Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 2
The Fundamentals of Mental Health and Mental Illness
A vast body of research on mental health and, to an even greater extent, on
mental illness constitutes the foundation of this Surgeon General’s report. To
understand and better appreciate the content of the chapters that follow,
readers outside the mental health field may desire some background information.
Thus, this chapter furnishes a “primer” on topics that the report addresses.
The chapter begins with an overview of research under way today that is focused
on the neuroscience of mental health. Modern integrative neuroscience offers a
means of linking research on broad “systems level” aspects of brain function
with the remarkably detailed tools and findings of molecular biology. The report
begins with a discussion of the brain because it is central to what makes us
human and provides an understanding of mental health and mental illness. All of
human behavior is mediated by the brain. Consider, for example, a memory that
most people have from childhood—that of learning to ride a bicycle with the help
of a parent or friend. The fear of falling, the anxiety of lack of control, the
reassurances of a loved one, and the final liberating experience of mastery and
a newly extended universe create an unforgettable combination. For some, the
memories are not good ones: falling and being chased by dogs have left marks of
anxiety and fear that may last a lifetime. Science is revealing how the skill
learning, emotional overtones, and memories of such experiences are put together
physically in the brain. The brain and mind are two sides of the same coin. Mind
is not possible without the remarkable physical complexity that is built into
the brain, but, in addition, the physical complexity of the brain is useless
without the sculpting that environment, experience, and thought itself provides.
Thus the brain is now known to be physically shaped by contributions from our
genes and our experience, working together. This strengthens the view that
mental disorders are both caused and can be treated by biological and
experiential processes, working together. This understanding has emerged from
the breathtaking progress in modern neuroscience that has begun to integrate
knowledge from biological and behavioral sciences.
An overview of mental illness follows the section on modern integrative brain
science. The section highlights topics including symptoms, diagnosis,
epidemiology (i.e., research having to do with the distribution and determinants
of mental disorders in population groups, including various racial and ethnic
minority groups), and cost, all of which are discussed in greater and more
pointed detail in the chapters that follow. Etiology is the study of the origins
and causes of disease, and that section reviews research that is seeking to
define, with ever greater precision, the causes of mental disorders. As will be
seen, etiology research examines fundamental biological, behavioral, and
sociocultural processes, as well as a necessarily broad array of life events.
The section on development of temperament reveals how mental health science has
attempted over much of the past century to understand how biological,
psychological, and sociocultural factors meld in health as well as in illness.
The chapter then reviews research approaches to the prevention and treatment of
mental disorders and provides an overview of mental health services and their
delivery. Final sections cover the growing influence on the mental health field
of the need for attention to cultural diversity, the importance of the consumer
movement, and new optimism about recovery from mental illness—that is, the
possibility of recovering one’s life.
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