Legal Insanity

The terms sane and insane are not used much by workers in the mental health care field. They are mainly legal terms that even lawyers are wary of using. People used to be considered legally insane if they were unable to understand the difference between right and wrong or if they were unable to control their actions. Such definitions have never been easy to apply. The notions of "right" and "wrong" are sometimes hard to pin down. It is even harder to determine whether a person really does understand that what he or she did was wrong. It is equally difficult to determine whether a person could have acted differently in a specific situation. In criminal cases, some defendants enter a plea of innocent on the grounds of temporary insanity. Should they be excused because sanity returned after the criminal acts were committed? The legal approach to defining mental illness has been difficult to use.

Adjustment to Society

Some psychiatrists say that a normal person is one who can get along—physically, emotion­ally, socially—in the world. Such people are able to earn their living; feed, clothe, and house themselves; and make friends. The abnormal or mentally ill people are the ones who cannot do these things. They cannot adjust to their society. They may not be able to hold a job. They may be unable to cope with the demands of daily life. They may have so much trouble with personal relationships that they avoid people.

This approach to defining mental illness is the one most often used by workers in the men­tal health care field. It is valuable in that it stresses ability to function rather than a stan­dard of behavior. There are problems with this approach, however. If a society has gone wrong, it may be a sign of health not to be able to adjust to it. Thus, people who find it impos­sible to function in a cruel or repressive society — Nazi Germany, for example —may be the most healthy ones in it.

The Need for Caution

As we have seen, there are various ways of defining mental illness, none of them entirely satisfactory. However, the fact that it is dif­ficult to define mental disorders does not mean that they do not exist. What it does mean is that we should be very cautious about judging a person to be mentally ill.

If a person behaves in a way that we don't understand, he or she is not necessarily men­tally disturbed. We may all behave a little strangely under stress. In addition, mild distur­bances are quite common. It is only when a person's problems become so severe that he or she cannot cope with everyday life that it be­comes an illness.

The Scope of the Problem

Mental disturbances are a huge public health problem. It has been estimated that 1 of every 10 Americans now needs some form of treat­ment for mental health problems. In large urban areas, 1 out of 5 people suffers from serious emotional problems. Moreover, mental illness affects teenagers as often as adults. An esti­mated 10 million people under the age of 18 have mental disorders. At least 1.4 million in this age group suffer from problems serious enough to need professional care.

Many social problems have underlying psychological problems as the cause. These in­clude such widespread and destructive prob­lems as delinquency, divorce, alcoholism, drug abuse, crime, even accidents. The economic cost of mental illness to the nation is conserva­tively estimated at $40 billion a year.

More important than these figures, though, is the personal cost of mental illness. People suf­fering from mental illness miss out on the very things that make life worth living: happiness, love, achievement, creativity, motivation, and personal relationships.