Promoting Mental Health and Adaptation - Essay Example

Promoting Mental Health and Adaptation: A Case Study and Analysis Life events John, a 24 years old man has been mentally disturbed due to certain events in his life. Two years ago his parents died in motor accident and until now he finds it difficult to come back to former happy and fullfilled life. Having been raised up in the atmosphere of love and care, John has never faced the loss of close people and did not previously deal with such kind of hardships. All his life was deprived of sorrows. If such appeared, support from the family was always helpful. Now, when John became an adult, the difficulty of facing the loss of dear people is dealt on the lever of child's perception of losing someone very dear who made up his or her world. John initially tried to fight with his problem. He was very much eager to accept life events that came on his way and to become happy again. Support of two sisters and an aunt, with whom he is living in two-bedroom house were supposedly to be helpful. However, the contact with relatives did not input to Johns' post-trauma healing; he rather became more annoying and lost. Taking medications for one year after the death of parents was not approved by doctors as well. Under the effect of anti-depressants, his state was only temporarly improved. In a while, he became depressed again and faced the problem over and over again. As his aunt noted, later on John's life started to stabilize. For half a year he was positive and seemed to go on well with the problem. But in the month of October, the time when the accident took place, John changed his behaviour instantly. Like after the death of parents, he became withdrawn from the outter world, reserved and depressed with low concentration and little sleep. John started to drink alcohol, gradually becaming abused to it, and finally lost motivation and interest in everything he did. The ultimate point that showed the evidence of taking Jone's problem under the control of psychologysts and clinicians was finding him unconcsious with a bruised face. He probably drank a lot, as the vomitting around him testified. Whether it is in acute care, such as the Emergency Room, chronic care such as a nursing home or a primary setting such as a doctor's office, the goals of broader contextual objectives must be kept in mind. In John's case, it is unfortunate that a mental health nurse was not present at the time that he was brought to the emergency room following what was obviously a failed attempt at taking his own life with an overdose of Paracetamol. In John's case, the attempted suicide is definitely a defining life event. Life stages John's case may be analyzed according to Erikson's theories of life stages. The most important points to bear in mind when diagnosing or analyzing a case according to the system of life stages are the following: The importance of seeing all behavior in a SOCIAL CONTEXT. This is summed up by the bio-psycho-social model. Erikson's introduction of ETHICAL PERSPECTIVES into psychology. The life stages exemplify this push/pull nature of life with its inherent dichotomies. When one accepts the existence of these conflicts, one can start trying to resolve issues in non-violent ways. (Brenman-Gibson and Mickles, 2006) Firstly, John's inability to share his trauma with others is an anti-social stance. As it has been pointed out above, any diagnosis of John's case should begin with the recognition that he must accept the presence of a conflict in his life. Since "transformation is possible only where man learns to be nonviolent towards himself as well as towards others" (Brenman-Gibson and Mickles, 2006), John's act of violence towards himself may only be resolved in his mind if he accepts that there may be non-violent solutions to his distress. John is at what Erikson described as the sixth stage in a human being's life, early adulthood. The primary development that an individual undergoes during this stage is Learning Intimacy Versus Isolation, and the "successful young adult, for the first time, can experience true intimacy - the sort of intimacy that makes possible good marriage or a genuine and enduring friendship." ("Erikson's Eight Stages," 1998) In John's case, the trauma of losing his parents has meant that he is unable to carry out the objective of this phase of his life, and he is therefore unable to build intimate personal relationships with other people (including his sister and aunt). As Clifton and Davis observe, "the danger at this stage is isolation which can lead to severe character problems" (Clifton and Davis 1995). John already seems to be suffering from isolation, which has led to his inability to communicate his thoughts to other people around him. This may be extended to doctors, nurses and other non-familial care-givers as well. Newman's concept of the consciousness may also be used to analyse John's case. For Newman, "consciousness is defined as the information of the system: the capacity of the system to interact with the environment" (Quoted in "Nursing Models," 2006). Consciousness, then, directs a person to act in varying situations, and determines the individual's responses to disparate contexts. John is the victim of such aberrant acts as alcohol abuse and suicidal depression because he is unable to interact with his environment in the way that he would have had his parents still been alive. Disease may be understood in Newman's system as the absence of the ability to deal coherently with the world: "Sickness can provide a kind of shock that reorganizes the relationships" that the person has constructed in his/her cognitive interactions with the world and with other people. If consciousness is the ability to interact with the world, then disease may be defined as the loss of control over one's responses to the world. John's loss of control over his processes of interaction with the world may be diagnosed as being the result of a reorganization of his relationships because of the shock that he has suffered. Erikson's model consists of two distinct halves, "a child development half and an adult development half" (Boeree 1997). John's adult development has been halted or distorted at an early stage, and the causes for the interruption must be addressed before the patient can proceed toward normal adult development on a psychological basis. There are essentially two kinds of traumas that may lead to the symptoms that John is experiencing: "shock trauma-single-episode traumatic experiences such as war, rape, or natural disasters-and developmental trauma, which refers to interruptions in the predictable psychological stages of growth" ("Body-Mind Mental Health Therapies," 1996). John's seems to be a case of the first leading to the second. After the shock trauma of his parents' death, John has moved toward developmental trauma because he is unable to move beyond his current psychological state. The diagnosis in John's case should be made on evidence-based practice rather than on a clinical diagnosis of his condition. "Evidence-based practice was initiated in England in the early 1990s as a way to ensure decisions regarding the provision of clinical services were driven by evidence that care was clinically effective and cost efficient" (Lee 2002). There are essentially two kinds of practice: that based on clinical diagnosis, and that based on diagnosis that rests on empirical evidence regarding the patient and/or disease. This provider holds the belief that evidence-based practice is more efficient and effective in terms of the care given to the patient, especially one like John, who has already been misdiagnosed. Coping mechanisms All of us cope with the world in different ways. As Harder points out, "Erikson's basic philosophy might be said to rest on two major themes: (1) the world gets bigger as we go along and (2) failure is cumulative" (Harder 2002). In other words, the world is already a very stressful place, and John's stress may be seen as a case of being unable to cope with his trauma adequately because of an excess of stress. Firstly, it may be suggested that John was put on medication with too much haste, leading to his discontinuing the drugs and worsening his situation. Consequently, John's coping mechanisms have become maladjusted, and possibly even damaged by the drugs creating in him a sense of clinical dependency. His decision to stop taking the anti-depressants may have been an attempt to kick his coping mechanisms back into shape, but the shock and trauma he had already suffered were apparently too great to allow him to substantiate his coping mechanisms once more. Following Lee's system, it would be advisable to take the following steps in understanding how John's coping mechanisms can be restored: Implementing Changes Based on Evidence Gathering sufficient evidence to support a change in prognosis. Initiating steps to inform the health care providers of these practice changes. Including mandatory instruction in the new procedure for all nursing personnel who hold responsibility Revising prescription materials and criterion-based competency checklists. The question may also be asked: why EBD and not CBD Doss (2005) has addressed the issue, arguing for the validity of EBD over clinical diagnoses. "A complete EBD assessment [] would thoroughly assess all domains and allow [the health care providers] to consider co-occurring diagnoses for [the patient]" (Doss 2005). John needs a revised prescription and methodology of treatment following an evidence-based diagnosis. Another aspect of John's diagnosis would be the consent of his family to a new programme of therapy, especially in terms of the financial status of the family. As Bakken (2002) points out, "measuring the cost of a new therapy" provides "useful information as part of an economic analysis," which may enhance the role of the health care provider. Whatever the prognosis may be, it is important that John's aunt and sister be consulted before any prescriptions are implemented. Also, this researcher recommends that the diagnosis and prescription be reviewed in a meeting of a group of mental health care providers who are accustomed to caring for patients diagnose with acute mental illnesses, since such an effort "allows nurses to combine knowledge and skills when addressing patient care issues, share the workload, provide mutual social support, and facilitate best practices" (Plonczynski 2005). Although more tests and study are required in John's case, this mental health care provider has made a preliminary diagnosis of Post-Traumatic Stress Disorder. Ass it has been observed, PTSD is often difficult to diagnose: The diagnosis of PTSD may be difficult to make for many reasons. Patients may not recognize the link between their symptoms and an experienced traumatic event; patients may be unwilling to disclose the event; or the presentation may be obscured by depression, substance abuse, or other co-morbidities. Direct, empathic, and nonjudgmental questioning is recommended when physicians take a patient history. (Grinage 2003) As recommended by Grinage, John will probably need several sessions of empathetic talk therapy in order for this provider to ascertain that he is indeed suffering from PTSD. It is also recommended that John be prescribed behavioural therapy, which will focus attention to his actions rather than his thoughts. Behavioural therapy involves some of the following implementations: People are encouraged to learn new ways of behaving through gradual changes and exposure to feared situations. They are often asked to keep diaries to record their activities and to monitor their progress. It is particularly useful in the treatment of phobias and anxiety. ("Talking Treatments," 2005) Once John has been treated for his physical condition following the event of his taking an overdose of medication, it is advisable that he be encouraged into a dialogue with himself by keeping a simple diary. This may encourage him to express some of his trauma in a communicative attempt to talk to himself. Once he is comfortable with this, he may be gently encouraged to share his writing with his health care provider, or perhaps be encouraged to talk about his feelings and communicate them to another person. In order to strengthen John's psychological state and coping mechanisms, it is imperative that he is not forced to find himself dependent on drugs. The alcohol abuse he has put himself through illustrates that he has a proclivity towards addiction and dependency. Therefore, in order to repair the patient's coping mechanisms, he must be allowed to recuperate and heal without the prescription of psychiatric drugs, at least until he has regained the cognitive ability to count on himself and his capacity to deal with his trauma. It is imperative that John's coping mechanisms be rerouted from the maladjusted direction they have been heading in since his parents' deaths, and they must be brought back on track before his psychological status may be returned to a state of normalcy. Role of a mental health nurse in promoting mental health Mental health often is described in negative terms--as the absence of objective signs of mental disease or in terms of "normality" reflecting the prevailing norms in the society. It is the objective of mental nurses to promote positive meantl health, that is regarded as real and existing in itself. A well-known example is Sigmund Freud's observation that a healthy person is a person who is able to work and love. Marie Jahoda's classic work (1958) remains an important and oft-cited contribution on this topic, in reviewing the literature, Jahoda found six different approaches to mental health: the attitudes of an individual toward self; growth, development, or self-actualization; integration; autonomy; perception of reality; and the ability to cope with one's environment. In a philosophical analysis of positive mental health, Tengland (1998) devised the concept of "acceptable mental health," which includes the ability to exercise practical rationality and to cooperate. According to Lindstrom (1987), mental health promotion is directed toward preserving the resource-bearing components of the individual, as well as regarding each person as a unique human being. Hummelvoll and Barbosa da Silva (1994) argue that the task for the nurse is to form models that provide opportunities for clients to experience a spirit of community and social support. "The ultimate goal is that such experiences can be transferred into daily living outside the therapeutic setting" (p. 9). This perspective opens up completely new opportunities compared to the comprehensive campaigns directed toward behavioral changes that often are connected with health promotion. To reach this goal, a life-world perspective is as necessary in mental health promotion as it is in caring in general. In the case with John, mental health nurse should develop a holistic approach to her practice. It will provide a roadmap to understanding both the limitations as well as the possibilities that the profession offers its practitioner. Sitzman suggests that 'mindfulness' of the other person - i.e., the patient - and his/her needs can provide a much deeper understanding of the nurse's role than if the nurse were to be a care-giver based on clinical or theoretical principles. She writes: "if one is to work from a caring healing paradigm, one must live it out in daily life" (Sitzman, 2002). In other words, it is important for the nurse to understand that whatever is offered to the patient in terms of care must be viable on an everyday, empirical basis. John's health promotion can be carried out in groups, where people can confirm and make each other visible as people. In the group, time can be devoted not only to reflection and focusing but also to educational and positive elements of importance to the group members (e.g., to study nutritional or economical issues, to perform social activities together such as making a theatre visit). The American Surgeon General has said that the "the health of the individual is inseparable from the health of the larger community" ("National Health Goals," 2000). It is important for the mental health care provider to recognise that the patient is not someone who is to be addressed in isolation, but that there are family and friends - indeed, the community itself - to consider. Since mental illness often carries a social stigma, an essential task of the health care provider is to debunk the myths about mental illness. As Grossman (2004) points out, "Innovation and change are two of the hardest things for people to accept." Any attempt to heal or care for the patient is an attempt at change, and the health care provider must persevere in his/her attempt to convince the patient and his family that a change is necessary. Conclusion Advancements in the standards of health-care are being implemented in leaps and bounds. Capuzzi (2002) points out that processes are constantly being revised in the context of the manner in which medical practitioners approach various levels of treatment: Woody Allen is still making movies, but the kind of psychotherapy he made famous -- lying on a couch, endlessly talking about your mother and your lousy childhood -- is losing its audience. Those who find themselves in a therapist's office these days are likely to encounter a very different form of treatment, one that's short-term, goal-oriented and evidence-based. It will probably involve sitting upright in a chair. (Capuzzi 2002) Capuzzi points out that new forms of treatment are overtaking the old, as in the traditional idea of lying on a psychotherapist's couch, which is now almost completely obsolete. One of these new methods, for example, is the idea of cognitive therapy, which is "the fastest growing and most rigorously studied kind of talk therapy, the subject of at least 325 clinical trials evaluating its efficacy in treating everything from depression to schizophrenia" (Capuzzi 2002). Consequently, the mental health care provider must have the critical ability to determine which patients are likely to respond to which method of treatment. It seems to be a myth that mental illness is fundamentally different from overtly physical illnesses. There is a psychological aspect to every physical ailment, and vice versa. As in any other form of health care, mental health care provision should be structured in terms of prognosis and prescription. The only primary way to promote health care for patients suffering from psychological illnesses is to create awareness among the public that mental illness is treatable with drugs like any other sickness. 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