Lesson 2: Fundamentals of Mental Health


Attention

 

Photo of patients in ice baths as part of their treatment in the St. Elizabeth's Hospital, a former mental asylum, in Washington, DC, date unknown.


Learning Outcomes

Upon completion of this lesson's material, students will be able to:

  • Understand relevance of defining normal and abnormal.
  • Understanding the importance of the history of the treatment of mental illness.
  • Understand potential for doing more harm than good in the name of treatment.

Teaching

Reading

Lecture

Watch the video about the "Being Sane in Insane Places": Click HERE to view this video directly on YouTube.

While this may seem crude and politically incorrect, a landmark study was published in l973 by David L. Rosenhan. It appeared in the Journal Science, Vol. 179, pages 250-258, and was entitled "On being sane in insane places." If the date seems ancient, it could not be MORE relevant today. With the publication of the latest Diagnostic and Statistical Manual - 5, from the American Psychiatric Association, in 2013, understanding and diagnosing mental illness is center stage yet again.

Defining Normality

What is normal? How do we define normal in our communities, cultures, countries? It all depends on the culture and environment you were raised in. What we in Maine define as normal is different than what individuals in other states or countries would consider normal.

Normalcy: the quality or condition of being normal, as the general economic, political, and social conditions of a nation; normality (from Dictionary.com)

Johoda (1958) proposed a mental health model of normality. The model suggests criteria for what might constitute normal psychological health. This is understanding that normal is in contrast to abnormal psychological health. Deviation from these criteria of normal would mean that the health of an individual is “abnormal”:

  • The absence of mental illness
  • Realistic self-perception and contact with reality
  • A strong sense of identity and positive self-esteem
  • Autonomy and independence
  • Ability to maintain healthy interpersonal relationships (e. g. capacity to love)
  • Ability to cope with stressful situations
  • Capacity for personal growth and self-actualization

This leads to the next question. As we consider what is normal, then what is abnormal? There are times in our lives when each of us may be suffering from a mental illness, may have some signs or symptoms of a mental illness or may believe we have a mental illness. If we look at all the above there are many times in each of our lives when we would each fall into the "abnormal" category. It is much easier to establish definitions and symptoms for physical health compared to mental health. According to Szasz (1962) psychological normality and abnormality are culturally defined concepts, which are not based on objective criteria. Generally people have “positive illusions” about themselves and as a result they rate themselves more positively than others would rate them (Lewinsohn et al., 1980). The criteria in the Johoda model are culturally biased value judgements, i.e. they reflect an idealized rather than realistic perception of what it means to be human in a Western culture.

The mental illness model sees psychological/mental health disorders as abnormal or psychopathology. Pathology means “illness” so the word psychopathology is literally “illness in the psyche”. The study and treatment of mental illness occurs in the field of psychiatry, which is a branch of medical science. Individuals with psychological problems are seen as “ill” in the same way as those who suffer from physical illnesses. Diagnosis of mental illness is based on the mental health worker’s observations, the individual’s self-reports, a clinical interview and diagnostic manuals (classification systems) that classify symptoms of specific disorders to help doctors find a correct diagnosis (from http://www.appsychology.com/IB%20Psych/IBcontent/Options/abnormal/Abnormal%20Q/1Abnormal.htm).

Community mental health is an ever evolving field of study. It continues to change as consumers needs changes and political policies change access to services. As we explore the field of community mental health we need to look at where we have come from to help us improve the plan for where community mental health services are going in the future.

The history of community mental health is checkered with wonderful innovations and programs that have helped tens of thousands of people and with horrific treatments that left people unable to live their daily lives. As the field of mental health expanded pioneers in the field worked to create medical interventions to help individuals with severe mental illness.

The History of Mental Illness

Please read the following slide presentation which outlines nicely the history of mental health treatment in the US. It does include some acronyms that may not be familiar to you but I believe the overall story it presents will help improve your understanding of psychiatry's early days and how far the field has come.

The History of Mental Health Treatment in the US

Read about the history of mental illness from a different perspective in the following link: https://www.nlm.nih.gov/hmd/diseases/introduction.html (read all 7 pages)

Understanding the history of where we come from really helps up to be thoughtful of where the field continues to move into the future.


Assessment

Lesson 2 Discussion (for online class only)

Share (1) one piece of the history of mental illness that stood out to you as you read the material in this lesson, (2) why you selected that piece of history and (3) how it will impact your current and/or future work in mental health. (Make sure your post includes answers to all of the questions in each discussion prompt, for this week there are three different questions.)

Lesson 2 Quiz

  1. Consider the idea of normal vs. abnormal. Share what your thoughts are on how the future consumers (clients) you will work with may present at various stages on the normal to abnormal continuum. We recognize that a sudden life changing event can also change our own normal life into a more abnormal state. Share you learning and understanding about this concept.
  2. Share your thoughts about The Case of Mrs. Packard and Legal Commitment. Why is this story important as you learn about the field of mental health? (Information can be found in the history of mental illness link referred to above: https://www.nlm.nih.gov/hmd/diseases/introduction.html).