Analysis of Mental Health and Mental Illness - Research Paper Example

As nurses have the responsibility of providing care to patients, it is important to understand the individual characteristics of a patient that contributes to their health behaviors. Nurses must consider the root or cause of an individual's behavior as well as its meaning and context because it may be mere reflections of realistic forces in the person's life and culture (Stuart & Laraia, 2005). Hence, it is imperative for professionals in the nursing field to have a strong grasp of the mental health and mental illness concepts and disorders in order to be able to render quality nursing care to all the individuals that are encountered in the health care setting. This paper tackles the broad concepts of mental health, mental illness, and anxiety as a deviation from mental health. Mental Health and Mental Illness Defined It is very difficult to give mental health an exact and precise definition. Often, people associate mental health with happiness, contentment, satisfaction, achievement, optimism, or hope (Videbeck, 2004). These associations, however, are problematic in the sense that these abstract concepts manifest differently with each individual. Generally, behavior is the determinant of a person's mental well-being, but since behavior is greatly influenced by culture, tradition, and personal beliefs, it is very difficult to determine what acceptable behavior is and what is not. As such, there is not one universal definition of mental health. The World Health Organization defines health as "the state of complete physical, mental, and social well-being" (WHO, 2007). Health, therefore, not only covers a person's physiologic needs, but also includes a person's psychologic, emotional, social, and mental needs. It is the balance between all aspects of our lives. According to Mosby's Pocket Dictionary, mental health defined is "a relative state of mind in which a person is able to cope with and adjust to the recurrent stresses of everyday living in an acceptable way" (Allen et. al. 2002, pp. 784-85). Videbeck, on the other hand, defined mental health as "a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability" (2004, p.3). In these definitions, the concepts of "acceptable behavior", "emotional stability", and "effective behavior and coping" are encountered. Are these terms measurable' If so, in what way' These concepts vary in manifestations in a person's everyday living, as there are different cultures, traditions and practices, beliefs and religions, and environment and familial background and upbringing. Stuart and Laria (2005) claims that it is dangerous to equate personal or mental abnormalities with mere deviant or non-conformist behavior, and that mental health and illness, and conformity and deviation must be regarded as separate concepts. Mental illness was hence defined by the American Psychiatric Association as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom" (2000, quoted in Videbeck 2004, p.3). The Draft Mental Health Bill of 2004 provides a shorter yet vague definition of mental disorder: "an impairment of, or a disturbance in, the functioning of the mind or brain resulting from any disability or disorder of the mind or brain" (Definition of Mental Disorder and Exclusions, 2008). There are many varied perceptions on mental illness throughout history. During the ancient times, it was believed that any illness was due to displeasure of the gods and was punishment for sins (Videbeck, 2004). People with mental disorders were perceived to be either divine or demonic, depending on the behavior. Those who were viewed as divine were worshipped, whereas those who were seen as demonic were ostracized, condemned, or burned at the stake (Videbeck, 2004). Some time later, Aristotle proposed that mental disorders stemmed from an imbalance in the amounts of blood, water, and yellow and black bile in the body (Videbeck, 2004). These four physical elements, according to Aristotle, corresponded with happiness, calmness, anger, and sadness respectively. Bloodletting, starving, and purging was the treatment for these imbalances, which persisted until the 19th century (Videbeck, 2004). During the early Christian times, as superstitions were very strong, mental illnesses were again believed to be caused by demons and they were deemed as possessed (Videbeck, 2004). Exorcism was hence the treatment. In 1547, the St. Mary of Bethlehem hospital was established, the first hospital for the insane during that time (Videbeck, 2004). Two hundred twenty-eight years later, the hospital was opened to visitors, who paid a fee just to be able to look at and ridicule the inmates, who were then viewed as less than human (Videbeck, 2004). Mental Health Statistics The Office for National Statistics states that one in every four people experiences some kind of mental health disorder in a year (Brindley, 2007). In Wales, there are one in every nine women, and one in every 14 men who have been diagnosed and treated with mental illness (Brindley, 2007). In addition to this, more than a million children were found to have mental health problems, based on a study done sometime in 2006 (The Disturbed Generation, 2007). On the other hand, there are more than 700,000 elders who have been diagnosed with dementia (Brindley, 2007). It seems that the numbers of mental illness patients have not been going down, but instead has been increasing, maybe because the health system in England is failing more patients than it helps (Brady, 2006). Emma Brady (2006) wrote in her article in The Birmingham Post that "the social stigma still attached to many mental health problems prevents patients from seeking appropriate treatment", and this, in turn, affects health care in general. Due to the negative perception on mental illness, people do not seek professional help, in fear of being found out and being ostracized or criticized. The finding that in 1996, 40 percent of tabloid articles on mental issues used derogatory terms such as "nutter" or "psycho" may evidence this (Brindley, 2007). In addition to this, the British Social Attitudes survey revealed that 81 percent of the population in England would experience feelings of "unhappiness" that a relative or family member would marry a person who has been diagnosed or treated with schizophrenia (Brindley, 2007). It is devastating to know that even young people are burdened by severe emotional problems and thus experience mental disorders. The Office of National Statistics claim that 10 percent of the youth aged between five and 16, has a "clinically recognisable" mental illness (The Disturbed Generation, 2007). Furthermore, the same study conducted by the same office discovered that these cases were mostly attributed to broken families and "reconstituted families" with stepchildren (The Disturbed Generation, 2007). Apart from this, another appalling number to consider is that in the year 2005 to 2006, there were 765 homicides and 52 murders recorded by the police that were committed by someone suffering from mental illnesses (Brindley, 2007). The number of antidepressants prescribed to patients has also increased to 31 million (Brindley, 2007). Vulnerability Factors To be able to understand better the concepts of mental health and mental illness, and how people become vulnerable to it, many different factors must be considered. According to the World Health Organization, mental health and mental illnesses are determined by a combination of social, psychological, and biological factors, just like health and illness in general (WHO, 2007). These factors may include poverty, level of education, poor housing, and poor income that may all affect a person's emotional experiences and general outlook in life. There are criteria or characteristics that influence mental health: Autonomy and independence refers to one's self-determination and the ability to recognize the opinions and decisions of others, as well as accept the consequences of his actions (Videbeck 2004; Stuart & Laraia, 2005). Maximization of one's own potential or self-actualization enables a person to recognize his own talents, skills, potential, and strive for growth and progress in life (What is Mental Health, 2006). A person who has self-actualization does not get contented with the status quo, but strives to realize his own potentials (videbeck, 2004). Environmental mastery, on the other hand, enables a person to feel fulfilled in his role in society, and can deal effectively with the world, cope and solve personal problems, and become satisfied with his own life as realized by his self-actualization (Stuart & Laraia, 2005). Integration and flexibility allows an individual to adjust himself to certain situations in the world (Stuart & Laraia, 2005). These mentally healthy persons are also able to express their emotions during times of stress and be able to bounce back from misfortune (What is Mental Health, 2006). Most important of all factors in determining a person's mental health, is the reality orientation or perception. This refers to how a person can differentiate between what is fact and fantasy in order to be able to act acceptably (Videbeck, 2004). The concepts discussed above are merely a few of the important factors that influence mental health. There are other physiologic, anvironmental, spiritual, and social factors that may affect a person's mental health. Among these important factors are self-esteem, self-concept, familial background, biologic make-up, emotional resilience, feelings of security and safety, and so forth (Videbeck, 2004). As mental health is comprised of many different factors, mental illness is as well rooted in many varying aspects of shortcomings or overindulgence in a person's life and experiences. Randolph Nesse provided five possible reasons using an evolutionary approach as to why people are vulnerable to mental disorders (2005). Nesse postulated that there is a mismatch between a person's body and his environment as the human body was not designed for life in a modern environment (2005). A precise example of this theory is the drug and alcohol problems. The Institute of Medicine stated, "The rapid spread of alcohol-making technology changed our world in ways our specieshas not yet adapted to" (1987, quoted from Nesse 2005, p.905). It has also been proposed that infections cause a wide range of mental illnesses especially that of mood or affective disorders like schizophrenia (Nesse, 2005). In addition, it may be deduced from this that infections may make a person anxious, and may then lead to depression. Anxiety Defined Anxiety is more commonly perceived as a general term pertaining to feelings of frustration, anger, or fear. However, the Mosby's Pocket Dictionary defines anxiety as "(1) anticipation of impending danger and dread accompanied by restlessness, tension, tachycardia, and breathing difficulty, not associated with any apparent source of stimulus; and (2) a vague, uneasy feeling, the source of which is often non-specific or unknown to the individual" (Allen et. al., 2002, p.92). Meanwhile, Stuart and Laraia (2005, p.858) expounded that anxiety is "a diffuse apprehension vague in nature associated with feelings of uncertainty and helplessness. It is an emotion without a specific object, is subjectively experienced by the individual, and is communicated interpersonally. It occurs as a result of a threat to the person's being, self-esteem, or identity." The ICD-10, or the International Classification of Diseases (2007) states that a generalized anxiety disorder is "anxiety that is generalized and persistent, but not restricted to, or even strongly predominating in, any particular environmental circumstances." The ICD-10 further more lists the dominant variable symptoms of a generalized anxiety disorder. These are: persistent nervousness, trembling, muscular tensions, sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort (ICD-10, 2007). Anxiety Statistics Throughout the general population, anxiety is common. However, to be able to get a formal diagnosis of anxiety, there must be present a certain number of symptoms as indicated in the ICD-10 or the 1994 version of the DSM-IV of the American Psychological Association (Baldwin et. al. 2005, p.569). The epidemiological studies conducted in 2005 revealed that people aged 18 to 65 years old had a 12-month period prevalence of approximately 15 percent, and a lifetime prevalence of 21 percent (Baldwin et. al. 2005). As there are a variety of different disorders under the umbrella of anxiety, the age and sex distribution of individual disorder varies as well (Baldwin et. al. 2005). For instance, some phobias are remarkably more prevalent in women than in men, and vise versa while some panic disorders are just as frequent in men and women between the ages 51 and 65 years old (Baldwin et. al. 2005). However, the overall ratio of anxiety disorders is 2 females: 1male across all age ranges. From Anxiety to Depression Central to the concept of anxiety is self-preservation as anxiety stems from a threat to an individual's self-esteem or identity, or a threat to something that is vital to one's personality, existence, and security (videbeck, 2004). These threats may be associated with fear of punishment, rejection, withdrawal from love, disruption of a relationship, or loss of a body function (Videbeck, 2004). Despite the fact that anxiety is a frightening facet a person can experience in his lifetime, it can be surpassed, and a person can even grow from it by confronting the threats, moving on, and overcoming the experience from where the anxious emotion rooted from. In 1963, Hildeguard Peplau, one of the early nursing theorists who helped shape psychiatric nursing, identified four levels in the continuum of anxiety and illustrated their effects to a person's response to stress (Stuart and Laraia 2005; Videbeck 2004). The first level is mild anxiety, which is connected to the tensions of day-to-day living. In this level, a person becomes more attuned to his or her surroundings, and is able to see, hear, and grasp more than before (Stuart and Laraia, 2005). This level is an adaptive response to stressors. The next level is moderate anxiety, wherein the person focuses only on immediate concerns, thereby narrowing his perceptions, and seeing, hearing, and grasping less than what he normally does (Stuart and Laraia, 2005). The third level is severe anxiety, wherein an individual markedly sees, hears, and grasps even less than that in the experience of moderate anxiety (Stuart and Laraia, 2005). The individual tends to focus on one thing only and is not able to think of anything else but it (Stuart and Laraia, 2005). The fourth and last level pertains to panic, which is marked by awe, dread, terror, and the inability of a person to do chores or tasks even with ample direction and guidance (Stuart and Laraia, 2005). Panic is a dangerous and maladaptive response to stressors, and may lead to disorganization of the personality, and in some cases even death (Stuart and Laraia, 2005). It is marked by restlessness, distorted perceptions, loss of rational thinking, and impaired relations with others (Stuart and Laraia, 2005). Panic is a common condition that is both debilitating and life threatening. Diagnosing anxiety disorders is a very taxing and tedious task. Accurate diagnosis is key to effective management and treatment. Hence, it must be realised that other conditions may also be present, such as depression (Anxiety amended, 2007). This is termed as comorbidity. Depressive symptoms are commonly present in patients with severe anxiety. Studies in the UK primary medical care suggest a considerable correlation between measures of anxiety and depressive symptom severity (Baldwin et. al. 2005). In addition to this, epidemiological studies reveal that 62 percent of those with an anxiety disorder also manifest the diagnostic criteria for depression (Baldwin et. al. 2005). The ICD-10 presented diagnostic features of chronic mixed anxiety and depression, where one or more physical symptoms and various anxiety and depression symptoms are present for more than six months (Chronic Mixed Anxiety and Depression, 2005): Low or sad mood Loss of interest or pleasure Prominent anxiety or worry Multiple associated sypmtoms such as: Disturbed sleep Disturbed apetite Tremor Suicidal thoughts or self-harm Fatigue or loss of energy Dry mouth Palpitations Tension and restlessness Poor concentration Irritability Dizziness Sexual dysfunction When there is comorbidity of anxiety and depression, the drug treatment for depression is most effective in improving anxiety (Baldwin et.al. 2005). Apart from medical management, there is a range of different effective interventions is available such as psychological therapy and self help (Anxiety amended, 2007). With continous treatment, people are able to get better, and they actually remain better (Anxiety amended, 2007). Gibb's Reflective Cycle Gibbs's Reflective Cycle of 1998 provides a model that can help a person through the learning process to be able to assess his experiences in life and, during episodes of anxiety and depression, be able to re-assess and move through. Gibbs outlined six stages of the reflective cycle (Jasper, 2003): 1. Description of the event (What happened') 2. Feelings (What were you thinking and feeling') 3. Evaluation (What was good and bad about the experience') 4. Analysis (What sense can you make of this situation') 5. Conclusion 6. Action Plan (If the same situation arises again, what would you do') Case Study William is a 34-year-old male, who broke up with his fiancee more than 6 months ago. They were engaged for five months, when he found out that she had been cheating on him with a co-worker. Since then, William has been hesitant to go out with other women, and would sometimes exclaim that he may never marry. William works in advertising. Due to his current break-up, William has been absenting himself from work. He also just recently failed to close a deal with an important client during a creative presentation. Because of this deal he failed to close, William fears that he may soon be fired. According to William's roommate, he has stopped eating well ever since failing to close that deal the previous week, and has not taken a bath since. He refused to eat proper meals, and mainly ate chips and junk food. He also refused to talk about his feelings. In addition to this, William's sleep pattern has been disturbed. He used to sleep for 6 to 8 hours a night. After the break-up, he sleeps for only an hour or two during the night and dozes off in the afternoon. He would in fact sometimes come home in the middle of the day from work to sleep. William's case is a classic example of the comorbidity between anxiety and depression. The symptoms that he manifests are under the ICD-10 description of anxiety and depression symptoms, as stated above. Upon assessment, it is apparent how his face looks sullen and pale. His dry skin and mouth is also noticeable. When asked how he was feeling, William merely shrugged and said "nothing. Okay I guess." William may have been devastated because of the disappointments in his life in the recent months. He fears that he may never feel the same way he used to, when he was still with his fiancee. In William's case, the reflective cycle of Gibbs may apply. He needs to be properly taught how to assess himself and the situations around him, so that he can determine wether his feelings are appropriate and wether his emotions are affecting his behaviour detrimentally. His case is not unique. Other people may have also experienced the same situation he is in right now. Effective coping mechanisms and techniques may be learned from the reflective cycle, and he may also be helped using medical management, psychotherapy, and emotional support from his family and friends. Bibliography Allen, M.A. et al. eds. (2002) Mosby's Pocket Dictionary of Medicine, Nursing, and Allied Health. 4th ed. Philadelphia, Mosby. Anxiety (amended) (2007) [Internet], London, National Institute for Health and Clinical Excellence. Available from: < www.nice.org.uk/nicemedia/pdf/CG022NICEguidelineamended.pdf> Baldwin, D.S. et al. (2005) Evidence-based Guidelines for the Pharmacological Treatment of Anxiety Disorders: Recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology, 19 (6), pp. 567-596. Brady, E. (2006) Midland: Mental Health a Problem in UK, say City Experts, The Birmingham Post, April. Brindley, M. (2007) Mental Health in Numbers. Western Mail, May, p.24. Chronic Mixed Anxiety and Depression (2005) [Internet], UK, National Library for Health. Available from: < http://www.library.nhs.uk/mentalhealth/viewresource.aspx'resid=82618> Definition of Mental Health and Exclusions (n.d.) [Internet], Mental Health Alliance. Available from: < http://www.mentalhealthalliance.org.uk/policy/documents/06Definition.pdf> International Classification of Diseases (2007) [Internet], 10th Revision. World Health Organization. Available from: < http://www.who.int/classifications/apps/icd/icd10online/> Jasper, M. (2003) Beginning Reflective Practice - Foundations in Nursing and Health Care. Cheltenham, Nelson Thornes. Mental Health: Strengthening Mental Health Promotion (2007) [Internet], World Health Organization. Available from: < http://www.who.int/mediacentre/factsheets/fs220/en/> Nesse, R.M. (2005) Evolutionary Psychology and Mental Health. In: Buss, D. ed. The Handbook of Evolutionary Psychology. NJ, Hoboken, pp. 903-927. Stuart, G.W. & Laraia, M.T. (2005) Principles & Practice of Psychiatric Nursing. 8th ed. Philadelphia, Mosby. The Disturbed Generation: A Million Children Now Suffer from Mental Health Problems (2007) The Daily Mail, June. Videbeck, S.L. (2004) Psychiatric Mental Health Nursing. 2nd ed. Philadelphia, Lippincott. What is Mental Health' (2006) [Internet], About.com. Available from: < http://mentalhealth.about.com/cs/stressmanagement/a/whatismental.htm> Read More