Mental Health and Mental Illness: Understanding Adaptation to Stress

1. Chapter 1 Mental Health and Mental Illness

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

3. Mental Health Maslow identified: • A “hierarchy of needs” • Self-actualization as fulfillment of one’s highest potential

4. Mental Health (cont’d) 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.”

5. 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.”

6. Mental Illness (cont’d) 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 • Culturalrelativity: the “normality” of behavior is determined by the culture

7. PHYSICAL AND PSYCHOLOGIAL RESPONSES TO STRESS

8. 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

9. Physical Responses (cont’d) Selye’s General Adaptation Syndrome • Alarm reaction stage • Stage of resistance • Stage of exhaustion

10. Stress as a Biological Response 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 stage b) Stage of resistance c) Stage of exhaustion d) Stage of biological stress

11. Stress as a Biological Response (cont’d) Correct answer: A The 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.

12. Physical Responses (cont’d) The Fight-or-Flight Syndrome • Immediate response • Sustained response

13. Physical Responses (cont’d) Sustained physical responses to stress promote susceptibility to many diseases of adaptation

14. 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.

15. Psychological Responses (cont’d) 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

16. Psychological Responses (cont’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

17. Psychological Responses (cont’d) 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.

18. Psychological Responses (cont’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

19. Psychological Adaptation to Stress 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.”

20. Psychological Adaptation to Stress (cont’d) 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.

21. Psychological Responses (cont’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.

22. Psychological Responses (cont’d) • 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.

23. Psychological Responses (cont’d) 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

24. Psychological Responses (cont’d) • 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.

25. Psychological Responses (cont’d) • 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.

26. Psychological Responses (cont’d) • 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.

27. Psychological Responses (cont’d) Maladaptive Grief Responses • Prolonged response • Delayed/inhibited response • Distorted response

28. Psychological Adaptation to Stress 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 response b) Prolonged grief response c) Delayed grief response d) Distorted grief response

29. Psychological Adaptation to Stress (cont’d) 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.