1. Present the students with the situation that someone they know is sick. What should the person do?

Most students will respond that the person should see a doctor. If students don’t make this connection quickly, provide more detail about the scenario by saying the person has been coughing for about a week, has a sore throat, and has developed a mild fever. (This should help distinguish the person’s problem from a cold, which wouldn’t require a visit to the doctor.)

2. Ask students to state why individuals go to the doctor. What do they want the doctor to do for them?

Students should respond that people want the doctor to make them feel better.

3. Prompt students to recall the definition for illness that they developed during Lesson 2 (see Activity 2, Step 2). Ask them to relate the factors in the definition to what they want the doctor to do for the individual.

The definition of illness includes three important parts that students should remember:

• Illness affects a specific part or parts of the body.
• Illness causes that part of the body to function outside normal ranges.
• Illness interferes with a person’s life.

What someone really wants the doctor to do is help the affected body part to function in a normal way so that his or her life is not affected negatively.

4. Ask whether anyone in the class remembers how mental illness affects the functioning of the brain as they discussed in Lesson 1.

Students learned in Lesson 1 that the brain controls feelings, thoughts, and behaviors. Mental illness changes a person’s feelings, thoughts, and behaviors in a long-term manner.

5. Ask students, “What does someone who has a mental illness want a doctor to do to help them?”

Using the information that they have learned about mental illness and illness (using the previous questions as prompts), students should respond that the individual wants the doctor to help the symptoms get better. This would enable the person to get his or her emotions, thoughts, and behaviors back to normal.

6. Have students consider the following questions about someone who is getting treatment for mental illness:

• How would a doctor or psychiatrist who is treating the patient decide whether the treatment is working and the person is getting better?

On the basis of what they have learned in previous lessons, students should answer that the doctor or mental health professional will want to know whether a person’s symptoms have improved and if the person is again doing the things he or she usually does. Relieving the symptoms would enable the person to go to work or school and participate more effectively in family or social events.

• How would a scientist who is investigating the cause of a mental illness decide whether the treatment works?

Students might propose that scientists could take PET images of people who received treatment for their mental illness to determine whether the treatment changed what happened in the brain. Such answers reinforce the idea that scientists are really trying to figure out what happens in the brain. This is different from doctors who treat mental illness; physicians decide how well treatment has worked by determining whether a person’s symptoms and level of functioning have improved.

7. Confirm for students that PET imaging is a way for scientists to learn more about whether treatment for mental illnesses works. Ask students what images the scientists would want to have for their analysis.

Students should recognize that scientists would want to compare the PET image from before someone begins treatment with one that is taken during or shortly after treatment. Students might correctly suggest taking several images over the time course of treatment. Having images taken over a period of time could be useful for scientists, but the most essential images are the before- and after-treatment images.

Emphasize again to students that PET imaging is used by scientists in their research investigations and not by physicians for diagnosing patients. Similarly, scientists use PET images to study the effects of treatment on the brain, but physicians evaluate treatment based on relief of the symptoms—the changes in thinking, feeling, and behavior—caused by the mental illness.

Note to teachers: Two versions of Step 8 follow. Choose the appropriate version depending on whether you will use a color transparency or the online version of the brain images. Continue the activity with Step 9.

For classes using the print-based version of Step 8:

8. Give each student a copy of Master 4.1, Do People with Depression Get Better? Ask for volunteers to read parts of the text. At the appropriate time in the reading, display a transparency of Master 4.2, The Brain’s Response to Treatment, on the overhead projector.

You will probably need to help students with words such as psychotherapy and psychotherapist. The reading explains how physicians usually treat depression. The PET images on Master 4.2 show dramatic changes in brain activity after treatment for depression. The changes in brain function after treatment enable scientists to determine whether the treatments that relieve the symptoms of a mental illness also make brain function return to normal.

As with the other PET images in the module, these PET images provide visual evidence that reinforces the biological nature of mental illnesses.

9. Ask students to summarize the treatments that helped Andrew in the scenario.

Students should respond that Andrew took medicine and got psychotherapy to relieve his symptoms.

10. Ask students to consider how other mental illnesses might be treated. Inform them that they will now analyze other cases to find out whether treatments for other diseases are similar or different. Divide students into teams of three. Each team will analyze either ADHD or schizophrenia. Give each student in half of the teams one copy of Master 4.3, Do People with ADHD Get Better? Give each student in the remaining teams one copy of Master 4.4, Do People with Schizophrenia Get Better?

Refer to your record of which student teams read about each disease in Lesson 3—or ask students to remind you. In this lesson, students can read about the mental illness that they did not read about in Lesson 3. Having them read about the other mental illness will broaden their understanding about mental illnesses.

11. Conclude the activity with a class discussion that summarizes issues about the treatment of mental illnesses. Guide the discussion with questions such as

• Are certain aspects of treatment similar for all of the mental illnesses discussed in the readings?

Students should recognize from the reading that the treatment plan for each of the mental illnesses discussed normally and optimally includes both medications and psychotherapy.

• Do medications or psychotherapy just fix the symptoms, or do they actually cure the illness?

This question isn’t addressed directly in the reading material, but the distinction between treatment and cure is an important one for students to think about. At present, doctors can only treat the symptoms of mental illnesses without necessarily curing them. Treatment allows individuals to enjoy normal aspects of life such as social events, family relationships, work, and school. If students have difficulty with this idea, ask them what they know about how a doctor treats strep throat. After taking antibiotics, will strep throat come back (resulting from the same infection and not another infection)? If the antibiotics are taken appropriately, the person will be cured. Ask students to compare that to a disease such as diabetes or asthma for which a person must take medication regularly. What happens if the person stops taking medication? If people with diabetes stop taking their medications, their symptoms return and their health is negatively (and potentially seriously) affected. The medication does not cure the disease. Depending on which mental illness a person has, he or she may need to stay on medication for much of his or her life. For other mental illnesses such as depression or ADHD, a person may only need to take medication for a while and can then stop after the symptoms go away. In these cases, a person may need to go back on medication or return to psychotherapy if the illness recurs.

The PET images might lead some students to suggest that the mental illness has been cured. However, this is another opportunity to have students think about the relationship between symptoms (effects on a person’s thoughts, feelings, and behaviors) and brain activity as seen in a PET image. Would they expect a person who is not experiencing symptoms to have brain activity that matches a person who is experiencing symptoms?

• What would happen if a person who has a mental illness stopped taking medication and stopped psychotherapy?

If students now understand that mental illnesses can usually only be treated and not necessarily cured, they should propose that the person’s symptoms might return. This is true of some mental illnesses. Some individuals will have only one episode of a mental illness, but in others, the symptoms reappear. Treating a mental illness decreases the chance that it will reoccur.

Students might raise questions about the length of time that a person needs to continue treatment. This varies depending on the individual’s mental illness and its severity. For some cases of depression, for example, a person may need treatment for a few months. On the other hand, a person who has schizophrenia may need to take medication for the rest of his or her life. The length of time recommended for psychotherapy treatment also varies. In general, the more severe the case of mental illness, the longer the period of psychotherapy.

• What do you think would happen if a person does not get help for his or her mental illness?

An untreated mental illness interferes with a person’s thoughts, feelings, and behaviors. People who have symptoms will not function as well as they could. This decreased level of functioning could result in difficulties at school or work, or in problems in their relationships with family and friends. The way that people feel affects not only how much they enjoy the activities that they do but also whether they participate in them at all.

Consider using an analogy to help students understand the idea of consequences. How many people would not seek medical help for a badly broken arm? What are the consequences of not having the broken arm fixed? The arm would probably heal, but it would probably not heal properly. This, in turn, might affect the person’s ability to move the arm. The person will have difficulty participating in many aspects of a usual life (for example, playing sports, driving a car, or using a computer). This will affect the kinds of jobs and hobbies the person can have, which may affect the friendships the person may have otherwise developed. The consequences of failing to treat the problem go far beyond the initial broken bone.

The major point here is that students recognize that not treating a mental illness often has negative consequences for all aspects of a person’s life. Although this idea is important to remember for all individuals who have a mental illness, perhaps it is most critical for young people, who are developing numerous academic, emotional, and social skills at this time in their lives. If they experience a delay in their development of important life skills, they may have difficulties reaching their full potential.

Lesson Wrap-Up

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. Having this information will help students when they do the Evaluate lesson (Lesson 6) at the end of this module.