CONCEPTS OF MENTAL CHARACTERISTICS OF A MENTALLY HEALTHY

HEALTH AND MENTAL PERSON

● Creative in performing tasks or problem-solving
ILLNESS ● Independent in thought and action
● Appreciate and enjoy life
HEALTH- a state of complete physical, mental, and ● Ability to accept themselves, others and nature
social wellness, not merely the absence of disease or ● Able to form close relationships with others
infirmity (WHO) ○ kindness
○ patience
MENTAL HEALTH according to: ○ compassion
● Perceive world as it really and people as they
Sheila Videbeck are
➔ level of psychological well-being or an absence ● Consistent behavior in respecting rights of
of mental illness others
➔ “Psychological state” of someone who is ○ willing to listen
functioning at a satisfactory level of emotional ○ learn from others
and behavioral adjustment. includes our ○ revere the uniqueness and difference of
emotional, psychological, and social well-being. others
➔ affects how we think, feel, and act It helps
determine how we handle stress, relate to MENTAL ILLNESS
others, and make choices. ➔ mental disorder/syndrome with physiologic or
➔ important at every stage of life, from childhood behavioral manifestation/impairment in
and adolescence through adulthood functioning
➔ state of emotional, psychological, and social ➔ causing people to display abnormal behavior
wellness evidenced by: more consistently than most people
1. satisfying interpersonal relationships ● Frequent irresponsibility
2. effective behavior ● Inability to cope
3. coping positive self-concept ● Being a odd with society
4. emotional stability ● Inaccurate perception of reality

Shives (2012) FACTORS CONTRIBUTING TO MENTAL ILLNESS

➔ a positive state – one is responsible, displays
selfawareness, self-directive, reasonably worry Individual
free, and can cope with usual daily tensions ● biologic make up
➔ ability to solve problems, fulfill one’s capacity for ● intolerable or unrealistic worries or fears
love and work, cope with crises without ● inability to distinguish reality from fantasy
assistance beyond the support of family or ● intolerance of life's uncertainties
friends ● sense of disharmony in life
➔ becoming independent as the need arises ● loss of something in one's life
without permanently losing one’s independence.
Interpersonal
Abraham Maslow - Hierarchy of Needs ● ineffective communication
● excessive dependency on or withdrawal from
relationships
● no sense of belonging
● inadequate social support
● loss of emotional control

Sociocultural
● lack of resources
● violence
● homeliness
● poverty
● unwarranted
Hanna Abajar BSN-3A
 ● negative view of the world ○ isolation of inhumane psychiatric
● discrimination such as stigma, racism, classism, treatment
ageism, and sexism
MID 18th to 18th CENTURY
PREDISPOSING FACTORS TO MENTAL ILLNESS ● sickness and mental illness
○ discovery of animal magnetism &
Biological hypnosis
● genetic background
● nutritional status LATE 19th to EARLY 20th CENTURY
● general health status ● intrapsychic, usually unconscious conflict
● exposure to environmental toxins ○ psychotherapy, analysis, interpretation
of dreams
Psychological
● intelligence MID 20th CENTURY
● verbal ability/skills  conflicts between individuals, family, community,
● personality type social forces
● self-concept o marital, family, community interventions
● past experiences
1970's to 1980's
Sociocultural  biochemical abnormalities in combination with
● age psychological factors
● religious beliefs o chemical therapies
● education
● social relationships Genetic
● income  replacement of normal genes
● gender
● occupation
MENTAL HEALTH-ILLNESS CONTINUUM
HISTORICAL BACKGROUND OF MENTAL ILLNESS
AND CARE Mental health is like a violin with strings of interaction,
behavior, affect and intellect. All these together may
Primitive Culture produce a pleasant or stimulating melody or they may be
● possession by evil spirits, sorcerers, ghosts discordant and irritating. The tune continually changes.
○ magic, exorcism No one is entirely mentally unhealthy and no one is fully
healthy at all time
Ancient Greece Ebersole and Hess, 1985
● supernatural forces and divine intervention
○ clinical observation replaces
superstition, start of humane to
procedures approaches

Medieval Period
● possession by devils and sorcerers
○ banishment, harsh method, 1st hospital
was established
○ Bethlehem hospital-"bedlam"

Renaissance
● naturalistic explanation of sickness
○ rebirth of humane attitude, clinical
observation and description
PSYCHIATRIC NURSING
17th to 18th Century
● irrationality and social deviance
Hanna Abajar BSN-3A
 interpersonal process whereby the professional ● rehabilitation programs
nurse practitioner through the therapeutic use ● vocation training
of self, assist an individual, family, group or ● after-care support
community;
 to promote mental health CHARACTERISTICS OF A PSYCHIATRIC NURSE
 to prevent mental illness & ● empathetic
suffering ● genuineness/congruence
 to participate in the treatment & ● unconditional positive guard
rehabilitation of the mentally ill &
if necessary to find meaning “Things to remember
MENTAL HYGIENE Setbacks don’t equal failure
 science that deals with measures to promote You are allowed to set boundaries
mental health, prevent mental illness and You are more than an illness
suffering and facilitate rehabilitation It’s okay to rest
 specialized area of nursing practice employing Not everything you thinks is true.”
theories of human behavior as its science as its
art

PRINCIPLES OF PSYCHIATRIC NURSING

THEORETICAL BASES FOR
1. Views the client as a holistic being with UNDERSTANDING MENTAL
interdependent and interrelated needs.
2. Accepts clients as a unique human being HEALTH & ILLNESS
3. Focuses on patient's strength and assets and
not on his weaknesses and liabilities STRESS AND ADAPTATION
4. Explores the patient's behavior for the need it
is designed to meet and the message it is STRESS
communicating  wear and tear that life causes on the body
5. Established therapeutic relationship with most,  occurs when a person has difficulty dealing with
if not all, patients problems and goals
6. Views client’s behavior nonjudgmentally while
assisting him to learn more effective adaptations Hans Selye
or coping  Stress response occurs whenever a person
7. Determines the degree of change that can encounters continuous stress
occur in the patient’s behavior through the  “Fight-or-flight” reaction
quality of nurse-patient relationship  General Adaptation Syndrome (GAS)

LEVELS OF INTERVENTION IN PSYCHIATRIC  ALARM

NURSING o Mobilizes the body's defense and
homeostatic responses against the stressor
Primary - "fight or flight"
● health education
● information dissemination  RESISTANCE
● counseling o body attempt to reduce damage from the
● stress reduction stressors
● psycho-social support
 EXHAUSTION
Secondary o evolves after the body's attempts to adapt to
● screening and case finding change fail to manage the stressors if
● crisis intervention appropriate interventions to reduce the
● prompt treatment-administration of medication stress or unsuccessful
● hospitalization
Tertiary

Hanna Abajar BSN-3A

STRESS RESPONSE SYSTEM  Distinctiveness
 Stability and consistency

PERSONALITY DETERMINANTS

Biological
● heredity
● brain
● physical features
Cultural
 traditional practices
 norms
 customs
 procedures
 rules and regulations
 precedents and values
Family
 coordination and cooperation in work role
responsibilities towards the family society and
PHYSICAL INDICATIONS OF FIGHT OR FLIGHT
real
 Dilated pupils
Social
 Trembling  relationships
 Pale or flushed skin  coordination
 Rapid heartbeat and breathing  cooperation
 interaction
Freud Psychoanalytic Model/Psychodynamic
 environment in the family
Framework
 organization
 focuses on intrapsychic processes
 workplaces
Personality
Freudian Concept
 aggregate of the physical & mental qualities of
"Early childhood experiences is important in the
the individual (Freud)
development of personal”
o expressed through behavior
o sum total of one’s behavior (John Watson)
FREUD'S STRUCTURE OF PERSONALITY
o complex, dynamic & unique 1. Id -unconscious part of the person primitive &
biologic drives and urges
General Concepts 2. Ego - the self or the ï
● behavior has meaning & is not determined by 3. Superego - "the conscience" or the censoring
chance force
● all behavior is goal-directed
● the conscious plays an active role in determining LEVEL OF CONSCIOUSNESS
behavior  Conscious- aware of here and now, in contact
● the early years of life are extremely important to with reality, functions only when the person is
personality development awake.
 Subconscious/Preconscious- ideas &
FACTORS WHICH INFLUENCE PERSONALITY
reactions are stored & partially forgotten.
 Heredity/Biologic
 Unconscious- storehouse for all memories,
 Training/Social feelings and responses (painful experience)
 Environment/Fam/Cultural

FREUD'S PSYCHOSEXUAL DEVELOPMENT

CHARACTERISTICS OF PERSONALITY
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 Autonomy vs. Shame & Doubt: Muscular-Anal (18
mos-3 yrs)
● anal needs: primary importance
● development of "holding on or letting go"
● obsessive-compulsive phase of development

Initiative vs. Guilt: Locomotor-Genital or Early

Childhood (3-5 yrs)
● development of conscience
Oral Stage (0-18 months) 1 yr and half ● initiative: positive response to challenges
● Pleasure & gratification through mouth ● accomplishment: resolution of Oedipus
● Complete dependence complex
● Task: distinguish self from mother ● failure: improper sex role identity
● Primary narcissism
Industry vs. Inferiority: Latency or Middle Childhood
Anal Stage (18 mos-3 yrs) or School Age (6-12 yrs)
● Pleasure: elimination & retention (anus) ● halfway outside the family
● Control of holding on & letting go ● works with others & produces things
● Break symbolic ties with mother ● peer- the most important person
● Toilet training is achieved ● learns to win recognition by finishing task
○ -you love yourself to much
○ -distinguished your attitude towards your Identity vs. Role Confusion
mother ● knowing who you are & how you fit to society
○ -power to control on how to let go and ● decides who he is & what kind of personal he
hold on to feces (breaking symbolic ties will be
to your mother) ● role confusion can occur
○ -decide for yourself ● highest incidence of schizophrenia

Phallic Stage (3-6 yrs) Intimacy vs. Isolation: Young Adulthood (18-30 yrs)
● Pleasure: genitals  close to others, as a lover or a friend
● Girl: Elektra complex, boy: oedipal complex establishment of friendships & satisfying
● Masturbation, touching of genitals marriage
● Develops guilt feelings & fears of punishment  isolation occurs when adolescent is unable to
parent of the same sex (castration complex)- develop lasting relationship
being afraid
Generativity vs. Stagnation
Latency Stage (6-12 yrs) Middle Adulthood (25-60 yrs)
● Gaining new skills & knowledge  Predictive & creative in both career & family
● Sense of industry & mastery  assume responsibility for others
● Control over aggressive & destructive impulses  self-sufficiency and maturity
 stagnation is self-absorption, caring for no one
Genitals Stage (12-20 yrs)
 stage of mid-life crises
● Becomes independent
● Develops sexual identity, ability to love and work
Integrity vs. Despair: Late Adulthood or Maturity (60
yrs to end of life)
 accepts responsibility, wisdom is achieved
ERICKSON'S PSYCHOSOCIAL MODEL
 period of reminiscence
Trust vs. Mistrust: Sensory - Oral (0-18 mos)  despair occurs when life was wasted & finds no
● depends on the quality of relations to maternal meaning in it
or primary caregiver
● able to relate well with others
● mistrust leads to hostility and suspiciousness
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Psychodynamic View of Mental Illness Preschoolers
 Traced back to unresolved problems ● consensual validation
 Repressed developmental conflicts ● behavioral traits: watch adults & imitate behavior
 A person behaves in less mature ways because ● imaginative playmates are common
defenses are fixed
SCHOOLER TWO ERA:
Psychodynamic Treatment A. Juvenile Era (6-10 yrs old)
● Focus: conflicts, anxiety, defenses, sexual, &  learns to relate to peers
aggressive drives  learns competition
● Seek to alter thoughts & behavior  compromise & cooperation
● Makes use of free association, dream analysis,  gang loyalties/gang formation
transference analysis (analysis of person's  acquires important interpersonal tools
feelings about the therapist), catharsis
● Improvement: early conflicts become conscious B. Preadolescence (11-12 yrs)
& are examined & resolved.  ability to experience intimacy
 chum relationship
Nursing Application
1. Assessment data are collected on client anxiety Adolescence (12-18 yrs)
and use of defense mechanisms  learns independence & how to relate to opposite
2. Psychodynamic theory can be used to sex
understand & interpret client behavior
3. Psychodynamic approach provides Young Adulthood (20-40 yrs)
developmental perspective on client behavior  learns to be economically, intellectually self-
sufficient
INTERPERSONAL FRAMEWORK (Sullivan's Theory)
3 Personifications Interpersonal Treatment
1. “GOOD ME” – resulting from positive approval  Trusting environment
& leading to good feelings about self  Assist the patient to develop a close relationship
2. “BAD ME” – resulting from experiences related  Patient is encouraged to share anxieties and
to increase anxiety & leading to bad feelings feelings
about self, anxiety state 
3. “NOT ME” – resolves from very disapproving Nursing Application
message and leading to overwhelming anxiety  Focus on nurse patient relationship.
 Here and now, interpretational concerns.
Toddlerhood  NPR as a corrective interpersonal experience for
● sense of POWER patient.
● behavioral traits: headstrong & negativistic
 Nurse assists psychiatric patient with effective
● parallel play
problem solving related to interpersonal issues.
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Interpersonal Views of Mental Illness Concepts:
 Mental illness is defined as inappropriate 1. Persons are shaped by their environment
interpersonal relationship 2. Behaviors are subject to rewards and
 The cause of mental illness is related to past punishment and punishment
relationships Inappropriate communication and 3. Experiments can determine Which
current crisis environmental aspects affect behavior
4. Certain behaviors can be changed or modified if
PIAGET'S STAGES OF COGNITIVE DEVELOPMENT the environment is changed

OPERANT CONDITIONING
● positive reinforcement: reward will help
continue behavior
● negative reinforcement: punishment for the
behavior that will help discontinue
● operant behavior that can be reinforced

TYPES OF TREATMENT
● Systematic desensitization-phobias
● Flooding- flooded by specific phobias
● Aversive therapy-applying painful stimulus
● Relaxation techniques-good for those who are
alcoholics, their wants in order to relax
Cognitive View of Mental Illness ● Assertiveness training-applying unpleasant
● Basis for mental health: distorted thinking stimulus, movies
● Thought processes are identified as
misperceptions: Behavioral View of Mental Illness
○ Arbitrary inference 1. Applies mainly to anxiety disorders, phobias,
○ Selective Abstraction- just selected behavioral problems, and alcoholism
particular thing instead looking to the 2. The environment can be changed by altering
whole picture or thing. original stimuli by using positive and negative
○ Overgeneralization reinforcements
○ Magnification 3. Maladaptive behavior can be modified by
○ Minimization changing the environment
○ Dichotomous thinking- all are nothing
Nursing Applications
Cognitive Treatment
 Privileges
1. Therapist examines client's thought patterns to
 Limit setting based on behavioral principle
promote understanding of individual
 Nurse and patient collaborate and identifying
2. Therapist assists clients to develop awareness
target behaviors for medication
of faulty thinking
 Nurse uses behavioral principles, in teaching
3. Client is encouraged to practice alternative
client families, and others
thought patterns that are healthier

HUMANISTIC (EXISTENTIAL) FRAMEWORK

Nursing Application
Concepts:
 Assist client thought or cognitive pattern
1. Human beings have potential to grow
 Participate in cognitive restructuring as part of
2. Human beings can exercise freedom of choice
team approach
3. Freedom to choose among alternatives gives
meaning to person’s life
BEHAVIORAL FRAMEWORK
4. Human beings are responsible for their own
 Focuses on learned behavior
behavior

Hanna Abajar BSN-3A

Humanistic View of Mental Illness “Accepting difference is when you recognize and respect
 Failure to fully develop one’s potential people who are different to you, but also embrace their
 Lack of self-awareness and unmet needs differences and see what you can learn from them.”
 Interfere with relationships and feelings of
security
 Fundamental human anxiety, fear of death

Humanistic Treatment
1. Client-centered therapy by Rogers
Therapist attempts to achieve emphatic
rapport, listens carefully to the patient &
reflect what is understood
2. Gestalt therapy by Pearls
Patient is assisting to express feelings
such as in role playing, confronting
feelings leading to acceptance of self &
to a more mature behavior

Nursing Application
 Basic nurse patient interaction are based on
positive regard, empathy and respect
 Client-centered patient is encouraged to initiate
topics

PSYCHOBIOLOGIC FRAMEWORK
 Focuses on disease approach such as
identification of syndromes, establishment of
diagnosis, and search for etiologies
 Mental illness has certain symptoms that can be
classified and treated

Psychobiologic View of Mental Illness

 Mental illness is a disorder of the body and can
be classified in DSM IV-TR and labeling a
mental disorder as an illness help patient on
treatment and recovery

Psychobiologic Treatment
 Diagnostic tools- brain scanning, imaging and
laboratory tests
 Pharmacotherapy
 Psychotherapy

Nursing application
1. Observe and assess patient behavior
2. Administer treatments and foster client’s
compliance
3. Teach clients and families about symptoms
recognition, medications, treatments, and
relapse prevention
4. Coordinate diverse aspects of care

Hanna Abajar BSN-3A