Explain that the concepts of mental health and mental illness are defined by an individual’s culture. Describe how cultural and religious beliefs can influence how a society view and treats mental health and mental illness.
Note that as a result, there are multiple definitions of mental health and mental illness.
Exam Q.
A peak experience is a moment accompanied by a euphoric mental state often achieved by self-actualizing individuals.
Nonconformance: means that something went wrong.
Read Townsend’s definition of mental health. Explain that this is the definition that will be used throughout the course.
Read Townsend’s definition of mental illness. Explain that this is the definition that will be used throughout the course.
Explain that cultural elements associated with individual’s perceptions of mental illness make a universal concept of mental illness difficult to define. Two of these elements are defined by Horowitz as incomprehensibility and cultural relativity.
Summarize the definitions of these two terms, and explain how they might influence attitudes toward mental illness.
Hans Selye : “was a pioneering Hungarian-Canadian endocrinologist who conducted important scientific work on the hypothetical non-specific response of an organism to stressors”.
Born: January 26, 1907, Vienna, Austria
Died: October 16, 1982, Montreal, Canada
Read Selye’s definition of stress and explain the fight-or-flight syndrome.
Selye in 1936, who defined it as “the non-specific response of the body to any demand for change”. ... Some people used stress to refer to an overbearing or bad boss or some other unpleasant situation they were subjected to. SA
Review the stages of Selye’s general adaptation syndrome:
Alarm reaction stage: Fight-or-flight syndrome responses are initiated
Stage of resistance: Using the physiological responses of the first stage, the person attempts to adapt to the stressor. If adaptation occurs, the third stage is prevented or delayed. Physiological symptoms may disappear.
Stage of exhaustion: The adaptive energy is depleted, and diseases of adaptation may ensue.
Biological responses associated with fight-or-flight can include immediate responses (release of norepinephrine and epinephrine, increased respiration rate, increased heart rate, etc.) and sustained responses (increased gluconeogenesis, increased basal metabolic rate, decrease in secretion of sex hormones, etc.).
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.] >> S&S of Alarm Reactions
Compare the immediate and sustained responses seen with fight-or-flight syndrome.
The immediate response is stimulation of the sympathetic nervous system. This can result in:
Dilation of the pupils
Dilation of the bronchioles and increased respiration rate
Increased force of cardiac contraction, which causes increased cardiac output, heart rate, and blood pressure
Decreased gastric motility and secretions
Increased secretion from the sweat glands
And other responses
Display Slide 13.
Describe anxiety and grief as psychological responses to stress. Explain that there is a variety of thoughts, feelings, and behaviors associated with these responses and that they may vary depending on the individual.
Explain that adaptation is determined by the degree to which these thoughts, feelings, and behaviors interfere with an individual’s level of functioning.
Read the definition of anxiety. Note the vague nature of the associated feelings.
Note that feelings of anxiety are very common in society and that nearly everyone feels anxiety in some way. Explain that there are varying levels of anxiety, and that anxiety can become problematic when an individual is unable to prevent it from interfering with everyday life.
Explain Peplau’s four levels of anxiety and their effect on an individual:
Mild anxiety: Prepares people for action. It sharpens the senses, increases motivation for productivity, increases the perceptual field, and results in a heightened awareness of the environment. Learning is enhanced, and the individual is able to function at his or her optimal level.
Moderate anxiety: Extent of the perceptual field diminishes. Individual becomes less alert to events occurring within the environment. Attention span and ability to concentrate decrease and assistance with problem-solving may be required. Increased muscular tension and restlessness.
Severe anxiety: Perceptual field diminishes greatly; concentration centers on one particular detail only or on many extraneous details. Attention span is extremely limited; the individual has much difficulty completing even the simplest task. Physical symptoms may include headaches, palpitations, and insomnia. Emotional symptoms may include confusion, dread, and horror. Virtually all overt behavior is aimed at relieving the anxiety.
Panic anxiety: Individual is unable to focus on even one detail within the environment. Misperceptions are common, and a loss of contact with reality may occur. Hallucinations or delusions may be present. Behavior may be characterized by wild and desperate actions or extreme withdrawal. Human functioning and communication with others are ineffective. Individuals may be convinced that they have a life-threatening illness or fear that they are “going crazy,” are losing control, or are emotionally weak. Prolonged panic anxiety can lead to physical and emotional exhaustion and can be life threatening.
Explain how individuals adapt a mild level of anxiety. Coping mechanisms such as sleeping, drinking, cursing, and finger tapping are common.
Define Ego defense mechanisms and explain that they are more common in mild to moderate anxiety. These include denial, isolation, and projection, among others.
Have students keep a record of ego defense mechanisms they observe being used. These may be identified in the clinical setting, with their classmates, or with families or friends. Have them share these observations in their student group.
- Compensation Covering up weaknesses emphasizing a more desirable trait or
by overachievement in a more comfortable area. A high school student too small to play football becomes the star long distance runner for the track team. Allows a person to overcome weakness
and achieve success
Denial An attempt to screen or ignore unacceptable realities by refusing to acknowledge them. A woman, though told her father has
metastatic cancer, continues to plan a family reunion 18 months in advance. Temporarily isolates a person from the full impact of a traumatic situation
Displacement The transferring or discharging of emotional reactions from one object or person to another object or person
A husband and wife are fighting, and the husband becomes so angry he hits a door instead of his wife. Allows for feelings to be expressed
through or to less dangerous objects or people A student gets a C on a paper she worked hard on and goes home and yells at her family.
Identification An attempt to manage anxiety by imitating the behavior of someone feared or respected. A student nurse imitates the nurturing
behavior she observes one of her instructors using with clients. Helps a person avoid self-devaluation
Intellectualization A mechanism by which an emotional response that normally would accompany an uncomfortable or
painful incident is avoided by the use of rational explanations that remove from the incident any personal significance and feelings
The pain over a parent’s sudden death is reduced by saying, “He wouldn’t have wanted to live disabled.” Protects a person from pain and traumatic events
Introjection A form of identification that allows for the acceptance of others’ norms and values into oneself, even when contrary to one’s previous assumptions
A 7-year-old tells his little sister, “Don’t talk to strangers.” He has introjected this value from the instructions of parents and teachers.
Helps a person avoid social retaliation and punishment; particularly important for the child’s development of superego
Projection إسقاط A process in which blame is attached to others or the environment for unacceptable desires, thoughts, shortcomings, and mistakes
A mother is told her child must repeat a grade in school, and she blames this on the teacher’s poor instruction. A
husband forgets to pay a bill and blames his wife for not giving it to him earlier. Allows a person to deny the existence of
shortcomings and mistakes; protects self-image
Rationalization justification of certain behaviors by faulty logic and attribution of motives that are socially acceptable but did not in fact inspire the behavior
A mother spanks her toddler too hard and says it was all right because he couldn’t feel it through the diapers anyway.
Helps a person cope with the inability to meet goals or certain standards
Reaction formation A mechanism that causes people to act exactly opposite to the way they feel An executive resents his bosses for
calling in a consulting firm to make recommendations for change in his department but verbalizes complete support of the idea and is exceedingly
polite and cooperative. Aids in reinforcing repression by allowing feelings to be acted out in a more acceptable way
Regression تراجع Resorting to an earlier, more comfortable level of functioning that is characteristically less demanding and
Responsible An adult throws a temper tantrum when he does not get his own way. A critically ill client allows the nurse to bathe and
feed him. Allows a person to return to a point in development when nurturing and dependency were needed and accepted with comfort
Repression قمع An unconscious mechanism by which threatening thoughts, feelings, and desires are kept from becoming
conscious; the repressed material is denied entry into consciousness A teenager, seeing his best friend killed in a car accident, becomes amnesic
about the circumstances surrounding the accident. Protects a person from a traumatic
Sublimation: Displacement of energy associated with more primitive sexual or aggressive drives into socially acceptable activities.
React in a very aggressive way to small problems then turn to be a very religious man. Protects a person from behaving in
irrational, impulsive ways.
- Substitution The replacement of a highly valued, unacceptable, or unavailable object by a less valuable, acceptable, or available object
A woman wants to marry a man exactly like her dead father and settles for someone who looks a little bit like him. Helps a person achieve goals and
minimizes frustration and disappointment.
Undoing An action or words designed to cancel some disapproved thoughts, impulses, or acts in which the person relieves guilt by making reparation
A father spanks his child and the next evening brings home a present for him. A teacher writes an examination that is far too easy, then constructs a grading
Allows a person to appease guilty feelings and atone for mistakes curve that makes it difficult to earn a high grade.
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.
Reaction formation A mechanism that causes people to act exactly opposite to the way they feel
Unresolved moderate to severe anxiety can contribute to physiological disorders including cardiovascular, gastrointestinal, neoplastic, neurological, and pulmonary conditions.
Extended periods of repressed severe anxiety can lead to psychoneurotic responses such as anxiety disorders, somatic symptom disorders, or dissociative disorders.
Common characteristics of individuals with neuroses include:
They are aware that they are experiencing distress.
They are aware that their behaviors are maladaptive.
They are unaware of any possible psychological causes of the distress.
They feel helpless to change their situation.
They experience no loss of contact with reality.
Unresolved panic anxiety can result in psychosis, which is a significant thought disturbance in which reality testing is impaired. Individuals may experience delusions, hallucinations, disorganized speech or catatonic behavior. Examples of psychotic responses to anxiety include the schizophrenic, schizoaffective, and delusional disorders.
The loss of anything of value to an individual can trigger the grief response. Discuss Kübler-Ross’s five stages of the grief response.
Denial: Stage of disbelief in which the reality of the loss is not acknowledged.
Anger: Stage of envy (حسد) and resentment (hatred).
Bargaining: Stage of making promises to reverse or postpone the loss.
Depression: Stage of desperation and disengagement.
Acceptance: Final stage of resignation.
حزن
Explain anticipatory grief and its process in mourning.
Describe the resolution of the grief process, which may take anywhere from weeks to years. Explain that individuals must be allowed to progress at their own pace: The length of the grieving process can be influenced by several factors, such as other recent losses and anticipation of the loss. The process can last from a few weeks to a few years.
Discuss indications that the mourning process is resolved. These include the regaining of a sense of organization, the pursuit of new interests and relationships, and the replacement of preoccupation with energy and resolve.
Discuss potential maladaptive grief responses, which occur when an individual cannot progress through the stages of grief to achieve resolution. These can include:
Prolonged responses characterized with intense preoccupation with the lost entity.
Delayed or inhibited responses in which the individual becomes stuck in the denial stage of the grieving process.
Distorted responses in which the individual becomes stuck in the anger stage of the process.
5 Stages of grief
Denial
Anger
Bargaining
Depression
Acceptance
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.
