Identifying Mental Health vs
Mental Illness Concerns in Farmers
with Disabilities
Peggy Mack, Ph.D.(c), APRN, BC
National AgrAbility Workshop
November 8, 2005
Email: Peggymack02@aol.com
Learning Objectives
This session has helped me improve my
understanding THAT
1. Mental health (emotional health) and physical
health are equally important.
2. Stress effects an individual’s mental health and
physical health.
3. Mental health problems, mental illnesses, can be
identified and treated.
What’s Mental Health?

Mental Health = Emotional Health
Emotions - examples: love, pleasure, dislike, anxiety
- give meaning to everything in life”
- originate in the brain
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Science – emotional signals, emotional pathways, in
the brain. - technology (MRI, PET scans)
Citation: National Institute of Mental Health. Seeing Our Feelings: Imaging Emotion in the Brain.
Publications. NIMH Publication No. 01-4601. Bethesda (MD): National Institute of Mental Health,
National Institutes of Health, US Department of Health and Human Services; 2001 (updated 2005,
September 9). Available from http://www.nimh.nih.gov/publicat/feel.cfm#2, accessed October 31,2005.
Sad vs Happy?
What challenges our mental health?
Health: Physical and Mental
•Genetics
•Stress
Perceptions
Learned
Coping
Challenges to Mental Health
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Stress – how do we know we’re stressed?
 stress is universal, but also unique
(due to our perceptions, genetics, coping).
Our Perceptions - how we view something;
 based on values, beliefs, morals.
Genetics – how we’re wired, heredity.
Learned Behaviors - coping strategies
 how we handle our problems
What Happens When There’s
Always a Fire to Put Out?
What does constant stress do?

Like a rubber band that is stretched out,
24/7.
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The brain responds with heightened arousal.

Continual vigilance - flight or fight
response
Stress Effects an Individual’s
Mental Health and Physical Health.
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Physical response from the body – fly or fight.
Physical health problems: high blood pressure,
headaches, backaches, etc.
At the same time - Emotional response from the
brain – fly or fight.
Emotional health problems: irritability, tearfulness,
etc. Can lead to mental illness, such as depression,
or even to suicide.
Linking
Physical and Mental Health
Examples from the scientific literature:
 Arthritis – considered a disability.
 Pain - associated with arthritis.
 Intermeshing of pain, arthritis, and depression,
seems to be related. When pain is not alleviated,
depression occurs.
 Brain’s amydagla – provides a physiological
connection with the psychological response to
depression.
Neugebauer, V., & Li, W., & Bird, G.C., & Han, J.S. (2004). The amygdale and persistent pain. The Neuroscientist. Vol.10, no.3, 221-234.
Wang, P.S. & Beck, A.L.& Berglund, P.& McKenas, D.K. & Pronk, N.P. & Simon, G.E. & Kessler, R.C. (2004). Effects of Major Depression
on Moment-in-Time Work Performance. American Journal of Psychiatry.161: 1885-1891.
Science, Stress,
Physical and Mental Health

Susceptible genes alter under stress and factor in the development of depression
(Caspi et al 2003).
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Persons may be predisposed to develop depression based on genetic makeup and
their ability to cope effectively with stress (Garcia, 2002).
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Changes in specific hormones and stressful life events with major depression,
duplicated the work of Caspi, et al., in a follow-up study with twins (Prescott, Kuhn,
Vittum, Riley, and Kendler,2004).
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Stress, unchecked, not coped with effectively, leads to permanent structural
changes in the brain (Hariri, et al. 2002; Saplosky, 2003)
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Citations: Caspi et al., 2003; Garcia, 2002; Hariri, et al., 2002; Prescott, Kuhn,
Vittum, Riley, and Kendler, 2004; Saplosky, 2003; Science, 2003.
(See next slide w/ full citations).
The Science Connections
Physical and Mental Health
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Caspi, A; Sugden, K; Moffitt, T.E.; Taylor, A; Craig, I.W.; Harrington, H.L.; McClay, J;
Mill, J; Martin, J.; Braithwaite, A.; Richie Poulton, R. (2003). Influence of Life Stress on
Depression: Moderation by a Polymorphism in the 5-HTT Gene. Science, 301(5631), 386389.
Garcia, R. (2002). Stress, Metaplasticity, and Antidepressants. Current Molecular Medicine,
2, 629-638.
Hariri, A.R.; Mattay, V.S.; Tessitore, A.; Kolachana, B.; Fera, F.; Goldman, D.; Michael F.
Egan, M.F.;Weinberger, D.R. (2002). Serotonin Transporter Genetic Variation and the
Response of the Human Amygdala. Science, 297(5580), 400-403.
Prescott CA, Kuhn JW, Vittum J, Riley BP, and Kendler KS. (2004, abstract). Environment
interactions in psychiatric disorders; substantive findings and methodological challenges.
American Journal of Medical Genetics Part B: Neuropsychiatric Genetics. 130B (1), 10-11.
Sapolsky, R. (2003). Taming Stress: an emerging understanding of the brain’s stress
pathways points toward treatments for anxiety and depression beyond Valium and Prozac.
Scientific American. 289(3), 86(10).
Science (2003). Decoding Mental Illness. Vol.302. 19.
Key Points – so far
• Mental health (emotional health) and
physical health are equally important.
• Science connects physical, mental health.
• Stress effects an individual’s mental health
and physical health.
Key Points – so far
Science shows that:
• Stress can cause structural brain changes.
• Structural changes in the brain leads to
mental illnesses, such as depression.
How Do We Identify
Mental Health Problems?
Two ways:
• specific signs, symptoms; or
• duration of specific signs, symptoms, as
described in the DSM-IV*
DSM-IV = Diagnostic Statistical Manual
Citation: American Psychiatric Association. (1994).
Diagnostic and Statistical Manual of Mental
Disorders. Washington DC: Author.
Identifying Mental Health Problems
Depression
 based on # of symptoms and duration.
 different levels of severity.
 all documented in the DSM-IV.
Example:
Forms of depression described in DSM-IV:
minor depression, major depression, bipolar.
Why be Concerned about an
Emotional, Mental Illnesses?
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Science shows emotional illnesses effect
physical illnesses.
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Mental illnesses, such as depression can
lead to suicide if not treated appropriately.
National Institute of Mental Health
Current Suicide Rates In U.S.
http://www.nimh.nih.gov/suicideresearch/suichart.cfm
Identification of a Mental Health Problem An Example – Major Depression
Major Depression signs, symptoms, and duration
required are:
 Five (or more) of the following symptoms have
been present during the same two-week period
and represent a change from previous
functioning; at least one of the symptoms is
either (1) depressed mood or (2) loss of interest
or pleasure.”
Source: DSM-IV
Identification of a Mental Health Problem with
DSM-IV Diagnosis - Major Depression Signs and Symptoms
•
•
•
•
•
•
irritability;
loss of interest/pleasure in activities;
fatigue/loss of energy;
feelings of worthlessness/guilt;
diminished ability to think/concentrate;
significant weight loss/gain (not associated with
dieting);
• sleeping too much or having insomnia;
• recurrent thoughts of death/suicide
(Would my family be better off without me? )
(Life’s not worth it.)
Source: DSM-IV
Correlations of Mental Health Challenges,
Stress, and Our Responses:
Behavioral – Psychological - Physiological
Behavioral
Responses
Psychological
Responses
Physiological Responses
Our actions
Our emotions, mental
health
Our physical health
diminished ability to irritability;
think/concentrate;
loss of interest/
loss of pleasure in
activities; feelings of
worthlessness/guilt;
recurrent thoughts of
death/suicide
significant weight loss/gain
(not associated with dieting);
sleeping too much or having
insomnia;
Mental Health and Physical Health
are Equally Important Vignette #1
Mr. Poultry Farmer has arthritis. The arthritis is severe in his hips and arms. His
other major health problem is poor circulation, and his heart has pacemaker.
“It’s my heart and I had to put in a pacemaker ….and because of the [circulation
problems], ….. the leg swells up. …(I) get ulcers on the leg….I have arthritis in
my waist, you know. So I have all these problems. I have (a) problem in
bending …”
“So my wife, I’m xx y.o., she’s xx y.o., she helps me as best as she could, but we
have nobody.”
“You know, and like I said, it does cause a lot of stress on us, because, you
know, like say, my wife, you know, she gets more stressed …. because I
can’t do anything. And she has to go …. and help me. And …she has her
aches and pains too.”
Stress Effects an Individual’s
Mental Health and Physical Health
Mental Health Challenges –Stress: Relationships Strain
Family Support Systems.
“So, it ends up sometimes that we end up in argument,
you know, because my wife says, “You’re doing too
much”, you know, and I say, “What am I going to do,
you know?” And then, you know, then the next day
she says, “We should do this, we should do that.” It’s
very stressful on us, you know….”
Mental Health Challenges –
Stress: Finances and a Strain on Resources
“I don’t have no children that live home, I don’t have
no grand children that live here to send anybody to
help me. I can’t, with a small farm like this,
afford to pay somebody to do it. If I get
somebody to tend the chickens, I have to give
them 40 percent of my gross…I have to give them
40 percent of my gross and still do all my repairs
and everything. That’s how they would do it. I
can’t get somebody. I simply give them $100 a
week and come and pick up the dead chickens. I
can’t.”
Mental Health Challenges –
Stress: Job Performance
“So because I’ve not been able to do some of the
things, because one is the bending, I can’t stoop. So
sometime, you know, like when the feed line stays
on the ground …. If somebody is wrong with the
feed line and leaking line, (I) cannot get down there
to fix it until when the flock is over to bring it up
here where I can reach it, even the water or
anything. …. You’d have to ….stop all the feed and
take that out and this is something we can’t do….
Mental Health Challenge – Stress:
Perceptions of Fairness (Values)
“They (Chickens) sit down there on the wet floor.
You see the floor keep wetted, if the floor keep
wetted and they sit there when they sit down on
the floor, all the feathers come off the and skin
gets all scarred. So then the company says, “We
can’t sell that as a whole chicken, we have to cut it
up.” So, when they cut up chicken and you go in
the supermarket you see parts are more expensive
but with the farmer they say when you have to cut
up the chicken we get less money.”
Mental Health Challenges –
Stress: Job Security
“All these things, you know, and they not only
effect you financially, it effects you because
they (poultry supervisor) come and they
complain, as you see, and then they can tell
you, “Listen, mate, if you don’t do better we
drop you.”
Mental Health Challenges –
Stress: Cost/Benefit Job Expectations
“You know, it’s stress enough …. these chicken
companies, every day they want more and more
and more, you know? They want more and more.
I mean, I don’t need that much money because
I’ve got old houses that were built in xxxx. I have
(to) compete with the newer people. So I have to
keep improving my houses. Every time they want
more and more and more, you know, and they
don’t give you any more money.”
Mental Health Challenges –
Stress - Job Demands & Coping
“You know, I mean, we can’t go anywhere, because, you
know, when you have chickens, you can’t leave. We can
go to the store or something like that, you’ve got to be
here. And then when the chickens go you have two weeks
to three weeks but then you have to get your house ready.
And with our state of health, when a younger man go in
there and do a house in a day, it takes us a few days to do
it, because, my wife, we go there and to a little bit and stop
and go back tomorrow and do a little bit and stop. So it
takes us a longer. We’ve got to pay to do a lot of things
that other farmers can do for themselves. Because of our
disability, you know?
Stress: Physical & Mental Health
Complications
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“ I don’t have difficulty falling asleep. I have difficulty, I get
up, you know, and I keep getting up.” They prescribe “x”
DRUG for me.
So when I got the first prescription I took in the prescription,
$270 for a month’s supply. So I have to stop using “x” DRUG
and I go to “y” DRUG which costs me $20-something a month.
I can’t afford (the $270).
I was on cholesterol, uh, the cholesterol pill. They had me on
20 milligrams. I cut it to 10, you know, because I couldn’t
afford the 20. My wife is using it, too. And then I stopped
using it. so expensive and so far the last time I went and they
checked your blood and your everything, it was all right. But
the doctor said I can’t guarantee, I have to see him in December,
you’ve got to go check the blood again and then he see.”
Stress: Physical & Mental Health
Complications
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But twice before that I had pains in my chest in the night and
they had to take me. And most of these things happen after I
spent a lot of time in the chicken house.
If I go in there and I have a lot of things, and the doctor tells me
you’re not supposed to be in the chicken house.
You know, my doctor, I said, “Doc”, he said, “I know, but you
can’t spend much time in there. So sometimes I go in there and I
feel so bad and I have to come out for some fresh air and my
wife and then I can’t get back to the house because I can’t walk
to come that far on my own.”
Mental Illness Can Be Identified
“I’m not thinking suicide thoughts, but I think
whatever happens, happens.
Whatever happens, happens, you know, I feel like
that a lot. Whatever happens, because, you know,
I see my wife have to work so hard,….. and my
children they have their own (lives) …. So what’s
the sense in living? But I can’t take my own life.
But sometimes I do wish that I wasn’t living…”
Mental Illness Can Be Treated
“And sometimes I voice and, you know, and my wife
says, ‘Why do you have to talk like that?’ and she
gets mad with me.”
“She gets mad, ‘Don’t you care about anybody? Do
you care about the children? Do you care about
your grandchildren?’ Yes, I do, I love all my
children and my grandchildren, but sometimes I
just can’t take it, the pain. I have so much pain
that I can’t sleep because of the pain, you know
…”
Mental Health Problems Can Be
Identified and Treated - Vignette #1
Start cycle
Mr. Poultry Farmer, 64 y.o. male
with arthritis which makes it
difficult for him to care for the chickens.
Pain escalates. More physical
problems. More financial losses.
Passive suicidal wishes. Depression
treatment indicated.
Cycle continues:
The farmer’s wife helps out
when her job, off -farm, allows.
The supervisor pressures the farmer.
Cycle complications
“You constantly have to do something. It’s more stress.”
Physical complaints: Decreased sleep, Increased acid reflux,
High cholesterol. Medications ordered. Too expensive.
RISKS:
Decreased sleep – more prone to accidents
Increased acid reflux – more prone to stomach bleeding
High cholesterol – risk for stroke, heart attack.
With Mental Health Identification –
Treatment Options
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Treatments
- Antidepressants (SSRIs)
- Talk therapy, with professionals.
- Support groups
Mental Health and Physical Health
are Equally Important - Vignette #2
Mr. Grain Farmer is divorced, remembering
his prior marriage and his health problems.
“Well, I never cried a tear after she left.
Something can get on your nerves so bad. I
couldn’t sleep.”
Stress Effects an Individual’s Mental
Health and Physical Health
“So the last two years she was here, I just
slept downstairs on the sofa. It wasn’t
working.”
“… I got depressed. I got so I couldn’t sleep.”
Major Depression:
Suicidal with Plan
“One time I did (think of suicide). Yeah. I
thought about taking a garden hose and
putting it in the window of my pick-up.”
“Yeah, I thought, I even had a road picked out
back of XXXX where I was going to do it
because it was like things just weren’t
working, you know.”
Suicidal Thoughts
are a Cry for Help… Not Sympathy.
Emergency Treatment is Indicated.
“And she knew I was in that kind of shape. She knew
it. Because she made me call her, like, two or three
times a day to let her know where I was.”
“But she was real sympathetic for a while then she got
so she wasn’t sympathetic. She was like, “Oh,
you’re just wanting sympathy yourself” and “Get out
of it”, you know. She only had so much patience and
when she used it up she’d let you know.”
Mental Health Problems, Mental Illnesses,
Can be Identified and Treated.
“I take Effexor, one a day. I’ve been doing it for
eight, ten years, and this, it makes me relax. If
I miss two or three days I tense right up.”
“I’ve been taking that ever since Dr. X said let’s
try it when I was really hurting bad. I was to
the point where, especially in winter time and
rainy days, I’d get really depressed. I didn’t
even have enough energy to hang my clothes
up sometimes.”
Depression Medicine Helps –
Treatment Works
“But I’ve been divorced XXXX years. I waited a
year before I divorced her… mean, not because
I wanted her back. But I just made up my mind
I…. So I just waited a year.”
"(started the medicine)…At least ten years ago.
…Yeah, and see, long as I take all this, I feel
great.”
Summary
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There’s an inter-relationship with one’s physical
and mental health, that’s impacted by various
challenges.
Challenges are usually based on stress.
Stress is modulated by our perceptions of a
stress event, the coping behaviors we’ve
learned, and our wiring, our genetics.
Summary - continued
When stress is overwhelming, we have
physical and emotional health symptoms.
 Stress is expressed in:
 Behavioral terms
 Psychological terms, and
 Physiological terms.
(correlated with DSM-IV- summarized next
slide).

Stress & Responses Behavioral, Psychological, and Physiological
Behavioral
Stress Responses
Psychological
Stress Responses
Physiological
Stress Responses
our actions
our emotions
our physical health c/o.
why we see our health
providers. Ex. Can’t sleep
Influenced by social
norms. Guided by
perceptions and learned
behaviors.
Intertwined - perceptions,
learned behaviors, and
genetics.
Impacted by genetics, as
well as our learned
behaviors.
Example: Farmers are
resourceful, fix things.
Example: Farmers can be
“handicapped, but not
disabled.”
Example: Farmers
bargaining w/ what
medicines they need?
Stress Responses’ Ex:
can’t concentrate, big wt
loss or gain, loss of
energy, can’t sleep,
accident prone.
Stress Responses’ Ex:
irritability, sadness, loss of
pleasure in activities, etc.
Depression
Stress Responses’ Ex:
co-morbidity health prob
(diabetes, high blood
pressure). chronic health
issues lead to disabilities.
Schematic
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Designed by Peggy Mack, January 2004.
* Caspi et al., 2003; Hariri, et al., 2002; Prescott, Kuhn, Vittum, Riley, and
Kendler, 2004;Saplosky, 2003; Science, 2003.
The Take-Home Message

Mental illnesses, emotional problems,
can be identified and can be
successfully treated.
Worksheets
Depression Signs and Symptoms
Irritability
loss of interest/
pleasure in activities;
fatigue/loss of energy
feelings of
worthlessness/guilt
Worksheet – Depression
Signs and Symptoms
diminished ability to
think/concentrate
significant weight
loss/gain (not
associated with dieting)
sleeping too much or
having insomnia
recurrent thoughts of
death/suicide
Questions?
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Thank you.

Email: PeggyMack02@aol.com