Chapter 1 Mental Health And Mental Illness

Chapter 1 Mental Health and Mental Illness

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Mental Health and Mental Illness • What is Mental Health?

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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. 5/17/2005

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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. 5/17/2005

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Mental Health

Maslow identified: • A “hierarchy of needs” • Self-actualization as fulfillment of one’s highest potential

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Maslow’s

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Hierarchy

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Mental Health (cont.)

• Defined as “The successful adaptation to

stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are ageappropriate and congruent with local and cultural norms.”

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Mental Health/Mental Illness • Continuum-not static

Mental health

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Mental illness

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Aspects of mental health • Emotional IntelligenceEmotions are skills for living. Important to recognize our emotions-know ourselves. Have emotional self control. Recognize emotions in others. Handle relationships.

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Aspects of Mental Health • Resiliency- emerge

and grow from negative life events.

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Aspects of Mental Health

• Spirituality that part of us that deals with relationships, values, and addresses questions of purpose and meaning in life.

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Mental Illness

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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.”

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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

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PHYSICAL AND PSYCHOLOGIAL RESPONSES TO STRESS

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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

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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.

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Physical Responses to Stress

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Physical Responses (cont.) • The Fight-or-Flight Syndrome – Initial stress response – Sustained stress response

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Physical Responses • Sustained physical responses to stress promote susceptibility to diseases of adaptation

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Physical and Psychological Responses to Stress

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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.

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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

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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

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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.

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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

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– – – – – – –

Rationalization Reaction formation Regression Repression Sublimation Suppression Undoing 26

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)

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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.

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Anxiety A feeling of tension, distress, and discomfort produced by a perceived or threatened loss of inner control rather than from external danger. DEFENSE MECHANISMS Alleviate anxiety by denying, misinterpreting or distorting reality. Mostly unconscious 5/17/2005

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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) – – – – – 5/17/2005

Denial Anger Bargaining Depression Acceptance 30

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. 5/17/2005

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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.

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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.

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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

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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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Global Assessment of Function Scale- GAF • http://depts.washington.edu/wimirt/GAF% 20Index.htm

• http://dpa.state.ky.us/library/manuals/me ntal/Ch22.html

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