How professional, public perceptions of mental illness changed over this decade

Photo Illustration by Nathan de la Cerda | Multimedia Journalist

By Madalyn Watson | Arts & Life Editor

Understanding of mental illness evolved this past decade through shifts in diagnoses, a decrease in stigma, innovations in technology and a willingness to communicate.

Dr. Sara Dolan, the director for the clinical psychology doctorate program and associate professor of psychology and neuroscience, said the definition of mental illness has changed over time and continues to change.

Dolan said when defining mental illness, a scientist would turn to the Diagnostic and Statistical Manual of Mental Health (DSM) for answers.

The book lists data about each disorder, including symptoms, what the course and prognosis could be, as well as how to divide these disorders from each other based on their symptoms — even when they tend to overlap.

Mental health professionals and scientists look to the fifth edition, of the DSM, which was published in 2013, more than a decade after the previous edition which was published in 2000. Dolan said for this decade’s edition, there were significant changes made in the way different disorders were diagnosed and defined.

“There’s been a big change in how mental illness is viewed at least from a scientist and practitioner view,” Dolan said.


Before coming to Baylor, Dolan pursued research full time through a postdoctoral fellowship with the Center for Alcohol and Addiction Studies at Brown University. One of the changes in the DSM that stood out to Dolan was the change in the definition of addiction.

“There used to be two separate diagnosis: one was substance abuse or alcohol abuse, and then the other was substance dependence or alcohol dependence, and they were completely separate disorders,” Dolan said. “The DSM-5 research team pulled those both together and made them one diagnosis, which is called alcohol or substance use disorder.”

Dolan said substance abuse was considered the less severe version of the two but with the term “alcohol or substance use disorder,” the symptoms lie on a continuum from less to more severe.

“Fewer people are being diagnosed, so we’re really capturing the people who have a legitimate addictive disorder now,” Dolan said. “When alcohol abuse was a possible diagnosis, we were capturing people and diagnosing them who didn’t have a serious problem.”

Getting in trouble with the law because of alcohol use was criteria for the diagnosis of “alcohol abuse” in the past. Dolan said people who get in trouble with the law because of alcohol use probably use alcohol in an unhealthy way, but that does not necessarily mean they have an addiction. By changing the criteria and organization of substance use disorder, these people are no longer factored in so other people can have a more accurate or valid diagnosis.

Dr. David Pooler, associate professor in the Diana R. Garland School of Social Work, said he has noticed other people in his field start to step away from the term “addiction” in recent years.

“I think [addiction] does a good job of including things like the misuse of substances, but [also] addiction to behaviors like sex, food, shopping, gaming and gambling,” Pooler said. “Those are process addictions, so you’re not literally putting a substance in, but you are compulsively engaging in some repetitive behaviors.”


When Pooler is not teaching and working with graduate students, he still practices as a social worker and sees clients in his office. Pooler said he has noticed since the stigma surrounding mental illness decreased in recent years, people became more open to talk about what they are going through with friends and family rather than just professionals.

“I think it’s more acceptable to say, ‘I deal with anxiety. I have OCD. I have depression — I take medication for it. I see a therapist,’” Pooler said. “So our understanding of it has been the same for a while, but our willingness to talk about it has definitely changed over the past decade.”

Pooler said that it is not professionals’ overall understanding of mental illness or treatment of mental illness that has changed in the last decade, but the shift of discussion about mental illness to the public sphere.

“What has changed is our willingness to talk about it more broadly, but especially on religious campuses,” Pooler said.

Although Pooler said he strongly believes that religion as a whole does not have a negative effect of mental illness, he said until recently, some people of faith had a limited understanding of mental illness.

“I think religious people, in Christianity in particular, have tended to view addiction [and mental illness] as a spiritual problem that requires discipleship,” Pooler said. “If you just get to know Jesus better — that’s the answer.”

Both Pooler and Dolan said a common misunderstanding about mental illness that they noticed among Christians and other people of faith in the past is its basis in sin.

“I think people are starting to see it’s not a sin,” Dolan said. “Mental illness is not the result of not praying enough or behaving badly.”

Dolan said people are learning that mental illness is based on many different biological, psychological and social factors.

“I think the more we see that really these are biologically based disorders, the more people can accept that these are real illnesses and not things that people are choosing to do,” Dolan said.

Pooler said religious people and institutions, including Baylor, are starting to understand how religion complements the scientific awareness of mental illness rather than competing with each other.

Dolan said the general population’s view of mental illness is moving in the right direction.

“People don’t want to be mentally ill. People don’t want their psychiatric or psychological symptoms to interfere with their lives, so that they can’t work and be in relationships,” Dolan said.


Although it does not fall under his expertise, Pooler said social media and the internet has to be a part of the destigmatizing of mental illness on some level.

“There are lots of apps that deal with mental health problems — that help people deal with mental health problems,” Pooler said. “Treatment doesn’t have to be, ‘I’m going to see a therapist.’ Treatment and maintenance of dealing with something that’s chronic can involve this app that gives me a reminder.”

Dolan also said innovations in technology have also created an excellent resource for people to understand mental health better and even access treatment.

“Technology has allowed us to integrate stress management techniques into our lives more,” Dolan said. “We’ve got Telehealth interventions, where instead of going to someone’s office to have a psychotherapy session, you can talk to them through Skype or something like that.”

According to Dolan, the arrival of social media platforms has also allowed people to find other people struggling with similar problems — forming online community.

“Social media has really allowed us to be more open about our symptoms,” Dolan said.

Dolan said communicating and talking about mental illness is the most important thing for people to do in order to help reduce the stigma surrounding mental illness.

“The more people we have been talking about it, the more people we have in our personal lives who are willing to share their experiences with mental health issues, [and] the more we’re going to be familiar with it, not frightened by it and not put off by it,” Dolan said.