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.

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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.

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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 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

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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
– Rationalization
– Denial
– Displacement – Reaction formation
– Identification – Regression
– Intellectualization – Repression
– Introjection – Sublimation
– Isolation
– Suppression
– Projection
– 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 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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