Concepts of Mental Health and Illness PDF

3 CONCEPTS OF MENTAL HEALTH & ILLNESS HORACE WILLIAMS MSc, CERT. PSYCHIATRY (Courtesy of Videbeck, 2017) At the end of interactive session, students should be able to: ❑Define psychiatric–mental health nursing as cited by American Nurses Association (2000); Videbeck, (2017); Shives, (...

3 CONCEPTS OF MENTAL HEALTH & ILLNESS HORACE WILLIAMS MSc, CERT. PSYCHIATRY (Courtesy of Videbeck, 2017) At the end of interactive session, students should be able to: ❑Define psychiatric–mental health nursing as cited by American Nurses Association (2000); Videbeck, (2017); Shives, (2012); Townsend, (2018); Fortinash, (2004) ❑Outline factors that influence the development of mental health as cited by Shives (2012); Wilner, (2008); Townsend (2018). ❑Explain the characteristics of mental health as proffered by Maslow (1970); Shives (2012) ❑Describe factors affecting mental health maintenance as stated by Powell (1995); Freud (1946); Townsend (2018); Shives (2012); Evans (1997) ❑Discuss the concept of mental illness according to Shives (2012); Altrocchi (1980); APA (2013); Sharokh and Hayes (2003); National Institute of Mental Health (2004). MENTAL HEALTH Definitions PSYCHIATRIC–MENTAL HEALTH NURSING ❑involves the diagnosis and treatment of human responses to actual or potential mental health problems (Manifestation / signs & symptoms). ❑It is a specialized area of nursing practice that uses theories of human behavior as its scientific framework and requires the purposeful use of self as its art of expression. ❑It is concerned with promoting optimum health for society (Videbeck, 2017; Shives, 2012, 2019). ❑Comprehensive services focus on prevention of mental illness, health maintenance, management of and referral for mental and physical health problems, diagnosis and treatment of mental disorders, and rehabilitation. ❑Psychiatric–mental health nursing is holistic and considers the needs and strengths of the individual, family, group, and community (American Nurses Association [ANA], 2000). MENTAL HEALTH ❑Although there is no universal definition of mental health, people in the helping professions seem to agree that mental health is a positive state in which one is responsible, displays self-awareness, is self-directive, is reasonably worry free, and can cope with usual daily tensions. ❑Such individuals function well in society, are accepted within a group, and are generally satisfied with their lives. ❑Other definitions refer to the ability to solve problems; fulfill one’s capacity for love and work; cope with crises without assistance beyond the support of family or friends; and maintain a state of well-being by enjoying life, setting goals and realistic limits, and becoming independent, interdependent, or dependent as the need arises without PERMANENTLY LOSING ONE’S INDEPENDENCE. (Videbeck, 2017; Shives, 2012; Townsend, 2018; Fortinash, 2004)  Factors Influencing Mental Health Three factors influence the development of mental health: ❑genetic characteristics ❑nurturing during childhood ❑life circumstances (Shives, 2012) GENE CHARACTERISTICS ❑mental health is, in part, based upon the absence of complex genetic risk factors and neurologic deficits that underlie psychiatric disorders. (Wilner, 2008). ❑Genetics is the scientific study of the transmitted or inherited genes and variations or defects in organisms. ❑For example, genetic defects resulting in innate differences in sensitivity and temperament that prompt various responses to the environment may predispose a person to cognitive disability, schizophrenia, or bipolar disorder (Shives, 2012) NURTURING DURING CHILDHOOD ❑Nurturing during childhood refers to the interaction between the family and child, which also affects the development of mental health. ❑Positive nurturing begins with bonding at childbirth and includes development of the feelings of love, security, and acceptance. ❑The child experiences positive interactions with parents and siblings. ❑Negative nurturing includes circumstances such as maternal deprivation, parental rejection, sibling rivalry, and early communication failures (eg. expletives, Johncrow, worthless, tar baby) ❑Individuals who are exposed to poor nurturing may develop poor self-esteem or poor communication skills. ❑They may also display socially unacceptable behavior as they seek to meet their basic needs (Shives, 2012; Townsend, 2018) LIFE CIRCUMSTANCES ❑Life circumstances can influence one’s mental health from birth. ❑Individuals who experience positive circumstances are generally emotionally secure and successful in school and can establish healthy interpersonal relationships. ❑Negative circumstances such as poverty, poor physical health, unemployment, abuse, neglect, and unresolved childhood loss generally precipitate feelings of hopelessness, helplessness, or worthlessness. ❑These negative responses place a person at risk for depression, substance abuse, or other mental health disorders. (Townsend, 2018) Characteristics of Mental Health ❑Maslow (1970), identified (needs motivation) a “hierarchy of needs” to describe an individual’s motivation to experience self-actualization, or mental health. ❑To achieve self-actualization, a person must progress through five levels ❑Also, an individual may reverse progression through these levels depending on various circumstances. ❑According to Maslow, mentally healthy people who achieve self-actualization can have positive self- concepts and relate well to people and their environment; form close relationships with others; make decisions pertaining to reality rather than fantasy; (Shives, 2012) ❑be optimistic and appreciate and enjoy life; be independent or autonomous in thought and action, relying on personal standards of behavior and values; and be creative, using a variety of approaches as they perform tasks or solve problems. ❑In addition, self-actualized individuals display behavior that is consistent as they appreciate and respect the rights of others. ❑They also display a willingness to listen and learn from others and show reverence for the uniqueness of and difference in others (Shives, 2012).  SELF-ACTUALIZATION NEEDS Need to be self-fulfilled, learn, create, understand, and experience one's potential SELF-ESTEEM Need to be well thought of by oneself as well as by others LOVE Need for affection, feelings of belongingness, and meaningful relations with others SECURITY AND SAFETY Need for shelter and freedom from harm and danger PHYSIOLOGIC Need for oxygen, food, water, rest, and elimination. The need for sex is unnecessary for individual survival, but it is necessary for the survival of humankind Hierarchy of needs/Needs motivation  Factors Affecting Mental Health Maintenance ❑Factors that influence the ability to achieve and maintain mental health include engaging in (1) interpersonal communication and resorting to the use (2) of ego defense mechanisms. ❑The presence of (3) significant others, or (4) support people, also plays a role in maintaining mental health. INTERPERSONAL COMMUNICATION ❑Any relationship is only as good as the intent of the interaction that occurs during interpersonal communications between two or more individuals. ❑Powell (1995) discusses five levels of communication that affect an individual’s personal growth and maturity during interpersonal encounters: (5) cliché conversation; (4) reporting facts; (3)revealing ideas and judgments; (2) spontaneous, here-and-now emotions; and (1) open, honest communication. ❑The levels range from 5 to 1, with level 5 indicating superficial communication in which no emotions are shared. ❑Level 1 reflects open communication in which two individuals share their emotions. Levels of communication ❑Level 5: Cliché Conversation - No sharing of oneself occurs during this interaction. Statements such as “How are you doing?” and “Talk to you later” are superficial. ❑No personal growth can occur at this level. ❑Level 4: Reporting of Facts - Communicating at this level reveals very little about oneself and minimal or no interaction is expected from others. ❑No personal interaction occurs at this level. ❑Level 3: Revelation of Ideas and Judgments – Such communication occurs under strict censorship by the speaker, who is watching the listener’s response for an indication of acceptance or approval. ❑If the speaker is unable to read the reactions of the listener, the speaker may revert to safer topics rather than face disapproval or rejection ❑Level 2: Spontaneous, Here-and-Now Emotions - Revealing one’s feelings or emotions takes courage because one faces the possibility of rejection by the listener. ❑Powell (1995) states that if one reveals the contents of the mind and heart, one may fear that such emotional honesty will not be tolerated by another. ❑As a result, the speaker may resort to dishonesty and superficial conversation. ❑Level 1: Open, Honest Communication - When this type of communication occurs, two people share emotions. ❑Open communication may not occur until people relate to each other over a period, getting to know and trust each other. What Is a Coping Mechanism? A coping mechanism is a technique individuals use to manage stress, anxiety, or negative emotions. Different coping mechanisms, such as problem-solving, exercise, relaxation techniques, self-care, and social support, can be healthy and constructive. Other types of coping skills, like substance abuse, avoidance, and self-harm, are unhealthy and destructive. Unfortunately, developing maladaptive coping mechanisms can exacerbate mental health conditions and worsen symptoms. Because of this, developing positive stress management practices is essential for maintaining overall well-being. Defense Mechanisms Vs. Coping Mechanisms Defense mechanisms can also help people deal with stress, anxiety, and other uncomfortable emotions. However, these are unconscious techniques and often distort or deny reality. Defense mechanisms may provide temporary relief but can be detrimental in the long run. Examples of defense mechanisms include repression, denial, projection, and rationalization. Coping mechanisms are conscious and intentional strategies individuals use to manage stress or navigate challenging situations. Unlike defense mechanisms, these skills are more proactive and involve actively seeking effective ways to deal with stressors. Coping mechanisms aim to alleviate distress and improve overall well-being. Adaptive Vs. Maladaptive Coping Mechanisms There are two types of coping mechanisms–adaptive (healthy) and maladaptive (unhealthy). Coping with stress can be challenging because worry and overwhelm can cloud judgment and rationality. In these cases, adopting maladaptive coping patterns can be easier than facing a problem head-on. However, utilizing adaptive strategies is the best path forward. Adaptive Coping Mechanisms Adaptive coping mechanisms are positive, supportive, and life-enhancing stress management tools. These actions bring joy and comfort to your life while reducing stressful emotions, leaving you feeling more balanced and at ease. Those with adaptive coping mechanisms tend to have positive outlooks, and dealing with challenges head-on builds self-confidence and self-esteem. Instead of avoiding their problems, they acknowledge the presenting issues and move forward with a solution in mind. These individuals can experience stress-related growth, meaning their stressors help improve emotional regulation and mitigate negative self-talk.1  Adaptive coping mechanisms examples include: Practicing yoga Seeking support Using relaxation techniques Problem-solving Using humor Physical activities Being creative Maladaptive Coping Mechanisms Maladaptive coping mechanisms are harmful and can worsen stress and difficult emotions. These techniques are counterproductive because, while they may appear helpful, individuals often experience more problems than benefits. Individuals with histories of anxiety, depression, and other mental health concerns may lean toward these coping styles because their symptoms can cloud thinking, feeling, and decision- making. They may lack emotional self-regulation skills central to healthy coping and understanding how to manage problems in life.2 Examples of maladaptive coping mechanisms include: Substance use Gambling Impulsivity Self-harm Emotional numbing Withdrawing from others Rationalizing bad behavior Escaping or distracting from the problem Overindulging (i.e., overeating, overspending, etc.) Types of Coping Mechanisms Coping mechanisms are strategies and behaviors that individuals use to manage and adapt to stress, adversity, or challenging situations. Individuals often employ a combination of strategies based on the nature of the stressor, their personality, and available resources. Finding effective coping mechanisms can help individuals reduce stress, enhance resilience, and improve overall well-being.  Emotion-based coping Social coping involves seeking strategies reduce reactive emotions to assistance and support from others to a stressor rather than the stressor itself. manage stress and adversity. This These skills help individuals manage coping mechanism can take various their feelings and responses before forms, like talking to a trusted friend or tackling the problem. E.g. writing family member, participating in a support group, or seeking professional help Problem-based coping strategies involve directly facing, addressing, and reducing an issue. Avoidance coping is a behavioral Individuals can feel empowered by mechanism aimed at avoiding or these tools because they take a suppressing sources of stress rather problem and apply solutions. They gain than addressing them. Avoidance a sense of control, productivity, and coping can take many forms, including self-confidence. E.g., doing Research denial, substance abuse, procrastination, or distraction EGO DEFENSE MECHANISMS ❑Ego defense mechanisms, also referred to as mental defense mechanisms, are considered protective barriers used to manage instinct (protect your ego)and affect in stressful situations (Freud, 1946). ❑They may be used to resolve a mental conflict, to reduce anxiety or fear, to protect one’s self-esteem, or to protect one’s sense of security. ❑Depending upon their use, they can be therapeutic or pathologic, because all defense mechanisms include a distortion of reality, some degree of self - deception, and what appears to be irrational behavior. ❑ They become maladaptive when they are used by an individual to such a degree that there is interference with the ability to deal with reality, with effective interpersonal relations, or with occupational performance. ❑Such mechanisms are supposedly in action by 10 years of age (Shives, 2012; Townsend, 2018) ❑Compensation is the covering up of a real or perceived weakness by emphasizing a trait one considers more desirable. Example: ❑A handicapped boy who is unable to participate in sports compensates by becoming a great scholar. ❑ A young man who is the shortest among members of his peer group views this as a deficiency and compensates by being overly aggressive and daring. (Townsend, 2018) ❑Denial is the refusal to acknowledge the existence of a real situation, or the feelings associated with it. Example: ❑woman has been told by family doctor that she has a lump in her breast - An appointment is made for her with a surgeon; however, she does not keep the appointment and goes about her activities of daily living with no evidence of concern. ❑Individuals continue to smoke cigarettes even though they have been told of the health risk involved. ❑Displacement is the transferring of feelings from one target to another that is considered less threatening or neutral. Example: ❑A man who is passed over for promotion on his job says nothing to his boss but later belittles his son for not making the basketball team. ❑A boy who is teased and hit by the class bully on the playground comes home after school and kicks his dog. ❑Identification is an attempt to increase self-worth by acquiring certain attributes and characteristics of an individual one admires. Example: ❑A teenage girl emulates the mannerisms and style of dress of a popular female rock star. ❑The young son of a famous civil rights worker adopts his father’s attitudes and behaviors with the intent of pursuing similar aspirations. ❑Intellectualization is an attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis. Example: ❑A man whose brother is in a cardiac intensive care unit following a severe myocardial infarction (MI) spends his allotted visiting time in discussion with the nurse, analyzing test results and making a reasonable determination about the pathophysiology that may have occurred to induce the MI. ❑A young psychology professor receives a letter from his fiancée breaking off their engagement - He shows no emotion when discussing this with his best friend - Instead, he analyzes his fiancée’s behavior and tries to reason why the relationship failed. ❑Introjection is the internalization of the beliefs and values of another individual such that they symbolically become a part of the self to the extent that the feeling of separateness or distinctness is lost. Example: ❑A small child develops her conscience by internalizing what the parents believe is right and wrong - The parents literally become a part of the child. The child says to a friend while playing, “Don’t hit people. It’s not nice!” ❑A psychiatric client claims to be the Son of God, drapes himself in sheet and blanket, “performs miracles” on other clients, and refuses to respond unless addressed as Jesus Christ. ❑Isolation is the separation of a thought or a memory from the feeling tone or emotions associated with it (sometimes called emotional isolation). Example: ❑A young woman describes being attacked and raped by a street gang - She displays an apathetic expression and no emotional tone. ❑A physician can isolate her feelings about the eventual death of a terminally ill cancer client by focusing her attention instead on the chemotherapy that will be given. ❑Projection is the attribution of feelings or impulses unacceptable to oneself to another person -The individual “passes the blame” for these undesirable feelings or impulses to another, thereby providing relief from the anxiety associated with them. Example: ❑A young soldier who has an extreme fear of participating in military combat tells his sergeant that the others in his unit are “a bunch of cowards.”  A businessperson who values punctuality is late for a meeting and states, “Sorry I’m late - My assistant forgot to remind me of the time - It’s so hard to find good help these days.” ❑Rationalization is the attempt to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors. Example: ❑A young woman is turned down for a secretarial job after a poor performance on a typing test – She claims, “I’m sure I could have done a better job on a word processor - Hardly anyone uses an electric typewriter anymore!” ❑A young man is unable to afford the sports car he wants so desperately - He tells the salesperson, “I’d buy this car, but I’ll be getting married soon - This is really not the car for a family man.” ❑Reaction formation is the prevention of unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors. Example: ❑The young soldier who has an extreme fear of participating in military combat volunteers for dangerous front-line duty. ❑A secretary is sexually attracted to her boss and feels an intense dislike toward his wife - she treats her boss with detachment and aloofness while performing her secretarial duties and is overly courteous, polite, and flattering to his wife when she comes to the office. ❑Regression is the retreating to an earlier level of development and the comfort measures associated with that level of functioning. Example: ❑When his mother brings his new baby sister home from the hospital, 4-year-old Tommy, who had been toilet trained for more than a year, begins to wet his pants, cry to be held, and suck his thumb. ❑A person who is depressed may withdraw to his or her room, curl up in a fetal position on the bed, and sleep for long periods of time. ❑Repression is the involuntary blocking of unpleasant feelings and experiences from one’s awareness. Example: ❑A woman cannot remember being sexually assaulted when she was 15 years old. ❑A teenage boy cannot remember driving the car that was involved in an accident in which his best friend was killed. ❑Sublimation is the rechanneling of drives or impulses that are personally or socially unacceptable (e.g., aggressiveness, anger, sexual drives) into activities that are more tolerable and constructive. Example: ❑A teenage boy with strong competitive and aggressive drives becomes the star football player on his high school team. ❑A young unmarried woman with a strong desire for marriage and a family achieves satisfaction and success in establishing and operating a daycare center for preschool children. ❑Suppression is the voluntarily blocking of unpleasant feelings and experiences from one’s awareness. Example ❑Scarlett O’Hara says, “I’ll think about that tomorrow.” (like putting something off) ❑A young woman who is depressed about a pending divorce proceeding tells the nurse, “I just don’t want to talk about the divorce - There’s nothing I can do about it anyway.” ❑Undoing is the act of symbolically negating or canceling out a previous action or experience that one finds intolerable. Examples ❑A man spills some salt on the table, then sprinkles some over his left shoulder to “prevent bad luck.” ❑A man who is anxious about giving a presentation at work yells at his wife during breakfast. He stops on his way home from work that evening to buy her a dozen red roses. SIGNIFICANT OTHERS OR SUPPORT PEOPLE ❑Although mental health can be maintained by engaging in positive interpersonal communication and using ego defense mechanisms, people may also reach out to individuals or groups for support during periods of increased stress or anxiety. ❑Such individuals or groups are referred to as significant others or support people. ❑For instance, labor and delivery is generally considered to be a normal healthy biologic process; however, many women desire the presence or encouragement of a support person, one who assists the woman in coping with the stress and anxiety that may occur during the labor and delivery process as well as during the postpartum recovery period. ❑Sullivan, an eminent psychiatrist, states that “PEOPLE MISTAKENLY BELIEVE THAT THEY CAN SOLVE THEIR OWN PROBLEMS AND MAINTAIN CONTROL OF THEIR LIVES WITHOUT ASSISTANCE FROM ANYONE OR ANYTHING” ❑Sullivan believed that those who “ATTEMPT TO SOLVE PROBLEMS BY THEMSELVES MAY BECOME CONSUMED BY THEIR PROBLEMS AND SUFFER SOME TYPE OF MENTAL DISORDER OR ILLNESS.” (Evans, 1997). ❑Mental health, in part, is determined by RELATIONSHIPS BETWEEN THOSE WHO EITHER LOVE OR REFUSE TO LOVE ONE ANOTHER. ❑Support people or significant others can be anyone with whom the person feels COMFORTABLE and whom the person TRUSTS AND RESPECTS (Shives, 2012) MENTAL ILLNESS Definition ❑Like Diabetes, Cerebral Palsy or most illnesses, mental illness is NO ONE’S FAULT. ❑It can be caused by chemical imbalances in the brain, by transfer of drugs across the placental barrier, or by organic changes within the brain. ❑Additionally, if a person is unsuccessful in dealing with environmental stresses because of faulty inherited characteristics, poor nurturing during childhood, or negative life circumstances, mental illness may develop. ❑The American Psychiatric Association defines mental illness or mental disorder as an illness or syndrome with psychological or behavioral manifestations and/or impairment in functioning as a result of a social, psychological, genetic, physical/chemical, or biologic disturbance. ❑The disorder is not limited to relations between the person and society. ❑The illness is characterized by symptoms and/or impairment in functioning (Shahrokh & Hales, 2003). ❑Other definitions refer to mental illness as a disorder causing people to display abnormal behavior MORE CONSISTENTLY than most people; a psychopathology exhibiting FREQUENT IRRESPONSIBILITY, the INABILITY TO COPE, frequently being at odds WITH SOCIETY, and an INACCURATE PERCEPTION OF REALITY; and the absolute absence or constant presence of a specific behavior that has a socially acceptable range of occurrences (Shives, 2012, Townsend, 2019) STIGMA AND PERCEPTIONS ABOUT MENTAL ILLNESS ❑Stigma, by definition, is A MARK OF DISGRACE OR SHAME. It has four components: 1. LABELING someone with a condition (Madman) 2. STEREOTYPING people who have that condition (anyone who behaves that way is a madman 3. CREATING A DIVISION BETWEEN A SUPERIOR “us” group and a devalued “them” group 4. DISCRIMINATING against someone based on their LABEL (Shives, 2012) ❑Unfortunately, mental illnesses have very complex causes that some individuals do not understand. ❑Negative comments about or portrayals of individuals with mental illnesses fuel fear and mistrust, reinforcing distorted perceptions. ❑The consequences of stigma can be devastating and, in some cases, worse than the illness itself. ❑Examples of some of the harmful effects of stigma include refusal to seek treatment, rejection by family and friends, subjection to physical violence or harassment, and inadequate health insurance coverage for mental illness (Shives, 2012). ❑Several perceptions about abnormal behavior and mental illness that could result in stigma have been identified  They are summarized, they are as follows: ❑Abnormal behavior is different or odd, and easily recognized. ❑We are all irrational at times and behave in an unusual or different manner. ❑Such behavior may occur in a variety of environments and still may go unnoticed by others. ❑Abnormal behavior can be predicted and evaluated. ❑Newspaper articles and television newscasts prove otherwise (Altrocchi, 1980). ❑Family members have verbalized complete surprise when confronted with acts of abuse or violence committed by loved ones, often describing the suspect as nice, quiet, friendly, or pleasant ❑Internal forces are responsible for abnormal behavior. ❑Although internal forces may cause abnormal behavior, other factors (eg, people, culture, and environment) can influence one’s behavior. ❑People who exhibit abnormal behavior are dangerous and violent. ❑This perception is often inflamed by media accounts of crime in which someone is vaguely referred to as mentally ill. (Altrocchi, 1980). ❑Statistics, however, don’t bear out a connection between mental illnesses and violence. ❑According to statistics provided by the National Institute of Mental Health (2004), more than 40 million Americans have a psychiatric diagnosis at any given time. ❑Approximately 60% to 65% of those individuals who are hospitalized for psychiatric treatment are discharged and live with their families. Maladaptive behavior is always inherited. ❑Heredity plays a part in the development of some types of abnormal behavior; however, learning also influences behavior. ❑Children learn early in life how to satisfy their needs. ❑They, as well as adults, may observe specific behaviors used by others to meet their needs. ❑As a result, they may imitate behavior that they believe to be acceptable to others. ❑Mental illness is incurable. ❑Much progress has occurred in the diagnosis and treatment of mental illness. ❑Early detection and treatment may alleviate symptoms and allow the person to function normally in society (Shives, 2012). ❑People with chronic mental disorders may receive maintenance doses of medication, attend various therapies, or care for themselves with minimal supervision. ❑As a result of de-institutionalization and the implementation of managed care, clients are empowered to function as independently as possible. ❑Community resources are used to provide education for the client and family. Ongoing supervision and support are available to minimize recidivism (Shives, 2012). REFERENCES