Notes on Preventive and Promotive Methods of Mental Disorders !
Mental hygiene involves two aspects-prevention of mental disorders and promoting positive mental health.
There are 3 types of prevention.
a. Primary prevention:
The main objective here is to prevent the occurrence of mental disorders. This reminds us the popular statement “prevention is better than cure”.
For this the causes of mental disorders must be removed. For example, avoidance of marriage among persons suffering from serious mental disorders. Or, by chance if they marry, the couple may be prevented from giving birth to children through family planning measures.
The other ways of prevention is, to prepare people to develop stable personalities, education of community, prenatal and postnatal education. Parents and children should be given education about diseases and mental health. Identification of high risk groups and organisation of educational programmes for these groups also can prevent many diseases.
b. Secondary prevention:
This type of prevention includes quick identification and immediate intervention. If the disease is not preventable, it is to be identified immediately and treated effectively. By this way the disease is not allowed to become severe or chronic.
This kind of prevention leads to reduction in prevalence rate. Identification of high risk groups and help for crisis and stress management is included under this category.
For example, a person who has incurred a great loss in business is prone to develop a mental disorder. He may be prevented through secondary prevention, or an acute case of anxiety admitted for treatment may be taken appropriate care and cured immediately and avoid from becoming chronic.
c. Tertiary prevention:
It is to provide good rehabilitative services and after care, so that relapse does not take place. Rehabilitation refers to restoring a person to his or her previous level of efficiency or capacity. This includes follow-up, family support, occupational, recreational training, etc.
Promoting Better Mental Health:
“An ounce of prevention is worth a pound of cure” is a premise. If it is so why should we not try harder to prevent mental illnesses?
Mental illnesses are mainly caused due to biological, socio-cultural and psychological reasons. Better mental health naturally, can be achieved by avoiding these reasons. Though it is not possible to avoid the influence of all these factors completely, the awareness about these factors can definitely help people to prevent most of the problems.
It is in this direction that the community mental health centres are working today. Better mental health can be achieved through training programmes to teachers in educational institutions, police and social service agencies which are major source of case referrals.
Community mental health centres take the services to people in the community, rather than make them to come to hospitals.
Promotion of mental health includes the campaigning for health maintenance, development of stable personalities in childhood, stress tolerance education, avoidance of alcohol and drugs, etc. The families must be given suitable education to learn to have emotional adjustment.
Promotion of mental health also includes spread of knowledge about mental health and illnesses in the community.
Counselling centres may be started in schools and colleges. Child guidance clinics, crisis therapy centres, family and marriage counselling centres can play a major role in this endeavour.
Role of Nurses:
The nurses have a major role in establishment of good mental health in the community. They come across many people including patients, relatives of patients and also other public. They work in community mental health centres also.
Hence, they can try to create awareness among people, regarding mental health, its importance, and ways of maintaining it. They can help people in crisis situations by giving proper guidance and counselling and refer them to appropriate places for early treatment if necessary. Every one of us should know that “trying to stay well is different from trying to get well”
Motives cause conflicts and in turn conflicts cause anxiety, stress and frustration in the individual. In our life we aspire for many things, different goals, etc. But we cannot achieve everything we aspire for. In many instances we become frustrated when we fail in our attempt. These failures and frustrations hurt our ego and cause a lot of anxiety and feelings of guilt and inferiority. Under such circumstances we do not want to accept failure easily. Instead we resort to certain mechanisms by which we can safeguard our self-respect.
The methods or mechanisms used for maintaining harmony with the environment can be grouped into two categories: direct and indirect methods:
1. The direct methods include:
a. Increasing trails or improving efforts
b. Adopting compromising means
c. Withdrawal and submissiveness
d. Making proper choices and decisions.
2. Indirect methods:
Such mechanisms are called ‘defence mechanisms’ or ‘mental mechanisms’. These mechanisms are defined as “the patterns of adjustment through which an individual relieves or decreases anxiety caused by an uncomfortable situation that threatens self-esteem”. According to psychoanalytic theory of Sigmund Freud, the Id’s demands cannot be fulfilled because they are instinctual, infantile and amoral. This leads to conflict between Id, ego and super ego. Such a conflict in turn causes a lot of anxiety.
The person then seeks ways to protect the ego from this anxiety and guilt by setting up defences which act as adjustmental mechanisms. A systematic and comprehensive study of the defences employed by the ego was first presented by Anna Freud, (the daughter of Sigmund Freud). In her classic monograph ‘The Ego and the Mechanisms of Defence’, Ms. Freud maintained that everyone, whether normal or neurotic, employs a characteristic repertoire of defence mechanisms- but to varying degrees. Hence, these defences are also called as ‘ego defence mechanisms’. However, defence mechanisms are generally accepted as a useful way of looking at how people handle stressful situations and conflicts. There are many ego defence mechanisms.
It is a mechanism in which people try to cope with one’s unwanted motives by shifting them on to someone else or blaming others. Usually negative traits are projected than positive ones. For example, a student caught while copying in the examination may start saying that all the students are copying. A corrupt officer may say that nowadays all are corrupt.
It is an active mental process by which a person forgets any thoughts that arouse anxiety by pushing down into unconscious. As the famous psychotherapist- RD Laing puts it “we forget and then forget that we forgot”. For example, a person who is troubled by his wife may forget his marriage date. A worker who was severely punished by his boss never likes to remember him.
3. Reaction formation:
This is a mechanism by which people reverse their motives in order to cope with conflict. A motive that would arouse unbearable anxiety if it were recognised is converted into its opposite. For example, a person who hates his wife may start showing a lot of affection apparently by hiding the real feeling.
When an individual feels highly maladjusted in the face of threat, he may retreat to an earlier pattern of adaptation. In a way it is going back from present complex life to childhood life and start behaving like a child. For example, on a new entry in the family, the elder child regress to previous ages and starts behaving like a young child- showing abnormal behaviour like bed wetting (enuresis), thumb sucking, nail biting, request to feed and dress, etc.
In this technique, the person withdraws from humiliating or frustrating situations. He develops a feeling of securedness by withdrawing. For example, a sportsman who is expecting a failure in his attempt may withdraw from participation and avoids humiliation by defeat. A nurse who feels that she is unable to assist an operation may give a lame excuse and escape from risk.
In this mechanism we make excuses by giving a reason different from the real one for what we are doing. It is nothing but justification of one’s own behaviour. Rationalisation is not lying; we believe our expectations as true. For example, an idle man doing no work may justify his behaviour, saying that he needs rest. A tense father who punishes his child may rationalise that he is acting for the good of the child only. Rationalisation is of two types:
a. Sour grape mechanism:
This is based on Aesop’s fable of the fox and the sour grapes. For example, a person who tries to get a particular job unsuccessfully may start saying that the job is not good so he stopped trying for that job.
b. Sweet lime mechanism:
Here, the person tries to justify by saying that what he got itself is very best. For example, a person who marries an ugly looking poor girl inevitably, may justify saying that he wanted to help the poor, that is why he married that girl only, and may say that character is more preferable than beauty.
In this mechanism, the motive of the person remains unaltered, but the person substitutes a different goal object for the original one. Generally the motive of aggression, that for some reason, the person cannot vent on the source of the anger may be displaced. For example, a clerk who is angry with his boss, but cannot show it for fear of being fired may come home and start banging his wife and children.
The sexual or aggressive motives which cannot be always expressed in socially acceptable ways will be redirected to socially valued activities and goals. For example, a writer may direct some of his/her libido from sexual activity to the creation of a poem or novel, thus indirectly satisfying the same drives. An aggressive person may satisfy his aggressive tendency by accepting a butcher’s job. A woman who cannot have her own child due to some problem, may adopt other’s child or work in an orphan school to satisfy her maternal drive.
An individual who is weak in some activity or ability may feel inferior. In order to overcome this inferiority he may compensate this weakness by achieving some goal or excelling in some other ability. For example, a student who is weak in studies may become a writer or a sportsman. A girl who is ugly in looks may become a good singer and become popular.
Fantasy is non-rational mental activity that allows an individual to escape from his daily pressures and responsibilities. By this mechanism the desires which cannot be fulfilled in real life will be satisfied by day dreaming, because in imaginary world there will not be any obstacles as in the real life. For example, a youth dreaming of becoming a famous actor. A beggar’s dreaming of becoming a millionaire. This is mechanism very common among children.
It is a commonly used mechanism wherein a person denies the existence of some external reality. The person using denial is unaware of it. For example, when a patient is informed about his serious condition, he usually denies its existence for some period of time. He may say-it is not true; I cannot have diabetes-1 am too young and healthy etc. This mechanism acts as a protective device to avoid shock of reality.
It is the unconscious adoption of the personality characteristics, attitudes, values and behaviour of another person. Usually the children identify with parents, students with favourite teachers, followers with leaders, sportsman with famous sports clubs, etc. This mechanism may temporarily help him for satisfaction, but over use leads to low self-esteem and little individuality, because they rely heavily on the advice and support of others.
Through this mechanism a person uses his intellectual powers of thinking, reasoning and analysing to blunt or avoid emotional issues. Talking about or dealing directly with feelings is too threatening or painful for him. Failures and disappointments are softened by pointing out that “it could have been worse”. Cynicism may become a convenient means of reducing guilt feelings over not living up to one’s ideals. For example, a nurse may use this mechanism to tell the relatives of patients who is very serious and in death bed-oh! After all life is very short, nobody in this world is permanent, etc.
Implications of Mental Mechanisms:
Most of us resort to these defence mechanisms. When people use them sparingly and without cost to others, they are nothing to worry about. If these mechanisms help us to relieve our tension and feel comfortable, they are welcome. However, too much dependence on these mechanisms is harmful. They do not solve our real life problems. They only relieve anxiety about these problems. Too much dependence makes us unable to face problems or problematic situations. For example, if a student who feels unable to face the examination withdraws from appearing, may feel still more difficulty in the next attempt. Hence, it is better to learn to face the problems instead of resorting to these mechanisms.
Many times, more than one mechanism may operate in the process of adjustment to situation. In the example cited above, a student in the event of inability feeling may adopt withdrawal or may use other mechanisms such as projection or rationalisation also in order to escape from humiliation and to avoid threat to his ego. It is unhealthy way of adjustment, instead of this he can resort to compensation mechanism. Further it should be noted that these mechanisms at times, represent our unconscious attempts to solve problems.
Under such circumstances the individual feels he is successful in his attempt, which leads to a feeling of self-worth. Again this may be a self-deception. Take the example of a patient having a serious disorder like cancer, who adopts the mechanism of denial and neglects the treatment; the result will be of serious consequence. Hence, in view of attaining a healthy and well adjusted life, it is advisable to minimise the use of these mental mechanisms and adopt direct methods of adjustment as far as possible.