The Social Worker's Role in Major Mental Illness

by Joan E. Shapiro LCSW BCD Wednesday, June 29, 2011

Maze of Mental Illness


After receiving a diagnosis of schizophrenia, bipolar disorder, or a personality disorder, one can become overwhelmed with the seemingly disastrous news. Fear and anxiety may creep in and take over, but it is important to gain knowledge and learn how best to cope with the news. By learning about these disorders, one can come to terms with the diagnosis and move toward seeking appropriate treatment. 

Schizophrenia, bipolar disorder (previously known as Manic-Depressive Illness), and the personality disorders are all treatable conditions. While they each have distinct characteristics, they can also have overlapping symptoms, making proper diagnosis challenging. 

Schizophrenia and bipolar disorder are two major mental illnesses. Schizophrenia is primarily a thinking disorder. Bipolar disorder is primarily a modd disorder. Both conditions can cause the person to lose touch with reality. 

Personality disorders refer to enduring patterns of being, which are maladaptive, and interfere with an individual's attainment of contentment, stability, safety, and integration into society. A personality disorder often supports symptoms that trouble the individual such as anxiety, depression, eating disorders, and substance abuse. 

The most talked about personality disorder is borderline personality disorder, distinguished as the personality disorder that may require specialized treatment for its behavioral aspects. One one personality disorder, antisocial personality disorder, is not considered to be treatable with medication or psychotherapy techniques currently available. 


Schizophrenia commonly starts in late adolescence. The young person with an emerging schizophrenia may suffer from unrealistic, compelling ideas (called "delusions"), perceptual disturbances such as hearing voices, social withdrawal, and difficulty putting thoughts together. 

Early intervention with psychotropic medications is always indicated in stabilizing the individual before symptoms become flagrant and disruptive to the person's life. Sometimes hospitalization is needed to accomplish this goal. Psychotherapy and group therapy centers are important adjuncts of the treatment for this illness in many cases. 

Social workers play an important role in providing psycho-education for patients and families, and making appropriate referrals for services specially designed for helping people with this illness. Clinical social workers directly deliver psychotherapy for the conditions of mental illnesses. People with schizophrenia often lack the consistency of judgment to cope alone in the world, can show deterioration over time, and may need lifelong help in sustaining themselves in the world.

Bipolar Disorder

Bipolar disorder is expressed in people who have episodes of serious depression (characterized by symptoms such as lack of appetite, withdrawal, pessimism, lack of energy and disinterest in normal activities), coupled with episodes of mania or elation (characterized by such symptoms as sleeplessness, high energy, distractibility, irritability and excessiveness of sexuality, spending, talking, and self-importance. 

As with schizophrenia, medication is essential to stabilize mood. In the case of bipolar disorder, psychotherapy is also essential for the person's overall understanding of, and coping with, their condition over their lifetime. Sometimes people resist believing they have a mental problem. Disbelief can lead to repeated involuntary hospitalizations for the safety of the person and others. Therapists who are social workers can be especially well equipped to look for and be sensitive to cultural attitudes which may impede the acquiring of appropriate mental health services.

Personality Disorders 

Personality disorders provide fertile soil for the maintenance of uncomfortable and sometimes behavioral symptoms. While medications may temporarily help with symptoms that are supported by the particular disorder (depression, anxiety, insomnia), the ultimate help comes with the psychotherapy that treats the underlying personality disorder. 

Psychotherapy for personality disorders often requires a commitment to meeting with an experienced therapist frequently and regularly over a long period of time to obtain a significant result. Those people whose condition includes seriously self-destructive behaviors do best with DBT (Dialectical Behavioral Therapy), a therapy which specifically focuses on curtailing these behaviors. As with major mental illnesses, hospitalization can be required at times. 

After Diagnosis

Post-diagnosis can be a confusing time and with a clinical social worker specializing in mental health issues can clarify the path to begin the process of obtaining help. An expert can help wade through the numerous types and modalities of therapies offered and find the best treatment available. 

Joan E. Shapiro LCSWJoan E. Shapiro LCSW, BCD is a Lecturer in Social Work for the North Shore University Hospital's Department of Psychiatry. She is in full time private practice on Long Island, N.Y. Ms. Shapiro earned her MSW from Smith College School for Social Work in Northampton, MA and attended the Institute for Psychoanalytic Training and Research in New York City. Ms. Shapiro has trained at New York Hospital Westchester Division, Bronx Municipal Hospital Center, and The Clifford Beers Guidance Clinic in New Haven. She was a staff social worker at North Shore University Hospital Department of Psychiatry's Out Patient Department for twenty five years.

*Photo Credit - Williamsburg Hedge Maze

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Social Work | Therapeutic Relationship


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