Mental health and illness are difficult to define. Generally, filling out societal roles and displaying “appropriate” behavior is considered healthy, while those who fail to fulfill their roles and behave “inappropriately” are viewed as ill. As a result, this societal definition varies between cultures and groups.
Mental Health
The World Health Organization defines mental health as a state of wellbeing in which the individual realizes their potential, is able to cope, and works productively and fruitfully contributes to their community.
Criteria for Mental Health
They offer the PRAISE criteria for identification of mental health:
- Positive Attitude Toward Self: a strong of identity, esteem, confidence.
- Realistic Perception: being able to view reality; avoidance of over-pessimism or over-optimism.
- Autonomous Behavior: independence in functioning.
- Integrative Capacity: the management of adverse or difficult situations. This involves resilience (ability to adjust), hardiness (resist illness under stress), self-efficacy (ability to succeed), and resourcefulness (problem-solving) .
- Self-Actualization and Personal Growth: the ability to be motivated to achieve one’s full potential and make use of it to achieve goals.
- Environmental Mastery: the ability to meet the demands of any situations and adapt to changing circumstances.
Mental Illness
A health condition marked by alterations in thinking, mood, or behavior that causes distress and/or impairs an individual’s major functions.
Types of Functioning
- Occupational Functioning: ability in performing ADLs, in one’s roles e.g. at work or in school.
- Emotional Functioning: the expression or assertion of feelings.
- Psychological Functioning: thinking abstractly and rationally, coping, and problem-solving.
- Social Functioning: the ability to create satisfying interpersonal relationships and involving oneself in communities or organizations.
- Spiritual Functioning: the essence of a person’s being and their beliefs about the meaning and purpose of life. It may involve faith in God as a primary source of comfort and help during stress and difficulty situations. It may be a primary coping device.
Criteria for Mental Illness
- Lack of Personal Growth
- Ineffective Coping
- Non-Satisfactory Relationships
- Self-Dissatisfaction
Factors Contributing to Mental Illness
Approximately 1 in 5 adults have some form of mental illness/es. Mental illnesses often start earlier in life. The effects of mental illness may be temporary or long-lasting.
Biologic Factors
- Genetic Factors: schizophrenia is among the most commonly inherited mental disorders (~70%) but is recessive.
- Neurostructural Factors
- Infections: development or exacerbation of mental illness and its symptoms may occur from brain damage from infections.
- Pediatric Autoimmune Neuropsychiatric Disorder (PANDA) is associated with the Streptococcus bacteria, and is linked with Obsessive-Compulsivity and other mental illnesses in children.
- Brain Defects or Injury
- Prenatal Brain Damage
- Brain Chemistry: disorders may be related to imbalances in the brain’s neural networks and their neurotransmitters.
Individual Factors (PAIN)
- Poor Physical Health
- Any kind of loss
- Ineffective coping, Inability to distinguish reality from fantasy
- Negative view of self
Interpersonal Factors (FAIL)
- Faulty families and nurturing during childhood
- Absence of belongingness
- Ineffective communication and interaction
- Loss of emotional control
Environmental Factors (SPRAIN)
- Severe Environment Aggression/Community Violence
- Poverty, Homelessness, Discrimination
- Racial Discrimination
- Abuse and Violence
- Inability to make use of support systems and community resources
- Negative view of the world
Risk Factors
- Familial history of mental illness.
- Personal history of mental illness.
- Stressful life situations e.g. financial problems, death of loved ones, divorce.
- On-going medical conditions
- Brain Injury e.g. traumatic brain injury
- Traumatic Experiences e.g. military combat or assault
- Alcohol or drug
- Inadequate interpersonal relationships
Complications of Mental Illness
Untreated mental illness can cause severe emotional, behavioral, and physical health problems.
- Unhappiness and decreased enjoyment of life
- Family and relational conflicts
- Social isolation
- Development of vices
- Affected occupational (work, school) functioning
- Legal and financial problems
- Poverty and homelessness
- Harm to oneself and others
- Immunocompromisation, heart diseases, among other physical conditions.
Classifications of Mental Illness
Psychosis
Characterized by the loss of reality, altered through processes, and presence of psychotic manifestations (illusion, delusion, hallucination).
Neurosis
Also known as psychoneurosis or neurotic disorder. It is a type of functional mental illness that results in distress. There is no psychosis nor socially unacceptable behavior. There is no loss of reality.
Functional Mental Illness
Impairment of brain function with no clear etiology.
Organic Mental Illness
Injury or disease affecting brain tissues either physically, chemically or through hormones. Aging is among the causes of this type of illness.
Mental Health vs Illness
| Characteristic | Health | Illness |
|---|---|---|
| Happiness | Life is enjoyable, responsible | Apathy, depressed, hopeless e.g. Major Depressive Episode |
| Behavior | Responsive, adaptive | Aggressive, violating rights and norms repeatedly e.g. Impulse Control Disorder |
| Perception | Realistic, conscientious | Delusions, hallucination e.g. Schizophrenia, Psychotic Disorders |
| Occupation | Effective in tasks, persistent in failure | Inhibition, declination of functioning e.g. Adjustment Disorder with Inhibition |
| Self-Concept | Capable, confident | Passively dependent due to personal dysfunction, lacks confidence e.g. Dependent Personality Disorder |
| Relationships | Satisfactory, stable, socially integrated | Unstable, intense, feeling of emptiness e.g. Borderline Personality Disorder |
| Coping | Healthy coping strategies | Substance dependence |
Coping Mechanisms
“Coping” is any effort done to reduce stress responses. It may be constructive; task-oriented (direct problem solving) or defense-oriented (regulate stress via defense mechanisms), or destructive, where the individual often avoid the problem.
“Defense Mechanisms” also known as “ego defense mechanisms” or “protective defenses” are patterns of behavior or thought utilized to protect oneself from threatening internal or external aspects. It allows an individual to maintain control, safety, self-esteem, lessen discomfort, cope with stress, and decrease anxiety.
Normal and Adaptive Mechanism
Persons who effectively utilize these mechanisms are perceived as virtuous. These mechanisms enhance the individual’s feeling of mastery and pleasure.
- Anticipation: planning ahead for realistic expectations.
- Compensation: making up for imagined or actual handicaps or deficiency.
- Compromise: give-and-take dynamics; often seen in relationships.
- Sublimation: channeling socially unacceptable behavior to a socially acceptable one. It is the most constructive defense mechanism.
- Humor: seeing the lighter side of the situation.
Narcissistic Defense Mechanism
The most primitive mechanism often utilized by children. These mechanisms eliminate the need to cope with reality.
- Denial: refusal to acknowledge reality.
- Projection: blaming others for unacceptable deeds or thoughts.
- Fantasy: gratification of wishes through imagination.
Immature Defense Mechanism
Often seen in adolescents and some non-psychotic individuals; it lessens distress and anxiety-provoking situations. Excessive use of these defenses are seen as socially undesirable (immature, difficulty, out-of-touch).
- Conversion: transferring emotional conflict into physical symptoms.
- Malingering: fabrication of ailments.
- Fixation: psychosocial development ceases to advance.
- Regression: returning to previous developmental stages.
- Identification: unconscious attempts to change oneself as another, admired person.
- Introjection: sub-type of identification in which a person incorporates traits or values of other individuals into themselves.
- Intellectualization: excessive reasoning to obscure feelings.
- Suppression: forgetting thoughts or feelings voluntarily.
- Isolation: blocking feelings associated with unpleasant experiences; may be physical or emotional.
- Symbolism: conscious use of an alternate idea or object to represent another idea or object.
Neurotic Defense Mechanisms
Often seen in obsessive-compulsive, hysterical individuals and adults under stress. These are advantageous in short-term coping situations, but can cause long-term problems in relationships and life if used as a primary coping method.
- Displacement: releasing anger in a less threatening way.
- Dissociation: blocking off events from the conscious mind e.g. amnesia.
- Substitution: replacing original goals or desires with something else.
- Rationalization: justification of behavior to make them acceptable.
- Reaction Formation: reacting in a way that is opposite of what is felt.
- Repression: involuntary forgetfulness of unacceptable thoughts.
- Undoing: engaging in behaviors opposite of previous unacceptable actions.