percent of the population experience
serious emotional problems each year. It might seem that these disorders could
be easily recognized, but diagnosing a mental disorder is much more complex than
it appears. Some symptoms are extreme, as in the case of someone who believes he
is commanded by God to kill atheists. But what about the person who believes
that recent storm damage shows that God is upset with new laws passed by the
city council? Or, consider the person who washes his hands unusually often
because he is concerned about shaking hands with others because they might have
been recently inoculated against smallpox and be infectious.
What is the difference between those who are eccentric and yet function well
in society, and those who are actually a threat to their own or others'
well-being? And what about behaviors that are viewed as abnormal in one culture
but as reasonable in another?
Consider these observations by Emily Dickinson:
Much madness is divinest sense
To a discerning eye;
Much sense the starkest madness,
'Tis the majority
In this as all, prevails.
Assent, and you are sane:
Demur,—you're straightway dangerous
And handled with a chain.
To complicate matters, we also encounter those who are viewed as normal and
successful and yet who feel miserable and confused.
Defining Disorders
A mental disorder is not a disease, but rather a way of thinking or behaving
due to a complex set of causes, including heredity, environment, traumatic
experiences, and learned reactions to the stresses of life.
The degree of a person's mental health can be judged by his appearance,
behavior, thinking, mood, and perception. If he does not have extreme
problems in these areas, he is probably adapting well to life.
Appearance
Although appearance and grooming vary widely among normal people, a person's
appearance can give some clue to his mental health. Someone who pays little
attention to his appearance maybe overly preoccupied with his own thoughts and
oblivious to the social needs of others. This may indicate a mental disorder.
This is especially true when basic personal hygiene is ignored by a person of
normal intelligence. Bizarre dress often indicates unusual thinking patterns as
well.
If you are counseling someone you think may have a mental disorder, look for
signs of tension and anxiety or depression. Does he seem angry or frightened, or
is he demanding and hostile? Pay attention to his eyes. Does he look around
nervously or avoid eye contact? Does he stare at you or at something else? Does
he seem to look through you rather than at you? Any of these may indicate some
mental problem.
Behavior
Perhaps the most dominant symptom in every mental disorder is anxiety. Does
the person show constant nervousness? Has he had periods of panic in which he
thought he might pass out or go insane? Other symptoms of anxiety are headaches,
dry mouth, ringing in the ears, difficulty in swallowing and breathing, sweaty
hands, dizziness, numbness and tingling in the extremities, digestive problems,
heart palpitations, and strong fears. Still other indicators include strange
posturing or very stereotyped movements. For example, the person might sit
rigidly for a long time or repeat a certain behavior almost like a ritual, or he
might collect items of little value and use or display them in unusual ways.
Any remarkable changes in a person's behavior may suggest a mental disorder.
These include a sudden drop in quality of job performance, schoolwork, ability
to concentrate, and self-care, and increasing social isolation. Often people who
know the person best will report that he is just "not the same."
Repeated abnormal behavior may indicate a mental disorder. If the person
keeps coming back for help with the same problem, his behavior maybe becoming an
obsession. This is particularly true if the person keeps talking about the same
concerns without realizing that he has already raised the issue. For example, a
man may confess that he has had unacceptable sexual feelings toward a certain
girl. Then the next week, he may confess that he had unacceptable sexual
feelings toward a different girl.
Thinking
Disturbed thinking is sometimes a sign of a mental disorder. The main
symptoms of disturbed thinking are delusions, which are incorrect inferences or
false beliefs about reality that are devoutly maintained in spite of obvious
evidence to the contrary. Delusions are not merely errors in thinking, as in the
case of a person who believes he is completely worthless because he has
disappointed his family. Delusions are false psychotic beliefs, such as those
held by a man who believes his words are not his own but are being spoken by a
supernatural source, a woman who believes that an electronic device has been
implanted in her head so that her thoughts can be monitored, or someone who
believes he need no longer eat since he has no insides.
A more difficult delusion to evaluate is one where the person believes he is
being attacked, cheated, persecuted, or conspired against. Since such things do
occur from time to time, you must evaluate whether the person's fears are
justified. If you tell a person that his fears are delusions, he may become
angry or feel rejected. Instead, ask the person for the reasoning behind his
fears. Try to understand how the person is thinking, and then determine whether
he should see a professional counselor.
Some mentally disturbed people have ideas that do not relate logically to
scientific views of cause and effect. An example is a person's belief that his
environment has particular and unusual significance for him, as when he thinks
that the message of a radio broadcast is meant especially for him.
Related to such ideas is magical thinking In this case the person
believes that his thoughts, words, or actions might override normal laws of
cause and effect. For example, a woman believes that if she has good spiritual
feelings all day, her son will not become ill or have an accident. A man
believes that if he were around an emotionally ill person it would cause him to
become emotionally ill.
There are also other beliefs that may indicate mental disturbances, such as
when someone says, "I sometimes have a feeling of gaining or losing energy
when certain people touch me," or "I might cause something to happen
just by thinking about it," or "I have felt that there are messages
for me in the way things are arranged in store windows."
Some disturbed people may overvalue a certain belief. For example, a person
may let the principle of good nutrition dominate his life. He may say, "I
know mother seemed to get better after her surgery, but if she had just taken
the right vitamins every day, she wouldn't have needed surgery in the first
place." He may then begin a campaign to challenge the need for any medicine
or physicians.
One of the most typical cases of mental illness is the person who believes
that his thoughts are known by others and that external forces can control his
thinking. Such a person might falsely believe that he has been possessed by evil
spirits or that someone is exercising influence by the use of hypnosis?
telepathy, or spiritual control. Since there are very few cases of documented
possession by evil spirits, we may assume in most of these cases that the
person's thinking is disordered. But such delusions can be very frightening to
the person, and he may take extreme measures to protect himself—even to the
point of killing someone in order to "appease the external forces."
Such a person is potentially dangerous, especially if he fears someone is trying
to hurt him.
One example is the person who is struggling with impulses to kill himself and
who thinks that others want to kill him or are provoking him to attempt suicide
by leaving knives on a kitchen table. (In an extreme case a man actually killed
his family and himself to protect them against living in a sinful world.)
Some people who claim extreme religious commitment twist religious principles
into destructive beliefs. We occasionally hear of such people
"sacrificing" family members or ignoring important responsibilities to
follow a "holy grail." Such fanaticism is the opposite of authentic
religious commitment. Anyone claiming to receive revelation for others should be
held suspect, especially when the information is believed to have relevance for
the Church or for large groups of people for whom the person has no particular
responsibility. In one such instance, a person received a "revelation"
that important new documents were about to be found and that he would recognize
these documents and point out to his church how policy should be changed. He
believed he had been selected for these "revelations" because there
was too much corruption in "high places."
Your initial contact with such a person does not require an on-the-spot
solution. You can usually schedule another discussion time. Meanwhile, you can
consult with a professional as to the next steps you should take.
Disturbed people often think in a confused fashion and use unclear or
illogical reasoning. Such thinking includes bizarre associations of words and
meanings. These people may create new words, repeat answers that no longer make
sense, or use a word for another word that has a similar sound, even though the
meaning is totally different. Here are some quotations from people who think in
this manner:
"Parents are the people who raise you. Parents can be anything—material,
vegetable, or mineral—that has taught you something. A person can look at a
rock and learn something from it, so a rock is a parent."
"I'm not trying to make noise. I'm trying to make sense. If you can make
sense out of nonsense, well, have fun. Trying to make sense out of sense. I'm
not making sense [cents] anymore. I have to make dollars." fn
In response to the question of why people believe in God a disturbed person
responded, "Um, I'm making a do in life. Isn't none of that stuff about
evolution guiding isn't true anymore now. It all happened a long time ago. It
happened in eons and eons and stuff they wouldn't believe in him. The time that
Jesus Christ people believe in their thing people believed in Jehovah, God that
they didn't believe in Jesus Christ that much." fn
Mood
A person's moods may range from manic excitement to the depths of depression.
Extremes in mood must be viewed as pathological. The person with borderline
manic excitement may be seen merely as very excitable and energetic until the
disorder becomes extreme. Symptoms include decreased need for sleep, high levels
of energy, and inflated feelings of self-esteem. The person may reduce his food
intake, strongly seek out people, demand more sexual activity, talk a lot, and
exaggerate past achievements. He may indulge in excessive laughing and joking,
buying sprees, or reckless driving.
A severely depressed person may have reduced energy, decreased productivity,
sleeping and eating disturbances, reduced sexual interest, and feelings of
sadness—even a desire to end his life.
In some cases, the person appears almost devoid of sensation. He seems unable
to experience pleasure and does not experience emotions appropriately—he may
laugh at the news of a loved one's death, or cry at inappropriate times. If
depression lasts for two weeks or more, it is imperative that the person be
referred to a professional for treatment—he may be suicidal.
The lay counselor should watch carefully for excessive guilt. Some people
have such perfectionistic expectations that they constantly feel guilt where
most other people do not. This is of greatest concern when the person responds
to guilt through inappropriate behavior or irrational ideas. Examples would be a
woman who believes that she has committed an unpardonable sin and that the death
of her child is part of her punishment, or a man who feels he is unworthy of his
wife and family because he has occasional sexual feelings toward women other
than his wife.
Perception
The mentally ill sometimes have disturbed perceptions —they see or hear
things that are not really there. Hallucinations are different from illusions,
in which the person sees or hears something he perceives to be different than it
actually is. A woman who sees a belt lying on the floor and believes she has
seen a snake suffers from an illusion. A man who sees snakes wriggling out of
someone's mouth is having hallucinations. Hallucinations of sounds most often
involve voices but may also include music. An extremely disturbed person might
report hearing two or more voices in conversation. Sometimes these voices are
frightening. One woman reported hearing a running commentary on her
"sins."
The person who has visual hallucinations has a greater probability of having
organic causes for his hallucinations than psychological ones.
It is not unusual for people who have undergone open-heart surgery to have a
brief period of perceptual changes. They often report visual hallucinations and
may even have delusions that nurses and doctors are trying to kill them. This is
usually the result of temporary brain changes and usually clears up
spontaneously in a few days.
People having hallucinations should definitely be referred to a professional
for evaluation.
Although many people are aware of their mental problems, others deny their
difficulties and hold to their disordered beliefs. This is an important
consideration when making referrals. The person who does not recognize his
difficulties can become angry and resist attempts to help him. This is
particularly true of those who fear that they will be abused or taken advantage
of. You should encourage the person to discuss his own perceptions of his
problems. This may help him come to the point where he will ask for help.
Incidentally, the fact that people with severe mental disorders often have
extreme religious views does not mean that religion has caused their disorder.
When a person begins to have unusual internal experiences, such as seeing things
or hearing voices, do not immediately assume that these are supernatural
experiences. This does not deny the existence of legitimate religious
experience, but it does suggest the importance of making proper diagnosis of the
causes of unusual behaviors and then taking appropriate action.
Recognizing Mental Disorders
1. Diagnostic and Statistical Manual of Mental Disorders (Washington,
D.C.: American Psychiatric Association, 1980), pp. 361, 355.
2. Ibid., p. 362.
About the Author
Dr. David G. Weight, professor of psychology at Brigham Young University,
received his bachelor's and master's degrees from that institution and his Ph.D.
from the University of Washington. A clinical psychologist, Dr. Weight has had
broad experience in therapeutic work in Washington and Utah. He is a consultant
to Utah Valley Regional Medical Center Mental Health Services and a large school
district. He supervises a department of the BYU Comprehensive Clinic. Professor
Weight has written a number of professional articles. In addition to his
professional activities, he has been a member of the board of education of the
Provo School District.
In the Church, Dr. Weight has served as a missionary, bishop, high counselor,
and Young Men's president.
He and his wife, Shauna, are the parents of five children.0
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