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Chapter 1

Mental Health and Mental Illness What is Mental Health? What is Mental Illness? Who defines Mental Illness?. Chapter 1. Introduction. The concepts of mental health and mental illness are culturally defined. For example: Homosexuality

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Chapter 1

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  1. Mental Health and Mental Illness What is Mental Health? What is Mental Illness? Who defines Mental Illness? Chapter 1

  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 life’s 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 individual’s social, occupational, or physical functioning.”


  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 individual’s 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 • Peplau’s 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

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

  20. 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. 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

  24. 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. Denial

  25. Attributing feelings or impulses unacceptable to the self onto another person Example: A student feels very attracted to her chemistry professor. She says, “He’s coming on to me.” Projection

  26. 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 Displacement

  27. 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 Rationalization

  28. Involuntarily blocking unpleasant experiences from awareness. An incest victim cannot remember details of the sexual abuse Repression

  29. Voluntarily blocking unpleasant thoughts and feelings from awareness A student says “I don’t want to think about that test tomorrow. I want to go to the movies tonight.” Suppression

  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 can’t be true” • Anger-”Why me?” • Bargaining-’If God will help me, I promise…” • Depression-intense sadness • Acceptance-feeling of peace

  33. 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 individual’s psychological, social, and occupational functioning on the GAF Scale

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