Chapter
1
Mental Health and Mental Illness
Mental Health and Mental Illness
•
What is Mental Health?
Introduction
•
The concepts of mental health and mental illness are
culturally defined.
•
What is acceptable behavior depends upon cultural
norms.
•
Give some examples from your own culture.
•
People respond to stress with physical and
psychological symptoms.
Classification of
Mental Illnesses
•
The Diagnostic and Statistical Manual of Mental
Disorders, 4th Edition, Text Revision (DSM-IV-TR).
•
Diagnostic criteria are listed for each of the
psychiatric disorders.
•
A multiaxial system- people are evaluated from
multiple aspects points of function.
Mental
Health
Maslow identified:
•
A “hierarchy of needs”
•
Self-actualization as fulfillment of
one’s highest potential
Maslow’s Hierarchy
Mental
Health (cont.)
•
Defined 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.”
Mental
Health/Mental Illness
Aspects
of mental health
•
Emotional Intelligence-
Emotions are skills for living.
Important to recognize our emotions-know
ourselves.
Have emotional self control.
Recognize emotions in others.
Handle relationships.
Aspects
of Mental Health
•
Resiliency- emerge and grow from
negative life events.
Aspects of Mental Health
•
Spirituality
that part of us that deals with
relationships, values, and addresses questions of purpose and meaning in life.
Mental
Illness
Mental
Illness
•
Defined 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 individual’s
social, occupational, or physical functioning.”
Mental
Illness (cont.)
•
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
PHYSICAL
AND PSYCHOLOGIAL
RESPONSES TO STRESS
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
Physical
Responses (cont.)
•
Selye’s General Adaptation Syndrome
–
Alarm reaction stage- the physiological
responses of fight or flight.
– Stage of resistance-attempting to adapt to the
stressor.
– Stage of exhaustion-adaptive energy is gone,
can no longer draw from resources, may become physically or psychologically
ill.
Physical
Responses to Stress
Physical
Responses (cont.)
•
The Fight-or-Flight Syndrome
– Initial stress response
– Sustained stress response
Physical
Responses
•
Sustained physical responses to
stress promote susceptibility to diseases of adaptation
Physical and Psychological Responses to Stress
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
individual’s functioning.
Psychological Responses (cont.)
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
Psychological Responses (cont.)
• Peplau’s four levels of anxiety
– Mild - seldom a problem
– Moderate - perceptual
field diminishes
– Severe - perceptual
field is so diminished that concentration centers on one detail only or on many
extraneous details
– Panic - the most
intense state
Psychological Responses (cont.)
• 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, laughing, and talking to
persons with whom
they
feel comfortable.
Psychological Responses (cont.)
•
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
Psychological Responses (cont.)
•
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, phobias, panic disorders, somatoform disorders and dissociative
disorders. (DSM-IV-TR)
Psychological Responses (cont.)
•
Extended periods of functioning at
the panic level of anxiety may result in psychotic behavior; for example,
schizophrenic, schizoaffective, and delusional disorders.
•
Person is not able to process what is
happening.
•
May lose touch with reality.
•
A flight from reality into a less
stressful world.
Anxiety
Psychological Responses (cont.)
Grief
•
The subjective state of emotional,
physical, and social responses to the loss of a valued entity; the loss may be real or perceived. CHANGE
•
Elisabeth Kübler-Ross
•
(5 Stages of Grief)
– Denial
– Anger
– Bargaining
– Depression
– Acceptance
Psychological Responses (cont.)
•
Anticipatory
grief - The experiencing of the grief process before the
actual loss occurs.
•
How does change relate to grief?
•
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.
Psychological Responses (cont.)
•
The experience of guilt for having
had a “love-hate” 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. May result in
disengaging from the loved one. Rejection/abandonment issues
•
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.
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.
Psychological Responses (cont.)
• Maladaptive grief responses
•
Prolonged response-intense preoccupation with
the memory of the loved one. Can be many years later. Anger, Denial. Difficulty
functioning, intense pain.
•
Delayed/inhibited response- fixed in denial
stage/ the emotional pain is not experienced.
•
Distorted response- fixed at anger stage.
Interferes with normal functioning. Depression
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 individual’s
psychological, social, and
occupational functioning on the GAF
Scale
Global Assessment of Function Scale- GAF