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

Summary and Key Points

□ Psychiatric care has its roots in ancient times, when etiology was based in superstition and ideas related to the supernatural.

□ Treatments were often inhumane and included brutal beatings, starvation, or other torturous means.

□ Hippocrates associated insanity and mental illness with an irregularity in the interaction of the four body fluids (humors)—blood, black bile, yellow bile, and phlegm.

□ Conditions for care of the mentally ill have improved, largely because of the influence of leaders such as Benjamin Rush, Dorothea Dix, and Linda Richards, whose endeavors provided a model for more humanistic treatment.

□ Maslow identified a “hierarchy of needs” that individuals seek to fulfill on their quest to self­actualization (one's highest potential).

 ▀ For purposes of this text, the definition of mental health is viewed as “the successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age­appropriate and congruent with local and cultural norms.”

□ In determining mental illness, individuals are influenced by incomprehensibility of the behavior; that is, whether or not they are able to understand the motivation behind the behavior.

□ Another consideration is cultural relativity. The “normality” of behavior is determined by cultural and societal norms.

□ For purposes of this text, the definition of mental illness is viewed 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 that interfere with the individual's social, occupational, and/or physical functioning.”

□ Anxiety and grief have been described as two major, primary psychological response patterns to stress.

□ Peplau defined anxiety by levels of symptom severity: mild, moderate, severe, and panic.

□ Behaviors associated with levels of anxiety include coping mechanisms, ego defense mechanisms, psychophysiological responses, psychoneurotic responses, and psychotic responses.

□ Grief is described as a response to loss of a valued entity. Loss is anything that is perceived as such by the individual.

□ Kübler­Ross, in extensive research with terminally ill patients, identified five stages of feelings and behaviors that individuals experience in response to a real, perceived, or anticipated loss: denial, anger, bargaining, depression, and acceptance.

□ Anticipatory grief is grief work that is begun, and sometimes completed, before the loss occurs.

□ Resolution is thought to occur when an individual is able to remember and accept both the positive and negative aspects associated with the lost entity.

□ Grieving is thought to be maladaptive when the mourning process is prolonged, delayed or inhibited, or becomes distorted and exaggerated out of proportion to the situation. Pathological depression is considered to be a distorted reaction.

Multiple Choice

1. A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The client’s appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the client’s behaviors?

A. The client’s behaviors demonstrate mental illness in the form of depression.

B. The client’s behaviors are extensive, which indicates the presence of mental illness.

C. The client’s behaviors are not congruent with cultural norms.

D. The client’s behaviors demonstrate no functional impairment, indicating no mental illness.

ANS: D