Mental Health and Mental Illness

1
Chapter 1

• Mental Health and Mental Illness
• What is Mental Health?
• What is Mental Illness?
• Who defines Mental Illness?

2
Introduction

• The concepts of mental health and mental illness
  are culturally defined.
• For example Homosexuality
• Family members are usually first to identify
  deviation from normal
• Families often try to deny and/or normalize
  deviations

3
Mental Illness and Culture

• Horwitz describes cultural influences that affect
  how individuals view mental illness. These
  include
• Incomprehensibility - the inability of the
  general population to understand the motivation
  behind the behavior
• Cultural relativity - the normality
• of behavior determined by
• the culture

4
Cultural Aspects of Mental Illness

• Lower socioeconomic classes have the highest
  amount of symptoms of mental illness but tolerate
  symptoms more
• More educated people recognize mental illness and
  seek treatment sooner
• Women are more likely to seek treatment than men

5
Mental Health

• Defined by the textbook author as The successful
  adaptation to stressors from the internal or
  external environment, evidenced by thoughts,
  feelings, and behaviors that are age-appropriate
  and congruent with local and cultural norms.

6
People with Good Mental Health

• Can take lifes disappointments in stride
• Are not overcome by their emotions, their fears,
  anger, jealousy, guilt or worries
• Accept their shortcomings
• Have self-respect
• Feel able to deal with most situations that come
  their way
• Are able to give love and consider the interests
  of others
• Welcome new experiences and new ideas
• Have personal relationships that are satisfying
  and lasting

7
Maslow

• Maslow identified a hierarchy of needs
• Physiological needs have to be met before higher
  level needs
• Mental Health is defined by Maslow as
  self-actualization. This person has
• An appropriate perception of reality
• The ability to be spontaneous
• The capacity for problem solving
• The ability to achieve satisfactory relationships
• Creativity
• The ability to accept oneself, others, and human
  nature

8
APA

• The American Psychiatric Association defines
  mental health as Simultaneous success at
  working, loving, and creating with the capacity
  for mature and flexible resolution of conflicts
  between instincts, conscience, important other
  people and reality.

9
Mental Illness

• Defined by the author as Maladaptive responses
  to stressors from the internal or external
  environment, evidenced by thoughts, feelings, and
  behaviors that are incongruent with the local and
  cultural norms and interfere with the
  individuals social, occupational, or physical
  functioning.

10
PHYSICAL AND PSYCHOLOGIAL RESPONSES TO STRESS
11
Physical Responses

• Hans Selye defined stress as the state
  manifested by a specific syndrome which consists
  of all the nonspecifically induced changes within
  a biologic system.
• Fight-or-flight syndrome

12
Physical Responses

• The Fight-or-Flight Syndrome
• Initial stress response-biological effects occur
  when the sympathetic nervous system is
  stimulated
• Norepinephrine and epinephrine are released
• Pupils dilate
• Bronchioles dilate and resp
• Heart rate, BP and cardiac output

13
Physical Responses

• Selye developed the General Adaptation Syndrome
  to describe the general reaction of the body to
  stress
• 3 Stages
• 1. Alarm reaction stage physiological responses
  of fight-or-flight begin-pupils dilate, BP , CO
• 2. Stage of resistance person uses responses of
  stage 1 to cope with stress
• 3. Stage of exhaustion when prolonged exposure
  to the stressor occur. The person is depleted
  and prone to diseases of adaptation. Without
  intervention, exhaustion and death can occur

14
Physical Responses

• Sustained physical responses to stress promote
  susceptibility to diseases of adaptation
• Headaches
• CAD
• Colitis
• Mental disorders
• Ulcers

15
The Sustained Response

• Prolonged stress stimulates the pituitary to
  release hormones
• ACTH causes decreased immune and inflammatory
  responses
• Vasopressin increases fluid retention, and
  constricts blood vessels, thus BP
• Growth hormone causes serum glucose
• Thyroid hormones the basal metabolic rate
• Gonadotropins cause _ sex hormones and libido
  and impotence

16
Psychological Responses

• Anxiety and grief have been described as two
  major, primary psychological response patterns to
  stress.
• A variety of thoughts, feelings, and behaviors
  are associated with each of these response
  patterns.
• Adaptation is determined by the extent to which
  the thoughts, feelings, and behaviors interfere
  with an individuals functioning.

17
Psychological Responses

• Anxiety
• A diffuse apprehension that is vague in nature
  and is associated with feelings of uncertainty
  and helplessness
• Extremely common in our society
• Mild anxiety is adaptive and can provide
  motivation for survival

18
Psychological Responses

• Hildegard Peplau-nursing educator and theorist
• Peplaus four levels of anxiety
• 1. MILD - seldom a problem
• Associated with the tensions of daily living
• Sharpens the senses
• Increases motivation
• Enhances learning
• Perceptual field is increased

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PEPLAU

• 2. MODERATE ANXIETY
• Perceptual field decreases
• Attention span decreases
• Concentration decreases
• Muscular tension increases
• Restlessness is present
• Problem solving ability decreases

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Peplau

• 3. SEVERE ANXIETY
• Perceptual field severely diminished
• Difficulty completing simple tasks
• Concentration centers on one detail only or many
  extraneous details
• Physical symptoms may occur headaches,
  palpitations or insomnia
• Emotional symptoms may occur confusion, dread or
  horror
• All behavior directed at relieving the anxiety

21
Peplau

• 4. PANIC
• The most intense state of anxiety
• Inability to focus at all
• Loss of contact with reality may occur
• Delusions or hallucinations may be present
• Desperate behavior or extreme withdrawal may
  occur
• Communication usually ineffective
• Person fears they are going crazy or losing
  control

22
Psychological Responses

• Behavioral adaptation responses to anxiety
• At the mild level, individuals employ various
  coping mechanisms to deal with stress. A few of
  these include eating, drinking, sleeping,
  physical exercise, smoking, crying, daydreaming,
  nailbiting, laughing, and talking to
• persons with whom theyfeel comfortable.

23
Psychological Responses

• At the mild to moderate level, the ego calls on
  defense mechanisms for protection, such as
• Compensation
• Denial
• Displacement
• Identification
• Intellectualization
• Introjection
• Isolation
• Projection

• Rationalization
• Reaction formation
• Regression
• Repression
• Sublimation
• Suppression
• Undoing

24
Denial

• Is not a river in Egypt
• Is refusal to acknowledge the existence of a real
  situation or the feelings associated with it

• A man drinks alcohol every day after work to the
  point he is intoxicated, but fails to acknowledge
  that he has a problem.

25
Projection

• Attributing feelings or impulses unacceptable to
  the self onto another person

• Example A student feels very attracted to her
  chemistry professor. She says,
• Hes coming on to me.

26
Displacement

• Transferring feelings from one target to another
  that is considered less threatening

• A woman who is harassed by her boss at work
  starts an argument with her husband and kids

27
Rationalization

• Attempting to make excuses to justify
  unacceptable feelings or behavior

• A client smokes 2 packs of cigarettes per day and
  says that many people smoke to cope with stress
  and live long and healthy lives

28
Repression

• Involuntarily blocking unpleasant experiences
  from awareness.

• An incest victim cannot remember details of the
  sexual abuse

29
Suppression

• Voluntarily blocking unpleasant thoughts and
  feelings from awareness

• A student says I dont want to think about that
  test tomorrow. I want to go to the movies
  tonight.

30
Psychological Responses

• Anxiety at the moderate to severe level that
  remains unresolved over an extended period can
  contribute to a number of physiological
  disorders--for example, migraine headaches,
  irritable bowel syndrome, and cardiac
  arrhythmias.
• Extended periods of repressed severe anxiety can
  result in psychoneurotic patterns of
  behaving--for example, anxiety disorders and
  somatoform disorders.

31
Psychological Responses

• Extended periods of functioning at the panic
  level of anxiety may result in psychotic
  behavior for example, schizophrenic,
  schizoaffective, and delusional disorders.

32
Psychological Responses

• Grief a major response to stress of loss
• The subjective state of emotional, physical, and
  social responses to the loss of a valued entity
  the loss may be real, as in death, hurricane
  damage or perceived, as in loss of femininity
  post mastectomy
• Elisabeth Kübler-Ross
• (5 Stages of Grief)
• Denial-No-it cant be true
• Anger-Why me?
• Bargaining-If God will help me,
• I promise
• Depression-intense sadness
• Acceptance-feeling of peace

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Psychological Responses

• Anticipatory grief - The experiencing of the
  grief process before the actual loss occurs.
• Resolution - Length of the grief process is
  entirely individual. It can last from a few weeks
  to years. It is influenced by a number of factors.

34
Psychological Responses

• The experience of guilt for having had a
  love-hate or conflictual relationship with the
  lost entity. Guilt often lengthens the grieving
  process.
• Anticipatory grieving is thought to shorten the
  grief response when the loss actually occurs.
• The length of the grief response is often
  extended when an individual has experienced a
  number of recent losses and when he or she is
  unable to complete one grieving process before
  another one begins.

35
Psychological Responses (cont.)

• Resolution of the grief response is thought to
  occur when an individual can look back on the
  relationship with the lost entity and accept both
  the pleasures and the disappointments of the
  association.

36
Psychological Responses (cont.)

• Maladaptive grief responses
• Prolonged response-when intense preoccupation
  with grief continues for years
• Delayed/inhibited response-person is fixated in
  denial and does not face pain of loss but
  develops anxiety disorders instead
• Distorted response-person is fixated in the
  anger stage of grief, turns anger inward and is
  in despair and unable to function normally

37
DSM-IV-TR Multiaxial Evaluation System

• Axis I - Clinical disorders and other conditions
• that may be a focus of clinical
  attention
• Axis II - Personality disorders and mental
• retardation
• Axis III - General medical conditions
• Axis IV - Psychosocial and environmental
• problems
• Axis V - The measurement of an individuals
• psychological, social, and
• occupational functioning on
  the GAF
• Scale