MENTAL HEALTH VERSUS MENTAL ILLNESS

Module Outline

• Essentials for Education in Psychiatric-Mental Health
• Mental Health Versus Mental Illness
• The History of Mental Illness

Module Learning Outcomes

• Review essentials for mental health nursing education
• Differentiate mental health versus mental illness
• Explore the history of mental illness

 Undergraduate Education Mental Health Essentials

The American Psychiatric Nurses Association (APNA) developed the Essentials for Undergraduate Education in Psychiatric-Mental Health (American Psychiatric Nurses Association Education Council, Undergraduate Branch, 2022). These essentials will guide as a framework for many of the topics throughout this book.  Visit this resource to learn more about the APNA’s Undergraduate Education Toolkit.

Mental Health Versus Mental Illness

A holistic view of health incorporates an individual’s physical, mental, emotional, and spiritual well-being. Mental health applies to everyone and can affect other aspects of one’s health and well-being. Envision mental health on a continuum, where mental health and mental illness are the anchors. Stress or stressful events are often related to mental illness exacerbations. Social determinants of health also contribute to one’s place on the mental health continuum.

Let’s Learn Public Health. (2018). What is public health? [Video]. YouTube. https://youtu.be/t_eWESXTnic

How do we differentiate mental health from mental illness? The short answer is mental illness typically relates to deviance in behavior and/or dysfunction and/or distress in one’s ability to carry out our typical day-to-day activities. For example, an individual experiencing increasing stress in a crisis situation such as being terminated from employment may feel and express suicidal thoughts. As healthcare professionals, we have a duty to report when an individual expresses intent to harm another person or themselves. We will discuss the legal implications within mental health nursing in another module.

Many people who need care never seek it out. Why is that?  We already know that society dictates what is considered abnormal behavior through culture and social norms, and you can likely think of a few implications of that. Overlapping with prejudice and discrimination in terms of how people with mental disorders are treated is stigma, or negative stereotyping, labeling, rejection, and loss of status occur.

The History of Mental Illness

Abnormal behavior is often dictated by the culture or society a person lives in, and unfortunately, the past has not treated the afflicted very well. In this section, we will examine how past societies viewed and dealt with mental illness.

Prehistoric cultures often held a supernatural view of mental illness and saw it as the work of evil spirits, demons, gods, or witches who took control of the person. This form of demonic possession often occurred when the person engaged in behavior contrary to the religious teachings of the time. Early Greek, Hebrew, Egyptian, and Chinese cultures used a treatment method called exorcism in which evil spirits were cast out through prayer, magic, flogging, starvation, having the person ingest horrible tasting drinks or noisemaking.

Rejecting the idea of demonic possession, Greek physician Hippocrates (460-377 B.C.) said that mental disorders were akin to physical ailments and had natural causes. Specifically, they arose from brain pathology, or head trauma/brain dysfunction or disease, and were also affected by heredity. He described four main fluids or humors that directed normal brain functioning and personality – blood which arose in the heart, black bile arising in the spleen, yellow bile or choler from the liver, and phlegm from the brain. Mental disorders occurred when the humors were in a state of imbalance such as an excess of yellow bile causing frenzy and too much black bile causing melancholia or depression. Hippocrates believed mental illnesses could be treated as any other disorder and focused on the underlying pathology.

During the Middle Ages with the increase in power of the Church and the fall of the Roman Empire, mental illness was yet again explained as possession by the Devil and methods such as exorcism, flogging, prayer, the touching of relics, chanting, visiting holy sites, and holy water were used to rid the person of demonic influence. In extreme cases, the afflicted were exposed to confinement, beatings, and even execution.

The number of asylums, or places of refuge for the mentally ill where they could receive care, began to rise during the 16th century. Hospitals and monasteries were converted into asylums. Though the intent was benign in the beginning, as the facilities were overcrowded, the patients came to be treated more like animals than people. Patients were chained up, placed on public display, and often heard crying out in pain.

Reform in the United States started with the figure largely considered to be the father of American psychiatry, Benjamin Rush (1745-1813). Rush advocated for the humane treatment of the mentally ill, showing them respect, and even giving them small gifts from time to time.  Despite this, his practice included treatments such as bloodletting and purgatives, the invention of the “tranquilizing chair,” and reliance on astrology, showing that even he could not escape from the beliefs of the time.

Due to the rise of the moral treatment movement in both Europe and the United States, asylums became habitable places where those afflicted with mental illness could recover. The number of mental hospitals greatly increased, leading to staffing shortages and a lack of funds to support them. Waves of immigrants arriving in the U.S. after the Civil War overwhelmed the facilities, and patient counts soared to 1,000 or more.

Dorothea Dix (1802-1887), a New Englander who observed the deplorable conditions suffered by the mentally ill while teaching Sunday school to female prisoners. Over the next 40 years, from 1841 to 1881, she motivated people and state legislators to do something about this injustice and raised millions of dollars to build over 30 more appropriate mental hospitals and improve others.

Check out the video below to learn more about Dorothea Dix and her influence within the profession of nursing.

National League for Nursing. (2022). NLN nursing edge unscripted saga-episode 2: Dorthea Dix. [Video]. YouTube. https://youtube.com/watch?v=S3O37lm8FMI&si=EnSIkaIECMiOmarE

Mental Health America (MHA) provides education about people with mental illness and their need for care with dignity. Today, MHA has over 200 affiliates in 41 states and employs 6,500 affiliate staff and over 10,000 volunteers.

By the end of the 19th century, it had become evident that mental disorders were caused by a combination of biological and psychological factors. As a society, we used to wait for a mental or physical health issue to emerge, then scramble to treat it. More recently, medicine and science have taken a prevention stance, identifying the factors that cause specific mental health issues and implementing interventions to stop them from happening, or at least minimize their deleterious effects.

Specific to the nursing profession, Linda Richards graduated from the New England Hospital for Women and Children in 1873 (Videbeck, 2020). She is known as the first psychiatric nurse and believed in parity of mental health care to physical care (Videbeck, 2020). The first psychiatric nursing textbook, Nursing Mental Diseases (Bailey, 1920), was written by Harriet Bailey in 1920. Hildegard Peplau, a nursing theorist, was instrumental in psychiatric nursing. She wrote Interpersonal Relations in Nursing as well as described the nurse-patient relationship (Videbeck, 2020). Watch the interview with Hildegard Peplau below.

American Psychiatric Association. (2018). A conversation with Hildegard Peplau. [Video]. YouTube. https://youtube.com/watch?v=Fdx5Dw-dkBg&si=EnSIkaIECMiOmarE

The interactive slide show contained within this chapter showcasing the topics (What is Mental Health, What is Mental Wellness, and the Wellness Wheel) was adapted from UBC Student Health and Wellbeing Staff, Gillies, J., Johnston, B., Warwick, L., Devine, D., Guild, J., Hsu, A., Islam, H., Kaur, M., Mokhovikova, M., Nicholls, J. M., & Smith. C. (2021). Starting a conversation about mental health: Foundational training for students. BCcampus and licensed under a Creative Commons Attribution 4.0 International License. Modifications: revised for clarity and flow.

Adapted from Fundamentals of Psychological Disorders 2nd Edition- Module 1  by Alexis Bridley, Ph.D. and Lee W. Daffin Jr., Ph.D. licensed under a Creative Commons Attribution 4.0 International License. Modifications: revised for clarity and flow .