How is Mental Illness Diagnosed?

How do we know if someone has a mental illness? Just like people in the general population, people with mild mental retardation can tell a doctor how they feel. Although their language may be more literal and concrete, they can and do talk about their symptoms and what is going on in their lives that is difficult. For these individuals, a psychiatrist or a psychologist can use the same criteria for evaluating symptoms as anyone else. The DSM (Diagnostic and Statistical Manual) which describes the symptoms associated with every mental illness is usually helpful. Medication can be prescribed when appropriate and the person often can take advantage of individual talk therapy or group therapy as well.

But because the DSM relies heavily on self-report of internal states, it is not as useful for people who are more cognitively impaired. For those individuals, behavior change that is observed by family or their staff is the key clue. Generally, we consider the possibility of mental illness when the behavior is consistent across settings; when a consistently applied behavioral intervention doesn’t create change; and when the person seems not to have any control over it.

Behaviors are seen as outward manifestations of the internal states described in the DSM. Anxiety, for example, may be expressed by pacing, restlessness or shouting. Caregivers might report sleeplessness, increased aggression, or trembling. Depression, on the other hand, might be indicated by a general slowing down, irritability, complaints of being tired, refusal to do things that used to give the person pleasure, or a drop in willingness to do self care. If a person starts to cover his or her ears or rub the eyes, brush at unseen things, or talk to the wall, it could be that there are auditory or visual hallucinations. It takes very careful observation and sometimes equally careful questioning of the people who know the person best to begin to understand what the person is experiencing.

Getting Help

If you think a family member with retardation is in psychological distress, it’s important to find a doctor who is knowledgeable in the field. A doctor who has had specific training and experience with people with mental retardation is going to be more sensitive to the unique ways that these individuals show distress and to the ways that they show negative side effects to medication.

We are very fortunate to live in a time when medicines have been developed that can relieve psychiatric suffering. But medicine should be used to treat, not to control. Doctors who have experience in dual mental health and mental retardation diagnosis take the time to attend to the data presented by staff or family and prescribe medicines specifically to address symptoms.

A psychologist or clinical social worker who has experience in the field may be able to suggest changes in the environment, routines, or interactions with family or caregivers that might relieve some of the stress on the person. Sometimes individuals, even individuals with severe retardation, can be taught some ways to relax or calm themselves.

Back to our new teacher: She’s young. She’s new. She doesn’t yet have a lot of experience. But she really does care. She wants the behaviors to stop because the person is hurting himself, because he is hurting others, and because she doesn’t know what to do. Fortunately her supervisor has been in the field for awhile. She knows that people with retardation really are fundamentally just like everyone else. So his parents will be called in to compare notes, data will be analyzed, a doctor will be consulted, and every effort will be made to figure out what is going on. Our new teacher will learn and grow into her job. The student will be given the relief and dignity of treatment instead of being merely controlled. It’s been a good day.

    Last reviewed: By John M. Grohol, Psy.D. on 19 Oct 2006
    Published on PsychCentral.com. All rights reserved.