The Science of Mental Illness
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National Institute of Mental Health

The Science of Mental Illness

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Teacher's Guide

Lesson 2—Explore/Explain

What’s Wrong? (Page 2 of 2)

Procedure

Activity 2: Defining “Illness”

  1. Remind students that they diagnosed the health problems of two individuals in Activity 1. Ask students if they can think of other words for “health problem.”

Students may suggest words such as sickness, illness, disease, syndrome, or disorder. Try to get students to introduce the term illness instead of supplying it yourself. Use probes such as, “If somebody is sick, you could say they have an…” or “Asthma, bronchitis, strep throat, and depression are….” In the next step, students will develop a definition for illness.

Note to teachers: If students ask about the difference between the various terms, explain that for this module, the terms illness, disease, sickness, disorder, and syndrome should be considered the same. For this unit, try to use the word illness consistently because of its relation to mental illness.

  1. After students have used the term illness, ask them to use what they learned in the previous activity to develop a definition for illness. Write the students’ definition on a transparency.

This is likely to be challenging for students. Use questions such as, “Did the six characters have a health problem?” and “What part of their body was causing their problem?” to lead students to the following key points about illness:

Students may not express the idea of usual or normal ranges of function. Give them the example of body temperature. A normal body temperature is considered 98.6°F, but the temperature of a healthy person may vary several tenths of a degree (for example, from 98.3 to 99.1) throughout the day. This person’s temperature would still be considered normal. A temperature of 101°F, however, would be considered abnormally high because it is outside the normal range.

Students will likely explain that an illness prevents a person from engaging in his or her usual activities, such as going to school or playing sports. Affirm this idea by saying, “Yes, an illness interferes with a person’s life.” This is a good time to emphasize the importance of considering the time course of an illness. In all six of the cases, the parents initially took a wait-and-see approach. They recognized that an illness would continue to disrupt their child’s life over the following days or weeks, while brief disruptions are not likely due to an illness. As students learned in Cases E and F, the length of time that symptoms are exhibited is a key factor in distinguishing sadness from depression.

Many students may think that all illnesses are caused by an infectious agent, such as a bacteria or a virus. Others may think that illness applies only to long-term and potentially fatal health problems. You can help students by pointing out that illness can refer to a broad range of health problems, from minor illnesses such as colds to a short-term health problem such as a broken leg to a long-term, more serious condition such as diabetes.

At the end of the discussion, make sure that the class has reached a consensus on what illness is. The definition should be something like the following:

An illness is a problem in which some part or parts of the body do not function normally in a way that interferes with a person’s life.

  1. Direct students’ attention to the cases again. Ask, “Are all of the cases examples of an illness?” Prompt students to use their definition of illness to justify their opinions.

Students likely will all agree that colds, strep throat, bronchitis, and asthma are illnesses. They should recognize that some part (or parts) of the body are not functioning normally and this is causing problems with the individual’s life. Students probably will have different opinions about whether sadness and depression are illnesses. For now, let students disagree about this idea. The next step asks students to think about this again.

  1. Ask students to sit with their team members from Activity 1 and refer to their completed copy of Master 2.1, Analyzing the Cases, for either Case E (sadness) or Case F (depression). Display a transparency of Master 2.7, Is It an Illness? Complete the table using input from the teams.

You may want to replay the animations or redistribute the medical charts for these cases, especially if it has been a few days since students completed that part of Activity 1.

Completing the table has several functions. First, students who analyzed Case E (sadness) will become familiar with the symptoms of depression. Second, comparing the two cases will help clarify their differences. Students should recognize that while sadness and depression have similar symptoms, depression has more symptoms and the symptoms last longer than for sadness. Third, this comparison should help students determine that depression should be classified as an illness and sadness should not. The completed table should look similar to the table following Step 5.

If students are not convinced that a part of the body is affected by sadness or depression, remind them of their experience in Lesson 1 and the conclusion that the brain controls how we feel, how we behave, and how we think. Feelings, behavior, and thinking are all affected by depression.

  1. Ask students to use their definition of illness and the completed master to decide whether depression and sadness are illnesses. After they have come to the consensus that depression is an illness, write the criteria for depression on the bottom of the transparency:

A diagnosis of depression is based on having five or more symptoms of depression nearly every day for more than two weeks.

Master 2.7, Is It an Illness?
Analysis Question Sadness (Case E) Depression (Case F)
What are the symptoms (effect on life)? Sad
Not interested in usual activities (e.g., volleyball)
Not hungry
Annoyed (irritable)
Sad
Not interested in usual activities (volleyball, music)
Not hungry
Not sleeping well
Unconfident
Spends most of time in room
Can’t get along with parents
What part of the body is affected? Brain Brain
How long did the symptoms last?

A few days to one week Six weeks
Are the symptoms outside the normal range? No—because it’s normal to be sad, not hungry, or not interested in usual things for short periods of time Yes—because this is not Jenna’s usual behavior

Students should decide that depression is an illness and that the symptoms of the patient in Case F fit the criteria for depression. If they are still confused about this, point out that in Case E, sadness affected the patient’s life for only a few days, whereas in Case F, depression caused changes in the character’s social activities, eating habits, sleeping patterns, and school performance for six weeks. The time course is actually a critical factor in the diagnosis of depression. See Section 1 Defining Mental Illness in Information about Mental Illness and the Brain for further details.

Note to teachers: Students may become concerned if they recognize symptoms of depression in themselves, a friend, or a family member. Emphasize that a diagnosis of depression can only be made by a qualified mental healthcare professional. Encourage them, however, to talk with the school counselor or their parents, or to ask their parents to schedule an appointment with their physician to discuss their concerns.

Activity 3: Observing the Depressed Brain

In this activity, students examine one way that scientists study what happens to the brain in depression. Emphasize to students that neuroscientists use imaging techniques such as PET in research studies that are conducted with adult volunteers. These techniques are not used clinically to diagnose depression or other mental illnesses, nor are they generally used with children, even in research settings. For more about the use of PET and other imaging techniques, see Section 5.2 Investigating Brain Function in Information about Mental Illness and the Brain. As necessary during this activity, remind students that PET and other imaging tests are used for scientific research and not for clinical diagnosis or treatment.

Web activity icon

For classes using the Web-based version of this activity:

  1. Ask students to recall how doctors diagnose depression.
National Science Education Standards icon
Content Standard A:
Different kinds of questions suggest different kinds of scientific investigations.

This step emphasizes that doctors diagnose depression (and other mental illnesses) by evaluating an individual’s symptoms. There is currently no physiological test for depression. Qualified mental health professionals can accurately diagnose depression based on a person’s symptoms. One of the goals of ongoing scientific research is to develop a clinical test for depression.

  1. Remind students that the brain is the part of the body affected in depression. Inform them that scientists don’t know what causes depression. Ask, “How could scientists study this?”

Scientists could find out more about what is happening in the brain of someone who has depression or another mental illness by doing imaging studies. Students should recall the PET images that they saw in Lesson 1.

  1. Tell students that they will examine PET images of the brains of one adult volunteer who has depression and one who does not. Ask students to predict what they will observe on the images and to explain their reasoning.

On the basis of previous activities in this lesson and the images they examined in Lesson 1, students should predict that the brain images will be different. Students should recall that the brain controls feelings, actions, and thoughts. Depression is an illness of feeling, so the brain of someone who is depressed will most likely be different from that of someone who does not have depression.

  1. Organize students into their teams and direct them to the computer stations. Instruct them to click on “Looking Inside the Brain.” Ask students to write three observations of the PET images they observe.

Alternatively, project the images from “Looking Inside the Brain” for the whole class to view together. The important aspect of these PET images is that they clearly show that the brains of people with depression are different from those of people who do not have depression. These differences are biological; that is, they are changes in the chemical workings of the brain.

The PET images here show different information from those in Lesson 1. Unlike the previous images, which showed differences in the activity levels in the brain, these PET images show changes in receptors in the brain. The scientists in this study used a radioactively labeled chemical that binds to a group of receptors for serotonin. In the brains of people without depression, the labeled chemical binds to the receptors, and this shows clearly as bright yellow in the PET images. Notice that the binding occurs in specific areas in the brain. In the brains of people with depression, the serotonin receptors don’t bind the chemical and the PET images reflect this.

  1. Reconvene the class and ask several teams to share their observations about the PET scans.

Students should have noticed that there are differences among the PET scans in the amount of different colors and in where individual colors are located. Specifically, the brain scan from a depressed person showed less binding activity than the brain scan from a person who is not depressed.

At this point in the activity, students may ask whether PET scans are used as a diagnostic test for depression. Scientists use neuroimaging techniques, such as PET, to study the activity and chemicals present in the brain and to understand how treatments for mental illness affect the brain. Doctors (physicians) do not use neuroimaging techniques as a test to diagnose mental illness or to assess the outcome of treatment. As the students learned in Activity 1, doctors diagnose depression and other mental illnesses by finding out what symptoms a person has. Specific symptoms are characteristic of each mental illness.

assessment icon
Assessment:
Step 6 is an opportunity for an informal assessment of what students have learned in this lesson. You can also determine whether they can apply their knowledge to a specific situation.
  1. Present the following situation to students: people who have strep, asthma, or diabetes usually go to the doctor for treatment, but many people who think they might have a mental illness don’t see a doctor. Ask students to decide whether people who might have a mental illness should go to the doctor. Tell them that their answer should include information from their definition of illness.

Students should respond that people who might have a mental illness should see a doctor to get help. Students should know at this stage that a mental illness, such as depression, is a problem with the way the brain is working and that it affects a person’s life in a negative way (as seen in the cases). You might wish to review with the class the definition of illness that they developed in Activity 2 in this lesson.

This situation portrays a very common event. People who think they might have a mental illness often avoid going to a doctor because they feel that they will be stigmatized or thought of as inferior to others.

print activity iconFor classes using the print-based version of this activity:

  1. Ask students to recall how doctors diagnose depression.

This step emphasizes that doctors diagnose depression (and other mental illnesses) by evaluating an individual’s symptoms. There is currently no physiological test for depression. Qualified mental health professionals can accurately diagnose depression based on a person’s symptoms. One of the goals of ongoing scientific research is to develop a clinical test for depression.

National Science Education Standards icon
Content Standard A:
Different kinds of questions suggest different kinds of scientific investigations.
  1. Remind students that the brain is the part of the body affected in depression. Inform them that scientists don’t know what causes depression. Ask, “How could scientists study this?”

Scientists could find out more about what is happening in the brain of someone who has depression or another mental illness by doing imaging studies. Students should recall the PET images that they saw in Lesson 1.

  1. Tell students that they will examine PET images of the brains of one adult volunteer who has depression and one who does not. Ask students to predict what they will observe on the images and to explain their reasoning.

On the basis of previous activities in this lesson and the images they examined in Lesson 1, students should predict that the brain images will be different. Students should recall that the brain controls feelings, actions, and thoughts. Depression is an illness of feeling, so the brain of someone who is depressed will most likely be different from that of someone who does not have depression.

  1. Ask students to work in their teams. Display a transparency made from Master 2.8, Looking Inside the Brain. Ask students to write three observations of the PET images they observe.

The important aspect of these PET images is that they clearly show differences between the brains of people with depression and those of people who do not have depression. These differences are biological; that is, they are changes in the chemical workings of the brain.

The PET images here show different information from those in Lesson 1. Unlike the previous images, which showed differences in the activity levels in the brain, these PET images show changes in receptors in the brain. The scientists in this study used a radioactively labeled chemical that binds to a group of receptors for serotonin. In the brains of people without depression, the labeled chemical binds to the receptors, and this shows clearly as bright yellow in the PET images. Notice that the binding occurs in specific areas in the brain. In the brains of people with depression, the serotonin receptors don’t bind the chemical and the PET images reflect this.

  1. Reconvene the class and ask several teams to share their observations about the PET scans.

Students should have noticed that there are differences among the PET scans in the amount of different colors and in where individual colors are located. Specifically, the brain scan from a depressed person showed less binding activity than the brain scan from a person who is not depressed.

At this point in the activity, students may ask whether PET scans are used as a diagnostic test for depression. Scientists use neuroimaging techniques, such as PET, to study the activity and chemicals present in the brain and to understand how treatments for mental illness affect the brain. Doctors (physicians) do not use neuroimaging techniques as a test to diagnose mental illness or to assess the outcome of treatment. As the students learned in Activity 1, doctors diagnose depression and other mental illnesses by finding out what symptoms a person has. Specific symptoms are characteristic of each mental illness.

assessment icon
Assessment:
Step 6 is an opportunity for an informal assessment of what students have learned in this lesson. You can also determine whether they can apply their knowledge to a specific situation.
  1. Present the following situation to students: people who have strep, asthma, or diabetes usually go to the doctor for treatment, but many people who think they might have a mental illness don’t see a doctor. Ask students to decide whether people who might have a mental illness should go to the doctor. Tell them that their answer should include information from their definition of illness.

Students should respond that people who might have a mental illness should see a doctor to get help. Students should know at this stage that a mental illness, such as depression, is a problem with the way the brain is working and that it affects a person’s life in a negative way (as seen in the cases). You might wish to review with the class the definition of illness that they developed in Activity 2 in this lesson.

This situation portrays a very common event. People who think they might have a mental illness often avoid going to a doctor because they feel that they will be stigmatized or thought of as inferior to others.

Lesson Wrap-Up

assessment icon
Assessment:
Students summarize the big ideas from this lesson.

Ask students to write a few sentences in their journals to summarize what they believe are the big ideas that are important to remember from this lesson. As with the previous summary students wrote, this information will help them when they do the Evaluate lesson (Lesson 6) at the end of this module.

Web activity icon Lesson 2 Organizer: Web Version
Activity 1: What’s the Health Problem?
What the Teacher Does Procedure Reference

Introduce activity by explaining to students that they will play the role of medical interns to learn about diagnosing patients.

Step 1

Organize the class into teams of two to three students and number the teams 1 through 8. Give each team 1 copy of Master 2.1, Analyzing the Cases.

master iconStep 2

Access the Web site for Lesson 2 and have students click on the link “The Cases.” After selecting their team number, they will view cases and complete Master 2.1. They can access additional information after Part 2 and during Part 3 by referring to the “Doctors’ Reference Manual.”

Web activity iconSteps 3–4

Ask teams to complete the appropriate columns related to one of their cases on transparencies made from Masters 2.4, 2.5, and 2.6, Comparing the Cases.

transparency iconStep 5

Display completed transparencies and hold a class discussion by asking the following questions:

  • What was the first symptom (or health complaint)?
  • What possible health problems did you list after Part 1?
  • After watching Part 2, did you rule out any of the possible problems? Why or why not?
  • Did you add any other possibilities? Why or why not?
  • After watching Part 3, what did you decide the health problem was?
  • How did you rule out the other possibilities?
  • What part of the body is directly affected by this problem?
  • How much time passed between Part 1, when symptoms were first noticed, and Part 3, when the doctor was ready to diagnose the problem?
Step 6

Make sure students understand that they based their diagnoses on the individual’s symptoms.

Step 7
Activity 2: Defining “Illness”
What the Teacher Does Procedure Reference

Ask students to recall their diagnoses of health problems in Activity 1. Challenge them to think of other words for “health problem.”

Step 1

After students suggest the word illness, ask them to use what they learned in Activity 1 to develop a definition for illness. Write their definition on a transparency. Compare their definition to the following one and make sure the three key ideas indicated are included:

An illness is a problem in which some part or parts of the body do not function normally in a way that interferes with a person’s life.

transparency iconStep 2

Remind students of the cases in Activity 1 and ask if all of the cases are examples of illness. Ask the students to use the definition of illness to justify their responses.

Step 3

Organize the class into the same teams as in Activity 1. Ask students to refer to their completed copy of Master 2.1, Analyzing the Cases, for either Case E or Case F. Display a transparency of Master 2.7, Is It an Illness?, and complete the table using input from the teams.

master iconStep 4

transparency icon

Ask students to use the definition of illness developed earlier to decide whether depression and sadness are illnesses. After reaching the consensus that depression is an illness, write the criteria for depression on the bottom of the transparency:

A diagnosis of depression is based on having five or more symptoms of depression nearly every day for more than two weeks.

Step 5
Activity 3: Observing the Depressed Brain
What the Teacher Does Procedure Reference

Ask students to remember again how doctors diagnose depression.

Step 1

Remind students that the brain is the part of the body affected in depression and that scientists don’t know what causes depression. Ask how scientists might investigate the causes of depression.

Step 2

Tell students that they will look at PET images of the brains of one person who has depression and one who does not. Ask students to predict what they will observe on the images.

Step 3

Reorganize students into their teams and direct them to the computers. After accessing the Web site for Lesson 2, instruct them to click on “Looking Inside the Brain.” Ask students to write three observations of the PET images.

Web activity iconStep 4

Reconvene the class and ask groups to share their observations of the PET images.

Step 5

Present the following situation to students: People who have strep, asthma, or diabetes usually go to the doctor for treatment, but many people who think they might have a mental illness don’t see a doctor. Ask students to decide whether people who might have a mental illness should go to the doctor. Instruct students to include information from the definition of illness in their answer.

Step 6
Lesson Wrap-Up
What the Teacher Does Procedure Reference

Ask students to summarize the main ideas of this lesson by writing a few sentences in their journal.

Wrap-Up
master icon= Involves copying a master.
Web activity icon= Involves using the Internet.
transparency icon= Involves making a transparency.

print activity iconLesson 2 Organizer: Print Version
Activity 1: What’s the Health Problem?
What the Teacher Does Procedure Reference

Introduce activity by explaining to students that they will play the role of medical interns to learn about diagnosing patients. They will review two medical cases.

master iconStep 1

Organize the class into teams of two to three students and number the teams 1 through 8. Give each team 1 copy of Master 2.1, Analyzing the Cases.

master iconStep 2

Write the team numbers and the first medical case letter on the board so each team knows which case it should analyze first. Point out where students will pick up their information. Make sure students understand that they will only analyze one part of the case at a time (Part 1, then Part 2, and then Part 3). As students review each part, they should complete the appropriate section on Master 2.1. Students can review relevant sections of Master 2.3, Doctors’ Reference Manual, as they complete Part 2 and Part 3.

Steps 3–4

Write the letters for the second case for each team on the board. Make Parts 1, 2, and 3 of the medical cases for each team’s second case available. Tell the teams to analyze the second case in the same way they did the first case and complete the table on Master 2.1.

transparency iconStep 5

Ask teams to complete the appropriate column related to one of their cases on transparencies made from Masters 2 .4, 2.5, and 2.6, Comparing the Cases.

Step 6

Display completed transparencies and hold a class discussion by asking the following questions:

  • What was the first symptom (or health complaint)?
  • What possible health problems did you list after Part 1?
  • After reading Part 2, did you rule out any of the possible problems? Why or why not?
  • Did you add any other possibilities? Why or why not?
  • After reading Part 3, what did you decide the health problem was?
  • How did you rule out the other possibilities?
  • What part of the body is directly affected by this problem?
  • How much time passed between Part 1, when symptoms were first noticed, and Part 3, when the doctor was ready to diagnose the problem?
Step 7

Make sure students understand that they based their diagnoses on the individual’s symptoms.

Step 8
Activity 2: Defining “Illness”
What the Teacher Does Procedure Reference

Ask students to recall their diagnoses of health problems in Activity 1. Challenge them to think of other words for “health problem.”

Step 1

After students suggest the word illness, ask them to use what they learned in Activity 1 to develop a definition for illness. Write their definition on a transparency. Compare their definition to the following one and make sure all the important ideas are included:

An illness is a problem in which some part or parts of the body do not function normally in a way that interferes with a person’s life.

master iconStep 2

Remind students of the cases in Activity 1 and ask if all of the cases are examples of illness. Ask the students to use the definition of illness to justify their responses.

Step 3

Organize the class into the same teams as in Activity 1. Ask students to refer to their completed copy of Master 2.1, Analyzing the Cases, for either Case E or Case F. Display a transparency of Master 2.7, Is It an Illness?, and complete the table using input from the teams.

Step 4

Ask students to use the definition of illness developed earlier to decide whether depression and sadness are illnesses. After reaching the consensus that depression is an illness, write the criteria for depression on the bottom of the transparency:

A diagnosis of depression is based on having five or more symptoms of depression nearly every day for more than two weeks.

Step 5
Activity 3: Observing the Depressed Brain
What the Teacher Does Procedure Reference

Ask students to remember again how doctors diagnose depression.

Step 1

Remind students that the brain is the part of the body affected in depression and that scientists don’t know what causes depression. Ask how scientists might investigate the causes of depression.

Step 2

Tell students that they will look at PET images of the brains of one person who has depression and one who does not. Ask students to predict what they will observe on the images.

Step 3

Reorganize students into their teams. Display a transparency of Master 2.8, Looking Inside the Brain. Ask students to write three observations of the PET images.

Step 4

Reconvene the class and ask groups to share their observations of the PET images.

Step 5

Present the following situation to students: People who have strep, asthma, or diabetes usually go to the doctor for treatment, but many people who think they might have a mental illness don’t see a doctor. Ask students to decide whether people who might have a mental illness should go to the doctor. Instruct students to include information from their definition of illness in their answer.

Step 6
Lesson Wrap-Up
What the Teacher Does Procedure Reference

Ask students to summarize the main ideas of this lesson by writing a few sentences in their journal.

Wrap-Up
master icon= Involves copying a master.
transparency icon= Involves making a transparency.

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