Mental Health and Mental Illness

Prepared by MSN ,RN .Tarek Qawasmeh

What is mental health

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.

Mental Health Maslow identified

He identified a hierarchy of needs Emphasized an individual motivation in continuous quest for self actualization(highest potential)

Maslow hierarchy

Maslow describe self actualization as

Psychological healthy ,fully human, highly evolved and fully mature and the individual in this level has the following characteristic

Cont
1. Focusing in problem solving 2. Ability to accept oneself ,others and human nature 3. Appropriate perception of reality 4. Desire for privacy 5. Creativeness 6. An democratic and has strong sense of ethics

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.

Mental health /metal illness

Continuum not static

Mental health

Mental illness

Mental Illness

Mental illness (cont)

Two elements are associated with individual perception to mental illness regardless of cultural origin(horwitz 1982)
a. Incomprehensibility--the inability of the general population to understand the motivation behind the behavior b. Cultural relativity--the normalityof behavior determined by the culture

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.

PHYSICAL AND PSYCHOLOGIAL RESPONSES TO STRESS

Physical Responses
stress defined as the a biological , psychological ,social or chemical factor that causes physical or emotional tension and may be a factor in the etiology of certain illness . Fight-or flightsyndromes

Physical Responses to Stress

 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.

Psychological adaptation to stress

Anxiety
A diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness So common in our society Mild anxiety is adaptive and can provide motivation for survival

Peplau s four levels of anxiety

Mild seldom problem associated with tension in response to day to day living Moderate -perceptual field diminishes sever -perceptual field is so diminished that concentration centers on one detail only or on many extraneous details Panic -the most intense state(unable to focus on one detail in the environment ,misperception is common

Mild anxiety
Perceptual field heightened perception ability to learn enhanced Physical characteristic restlessness irritability Emotional and behavioral characteristic motivation is increased , may remain superficial with other

Moderate anxiety
Perceptual field reduction in perceptual field ability to learn occurs but not optimal , ed attention spin(AS), and ed ability to concentrate ` Physical characteristic ed restlessness , HR,RR ,speech rate and muscular tension Emotional and behavioral characteristic feeling of discontent impairment in interpersonal relationships

Sever anxiety
Perceptual field greatly diminished ;only extraneous details are perceived, or fixation in single detail ability to learn extremely limited AS, unable to concentrate and learning can not occur Physical characteristic headache, dizziness, nausea ,palpation ,insomnia ,urinary frequency, diarrhea Emotional and behavioral characteristic feeling of dread ,total focus on self and intense focus on relieve anxiety

Panic
Perceptual field unable to focus on even one detail within the environment ,misperception of the reality ability to learn learning cannot occur , unable to concentrate and unable to comprehend simple direction Physical characteristic dilated pupils, labored breathing, diaphoresis, incoherence, pallor , immobility or purposeless hyperactivity Emotional and behavioral characteristic terror, bizarre behavior(shouting, screaming ), hallucination ,delusions

Behavioral adaptation responses to anxiety:

a variety of behavioral adaptation response to stress occur at each level of anxiety These behavioral adaptation response on continuum from mild to panic

mild

Moderate

Severe

Panic

.
Ego Mechanism defense mechanism
Coping

Psychophysiological Response

Psychoneurotic Response

Psychotic Response

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 persons they feel comfortable Some of these behaviors are more adaptive than other

mild to moderate level,

At the mild to moderate level, the ego calls on defense mechanism for protection, such as Compensation Identification Isolation Rationalization Sublimation - Denial - Displacement - Intellectualization - Introjections - Projection -reaction formation - Regression -Repression - Suppression -Undoing

Ego defense mechanisms

Compensation: covering up a real or perceived weakness by emphasizing a trait one considered more desirable denial : refusing to acknowledge the existence of a real situations or feeling associated with it displacement : transfer of feeling from one target to another that is considered less threatening or that is nature Rationalization : attempting to make excuses or logical reasons to justify unacceptable behavior or feeling reaction formation : prevention unacceptable or undesirable thought or behavior from being express by exaggerating the opposite thought or type of behaviors

Ego defense mechanisms (cont)

Identification : attempt to increased self worth by acquiring certain attributes and characteristic of an individual one admires isolation : separating a thought or memory from feeling tone or emotion associated with it projection : attributing feeling unacceptable to one's self to another person Repression : involuntary blocking unpleasant feeling or experiences from one's awareness Sublimation : rechanneling of drives that are personally or socially unacceptable into constrictive activities Suppression : voluntary blocking of unpleasant feeling or experiences from one's awareness

moderate to severe anxiety

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. (Psycho-physiological Response) These disorder describes as presence of one or more psychological factors that adversely effect a general medical condition (psychophysiological disorders )

severe anxiety
Extended periods of repressed severe anxiety can result in psychoneurotic patterns of behaving -- for example, anxiety disorders, phobias, panic disorders, obsession, and sexual dysfunction People with psychoneurotic response 1. They aware that they are experiencing distress 2. They aware that their behaviors are maladaptive 3. They are unaware of any psychological causes of the distress 4. Feel helpless to change their situation 5. no loss of contact with the reality

 Extended periods of functioning at the panic level of anxiety may result in psychotic behavior(psychotic response ); for example, schizophrenic and delusional disorders. People with psychotic response 1. They experience minimal distress(emotional tone is flat) 2. They are unaware that their behaviors are maladaptive 3. They are unaware of any psychological problem. 4. May lose touch with reality. 5. A flight from reality into a less stressful world

panic

Psychological response to stress( 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 or anticipatory

Elisabeth Ross five stages of feeling and behavior that individual experiences in response to real ,perceived or anticipated loss

stages of grief
1. Denial stage of shock and disbelief no it cant be true 2. Anger why me and its not fair 3. Bargaining is made with god in attempt to reveres the loss 4. Depression-the sense of loss is intense and feeling of sadness and depression prevail 5. Acceptance feeling of peace regarding the loss occurred these stages not necessary to be experience by individual in this order

grief (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

grief (cont)
The experience of guilt for having had a love hate relationship with the lost entity. Guilt often lengthens the grieving process. love-hate Anticipatory grieving is thought to shorten the grief response when the loss actually occurs. May result in disengaging from the loved one. Rejection/ 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

grief (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. Maladaptive grief responses :occur when the individual is not able to progress through the grieving stages to achieve resolution

grief (cont)
Types of maladaptive grief responses : 1. Prolonged response-intense preoccupation with the memory of the loved one. Can be many years later. Anger, Denial. Difficulty functioning, intense pain.

2 . Delayed/inhibited response - fixed in denial stage/the emotional pain is not experienced.

3. Distorted response - fixed at anger stage. Interferes with normal functioning. Depression