A Psychiatrist Explains the Different Types of Mental Disorders
Recently we caught up with Professor Kuruvilla George (known as KG) to learn more about some of the different types of mental illnesses, their risk factors, and how we can respond to those struggling.
KG was a practising psychiatrist both in the UK and here in Australia, where he’s worked in clinical practice, headed up programs for hospitals, taught as a clinical professor at universities, and even served as the Deputy Chief Psychiatrist for the state of Victoria for 10 years. Now he’s retired, and spends his time using his medical knowledge – as well as his faith – to break the stigma of mental illness in the church through his work with the Centre for Theology and Psychology in Melbourne, Australia.
This is a broader overview of some of the main insights Prof KG had to share with us, but you can find more in-depth explanations in his podcast episode or full video interview. Let’s jump in!
Types of Mental Health Conditions
In psychiatry, Professor KG explains that mental health conditions are broken into two overarching categories: the first are conditions with a high impact and low prevalence (meaning they occur less frequently), and the second are conditions with a lower impact but higher prevalence.
Psychotic Disorders
“At the high impact end,” KG goes on to explain, “are ‘psychotic disorders’ – where a person’s thoughts, mood, cognition and behaviour are all impacted. You can typically tell that something is ‘wrong’ with the person.” There are both ‘organic’ psychotic disorders that occur naturally, as well as those caused by other medical problems (for example, a brain tumour causing psychosis) or drug-induced psychotic episodes.
Psychotic disorders are made up of two main elements. Firstly, they produce delusions, which are false beliefs that can’t be corrected with reasoning. These might be delusions a person has about their environment and the world they live in (such as “I live in a magical realm”), or delusions about themselves (e.g. “I’m the King/Queen” or “I can fly”).
The second element to psychotic disorders are hallucinations, which are false perceptions without a stimulus. We might hear in shows or movies of people who see and hear things that aren’t there, but KG tells us that these hallucinations can be in all five senses, including feeling, smelling and tasting things that aren’t really there.
These delusions (‘wrong beliefs’) and hallucinations (‘wrong perceptions’) often lead to wrong behaviours, because the person will act on what they think is true. The most well known forms of a psychotic disorder are schizophrenia and bipolar affective disorder, which is a mood disorder with cyclical periods of mania and depression. A combination of these two disorders is called schizo-affective disorder.
If a person is experiencing a psychotic episode, KG shares that there are three ‘A’s’ to remember; argue, agree, and accept. Don’t argue with the person, as their delusions mean they aren’t able to be reasoned with. Don’t agree with what they’re saying, either, as this reinforces their delusion. Instead, you should aim to “accept” what the person says without attempting to sway them either way.
Stress-Induced Disorders
In the category of high prevalence and low(er) impact mental disorders, Professor KG mentions two commonly known conditions; generalised anxiety disorder and obsessive-compulsive disorders.
“There is also a form of depression that is stress-induced,” KG adds, “where someone has been anxious for a long time and their mood is affected. When stress becomes so severe, it can lead to depression. And though it usually passes away after the stress disappears, post-traumatic stress disorder is when the stress lingers for a long time, past the events that caused it.”
Personality Disorders
What are personality disorders? Don’t we all have a ‘personality’? KG explains: “If we have a particular personality trait that is impacting on our own or others’ lives, it’s called a disorder. For example, there are disorders called schizoid personality disorder, paranoid personality disorder, narcissistic personality disorder, and antisocial personality disorder.” On top of these ‘organic’ disorders, there are also alcohol or drug-induced personality disorders.
Depression
“All of us are created as emotional beings,” says Professor KG. “We’ve been made with anxiety, the possibility to feel happy, sad and angry… But when these emotions that we all experience have become prolonged and sustained, that’s when we call it a disorder.”
“One of the criteria for calling something a ‘mental illness’ is when it begins to greatly impact our own or someone else’s life,” KG goes on to explain. “Feelings of sadness are normal, and there’s nothing wrong with experiencing that emotion when things upset us. But the difference between a person experiencing sadness and one that is clinically diagnosed with depression is that the ‘sadness’ is prolonged and sustained over a period of two weeks or longer.”
“With depression, we talk about serious (or major/melancholic) depressive disorders that have certain criteria needing to be fulfilled,” he says. “In melancholic depression, there’s a specific type of sleep disturbance that a psychiatrist will look for, where the sufferer finds themselves consistently waking around 2 or 3am in the morning. Other symptoms include a loss of appetite coupled with weight loss, and an overall lack of energy.”
Professor KG says that most people with depression also fall on either extreme of the spectrum where they’re either agitated and can’t sit still, or they’re slow to process things and react, which is called “psycho-motive retardation”. On top of these symptoms, the more serious forms of depression can present themselves with suicidal ideation, and even lead to psychotic episodes and hallucinations.
What Causes Mental Disorders?
Why is it that only some people suffer with these disorders?, we asked Professor KG. He explained that psychiatrists break up the contributing factors into these four categories; Biological, Psychological, Social, and Lifestyle.
Biological factors include a person’s genetics, especially when it comes to illnesses that are hereditary. We’re all born with different genes and predispositions to illnesses, and though that’s not always an indication that we’ll experience the same disorders as our parents or grandparents, it’s a significant factor. “For example, you might have the gene for diabetes,” KG says, “but if you’re careful with your diet, you won’t end up with it. But because you have this ‘genetic vulnerability’, you’re more susceptible to getting diabetes.”
As for psychological factors, KG says that our upbringing and background makes a lot of difference to whether we develop a mental disorder. In the same way, social and lifestyle factors can make us more susceptible to these illnesses; for example, if we lead an unhealthy lifestyle or are socially isolated, we’re more likely to experience anxiety, depression, or other disorders.
“I also introduce a fifth term,” KG says. “‘S’, for ‘spiritual’”. As a Christian, KG believes that there can be spiritual elements to our mental illnesses, and that it’s wise to be discerning here when we’re faced with mental illness as believers.
Does Psychiatry Clash With Our Faith?
As a practising psychiatrist in the 1970’s, Professor KG would have people ask him, “How can you promote psychiatry when it’s a non-Christian field?” Ever since, he says he’s been trying to break the stigma that churches and people of faith have against the field.
“There’s a lot of fear about Christians seeing a non-Christian psychologist or psychiatrist,” says KG. “But whatever their beliefs, these professionals have been trained to accept what the patient is saying and work along with that patient.”
KG provides us with an example. Imagine there’s an atheist or secular psychiatrist seeing a Christian patient who believes they’ve done something wrong, and the guilt that patient is feeling is contributing to their depression or anxiety. Even though the psychiatrist might not agree with the patient’s moral conviction and therefore doesn’t believe they did anything wrong, they’ve been trained to accept what the patient is saying, so they’ll work alongside this patient from the patient’s point of view. In other words, as KG says, “We don’t need to be worried that they’re trying to convert us away from our faith.”
If you’re interested in this topic further, read our blog post, ‘If Jesus Is Enough, Why Would I Need Psychology?’.
How Should We Be Dealing With Mental Illness?
Firstly, Professor shares, it’s important to break down the stigma that many churches have of mental illness. Professor KG believes that more education is key, and that by learning more about what mental illnesses are and how they work in our minds and bodies, we’re better able to understand them in light of our faith. Another big part of breaking down these barriers, KG says, is to talk more openly about mental illness, especially within church communities.
“Mental illness is a lonely path,” he continues. “One of the major factors that helps people going through it is to have someone who understands, supports, and walks alongside them. When people come to us with difficulties, we want to solve their problems, but what we need to be doing is to learn to refer them on [to pastors or mental health professionals]. We need to be fellow travellers and not solution-providers.”
As we mentioned, Professor Kuruvilla George (KG) now spends his time working to break the stigma of mental illness in the church. He currently serves as the Associate Director at the Centre for Theology and Psychology in Melbourne, Australia. To find out more about what CTP do, you can visit their website here.
