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3.1 Introduction
Optimum health
cannot be achieved without having
positive mental
health,
defined as: (1) being comfortable with yourself, (2) feeling
good about relationships with others, and (3) being able to cope
with the demands of life.
Low self-esteem, poor relations with others, inability to cope
with the problems and challenges of day-to-day living, and
difficulty to distinguish fantasy, imagination and reality are
characteristics of mental illness. |
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3.2 Promoting Mental Health:
Information and Skills
Exploring the Self
Socrates said “know yourself”. This is an essential step in
being comfortable with, and accepting yourself: a complex entity
that includes ideal self, public self and private self.
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Personality:
a blend of physical, mental, and social traits unique to the
individual. Heredity, environment, culture and self-concept
influence personality. (Culture: a blend of the influence of
the people in your home, city, and nation. In many ways you
act and think like them).
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Self-concept:
All your beliefs about yourself coming from self-appraisal
of your strengths and weaknesses. Others’ opinions about you
may matter but become less important as you mature.
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Ideal self:
your conscience. Much of it is influenced by your parents
and their values.
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Public self:
is the reputation for which you strive. You act and speak in
ways calculated to influence people to form a certain
opinion of you.
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Private self:
is the actual you. It may
or may not be what you think you ought to be (ideal self),
or what you want others to think of you (public self).
Ideal self, public self, and private self influence personality
and self-concept. Similar ideal, public, and private selves
contribute to a healthy personality.
Maslow’s Hierarchy of Needs
The
psychologist
Abraham Maslow
identified
a hierarchy of needs
necessary for promoting physical and mental health, see Figure
3.1. He believed that needs at the
lower levels
must be met before those at
higher levels
could be attained. At the most basic level is
physiological needs –
food, water, sleep- that sustain life.
Superimposed are the needs for: (1)
safety/security,
first provided by the family, (2)
love/affection;
the example of your family shows you how to receive and give
love, you can then form healthful relations with others, (3)
self-esteem
that develops as you learn more skills that make you
independent, and (4)
self-actualization,
the highest level, when you make full use of your abilities,
developing your talents and fulfilling your potential.
Self-actualization is a lifetime process of always doing your
best. Only a few people manage to develop all their talents to
their fullest.
Figure 3.1: Maslow’s Hierarchy of Needs
Developing a Philosophy of Life
Your philosophy
of life reflects your values and your attitude towards life and
its purpose. It
influences your
thoughts, goals, decisions and actions.
Thoughts generate emotions or feelings. Emotions affect
performance. Examining your philosophy of life is an important
aspect in knowing yourself.
Expressing Emotions
Emotions are feelings arising in
response to life
situations. Happy feelings,
e.g., being loved,
have a holistic
effect
on your lifestyle and situations that produce them contribute to
optimum health. Some situations may result in feelings of loss
or rejection and generate negative emotions, e.g., hurt,
anxiety, anger, guilt, and depression. Healthful ways to deal
with and express these emotions contribute to optimum health.
Feeling hurt/distressed/harmed:
do not bottle your feeling up. Identify the source of the hurt
and express your feelings.
Anxiety
or worry about an anticipated or imagined situation. Pretending
you are not anxious is risk behavior. Try to identify the source
of the anxiety and deal with it if possible. Exercise has a
beneficial effect.
Anger:
if not expressed in healthful ways, harmful mental and
physiological changes occur. It is best to talk about your
feelings with the person who has caused the anger. This should
be done privately as soon as you are calm.
Guilt:
the feeling of having done something wrong or being at fault.
Denial may intensify the feelings of guilt. It is best to admit
you are wrong, to apologize and accept responsibility for your
actions
Depression:
the
feeling of being sad, unhappy, discouraged is a leading mental
disorder.
Defense Mechanisms
A
defense mechanism
is a behavior that is used consciously or unconsciously to
cope with uncomfortable situations or emotions. It may help
you solve a problem when you willfully suppress/delay expressing
your emotions to allow you time to think. Defense mechanisms may
also be used to avoid solving problems, e.g., displacement,
i.e., transferring emotions from the original source to another
object.
It
is helpful to evaluate your use of defense mechanisms. There may
be risks in their frequent use.
Time Perspectives
A
time perspective
is the time
orientation of your thoughts.
Do you think mainly about the past, the present or the
future? A balanced time perspective emphasizes individual
responsibility in achieving positive mental health by making
you (1)
learn from past mistakes
rather than worry
about them so as to hinder performance; a past–time perspective,
(2) enjoy
the pleasures of day-to-day living and work
to accomplish goals rather than needlessly delaying important
decisions or not thinking through your actions; a present-time
perspective, (3)
set goals and become
actualized,
rather than seeking only pleasures and ignoring responsibility
to yourself and others; a future-time perspective.
Focus on Life Management Skills
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Develop a positive
self-concept by
developing strengths, recognizing limitations and
understanding your feelings.
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Make your ideal self, public
self and private self
consistent with each other.
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Take steps
to satisfy your basic needs.
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Be aware when you are using
defense mechanisms,
try to identify what you are trying to avoid.
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Develop a philosophy of life
that influences your thoughts, emotions, and body’s
performance in healthful ways.
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Express love, hurt, anxiety,
anger, guilt, and depression
in healthful ways.
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Balance your time
perspective to
include your past, present, and future.
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3.3. Mental Disorders
Levels of Mental Health
Mental health status is a
combination of the
healthful and risk behaviors you select.
It may fluctuate from day to day and can be rated on a scale
from 0
-e.g., when
suicide is considered
because coping with life is overwhelming – to
100,
(optimum mental health). Closer to the
0
end of the scale
are persons with
mental disorders.
They do not feel comfortable with themselves. They do not have
satisfactory relationships. They are unable to express emotions
or handle problems. Some may be able to function in society;
others are not and have to be hospitalized.
Causes of Mental Disorders
People respond in
different ways to
environmental stress
(i.e., the
physical and mental
demands associated with your environment) and to
life crises
(experiences that cause a high level of mental stress). These
differences may be due to
environmental and
hereditary factors.
The family is most important. It teaches children how to
express emotions and cope with problems and influences
self-concept and behavior pattern. Some mental disorders
tend to run in families. A hereditary predisposition may
still require environmental factors to materialize
(polygenic inheritance).
Brain damage can
cause organic mental disorders.
This may be due to illnesses, e.g.,
brain tumor,
hypothyroidism,
or to
chemical abuse, e.g., alcohol and marijuana.
Types of Mental Disorders
1-Anxiety
Disorders:
Mental disorders characterized by the manifestations of fear
(e.g., apprehension, shakiness, sweating, palpitations, sinking
feelings in the stomach, urinary urgency/frequency). Unlike
fear, the cause of the danger is not known or recognized.
Everybody experiences some anxiety in day-to-day living. Only if
persistent or recurrent, one needs to be concerned. Some types
of anxiety are:
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Phobias:
irrational/exaggerated fears of a thing, e.g., cats,
heights, or a social/environmental situation, e.g., public
speaking, using public toilets.
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Obsessive/compulsive
disorder:
recurrent thoughts or feelings (obsession), or repetitive
actions (compulsion) that are known – by most patients- to
be irrational.
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General anxiety disorder:
the patient feels anxious, tense, fearful and upset most of
the time without apparent reasons.
2-Dissociative
Disorders:
abrupt but temporary loss of memory or identity or feelings of
detachment due to psychological factors. Multiple personality
disorder in which the patient shifts from one personality to
another without being aware is a rare variant.
3-Mood
Disorders:
involve moods that are extreme and interfere with daily living.
It is normal to experience different moods, e.g., loving/happy
moods, hurt/anxious moods.
Depression
is a feeling of hopelessness, sadness, helplessness; with loss
of interest, appetite, sleep, and energy…It may follow loss of a
parent in the first decade of life or a social loss during adult
life, e.g., loss of a spouse. In Manic-depressive
disorder the patient alternates between periods of
depression when he may be suicidal and periods of high mood when
he may be very happy or agitated and angry and may become
violent.
4-Personality
Disorders:
Adults with unusual personality, i.e., unusual patterns of
thinking, feeling, and acting, that interferes with happiness
and daily living have a personality disorder. Examples include:
1- avoidant personality (avoids social contacts because of low
self-esteem and fear of rejection), 2-dependent (insecure and
leaning on others for advice and support), 3-histrionic
(constantly behaves in ways to draw attention to himself)…
5-Schizophrenia:
a mental disorder in which there is a breakdown
in logical thought processes. The patient experiences delusions
(false beliefs), and hallucinations, (false sensations, e.g.,
hearing voices). In paranoid schizophrenia, the patient has
delusions of persecution or grandeur.
6-Somatoform
Disorders:
a group of disorders in which there are symptoms of physical
illness from emotional causes, the patient truly believing that
he has a physical illness. Hypochondria is constant
anxiety about illness. In a conversion disorder,
the patient suddenly loses vision or hearing or sensation in the
skin or becomes paralyzed to get a secondary gain, e.g., to
avoid some responsibility.
7-Suicide:
is not necessarily related to a mental disorder but to the
experience of loss and rejection (loss of love, control,
self-confidence) or the loss of health (e.g., incurable cancer).
Signs that a person may be suicidal include drastic changes in
personality and in sleeping and eating habits, withdrawal from
family and friends, loss of interest in personal appearance and
work, preoccupation with death. When you suspect that someone is
suicidal you should inform others (family, friends),encourage
the suicidal person to talk but do not give false reassurances
that everything will be OK, be supportive, show that you care
and seek professional help.
Recognizing Mental Health Problems
To
stay mentally healthy, it is important to
assess your behavior regularly, recognize risk behaviors and
change them.
Six warning
signs
suggest that it may be time to change a risk behavior: 1)
Boredom with daily activities, 2)
Illness/mental
distress,
3)
Chronic anxiety
and guilt, 4)
Failing performance
at work, 5)Unexpected
failure
in personal relationships, and 6)
Fear of being
unmasked
if your private self and public self are different.
If
you experience these warning signs, then you should seek help.
This may range from talking to family or friends to consulting a
mental health specialist, e.g., a psychiatrist (has a medical
degree) or a psychologist (without a medical degree).
Life Management Skills
·
Assess
mental health status regularly.
·
Avoid
environmental stresses,
e.g., high levels of noise, air pollution, poor lighting.
·
Avoid
abuse
of substances that may harm the brain, e.g., alcohol, marijuana.
·
Learn
to express anger in healthful ways
to avoid depression.
·
Develop a philosophy of life
that focuses on living life to the fullest.
·
Recognize the signs of suicide
and assist others in suicide prevention.
·
Recognize warning signs
that indicate it may be time to change risk behaviors.
·
Be
aware of mental health
services available in your community. |
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3.4 Stress Management
Definitions
Stress:
a nonspecific response of the body to any demand (stressor) made
upon it.
Stressors may be physical,
e.g., running a race,
mental,
e.g., sitting for an exam,
or social,
e.g., asking for a date.
Eustress:
positive and healthful response. You cope successfully with the
stressor.
Distress:
results from unsuccessful coping with, or harmful response to a
stressor, e.g., you are overwhelmed by anxiety and cannot
perform well. The same stressor can produce either eustress or
distress depending on the person's response.
General Adaptation Syndrome
The
response to stress is referred to as the general adaptation
syndrome (GAS). It is divided into
three
stages:
1)
The
alarm stage:
prepares the body for rapid action (fight or flight). Adrenalin
is secreted and increases delivery of blood, oxygen and nutrient
glucose to the muscles.
2)
The
resistance stage:
returns the body to normal homeostasis (i.e., internal balance).
The increased pulse, blood pressure and respiration rate of the
alarm stage return to normal.
3)
The
exhaustion stage:
To remain healthy, stresses must be experienced as eustress or
homeostasis must be regained rapidly after experiencing
distress. Prolongation of either distress or the resistance
stage of GAS leads to the exhaustion stage in which the body
does not function well and its resistance to disease is lowered.
The hormone, cortisol, is secreted.
Holistic Effects of Stress
Stress has a holistic effect. A stressor in one area of health
affects other areas.
Stress and mental health:
Certain personality types tend to react to stress as distress.
Type A personality is competitive, achievement-oriented, with an
intense sense of time urgency and the necessity to accomplish
much in a short time. Type B personality is more relaxed. Too
much type A behavior can cause unnecessary frustration, anxiety
and distress. Too much type B behavior may lead to lack of
meaningful and interesting goals with consequent boredom and
distress.
Stress and family and social health:
common stressors include divorce, death of a loved one,
loneliness, lack of communication skills… Talking to family
or friends, becoming interested in a variety of social
activities, and developing communication skills can help.
Stress and growth and development:
Hormonal and body changes during puberty may cause distress,
e.g., if adolescents develop sooner or later than their friends.
Stress and nutrition :
Diet can affect you, especially during periods of stress. It is
healthful to limit consumption of caffeine, salt, refined sugars
and animal fats (source of cholesterol). Consumption of 250 –
300mg of caffeine over a 2-hour period can trigger the alarm
stage of GAS (Approximate caffeine contents are 100 mg for a cup
of French coffee, 50 mg for a 12-ounce cola, and 20 mg for a
1-ounce chocolate bar).Too much salt increases blood pressure
and cholesterol clogs arteries. Both are risk factors for heart
disease.
Stress and exercise and fitness
: exercise is a good way to relieve stress. Too little exercise
may result in weight gain and a flabby heart muscle.
Stress and drugs:
Drugs such as tobacco, marijuana, and cocaine increase GAS
effects. Alcohol and tranquilizers depress body and brain
functions.
Stress and consumer and personal health:
A consumer is someone who has time and money to spend. Poor
money management obviously creates distress. Distress can also
result from having either too little or too much to do. The
former may be frustrated with boredom (learning a new skill may
help), the latter have a hectic schedule and are susceptible to
disorders such as high blood pressure and heart disease (setting
priorities and limits on time and energy can help).
Stress and Safety and First Aid :
Many accidents occur during periods of stress, especially
reckless driving.
Stress and Community and Environmental Health :
Pollutants in the air and water as well as loud noise create
distress. The behavior of persons with whom you associate can
alter the quality of the environment and reduce or increase your
level of distress, e.g., if your friend is a chain smoker,
drives recklessly and plays loud music, you breathe polluted
air, cannot concentrate from the loud music, and are at risk of
a car accident.
Stress Management Skills
Stress-related and lifestyle-related
illnesses
and accidents
are leading causes of death and disability today.
Knowing and applying stress management skills helps keep you
healthy. These include:
Problem-solving:
is the application of a series of steps to help one make
responsible decisions. 1)
Identify
a-the cause of your stress, and b-ways to cope with it. 2)
Evaluate
each
way of coping with the stress, 3)
Choose
a way which results in actions that are healthful, safe, and
legal, and conform to accepted guidelines, and 4)
Evaluate
your choice. Does it relieve the stress? In case of difficulty,
it may be of help to talk to family, friends, or counselors.
Diet and exercise:
are two of the most healthful ways of coping with stress.
Exercise begun immediately or
up to 24 hours after
the onset of distress
will help reduce the harmful effects of distress.
The
relaxation response:
The alarm and resistance stages of GAS are mediated
involuntarily by the sympathetic and parasympathetic nervous
systems, respectively. Learning techniques such as meditation,
progressive relaxation, autogenic training and biofeedback can
initiate the relaxation response voluntarily.
Pets:
can be a great asset in stress management by providing a
constant, affectionate relationship.
Life Management Skills
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Talk over your problems with
family or friends
when you experience distress.
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Take part in a variety of
social activities.
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Limit the amount of
caffeine, salt, refined
sugar, and cholesterol in the diet.
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Avoid
tobacco, marijuana, cocaine, alcohol, and tranquilizers.
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Follow
a carefully planned budget.
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Select friends
who have healthful habits.
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Engage
in a regular exercise
program.
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Learn to use meditation,
progressive relaxation, autogenic training, or biofeedback
to initiate the relaxation response
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