Mental Health

According to the World Health Organization

(WHO), 1948, “Health is a state of complete
physical, mental and social well-being and not
merely the absence of disease or infirmity.”
Therefore Mental Health
 Includes our emotional, psychological, and social
well-being.
 It affects how we think, feel, and act. It also
helps determine how we handle stress, relate to
others, and make choices.
 Mental health is important at every stage of
life, from childhood and adolescence through
adulthood
Mental Illness

Definition(s):
 An illness with psychological manifestation
and/or impairment in functioning, due to
social, psychological, genetic, physical or
biological disturbance.” (American
Psychiatric Association)

 Mentally ill person means a person who is in

need of treatment by reason of any mental
disorder other than mental retardation.
(Indian Mental Health Act, 1987)
Normality
The mental health model of normality
(Jahoda, 1958), suggests that the criteria for what
might constitute normal psychological health are:
 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.
Abnormality
Abnormality has been defined in a number of
ways, including:
 Unusual behaviour that is different from the
norm;
 Behaviour that does not conform to social
expectations or demands;
 Statistical infrequency;
 Failure to function adequately;
 Presence of pronounced psychological
suffering or distress;
 Deviation from ideal mental health.
 Our historical efforts to understand abnormal
psychology include both humour and tragedy.
In this section, we will highlight some views
of psychopathology, and some of the
treatments administered, from ancient times
to the twenty-first century.

 DEMONOLOGY, GODS, AND MAGIC

➢ Early man widely believed that mental illness
was the result of supernatural phenomena
such as spiritual or demonic possession,
sorcery, etc.
Demonic Possession
➢ Not all abnormal behaviour was the cause of
demonic possessions, it began to be rationed as
the wrath of God as a punishment of their sins.
➢ When it came to treatment of these mental
illnesses many approaches were sorted such as
❖ Magico-religious rituals as mental pathology was
believed to mask demonic possession (Alexander,
1996).
❖ Exorcism was the primary type of treatment for
demonic possession, which included various
techniques for casting an evil spirit out of an
afflicted person.
Exorcism being performed.
➢ Attempts to treat mental illness date back as
early as 5000 BC as evidenced by the discovery
of trephined skulls in regions that were home to
ancient world cultures (Porter, 2002). *

➢ In addition, in Babylonia, Assyria, the

Mediterranean-Near East, and Egypt in hopes of
achieving a cure music was used a therapy to
affect emotion, and the singing of charms and
spells was performed (Rosen, 1968).
A depiction of treppaning from the painting Cutting the
Stone (circa 1494) by Hieronymus BoschHieronymus Bosch.
 HIPPOCRATES’ EARLY MEDICAL CONCEPTS
Between the 5th and 3rd centuries BCE, Greek
physician Hippocrates denied the long-held belief
that mental illness was caused by supernatural
forces and instead proposed that it stemmed from
natural occurrences in the human body,
particularly pathology in the brain.
 LATER GREEK AND ROMAN THOUGHT
➢ Hippocrates’ work was continued by some of the later
Greek and Roman physicians. Particularly in Alexandria,
Egypt (which became a center of Greek culture after its
founding in 332 B.C. by Alexander the Great), medical
practices developed to a higher level.

➢ Greek physician Galen also took a scientific approach to

the field, dividing the causes of psychological disorders
into physical and mental categories. Among the causes
he named were injuries to the head, excessive use of
alcohol, shock, fear, adolescence, menstrual changes,
economic reversals, and disappointment in love.

Roman
➢ Roman physicianswanted
physicians wanted to
to make
make their
theirpatients
patients
comfortable
comfortable andthus
and thusused
used pleasant
pleasant physical
physicaltherapies
such as warm baths and massage.
therapiessuch as warm baths and massage.
 VIEWS OF ABNORMALITY DURING THE MIDDLE
AGES
➢ During the Middle Ages (about A.D. 500 to A.D.
1500), the more scientific aspects of Greek
medicine survived in the Islamic countries of the
Middle East. The first mental hospital was
established in Baghdad in A.D. 792, followed by
Allepo and Damascus (Butcher, 2007).
➢ The mentally ill in the custody of family were
widely abused and restrained, particularly in
Christian Europe. Due to the shame and stigma
attached to mental illness, many hid their
mentally ill family members in cellars, caged them
in pigpens, or put them under the control of
servants (Porter, 2002)
Mentally ill family members in cellars, caged them in pigpens, or
put them under the control of servants.
➢ In Europe, management of the mentally disturbed
was left largely to the clergy. Monasteries served
as refuges and places of confinement. The
mentally disturbed were, for the most part,
treated with considerable kindness. “Treatment”
consisted of prayer, holy water, sanctified
ointments, the breath or spittle of the priests, the
touching of relics, visits to holy places, and mild
forms of exorcism.
➢ In China, the mentally ill were concealed by their
families for fear that the community would
believe that the affliction was the result of
immoral behaviour by the individual and/or their
relatives.
➢ In Greece, “a mentally ill [family] member
implies a hereditary, disabling condition in the
bloodline and threatens [the family’s] identity
as an honourable unit,” therefore treatment of
the mentally ill in these cultures meant a life
of hidden confinement or abandonment by
one’s family.
➢ It had long been thought that during the Middle
Ages, many mentally disturbed people were
accused of being witches and thus were
punished and often killed (e.g., Zilboorg &
Henry, 1941).
 THE
RESURGENCE OF SCIENTIFIC
QUESTIONING IN EUROPE
➢ Paracelsus postulated a conflict between the
instinctual and spiritual natures of human beings,
formulated the idea of psychic causes for mental
illness, and advocated treatment by “bodily
magnetism,” later called hypnosis (Mora, 1967).
He was convinced that the moon exerted a
supernatural influence over the brain—an idea,
incidentally, that persists among some people
today.
➢ St. Vincent de Paul (1576–1660), at the risk of his
life, declared, “Mental disease is no different than
bodily disease and Christianity demands of the
humane and powerful to protect, and the skillful
to relieve the one as well as the other”
(Castiglioni, 1924).
THE ESTABLISHMENT OF EARLY ASYLUMS
➢ From the sixteenth century on, special
institutions called asylums—sanctuaries or places
of refuge meant solely for the care of the
mentally ill—grew in number.
➢ The first asylum established in Europe was
probably in Spain in 1409—the Valencia mental
hospital.

➢ In 1547 the monastery of St. Mary of Bethlehem

in London (initially founded as a monastery in
1247; O’Donoghue, 1914) was officially made
into an asylum by Henry VIII. Its name soon was
contracted to “Bedlam,” and it became widely
known for its deplorable conditions and
practices.
Egs. of how patients were treated in asylums
 HUMANITARIAN REFORM
By the late 18th century, most mental hospitals in
Europe and American were in great need of reform.
➢ The humanitarian treatment of patients received
great impetus from the work of Philippe Pinel (1745–
1826) in France.
➢ An English Quaker named William Tuke (1732–1822)
established the York Retreat, a pleasant country house
where mental patients lived, worked, and rested in a
kindly, religious atmosphere (Narby, 1982).
➢ In the U.S., Benjamin Rush (1745–1813), encouraged
more humane treatment of the mentally ill; wrote the
first systematic treatise on psychiatry in America,
Medical Inquiries and Observations upon Diseases of
the Mind (1812); But even he did not escape entirely
from the established beliefs of his time. He invented
and used a device called “the tranquilizing chair”.
Pinel at the Salpêtrière, 1795 by Tony Robert-Fleury. Pinel ordering the removal of
chains from patients at the Paris Asylum for insane women

Bush’s Tranquilizing chair

➢ Moral management focused on the mentally ill
individual’s spiritual and moral development as well as
the rehabilitation of their personal character to lessen
their mental ailments.

➢ Biomedical advances also led to the demise of moral

management as most believed that medicine would
soon be the cure-all for physical as well as mental
afflictions and, therefore, psychological and social
help was not necessary.

➢ Lastly, the rise of a new movement called Mental

Hygiene focused solely on the patient’s physical health
and ignored their psychological disturbances. Dorothea
Dix commenced a forty-year long campaign to reform
asylums called the Mental Hygiene movement.
Although this movement did not directly affect
patients’ mental illnesses, it raised millions of dollars
to build hospitals that were suitable for proper care
and greater physical comfort of the patients.
In an 1872 "Bird's Eye View" of Raleigh, the Dix Hill Asylum (now Dix Hospital) was
labeled simply "Lunatic Asylum."
 Great technological discoveries occurred globally. These advances
helped usher in the emergence of contemporary views and
perspectives of abnormal behaviour what we know today as the
scientific, or experimentally. We will describe models of mental
illness that spanned the nineteenth and twentieth centuries and
generated powerful influences on our contemporary perspectives in
abnormal behaviour:
➢ The spiritual model: From a traditional spiritual
perspective, consciousness is seen as resulting from
or deeply connected to some supernatural force.
➢ Moral Character: The idea is of has been advocated
by many cultural systems. In a nutshell, the position
of moral character is that there are virtues which
one must learn, such as courage and fortitude,
honesty and integrity, compassion and grace that
enable on to live the admirable life.
➢ The Statistical Model: Derived more from the mathematics
than from psychology, the statistical model concentrates
on the definition of abnormality. According to this
approach, abnormality is any substantial deviation from a
statistically calculated average. Those who fail within the
“Golden mean” i.e. those whose behaviour differs from
those of the majority is considered abnormal.
➢ Biological Perspective
Biological underpinnings of abnormal behavior.
❖Mental illness stems from malfunctioning
neurophysiological processes.
o Brain Structure- Atrophy of certain
regions of the brain. Enlargement or
shrinkage of any anatomy of the brain
o Imbalance of Biochemicals - Increase or
Decrease of neurotransmitters or
hormone.
❖Genetics -The illness could be hereditary.
Enlarged Ventricles of a person with
Schizophrenia

“Apun ke bheje mein chemical locha hai.”

(Film: Lage Raho Munna Bhai)
➢ Psychological Perspective:

❖ Psychodynamic models: This involves unconscious

motives and conflicts that can be traced back to
childhood. The psychodynamic model led us to
recognize that we are not transparent to ourselves
❖Learning models: Learning perspectives have
spawned a model of therapy, called behavior therapy
(also called behavior modification), that involves
systematically applying learning principles to help
people change their behaviour
❖ Humanisticmodels: Roadblocks that block self
awareness and self-acceptance. How do a person’s
emotional problems reflect a distorted self-image?
What roadblocks did the person encounter in the
path toward selfa cceptance and self-realization?

❖ Cognitive models: Faulty thinking underlying

abnormal behavior. What styles of thinking
characterize people with particular types of
psychological disorders? What role do personal
beliefs, thoughts, and ways of interpreting events
play in the development of abnormal behavior
patterns?
❖ Cognitive models: Faulty thinking underlying
abnormal behaviour. The styles of thinking
characterize people with particular types of
psychological disorders. The role personal beliefs,
thoughts, and ways of interpreting events play in
the development of abnormal behavior patterns.
➢ Sociocultural Perspective: Social ills, such as poverty, racism, and
prolonged unemployment, contributing to the development of
abnormal behavior.
❖ Relationships between abnormal behavior and ethnicity, gender,
culture, and socioeconomic level.
❖ The relationships that exist between social-class status and risks of
psychological disorders.
❖ The effects of stigmatization of people who are labeled mentally
ill.

➢ Biopsychosocial Perspective: Interactions of biological,

psychological, and sociocultural factors in the development of
abnormal behavior.
❖ Genetic or other factors predispose individuals to psychological
disorders in the face of life stress.
❖ When biological, psychological, and sociocultural factors interact in
the development of complex patterns of abnormal behavior.
Signs and Symptoms of diseases
 A syndrome is a constellation of symptoms that
are unique as a group.
 It may contain some symptoms that occur in
other syndromes also.
 In psychiatry, as in other branches of medicine,
many syndromes began as one specific and
striking symptom.
 Sometimes the symptoms of the syndrome seem
to have a meaningful coherence. For example, in
mania.
 Mental health professionals will have to diagnose
mental illnesses based on the symptoms that a
person has. Mental health professionals often
gather information through an interview during
which they ask the patient about his or her
symptoms, the length of time that the symptoms
have occurred, and the severity of the symptoms.
Emil Kraepelin (1856–1926), a German
psychiatrist, played a dominant role in the
early development of the biological
viewpoint. The most important of these
contributions was his system of classification
of mental disorders, which became the
forerunner of the Diagnostic and Statistical
Manual of Mental Disorders (DSM).
The Diagnostic And Statistical Manual Of Mental Disorders
(DSM)
 The Diagnostic And Statistical Manual Of Mental
Disorders (DSM)
The Diagnostic and Statistical Manual of Mental
Disorders (DSM) is widely known as the bible of
psychiatry and psychology. The origins of the DSM
date back to 1840 — when the government wanted
to collect data on mental illness. The term
“idiocy/insanity” appeared in that year’s census.

The evolution of the concepts of mental illness

and therefore the classifications of the mental
disorder:
❖ DSM I: DSM-I (1952), featured descriptions of 106
disorders, which were referred to as “reactions.” The
term reactions originated from Adolf Meyer, who had a
“psychobiological view that mental disorders
represented reactions of the personality to
psychological, social and biological factors”.
❖ Disorders also were split into two groups based
on causality (Sanders, 2010).

➢ DSM II: Launched in 1968, It was only slightly

different from the first edition. It increased the
number of disorders to 182 and eliminated the
term “reactions” referred to psychoanalysis.

➢ DSM III: The third edition (which was revised in

1987) leaned more toward German psychiatrist
Emil Kraepelin’s concepts that biology and
genetics played a key role in mental disorders.
➢ DSM IV: In the fourth edition the number of disorders (over 300)
changed, and this time, in order for disorders to be included,
they had to have more empirical research to substantiate the
diagnosis, after a revision only the background information, such
as prevalence and familial patterns, was updated to reflect
current research.

➢ DSM 5: Launched in 2013, organization of chapters is designed to

demonstrate how disorders are related to one another. Multi-
axial system has been eliminated. Organization also reflects a
broader clustering among groups of diagnostic categories,
with those that tend to have similar premorbid personality
traits and/or co-occur being placed proximally to one another.
It helps “removes artificial distinctions” between medical and
mental disorders.

▪ Criticism of the DSM 5: The diagnosis of mental disorders is too

subjective (Greenberg, 2013), The diagnosis of mental disorders
in the DSM-5 is based on symptoms, not causes. The manual
provides checklists of the features of the various disorders, but
little information on what causes the disorders (American
Psychiatric Association, 2013). DSM is seldom useful in the
determination of a specific treatment plan.
 The International Classification Of
Diseases (ICD)
The International Classification of Diseases (ICD)
is the global standard for reporting and
categorizing diseases, health-related conditions
and external causes of disease and injury. In the
early 1960s, the Mental Health Programme of the
World Health Organization (WHO) became
actively engaged in a programme aiming to
improve the diagnosis and classification of
mental disorders.
 The need for precise psychiatric diagnoses is
indisputable, both for cooperation within the
health service systems and for scientific
purposes.
 After the Second World War, the WHO succeeded in introducing
an internationally accepted diagnostic system, the ICD-
classification. The ICD-6, published in 1949, with use for
morbidity there was a need for coding mental conditions, and
for the first time a section on mental disorders was added.

 The clinical descriptions and diagnostic guidelines for ICD-10

mental and behavioural disorders (WHO, 1992), define a mental
disorder as “a clinically recognizable set of symptoms or
behaviours associated in most cases with distress and with
interference with personal functions”. The classification of the
mental disorders is based on etiological considerations

 Criticisms of the ICD 10: Considerable criticism was levelled at

the overly long and often tediously formulated text, and the
lack of didactic organisation. A number of examples of
translation difficulties are given, and the differences between a
too literal and a technically correct equivalent translation
disused.
Evolution of DSM and ICD
Revision of Mental Disorders
 In 1986, the diagnosis was removed entirely
from the DSM. The only vestige of ego
dystonic homosexuality in the revised DSM-III
occurred under Sexual Disorders Not
Otherwise Specified, which included
persistent and marked distress about one's
sexual orientation (American Psychiatric
Association, 1987.
 The diagnosis of sexual aversion disorder has
been removed due to rare use and lack of
supporting research.
Additions of Mental Disorders
 In the chapter on obsessive-compulsive and
related disorders, which is new in DSM-5,
new disorders include
a. Hoarding disorder
b. Excoriation (skin-picking) disorder
c. Substance-/medication-induced obsessive-
compulsive and related disorder
d. Obsessive-compulsive and related disorder
due to another medical condition.
 Psychological Factors Affecting Other Medical
Conditions and Factitious Disorder
Psychological factors affecting other medical
conditions
 Genito-pelvic pain/penetration disorder is
new in DSM-5
Examples of Hoarding

Example of Skin Picking

  Cannabis withdrawal is new for DSM-5, as is
caffeine withdrawal
 Mild Neurocognitive Disorder
 Social (Pragmatic) Communication Disorder
 Binge Eating Disorder
 Premenstrual Dysphoric Disorder

Binge Eating Disorder

 The Internet is now an integral, even
inescapable, part of many people’s daily lives;
they turn to it to send messages, read news,
conduct business, and much more.
Internet Addiction
 The inability of individuals to control their
internet use, resulting in marked distress and/or
functional impairment in daily life.
 Internet addiction appears to be a common
disorder that merits inclusion in DSM-V.
Conceptually, the diagnosis is a compulsive-
impulsive spectrum disorder that involves online
and/or offline computer usage and consists of at
least three subtypes: sexual preoccupations, and
e-mail/text messaging and excessive gaming,
Internet Gaming Disorder

 Recent scientific reports have begun to focus on

the preoccupation some people develop with
certain aspects of the Internet, particularly
online games.
 The “gamers” play compulsively, to the exclusion
of other interests, and their persistent and
recurrent online activity results in clinically
significant impairment or distress.
 People with this condition endanger their
academic or job functioning because of the
amount of time they spend playing. They
experience symptoms of withdrawal when pulled
away from gaming
 They experience symptoms of withdrawal
when pulled away from gaming.
 Much of this literature stems from evidence
from Asian countries and centers on young
males.
 The gaming prompts a neurological response
that influences feelings of pleasure and
reward, and the result, in the extreme, is
manifested as addictive behaviour.

Internet Gaming
Disorder
Conditions for Further Study
 Attenuated Psychosis Syndrome
 Depressive Episodes With Short-Duration Hypomania
 Persistent Complex Bereavement Disorder
 Caffeine Use Disorder
 Neurobehavioral Disorder Associated With Prenatal
Alcohol Exposure
 Suicidal Behavior Disorder
 Nonsuicidal Self-Injury
APA hopes to encourage research to determine
whether these conditions should be added to the
manual as a disorder.
Neurobehavioral Disorder Caffeine Use Disorder
Associated With Prenatal
Alcohol Exposure
➢ We turn now to some of the research strategies in use
today, which have evolved from the work of early
experimental researchers in psychology. Through
research we can learn about the symptoms of a
disorder, its prevalence, whether it tends to be either
acute (short in duration) or chronic (long in
duration), and the problems and deficits that often
accompany it.
➢ Research allows us to further understand the etiology
(or causes) of disorders. Finally, we need research to
provide the best care for the patients who are
seeking assistance with their difficulties.
➢ . As new techniques become available (brain-imaging
techniques and new statistical procedures, to name a
few), methodology in turn evolves.
 Anti-stigma: Time to change: This
evaluation of the Time to Change anti-stigma
campaign in England represents a milestone
in international stigma research. While
showing some positive outcomes, the overall
picture is mixed and falls short of the
wholesale shift in attitudes that is needed. A
new approach is proposed for the coming
decades. (Smith, M., 2013).
 Perception and Attitude towards Mental Illness
in an Urban Community in South Delhi – A
Community Based Study: This study reported lack
of awareness about bio-medical concepts of
mental illness in a community in the capital city
of India.There is a need for creating awareness
regarding biomedical concepts, availability of
effective treatment for mental illness, for
identification and better care for these disorders
in a community as a part of National Mental
Health Programme. Health education and
increase in public awareness regarding factual
information about mental illness can decrease
the stigma attached with mental illness and
improve help-seeking behaviour of the
community. This will also help in reducing burden
of psychiatric morbidity in the community.
(Salve, H., Goswami,K., & Sagar, R., 2013)
 The science of abnormal psychology is young and filled with
a rich history of theoretical approaches ranging from early
animistic approaches to the modern technology of medical
science. We should note that decisions about abnormal
behaviour involve social judgments. Because society is
constantly shifting and becoming more or less tolerant of
certain behaviours, what is considered abnormal or deviant
in one decade may not be considered abnormal or deviant a
decade or two. Every theoretical approach is focused on
some measure of reliving individuals of the discomfort and
dysfunction associated with abnormal behaviour, and various
advancements and new progressions in diagnosis and
treatments are being discovered. At one time, as discussed,
homosexuality was classified as a mental disorder. But this
is no longer the case. And 20 years ago, tattoos, pierced
noses and navels were regarded as highly deviant and
prompted questions about a person’s mental health. Now,
however, such adornments are quite commonplace, are
considered fashionable by many, and generally attract little
attention (Butcher, 2007).