NOTES ON PSYCHIATRIC AND MENTAL HEALTH

PSYCHIATRIC NURSING
 It is the process whereby the nurse assists mentally ill persons, as individuals or in groups, in developing a more
positive self-concept, a more harmonious pattern of interpersonal relationships, and a more productive role in
society.
 The care of the mentally ill is no longer exclusively rendered in hospitals, but rather is being focused more and more
in community-based situations.
MENTAL HEALTH
 A state of well being in which a person is able to cope with the normal stresses of daily life and his ability
to realize his potentials. (WHO Definition)
 Margaret Mead, world famous anthropologist, has written that mental health is actually determined by a set of ratios
involving the emotional, social and psychological strengths with which an individual is fortified; the events which he
has experienced throughout life; the pressures which he has experienced throughout life; the pressures which he
is currently undergoing, and the expectations which society has established for him.
 The individual’s level of self-acceptance and the way he perceives reality are usually mentioned as two other
capacities significant in the development of mental maturity.
 Has been defined as “that state in the interrelationship of the individual and his environment in which personality
structure is relatively stable, and the environmental stresses are within its absorptive capacity.” (cited by Sia 2010,
Marmor, 1950)
CHARACTERISTICS OF A MENTALLY HEALTHY PERSON (cited by Sia 2010, Taylor 1990)
 Self-acceptance – Accepts his strengths and limitations realistically, works to maximize strengths and minimize
limitations.
 Perceives reality accurately
 Exhibits environmental mastery – Capacity to feel in control of self and environment
 Self-determination or autonomy – Engages in independent thinking and action.
 Achieves a unifying, integrated outlook in life – Confident and sure of his role and direction in life.
MENTAL HEALTH INDICATORS (JAHODA):
 Positive attitude toward self
 Autonomy
 Perception of reality
 Integration
 Growth, development and ability to achieve self-
actualization
 Environmental mastery
MENTAL ILLNESS
 It is thought to be a unique response involving an individual’s personality as it interacts with his
environment at a time when he is particularly vulnerable to disease.
 A state of imbalance characterized by a disturbance in person’s thoughts, feelings and behavior.
 Poverty and abuses are major factors which increases the risk of mental illness in the home.
FACTORS THAT MAY CONTRIBUTE TO MENTAL ILLNESS
1. Genetic Factors – the individual inherits the family milieu into which he is born and the cultural
forces with which he will be required to deal.
2. Organic Factors –this factor suggest that personality plays an important role in behavioral
response even when brain tissue is involved. Traumatic brain damage is one of the common
organic problems to which the human organism reacts with abnormal mental symptoms.
3. Psychogenic factors –are involved with the individual’s subjective and emotional feelings about
himself. These include feelings of self-esteem, security, well-being, personal value, guilt and
inferiority.
4. Causative factors related to age – There are some periods in life when the individual is more
vulnerable emotionally than others.
The following are the critical periods:
a) Adolescence – the adolescent’s desperate need to belong to his age group causes him
to be influenced greatly by the social standards of his peers.
b) Involutional period of women – this critical period during the late forties for women and
during the late fifties for men. In this period, declining activity of the reproductive function,
which many men and women consider to distinguish them as being manly or womanly.
c) Old age ( after the age of 60) – This is an extremely critical period in the lives of many
individuals because of the feelings of insecurity brought on by the changes in life style
caused by retirement, the threat of financial dependency resulting from the loss of income,
and the fear of the loss of physical competence.
5. Interpersonal factors – refer to the relationships that individual develops with significant factors.
6. Cultural factors – the culture into which one is born superimposes upon the individual many values
and ideas with which he must cope for the remainder of his life.
7. Childhood Experiences
PSYCHIATRIC NURSING
 Interpersonal process whereby the professional nurse practitioner through the therapeutic use of
self, assist an individual, family, group or community to promote mental health, to prevent mental
illness and suffering, to participate in treatment and rehabilitation of the mentally ill and if necessary
to find meaning in these experiences.
 It is both a Science and an Art
o Science
 The use of different theories in the practice of nursing, these serves as the science of
psychiatric nursing
o Art
 The therapeutic use of self is considered as the art of psychiatric nursing
 The core of psychiatric nursing is:
o The interpersonal process, that is human to human relationship.
 Clientele of psychiatric nursing:
o Individual, family, community, both mentally ill and healthy person.
MENTAL HYGIENE
 It is the science that deals with measures to promote mental health, prevent mental illness and
suffering and facilitate rehabilitation.
DEFINITION OF PERSONALITY
 Personality – includes the individual’s biological and intellectual endowment, the attributes that
had been acquired through experience, and his conscious and unconscious reactions and feelings.
FREUDS PSYCHOANALYTIC MODEL (1856 – 1939)
It was Freud who first proposed that childhood experiences are crucial in the development of personality
and that personality is primarily shaped during childhood. Freud also believed that at each stages of
personality development, the libidinal energy is focused at certain areas of the body. The person derives
pleasure and expresses needs through the area of the body where the libidinal energy is concentrated.
 Levels of consciousness (Freud)
 Conscious – part of the mind that is aware of the here and now as it relates to the individual
and his environment. It only functions when the individual is awake. It is concerned with
thoughts, feelings and sensations.
 Preconscious and subconscious – is that part of the mind in which ideas and reactions are
stored and partially forgotten – it is not economical for human beings to burden the conscious
mind with a multitude of facts that are infrequently used and currently not in demand.
 Unconscious – largest part of the mind and is sometimes compared to the large hidden part
of an iceberg that floats under the water. It is the storehouse for all the memories, feelings
and responses experienced by the individual during his entire life.
Freud did not exactly invent the idea of the conscious and subconscious. But it was him who made them
famous and he added another part of the mind, which is the unconscious.
 Structure of Personality (Freud)
 Id
 Is part of and derived from the unconscious. It is unlearned, primitive, selfish and the source
of all psychic energy. It contains the instinctual drives, included in which we are the drive for
self-preservation, the drive to reproduce and the drive for group association.
 When the new individual is born he is said to be a bundle of id, seeking only to satisfy his
needs and to find release for psychological tensions
 It operates on the basis of pleasure principles, that is to say, the id presses for avoidance
of pain at all cost and seeks to maintain pleasure.
 Primary process according to Freud is the translation of need to drive. When a hungry
person wishes for food or fantasizes food, that person is engaging in primary process
thinking.
 Ego
 It promotes the individual’s satisfactory adjustment in relation to his environment. Its main
function is to effect an acceptable compromise between the crude pleasure – seeking
strivings of the id and the inhibitions of the superego.
 The means through which ego achieve this goal is reality testing, meaning the ego deals
with the demands of reality as it strives to control and derive satisfaction from the
environment. This states that, “take care of a need as soon as an appropriate object is found.”
 Secondary process is the problem solving mechanism of the ego. The ego controls the
demands of and mediates between the id and superego according to the demands of the
reality.
 Superego
 The last to develop. Its development is partially a result of the socialization process that the
child undergoes. The superego incorporates the taboos, prohibitions and ideals and
standards of parents and the other significant adults with whom the child associates. It refers
to the blindly rigid, strict moralistic part of the mind, which can be as relenting and ruthless
as the id.
 It operates mostly on the unconscious levels and at this level is an inhibitor of the
Id. At the conscious levels it may be regarded as the voice of the conscience or
the phase of personality that is keenly sensitive to the demands of strict
convention.
 Ego ideal- one aspect of the superego which directs behavior to simulate that of
the individuals the person admires and wishes to emulate.

It is important to note that the rewarding and punishing of the superego

is based on the internalized standards of right and wrong and not reality.

Life and death Instincts

  According to Freud there are two instincts;
1. Life Instincts
 These instincts perpetuate :
 The life of the individual by motivating him or her to seek food and water.
 The life of the species, by motivating him or her to have sex.
 These life instinct is also referred to as LIBIDO meaning “I desire.”
2. Death Instincts
 Every person has an unconscious wish to die.
 Death provides escape from all these pain and struggle. The day-to-day evidence
of the death instinct is in our desire for peace, for escape from stimulation, our
attraction to alcohol and narcotics, our penchant for escapist activity, etc. (cited by
Sia, 2008: Boerce, 1997).
 We direct death in a way of aggression, cruelty, murder and destructiveness.
ANXIETY
 A person experiences anxiety when his very person is threatened. The ego has to constantly create
a balance between the forces of reality, id and superego. When those forces make conflicting
demands, the ego could get into trouble and the person feels threatened.
 Freud said that the goal of therapy is simply, “ to make the unconscious conscious.”
 Some major points:
 Relaxed Atmosphere – providing a relaxed couch, dim lights, quiet, sound proof walls and the
reassurance that everything he says is confidential.
 Free Association – allowing the client to talk about anything.
 Resistance – exhibited by complete blank, falls asleep, comes in late, or skips an appointment
altogether.
 Dream analysis – in sleep we are somewhat resistance to our unconscious and we will allow
a few things, in symbolic form, to come to our awareness.
 Parapraxes – Slip of the tongue. Often referred to as Freudian Slip.
 Transference – occurs when the client projects feeling towards the therapist.
 Catharsis – sudden and dramatic outpouring of emotion that occurs when the trauma is
resurrected.
 Insight – being aware of the source of the emotion, of the original traumatic event.

DEVELOPMENT OF THE PERSONALITY

 Freud’s Psychosexual Stages
o Authored by Sigmund Freud
o Theorized that the development of personality was intimately involved with the maturation
of the libidinal drives as they focused first upon the self and the later upon other appropriate
persons in the environment.
o Primary narcissism – a process wherein the infant directs his libidinal drives towards him
or referred also as self-love.
Age FREUD Points To Remember
Infancy Oral  The child’s whole being is focused upon the mouth and its function.
(1-1 1/2
 The total being of the infant is focused upon fulfilling the demands of the
years old) id, which insist on relief from hunger, cold or tension.
 Tensions are relieved by breastfeeding, nursing a bottle, or sucking a
thumb.
 The lips, mouth, tongue and skin are the areas of an infant’s body from
which he receives pleasures.
 Development of the “good me” and the “bad me”
o Good me – see himself as a worthwhile individual
o Bad me – begins to see self as not worthwhile.
 Trust and security develops
 Orally aggressive: Signs include chewing gum or ends of pens.
  Orally Passive: Signs include smoking, eating, kissing, fellatio,
cunnilingus
 Fixation at this stage may result in passivity, gullibility, immaturity and
manipulative personality
Toddler Anal  Also known as habit – training period
(11/2 and 3  Period when the mothering person insists that the infant achieve
years) sphincter control and begin to communicate through the use of
language.
 The child freely gratifies his love of self with the pleasurable sensations
involved in evacuating the bladder and bowels naturally and without
restriction.
 Although the mouth remains as an important zone of pleasure, the infant
derives much pleasure from the anus and the urethra during these early
years.
 To retain his mother’s love the child must learn to postpone the immediate
pleasure of urinating or evacuating until the appropriate time and place.
 Independence and control.
 Anal retentive: Obsession with organization or excessive neatness
 Anal expulsive: Reckless, careless, defiant, disorganized, Coprophiliac
Preschool Phallic  Period of family triangle
(3-6 years  Focus of pleasurable sensations has shifted from the mouth and
old) excretory organs to the genitalia and that the child begins to identify with
parent of the same sex and to unconsciously wish to replace that parent
in the family situation.
 Castration fears – anxiety of boys about the loss of his sexual organs.
 Penis envy – attitude of girls to conclude that her penis is lost.
 Oedipus complex – attachment of boys to his mother
 Electra complex – attachment of girls to the father (develop by Carl
Jung)
 Sexual identity is developed

School Latency  During this period the child represses sexual thoughts and channels his
age (6-12 libidinal energies into the pursuit of intellectual interests.
years old)  The child begins the process of emancipating himself from the family by
seeking security and companionship from peer group of the same sex.
 Gang formation and fierce gang loyalties.
 Normal homosexual relationship because groups of boys cling
together and shun girls. In the same way, groups of girls band together
and declare they despise boys.
Puberty Genital  In this stage the focus is again on the genitals, like in the phallic stage,
(12 – 18) but this time the energy is expressed with adult sexuality.
 Another crucial difference between these two stages is that, while in the
phallic gratification is linked with satisfaction of the primary drives, the
ego in the genital stage is well-developed, and so uses secondary
process thinking, which allows symbolic gratification.
 The symbolic gratification may include the formation of love relationships
and families, or acceptance of responsibilities associated with
adulthood.
 Heterosexual relationship may occur.