Historical and Theoretical Concepts

What is a mental illness?

Historical Overview of Psychiatric Care

• Some cultures thought an individual with mental illness has been dispossessed of his or her soul and wellness could only be achieved if the soul was returned.

• Others believed that evil spirits or supernatural or magical powers had entered the body.

• Dorthea Dix

• Linda Richards 

• In 1946, the government passed the National Mental Health Act

• This provided funds for the education of psychiatrists, psychologists, social workers, and psychiatric nurses.

• Graduate-level education in psychiatric nursing was also established during this period.

Mental Health

• Many concepts of mental health deal with the individual's aspects of functioning.

  • One theorist, Maslow, created the “hierarchy of needs” with the most basic needs needing fulfilled before the highest (self-actualization) can be achieved.

  • Self-actualization is described as being psychologically healthy, fully human, evolved, and fully mature.”

  • An individual can also revert to a lower level based on circumstances in life.

Maslow’s Hierarchy of Needs
Six Indicators of Mental Health

• Positive attitude toward self

• Growth, development, and the ability to achieve self-actualization

• Integration

• Autonomy

• Perception of reality

• Environmental mastery

Mental Illness

• Mental illness is a universal concept that have different cultural factors that influence the definition.

• Certain elements are associated with how an individual views mental illnesses, however, despite cultural origin.

  • Incomprehensibility

  • Cultural Relativity

Anxiety and Grief are two primary responses to stress

• Anxiety is a feeling of discomfort related to fear of impending danger A lot of the time, anxiety is associated with feelings of uncertainty and helplessness.

• Grief is a subjective feeling of sorrow and sadness that is accompanied by emotional, physical, and social responses to the loss of a loved one or thing. 

Anxiety

• There are four levels of anxiety according to the theorist Peplau. Table 2-1.

  Level of Anxiety	Ability to Learn	Physical Characteristics	Emotional/Behavioral Characteristics
  Mild	Learning is enhanced	Restlessness, irritability	Rarely experienced as distressful Motivation is increased
  Moderate	Learning still occurs but not at full ability Attention span and ability to concentrate diminish	Muscular tension and restlessness Increased HR & RR Increase in speech and volume Sweating	Feelings of discontent Can lead to impairment in interpersonal relationships
  Severe	Extremely limited attention span Cannot concentrate or problem solve	HA, palpitations, dizziness, tachycardia, nausea, diarrhea, insomnia, hyperventilation, trembling, urinary frequency	Can feel feelings of dread, loathing, horror Main focus is on self and how to relieve the intense feeling of anxiety
  Panic	Learning cannot occur Cannot understand simple directions	Dilated pupils, Labored breathing, palpitations, pallor and diaphoresis, incoherence	Sense of impending doom Bizarre behavior (shouting, screaming, running around, clinging to things) May see hallucinations, delusions

Severe anxiety can result in psychoneurotic behavior patterns

• This can include what is called neuroses, which are psychiatric disturbances characterized by excessive anxiety that is expressed directly or altered through defense mechanisms.

Psychosis is different from neurosis

• Psychosis is a significant thought disturbance and results in a loss of touch with reality.

• This includes delusions, hallucinations, disorganized speech, catatonic behavior (abnormal movements)

Defense Mechanisms

• As levels of anxiety increases, the ego is tested in an individual and sometimes needed to confront a perceived threat.

  • Anna Freud identified different defense mechanisms that others may use in the face of threats to the ego. Defense mechanisms are used to manage conflict in response to anxiety.

• You need to know these (Table 2-2) Examples are also included

• Defense mechanisms become maladaptive when an individual uses the defense mechanisms and it Begins To interferes with reality, relationships, and/or occupational performance.

• Can be used consciously or unconsciously

Defense Mechanisms

1. A person who is angry about losing their job destroys their child’s favorite toy.

2. A married client that is attracted to another individual accuses their partner of cheating on them.

3. A parent is notified that their child was killed overseas tells everyone that the child is coming home for the holidays.

4. A patient tells the nurse that they are the only one in the world that cares about them, then the following day refuses to talk to or acknowledge that same nurse.

5. A law enforcement officer blocks out the emotional aspect of a crime so they can focus on the investigation.

6. A young adult explains they had to drive home from a party after drinking alcohol because they had to feed their animals.

7. A person experiences deafness after their partner tells them they want a divorce.

8. An adolescent who is physically unable to play contact sports excels in academic competitions.

9. An individual buys their significant other flowers and gifts after an incident of abuse.

10. A person who resents having to care for an aging parent becomes overprotective and restricts their freedoms.

11. A parent blocks out the distracting noise of their children in order to focus while driving in traffic.

12. A person who has lost their job states they will worry about paying bills next week.

13. A person who has feelings of anger towards their supervisor at work goes to the gym during their lunch break to vigorously work out their feelings of hostility.

14. A nurse who lost a family member in a fire is a volunteer firefighter.

GRIEF:

• This period of characteristic emotions and behaviors is called mourning. This includes feelings of sadness, guilt, anger, helplessness, hopelessness, and despair and is considered an adaptive response to grief.

• Stages of Grief (Kubler-Ross)

  • Stage 1- Denial

  • Stage 2- Anger

  • Stage 3- Bargaining

  • Stage 4- Depression

  • Stage 5: Acceptance

• The grief process is different for every individual.

• Different factors can influence the grieving process, including anticipatory grief and other recent losses.

• Anticipatory grief:

• Resolution

• different factors can prolong the grief process

• Grief can accumulate into bereavement overload. 

• Grief also does not always disappear, but can re-emerge with specific triggers, like anniversary dates.

• The mourning process is resolved once the individual can regain some organization, redefine their life, and take an interest in relationships and hobbies again.

• Maladaptive responses to grief

Types of maladaptive grief responses

• Prolonged

-            Delayed or inhibited

-            Distorted