Mental Health/Mental Illness: Historical and Theoretical Concepts Chapter 2 Mental Health/Mental Illness: Historical and Theoretical Concepts

Introduction The concepts of mental health and mental illness are culturally defined. Individuals experience both physical and psychological responses to stress.

Historical Overview Early beliefs centered on mental illness in terms of evil spirits or supernatural or magical powers that had entered the body. The mentally ill were beaten, starved, and otherwise tortured to “purge” the body of these “evil spirits.”

Historical Overview (cont.) Some people correlated mental illness with witchcraft, and individuals with mental illness were burned at the stake. Hippocrates associated mental illness with an irregularity in the interaction among the four humors: blood, black bile, yellow bile, and phlegm. During the Middle Ages, the mentally ill were sent out to sea on sailing boats without guidance to search for their lost rationality. This practice originated the term ship of fools.

Historical Overview (cont.) During this same period, the Middle Eastern Islamic countries began to establish special units in general hospitals creating what were likely the first asylums for individuals with mental illness. In colonial America, mental illness was equated with witchcraft. Many were burned at the stake or put away in places where they could do no harm to others.

Historical Overview (cont.) The first hospital in America to admit individuals with mental illness was established in Philadelphia in the mid-18th century. Benjamin Rush, often called the father of American psychiatry, was a physician at the hospital and initiated the first humane treatment for individuals with mental illness in the United States.

Historical Overview (cont.) In the 19th century, Dorothea Dix was successful in lobbying for the establishment of state hospitals for individuals with mental illness. Her goal was to ensure humane treatment for these patients, but the population grew faster than the system of hospitals, and the institutions became overcrowded and understaffed.

Historical Overview (cont.) Linda Richards is considered to be the first American psychiatric nurse. She graduated from the New England Hospital for Women and Children in Boston. She helped establish the first school of psychiatric nursing at the McLean Asylum in Waverly, Massachusetts, in 1882. Psychiatric nursing was not included in the curricula of schools of nursing until 1955.

Historical Overview (cont.) The National Mental Health Act was passed by the federal government in 1946. It provided funds for the education of psychiatrists, psychologists, social workers, and psychiatric nurses. Graduate-level psychiatric nursing was also established during this period. Deinstitutionalization and the community health movement began in the 1960s.

Mental Health Mental health is 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 Illness Mental illness is 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.”

Mental Illness (cont.) Horwitz described cultural influences that affect how individuals view mental illness. These include: Incomprehensibility, which is the inability of the general population to understand the motivation behind the behavior Cultural relativity, in which the “normality” of behavior is determined by the culture

Psychological Adaptation 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 (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

Psychological Adaptation to Stress (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

Psychological Adaptation to Stress (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.

Psychological Adaptation to Stress (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

Psychological Adaptation to Stress (cont.) 1. A client hates her mother because of childhood neglect. The nurse determines which client statement represents the use of the defense mechanism of reaction formation? A. “I don’t like to talk about my relationship with my mother.” B. “My mother hates me.” C. “I have a very wonderful mother whom I love very much.” D. “My mom always loved my sister more than she loved me.”  

Psychological Adaptation to Stress (cont.) Correct answer: C The client hides her negative unacceptable feelings by the exaggerated expression of positive feelings. This is an example of the defense mechanism of reaction formation.

Psychological Adaptation to Stress (cont.) Anxiety at the moderate to severe level that remains unresolved over an extended period of time can contribute to a number of physiological disorders such as 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, somatic symptom disorders, and dissociative disorders.

Psychological Adaptation to Stress (cont.) Extended periods of functioning at the panic level of anxiety may result in psychotic behavior. Examples of psychoses include schizophrenic; and schizoaffective and delusional disorders.

Psychological Adaptation 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. Elisabeth Kübler-Ross’s five stages of grief: Denial Anger Bargaining Depression Acceptance

Psychological Adaptation to Stress (cont.) Anticipatory grief is the experiencing of the grief process before the actual loss occurs Resolution. The 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.

Psychological Adaptation to Stress (cont.) Resolution is hindered or delayed by: The experience of guilt for having had a “love-hate” relationship with the lost entity Having experienced a number of recent losses and being unable to complete one grieving process before another one begins Resolution is facilitated by: Anticipatory grieving (being able to experience feelings associated with grief before the actual loss occurs)

Psychological Adaptation to Stress (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.

Psychological Adaptation to Stress (cont.) Maladaptive Grief Response Prolonged response Delayed/inhibited response Distorted response

Psychological Adaptation to Stress (cont.) A widow of 23 years has not removed any of her husband’s possessions including his slippers beside their bed. Which pathological grief response is being exhibited by this client? A. Inhibited grief response B. Prolonged grief response C. Delayed grief response D. Distorted grief response

Psychological Adaptation to Stress (cont.) Correct answer: B The prolonged grief response is characterized by intense preoccupation with memories of the lost person years after the loss has occurred. This is how this client has responded to her husband’s death.

Mental Health/Mental Illness Continuum In Figure 2-3 of the text, anxiety and grief are presented on a continuum according to the extent of symptom severity. Disorders, as they appear in the DSM-5, are identified at their appropriate placement along the continuum.