Mental Health and Mental Illness

1
Chapter 1

• Mental Health and Mental Illness

2
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.

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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
Mental Health

• Maslow identified
• A hierarchy of needs
• Self-actualization as fulfillment of
• ones highest potential

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Maslows 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 age-appropriate and congruent
  with local and cultural norms.

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Mental Health/Mental Illness

• Continuum-not static

Mental health
Mental illness
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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.

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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
13
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 individuals 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.)

• Selyes 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 individuals 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.)

• Peplaus 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 theyfeel 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

• Rationalization
• Reaction formation
• Regression
• Repression
• Sublimation
• Suppression
• Undoing

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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
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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)
• Denial
• Anger
• Bargaining
• Depression
• Acceptance

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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.

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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 individuals
• psychological, social, and
• occupational functioning on
  the GAF
• Scale

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Global Assessment of Function Scale- GAF

• http//depts.washington.edu/wimirt/GAF20Index.htm
  
• http//dpa.state.ky.us/library/manuals/mental/Ch22
  .html