Mental Health: Core Concepts & Historical Overview

Core Concepts of Mental Health and Mental Illness

• Anxiety
• Grief

Cultural Basis

• Mental health and illness are rooted in a given society's cultural beliefs
• Cultures vary in their tolerance for behaviors that deviate from the norm.
• The history of psychiatric care reveals shocking truths about the treatment of the mentally ill.

Historical Overview of Psychiatric Care

• Primitive beliefs attribute mental disturbances to soul possession or the influence of evil spirits/supernatural powers
• Ritualistic exorcism was performed to purge unwanted forces from the body.
• Brutal beatings and starvation were inflicted or ritualistic purification and retribution demanded for breaking taboos or sinning.
• Mental illness was correlated to demonology or witchcraft, leading to some individuals being burned at the stake.
• Around 400 B.C., Hippocrates began moving away from supernatural beliefs.
• Hippocrates associated insanity and mental illness with irregularities in the interaction of the four body fluids: blood, black bile, yellow bile, and phlegm.
• He called these body fluids humors and linked each to a specific disposition.
• Mental illness was thought to be caused by disequilibrium among these humors, which were treated by inducing vomiting and diarrhea using strong cathartic drugs.
• During the Middle Ages (A.D. 500-1500) in Europe mental illness continued to be associated with witchcraft, leading to people being sent out to sea for their lost rationality; this derived the expression "ship of fools."
• In Middle Eastern Islamic countries during the same period, attitudes shifted; mental illness was no longer viewed as witchcraft but as an actual illness.
• This led to establishing mental illness units within hospitals and residential institutions, becoming the first asylums.
• Colonial Americans reflected European attitudes and punished individuals for behaviors attributed to witchcraft, particularly in New England.
• In the 16th and 17th centuries in the United States, care for the mentally ill became a family responsibility due to there being a lack of institutions
• Those without family became the community's responsibility and were incarcerated in places where they could not harm themselves or others.
• The first American hospital to admit mentally ill clients was established in Philadelphia in the mid-18th century.
• Benjamin Rush, considered the father of American psychiatry, introduced humane treatment and care to the hospital.
• Despite kindness, exercise, and socialization, Rush also employed harsh methods like bloodletting, purging, restraints, and extremes of temperatures.

19TH CENTURY

• Dorothea Dix establishment of state asylums.
• Dix stated that hospitals should offer humanistic therapeutic care.
• Psychiatric nursing emerged in 1873 with Linda Richards (first american psychiatric nursing) establish psychiatric hospitals and the first school of psychiatric nursing at McLean Asylum in 1882.
• Nursing curricula emphasized the nurse-patient relationship and therapeutic communication.

Post World War II

• National Mental Health Act of 1946 which provided funds for the education of psychiatrists, psychologists, social workers, and psychiatric nurses.
• Antipsychotic medications were introduced

Mental Health

• Theorists have tried defining mental health, emphasizing individual motivation in self-actualization.
• Maslow (1970) highlighted a "hierarchy of needs", where lower levels are fulfilled before higher ones; self-actualization is reaching one's highest potential.

Self-Actualization

• Maslow described this as being psychologically healthy, fully human, highly evolved, and fully mature
• Characteristics include:
  • Appropriate perception of reality
  • Acceptance of oneself, others, and human nature
  • Ability to manifest spontaneity
• Jahoda (1958) listed six indicators reflecting mental health:
  • A positive attitude toward self which includes self-knowledge and acceptance, along with a strong sense of personal identity and security within the environment.
  • Growth, development, and ability to achieve self-actualization; this correlated to successfully completing each level of development and gaining motivation to reach his or her highest potential
  • Integration which focuses on balance among life processes, adaptability, environment response, and developing a life philosophy to minimize anxiety to deal with stressful situations
  • Autonomy refers to the individual's ability to perform independently and make choices, accepting responsibility for the outcomes.
  • Perception of reality includes accurate environment perception, empathy, social sensitivity and caring for the wants and needs of others.
  • Environmental mastery suggests the individual's satisfaction within group/society/environment, the ability to love/accept love, strategize, make changes in life adapting to life's circumstances, and has achieved satisfaction.
• Black and Andreasen (2011) defined mental health as a relative state.
• Robinson (1983) defined mental health as a dynamic state.

Mental Illness

• Horwitz (2002) identifies two elements: incomprehensibility and cultural relativity.
• Incomprehensibility refers to the general population's inability to understand the motivation behind a behavior.
• Cultural relativity includes the rules, conventions, and understandings that are conceived within someone's culture
• The American Psychiatric Association (APA, 2013) defines mental disorder as a syndrome.
• Mental illness is seen as maladaptive responses to stressors from the internal or external environment, shown by thoughts, feelings, and behaviors that clash with local/cultural norms and negatively affects social, occupational, and/or physical functioning.