BASIC CONCEPT OF MENTAL HEALTH Self-

- Mental health is one’s ability to cope with and

- This is the framework of reference the individual
adjust to the recurrent stresses of everyday living.
uses for all he or she knows and experiences.
- Mental illness is evidenced by a pattern of
- It includes all perceptions and values held by the
behaviors that is conspicuous, threatening, and
individual and the individual’s behaviors and
disruptive of relationships or deviates from
interactions.
acceptable behaviors.
BASIC CONCEPTS RELATED TO MENTAL HEALTH
Mental Health Continuum - Stress is the nonspecific response to the body to
any demand made on it.
On the illness end, the person is rarely in touch with reality, - An individual’s response to stressful situations or
but on the healthy side, the person demonstrates a high events is often a result of learned or conditioned
level of wellness. behavior.
ASSESSMENT OF COMPONENTS OF MENTAL HEALTH
➢ A positive self-concept • Physical, social or spiritual, economic, chemical
➢ Awareness of responsibility for one’s behavior and
its consequences
➢ Maintenance of satisfying interpersonal
relationships - This is a vague feeling of apprehension that results
➢ Adaptability to changes from a perceived threat to self.
➢ Effective communication - Anxiety is a major component of all mental health
➢ Awareness and acceptance of emotions and their disturbances.
expressions
➢ Recognition and use of supportive system
PERSONALITY AND SELF-CONCEPT
Personality ➢ Problem-solving and constructive action
➢ Severe forms interfere with daily activities.
➢ The relatively consistent sort of attitudes and ➢ Immobilized coping skills and result of emotional
behaviors particular to an individual chaos
➢ Patterns of mental, emotional, and behavioral traits ➢ Degree of anxiety influenced by
woven together - How the person views the stressor
➢ Influenced by genetics and interactions with the - The number of stressors being handled at
environment one time
➢ Individual’s internal and external patterns of - Previous experience with similar situations
adjustment to life - Magnitude of change the event
Erik Erikson represents for the individual

- Provided a framework for understanding

personality development - The gathering of personal resources or inner drive to
- If a given task is not mastered, then a set of complete a task or reach a goal
behaviors can be predicted.
- May be generated by
Sigmund Freud
• Perceived reward
Personality development has three parts: • Perceived threat of punishment
• Frustration
Functions on a primitive level and is aimed primarily at
experiencing pleasure and avoiding pain - This involves anything that interferes with goal-directed
activity.
Ego Functions to integrate and mediate between the self - Some people are more flexible and adaptable than
and the rest of the environment others.
- When adaptive behavior fails, anxiety increases.
Superego The moralistic censoring force; that develops
from the ego in response to reward or punishment from
others
- This is a mental struggle, either conscious or unconscious, - Confusion, disbelief, and high anxiety
resulting from the simultaneous presence of opposing or - Denial
incompatible thoughts, ideas, goals, or emotional forces, - Reality; anger and remorse
such as impulses, denials, or drives. - Sadness and crying
- Reconciliation and adaptation
- Some conflicts are easily resolved; others are more
complicated.
- Provide accurate information that aids in a realistic
ADAPTATION AND COPING
perception of the situation.
Adaptation - Encourage venting of feelings.
- Identify family supports and adequate coping
- An individual’s ability to adjust to changing life
mechanisms.
situations using various strategies
- Coping responses: Used to reduce anxiety
brought on by stress:
Examples: Overeating, drinking, smoking, withdrawal,
seeking someone to talk to, yelling, exercising, fighting,
pacing, or listening to music

- Unconscious intrapsychic reactions that offer

protection to the self from a stressful situation
- Behavioral patterns that protect the individual
against a real or perceived threat
- Blocking conscious awareness of threatening
feelings

ILLNESS BEHAVIOR
Illness

- This is a state of homeostatic imbalance.

Crisis

- This is a time of change or turning point in life

when patterns of living must be modified to
prevent disorganization of the person or family.
- Behavior is learned, and individuals bring their
learned behavior patterns into the health care
setting.

• Denial
• Anxiety
• Shock
• Anger
• Withdrawal
 the boy as taboo against incest in the boy’s
superego.
Psychosexual Stages
The stages include: oral, anal, phallic, latency, and genital
A person can become “fixated” or stuck at a stage and as - Girls also have incestuous feelings for their dad
an adult attempt to achieve pleasure as in ways that are and compete with their mother.
equivalent to how it was achieved in these stages - Penis Envy – Little girl suffer from deprivation and
loss and blames her mother for “sending her into
Freud’s Stages of Development the world insufficiently equipped” causing her to
resent her mother
- In an attempt to take her mother’s place, she
eventually identifies with her mother
- Fixation can lead to excessive masculinity in males
and the need for attention or domination in
females

- Sexuality is repressed (Latent means “hidden”) due

to intense anxiety caused by Oedipus complex
- Mouth is associated with sexual pleasure - Children participate in hobbies, school, and same-
sex friendships that strengthen their sexual
- Pleasure comes from chewing, biting, and sucking. identity
- Weaning a child can lead to fixation if not
handled correctly
- Incestuous sexual feelings re-emerge but being
- Fixation can lead to oral activities in adulthood
prohibited by the superego are redirected toward
others who resemble the person’s opposite sex
parent.
- Gratification comes from bowel and bladders - Healthy adults find pleasure in love and work,
functions. fixated adults have their energy tied up in earlier
- Toilet training can lead to fixation if not handled stages
correctly
- Fixation can lead to anal retentive or expulsive
behaviors in adulthood

Erikson’s Theory
- Focus of pleasure shifts to the genitals - Biological in belief that there are innate drives to
- Sexual attraction for opposite-sex parent develop social relationships and that these
- Boys cope with incestuous feelings toward their promote survival (Darwinism)
mother and rival feelings toward their dad - Divided life span into eight psychosocial stages,
(Oedipus Complex). each associated with a different drive and a
- For girls it is called the Electra Complex. problem or crisis to resolve
- Child identifies with and tries to mimic the same - Outcome of each stage varies along a continuum
sex parent to learn gender identity. from positive to negative

- Boys feel hostility and jealousy towards their

fathers but know their father is more powerful. This
leads to:
Castration Anxiety results in boys who feel their father
will punish them by castrating them.
- Resolve this through Identification – imitating and - Infants must rely on others for care
internalizing one’s father’s values, attitudes and - Consistent and dependable caregiving and
mannerisms. (Formation of gender identity & meeting infant needs leads to a sense of trust
superego) - Infants who are not well cared for will develop
- The fact that only the father can have sexual
relations with the mother becomes internalized in
 - Gradually, the adolescent arrives at an integrated
identity
- Successful resolution leads to a positive identity
- Unsuccessful resolution leads to identity confusion
or a negative identity

- Children are discovering their own independence

- Testing more independence by assuming more
self-responsibilities
- Toilet, Feeding, Dressing
- Those given the opportunity to experience
independence will gain a sense of autonomy
- Children that are overly restrained or punished
harshly will developed shame and doubt
- Time for sharing oneself with another person
- Capacity to hold commitments with others leads
to intimacy
- Failure to establish commitments leads to feelings
of isolation

- Preschoolers learn to plan out and carry out their

goals
- Sense of accomplishment leads to initiative
- Feelings of guilt can emerge if the child is made
to feel too anxious or irresponsible

- Caring for others in family, friends, and work leads to

sense of contribution to later generations
- Stagnation comes from a sense of boredom and
meaninglessness

- Stage of life surrounding mastery of knowledge and

intellectual skills
- Sense of competence and achievement leads to
industry
- Feeling incompetent and unproductive leads to
inferiority

- Developing a sense of who one is and where one

is going in life
- The adolescent’s path to successful identity
achievement begins with identity diffusion.
- This is followed by a moratorium period.
 emotional balance for nurse and patient (difficult for both
patient and nurse as psychological dependence persists)

ROLES OF THE NURSES IN THE THERAPEUTIC

The primary roles are the following:

Stranger – offering the client the same acceptance and
courtesy that the nurse would to a stranger
Resource person – providing specific answers to questions
within a larger context.
helping the client to learn formally or informally
Leader – offering direction to the client or group
- Theory was published in 1953
Surrogate – serving as a substitute for another such as a
- Framework for psychodynamic nursing
parent or sibling
- Theory was influenced by Harry Stack Sullivan’s
theory of interpersonal relations. promoting experiences leading to health for
- Middle-range, descriptive, classification theory the client such as expression of feeling
Secondary role
- Consultant
- Stresses the importance of nurses’ ability to understand - Tutor
their own behaviors to help others identify perceived - Safety agent
difficulties. - Mediator
- Administrator
- Emphasizes the focus on the interpersonal processes and
- Observer
therapeutic relationship that develops between the nurse
- Researcher
and client.

- The interpersonal relationship identified by Peplau initially

had four distinct phases: orientation, identification,
exploitation, and resolution.
- In 1997, Peplau combined identification and exploitation
into the working phase and renamed resolution
“termination”

1. Orientation phase
- client seeking assistance, meeting of nurse-patient,
identifying the problem and services needed (interview
process), and guidance.
2. Working phase
- identifying who is best to support needs, patient
addresses personal feelings about the experience and is 1. Sensorimotor stage,
encouraged to participate in care to promote personal • from birth to age 2
acceptance and satisfaction patient attempts to explore, 2. Preoperational stage,
understand and deal with the problem, and gains • from age 2 to age 7
independence on achieving the goal 3. Concrete operational stage,
• from age 7 to age 11
3. Termination Phase
4. Formal operational stage,
- termination of the therapeutic relationship to encourage •
 • begins during adolescence and continues • The theory further states that the purpose of all
into adulthood. behavior is to get needs met through interpersonal
interactions and decrease or avoid anxiety

- Information is gained directly through the

senses and motor actions
- In this stage child perceives and manipulates
but does not reason
- Symbols become internalized through
language development
- Object permanence is acquired – the
understanding that an object continues to
exist even if it can’t be seen

Assumes that clients can be trusted to select their own

therapists, to choose the frequency and length of their
• Ability to think logically about abstract principles therapy, to talk or to be silent, to decide what needs to
and hypothetical situations be explored, to achieve their own insights, and to be the
architects of their own lives.
• Develops logical thinking and reasoning, achieves
cognitive maturity NECESSARY AND SU FFICIENT CONDITIONS FOR
• Adolescent egocentrism illustrated by the
phenomenon of personal fable and imaginary
audience
- A relationship must exist so that two people may have
an impact on each other.

- For change to take place, a client must be in a state of

psychological vulnerability. There is a discrepancy between
individuals' views of themselves and their actual
experience. Included would be depression, anxiety, or a
wide variety of problems. Although individuals may not be
• He proposed interpersonal theory of personality. aware at first of their incongruence or vulnerability, they
will be so if therapy continues.
• He explained the role of interpersonal relationships
and social experiences in shaping personality.
• He also explained about the importance of Therapists are aware of themselves. They are aware of
current life events to psychopathology. their feelings, their experiences as they relate to the client,
and their general reaction to the client. Therapists are
open to understanding their own experiences as will as
those of the client
- Also known as respondent conditioning refers to a
form of learning that occurs through the
repeated association of 2 or more different stimuli.
- The therapist does not judge the client but accepts the
- Learning is only said to have occurred when a
client for who he or she is. Accepting the client does not
particular stimulus consistently produces a
mean that the counselor agrees with the client. With
response that it did not previously produce.
acceptance often comes caring and warmth.
- In classical conditions, a response that is
automatically produced by one stimulus becomes
associated, or linked, with another stimulus that
- The therapist enters the world of the client, leaving
would not normally produce this response.
behind, as much as possible, his or her own values. Since it
is not possible to be "value free," the therapist monitors his
or her own values and feelings. The therapist tries to
There are 4 key elements that are used to describe the
understand the experience of the client, what it is to be
process of classical conditioning:
the client. Caring and warmth are expressed often in
statements of empathy. 1. Unconditioned Stimulus
The unconditioned stimulus (UCS) is any stimulus that
consistently produces a particular, naturally occurring,
- Not only must the therapist unconditionally accept and
automatic response. In Pavlov’s experiment, the UCS was
understand the client, the client must perceive that he or
the food (meat powder).
she is being understood and accepted. Therapists' voice
tone and physical expression contribute to the 2. Unconditioned Response
communication of empathy and acceptance. Thus, they
The unconditioned response (UCR) is the response that
are a part of the client's perception of empathy.
occurs automatically when the UCS is presented. A UCR
is a reflexive, involuntary response that is predictably
caused by a UCS. In Pavlov’s experiments, the UCR was
the salivation.
Pavlov, a Russian physiologist, first described classical
3. Conditioned Stimulus
conditioning in 1899 while conducting research into the
digestive system of dogs. The conditioned stimulus (CS) is the stimulus that is neutral
at the start of the conditioning process and does not
He was particularly interested in the role of salivary
normally produce the UCR. Yet, through repeated
secretions in the digestion of food and was awarded the
association with the UCS, the CS triggers a very similar
Nobel Prize for Medicine or Physiology in 1904.
response to that caused by the UCS. Association refers to
the pairing or linking of 1 stimulus with another stimulus.
In Pavlov’s experiments, the bell and subsequently other
- Pavlov used an apparatus to measure the
stimuli were initially neutral, but each became associated
amount of saliva produced when a dog ate. with the meat powder. Once conditioning has occurred
- The flow of saliva occurred naturally
and the originally neutral stimulus produces the response
whenever food was placed in the dog’s
of salivating, then it is called the CS.
mouth, as salivation is an involuntary, reflex
response.
4. Conditioned Response

The conditioned response (CR) is the learned response

- Dog was restrained in a harness to avoid that is produced by the CS. The CR occurs after the CS
extraneous variables. has been associated with the UCS. The behaviour involved
- Meat powder was placed directly on the dog’s in a CR is very similar to that of the UCR, but it is triggered
tongue or in the bowl. by the CS alone. Pavlov’s dogs displayed a CR (salivation)
- A tube was surgically attached to the dog’s cheek only when they began to salivate to a CS. When the dog
near one of the salivary glands and a fistula was responded to a CS, such as the sound of a bell, classical
made so that the saliva drained straight out into conditioning had taken place because salivation would not
a measuring device. be a usual response to the sound of a bell.
- Further on, more sophisticate measuring devices
were used to measure the speed of saliva flow.