Chapter01

Copyright © 2014. F.A. Davis Company

Mental Health and Mental IllnessMental Health and Mental IllnessDr. Juanita E. RassDr. Juanita E. Rass

Chapter 1Chapter 1


• The concepts of mental health and mental illness are culturally defined.

• Individuals experience both physical and psychological responses to stress.

IntroductionIntroduction


Maslow identified:• A “hierarchy of needs”• Self-actualization as fulfillment of one’s highest

potential

Mental HealthMental 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 Health (contMental Health (cont’’d)d)


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 IllnessMental Illness


Horwitz describes cultural influences that affect how individuals view mental illness, which include:– Incomprehensibility: the inability of the

general population to understand the motivation behind the behavior

– Cultural relativity: the “normality” of behavior is determined by the culture

Mental Illness (contMental Illness (cont’’d)d)


PHYSICAL AND PSYCHOLOGIAL PHYSICAL AND PSYCHOLOGIAL RESPONSES TO STRESSRESPONSES TO STRESS


• 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

Physical ResponsesPhysical Responses


Selye’s General Adaptation Syndrome– Alarm reaction stage– Stage of resistance– Stage of exhaustion

Physical Responses (contPhysical Responses (cont’’d)d)


1. A 25-year-old man barely avoids a motor vehicle accident. His heart is pounding, his palms are sweaty, and his respirations are increased. This is

an example of which stage of the General Adaptation Syndrome?

a) Alarm reaction stageb) Stage of resistancec) Stage of exhaustiond) Stage of biological stress

Stress as a Biological ResponseStress as a Biological Response


Correct answer: AThe physiological responses of the “fight or flight syndrome” are initiated in the alarm reaction stage of the General Adaptation Syndrome. These physiological responses generally include an increase in heart rate and respirations, and may include other symptoms such as headache, sweaty palms, and a sensation of dizziness.

Stress as a Biological Response (contStress as a Biological Response (cont’’d)d)


The Fight-or-Flight Syndrome– Immediate response– Sustained response



Sustained physical responses to stress promote susceptibility to many diseases of adaptation



• 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 ResponsesPsychological Responses


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 Responses (contPsychological Responses (cont’’d)d)


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



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 Responses (contPsychological Responses (cont’’d)d)• 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


2. 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 StressPsychological Adaptation to Stress


Correct answer: CThe 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 (contPsychological Adaptation to Stress (cont’’d)d)


• Anxiety at the moderate to severe level that remains unresolved over an extended period

can contribute to a number of physiological disorders, e.g., migraine headaches, irritable bowel syndrome, and cardiac arrhythmias.

• Extended periods of repressed severe anxiety can result in psychoneurotic patterns of behaving, e.g., anxiety disorders and somatoform disorders.



• Extended periods of functioning at the panic level of anxiety may result in psychotic behavior.

• Examples of psychotic disorders include schizophrenia, schizoaffective disorders, and delusional disorders.



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

– 5 Stages of Grief Denial Anger Bargaining Depression Acceptance



• Anticipatory grief: the experiencing of the grief process before the actual loss occurs.

• 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.



– 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.

– 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.



• 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– Prolonged response– Delayed/inhibited response– Distorted response



3. A widow of 23 years has not removed any of her husband’s possessions, including the slippers beside their bed. Which pathological grief response is being exhibited by this client?

a) Inhibited grief responseb) Prolonged grief responsec) Delayed grief responsed) Distorted grief response

Psychological Adaptation to StressPsychological Adaptation to Stress


Correct answer: BThe 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.

Psychological Adaptation to Stress (contPsychological Adaptation to Stress (cont’’d)d)

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