UNIT 1: PSYCHIATRIC NURSING
PSYCHIATRY – branch of medical science which deals on the
study of causes, diagnosis, and treatment of maladaptive
patterns of behavior.
PSYCHE – mind; IATRIA – healing
MIND – integrative response of the organism.
To the complex physiological, psychological and social
processes that impinge upon him.
COMPONENTS OF THE MIND
1.
2.
3.
Cognition – intellectual aspect
Conation – motives, drives, striving force
Emotion – effect, feeling tone
STRUCTURES OF THE MIND
1.
2.
3.
ID – innate desires, pleasure seeking, aggression, sexual
impulses.

The id developed out of Freud’s concept of the
pleasure principle.

The id comprises primitive, instinctual drives (hunger,
sex, aggression).

The id says “I want”.

Seeks instant gratification. Causes impulsive,
unthinking behavior.

No regard for rules or social convention.
SUPEREGO – moral, ethics, values. Parenteral and social
expectations, indirect opposition of the ID.

The superego is the conscience of the psyche and
monitors the ego.

The superego says “I should/I ought”.

People pleaser
EGO – mature adaptive behavior. Mediating force between
the id and superego.

It is the ego, or the rational mind, that is called upon to
control the instinctual impulses of the self-indulgent id.

The ego says, “I think/I evaluate”
TOPOGRAPHIC MODEL OF THE MIND
Freud’s topographic model deals with the level of awareness.
Divided into 3 categories:
1. Unconscious mind – all mental content and memories
outside of conscious awareness; becomes conscious
through the preconscious mind.
2. Preconscious mind – not within the conscious mind but
can more easily be brought to conscious awareness.
(repressive function of instinctual desires or undesirable
memories)
Reaches consciousness through word linkage.
Conscious mind – all content and memories immediately
available and within conscious awareness.
Of lesser importance to psychoanalysts.
The provision of nursing care to patient where the therapeutic
goal is the:

Prevention

Detection

Treatment

Rehabilitation of psychiatric disorders
An interpersonal process whereby the professional nurse
practitioner assists an individual, family, or community to:

Promote mental health

Prevent or cope with the experience of mental illness
and suffering

Find meaning in these experiences
A process whereby the nurse assists persons in the
achievement of man’s:

Positive self-image

More harmonious patterns of relationships

Productive social role
FUNDAMENTAL GOALS OF PSYCHIATRIC NURSING
FOR THE MAN TO:
1. Achieve positive self-image
2. Have a more harmonious interpersonal process
3. Have a high productive societal role
THERAPEUTIC GOALS OF NURSING CARE:
1. To help the client accept himself
2. To improve relationships with others
3. To learn to function individually, and independently on
a realistic basis
PSYCHOBEHAVIOR ROLE OF THE NURSE
RECOGNITION – memory, mood, affect, appearance, speech,
thoughts, perception, orientation
RELATIONSHIP
genuineness
–
concreteness,
respect,
RESOURCES/REFFERAL – community agencies, hospitals,
doctors, churches
SCOPE/AREAS OF PRACTICE
Basic Level Functions
1. Counselling
(interventions
and
communication
techniques, problem solving, crisis intervention, stress
management, behavior modification)
2.
Milieu therapy (maintain therapeutic environment, skills
teaching, communication, role modeling)
3.
Self-care activities (encourage independence, increase
self-esteem, improve functions and health)
4.
Psychobiologic
interventions
medications, teaching, observations)
5.
6.
7.
Health teaching
Case management
Health promotion and maintenance
3.
PSYCHIATRIC NURSING
empathy,
(administering
Advanced Level Functions
1. Psychotherapy
2. Prescriptive authority for drugs
3. Consultations
4. Evaluations
NATURE OF PSYCHIATRIC NURSING
Scope of Nursing Practice

Individual, family and community

Healthy and ill person
THE MENTAL HEALTH TEAM
4 Core Psychiatric Disciplines
1. Physicians
2. Nurses
3. Psychologists
4. Social workers
5 EPOCHS OF THE DEVELOPMENT OF PSYCHIATRY
ANCIENT TIMES – beliefs on sickness as:
Displeasure of the Gods
Punishments for sins and wrong doings
Persons with mental disorders were viewed depending
on their behavior as:
a. Demonic – aggressive, violent (ostracized,
punished, burned)
b. Divine – aloof, silent, melancholic (worshipped,
adored)
Diseases are attributed to demons in the form of evil spirits.
1.
ARISTOTLE (382-322 B.C) relate mental disorders to physical
disorders.
Developed his theory that emotions were controlled by the
amount of blood, water, yellow and black bile in the body which
corresponds to emotions of happiness, calmness, anger and
sadness.
Imbalance of these result to mental disorder.
Treatment = aimed to restore balance by bloodletting, starving,
and purging. Persisted well until the 19th century.
EARLY CHRISTIAN TIMES (1-1000 A.D.) – beliefs and
superstitions were strong. All diseases were blamed on the
demons and mentally as possessed.
Treatment = priest performed exorcism to rid the evil spirits. If
failed, more severe measures such as incarcerations in
dungeons, flogging, starving and other brutal ttts.
2.
-
RENAISSANCE (1300-1600)
Mentally ill were distinguished from criminals in England.
Harmless = allowed to wander in countryside or live in rural
communities.
Dangerous/lunatics = thrown to prison, chained, starved.
1547 – hospital of St. Mary of Bethlehem was declared as hosp.
for the insane
1775 – visitors of mental institutions were charged a fee for the
privileged of viewing and ridiculing inmates who were seen as
animals, less than human
In the U.S., mentally ill were considered as evil or
possessed, were punished.
Diseases were attributed to witchcraft.
Witch – hunt was conducted and offenders were burned
3.
-
CHEMICO – ASTROLOGIC
Started the study of Psychiatry
Beliefs that illness was associated with astrology
Full moon/Moon = high tide, affects mood of people
Paracelsus Mesmer – advocated the use of Hypnotism
4.
HUMANITARIAN/ PERIOD OF ENLIGHTENMENT AND
CREATION OF MENTAL INSTITUTIONS
1790’s – the concept of asylum was instituted by Philippe Pinel
in France and William Turke in England
Asylum became a safer refuge to people who were
whipped, beaten, and starved just because they were
mentally ill
1802-1887 – in the U.S. Dorothea Dix began the crusade to
reform the treatment of the mentally ill after the visit to Tukes in
England. Opened 32 state hosp.
This period was short-lived. Within 100 years after the 1st
asylum was established, state hospitals were in trouble.
Attendants were accused of abusing the patients, rural
location of the hosp. were viewed as isolating patients from
their families and homes.
Ben Rush (Father of American Psychiatry) – recommended
that mentally ill should have a normal environment. Should be
subjected to therapy because mental illness is a disease entity.
5.
MODERN PERIOD/PERIOD OF SCIENTIFIC STUDY
Began with Sigmund Freud (1856-1939) – challenged
the society to look at human beings a studied
objectively and studies the mind and its disorders and
their ttt.
along with others such as:

Emil Kraepelin (1856-1926) – began classifying mental
disorders accdg. to symptoms

Eugene Bleuler (1857-1939) – coined the term
Schizophrenia
The study of Psychiatry and the diagnosis and ttt of mental
illness began.
1950 – began the development of Psychotropic drugs
Chlorpromazine (Thorazine) – antipsychotic drug
Lithium – anti-manic agent was the 1st drug to be developed
Monoamine oxidase inhibitor – anti-depressant
Haloperidol (Haldol) – anti-psychotic
Tricyclic antidepressant and Benzodiazepines – anti-anxiety
agents were introduced over the next 10 years
These drugs improved the condition of many patients.
Thus,
a. Decreased/ shortened hospital days
b. Many people were well enough to go home
c. The level of noise, chaos, and violence greatly
diminished in the hospital setting
NATURE OF PSYCHIATRIC NURSING
MENTAL HEALTH – it is difficult to define mental health illness
because these concepts are for the most part culturally
determined and are defined differently in various parts of the
world.
Ability to cope successfully with the recurrent stresses of
living and achievement of a relatively effective adjustment
to life.
Ability to adjust to situations
Continuous interplay of acting, interacting, coping and
adapting
A state of emotional, psychological and social wellness
evidenced by;

satisfying interpersonal relationships,

effective behavior and coping,

positive self-concept

emotional stability and

self-awareness
Lifelong process of successful adaptation to a changing internal
and external environments
MEDICAL POINT OF VIEW OF MENTAL HEALTH
MENTAL HEALTH – freedom from;

Pain

Gross pathology

Disability
Disorders are defined in terms of DSM IV (Diagnostic Statistical
Manual of Mental Health)
CULTURAL POINT OF VIEW OF MENTAL HEALTH
MENTAL HEALTH – is the capacity to be competent in the
performance of social role within a wide range of behavior
1.
-
2.
-
3.
-
4.
-
5.
-
PROCESS CONCEPT OF MENTAL HEALTH
MENTAL HEALTH – is the ability to effectively integrate
biological, and social system as life events as they are met at
the progressive stage of growth and development
6.
-
LEGAL CONCEPT OF MENTAL HEALTH
INSANITY – term of mental illness in legal aspect
Inability to distinguish right from wrong to confirm behavior to
law
-
MENTAL HEALTH CONTINUUM
NORMAL
ILLNESS
NEUROTIC
-
PSYCHOTIC
INTER-
INTER-
PERSONAL
PERSONAL
ADEQUACY
COMPETENCE
Growth, Development and Self actualization
What the person does within his abilities and potentialities
are considered important
His involvement in outside interests, relationships,
concern with occupation, ideals and his goals in life are
considered.
Integrative Capacity
The balance of psychic forces (id, ego, superego)
Functions as a unified whole (physical, psychological,
mental, emotional, spiritual)
The ability to tolerate anxiety and frustration in a stressful
situation (adaptation)
Autonomous behavior
the individual’s ability to make his own decision and react
according to his own conviction regardless of outside
environmental forces.
Accepts responsibilities for his own actions
Perception of reality
Deals with how the person perceives his environment and
other people
Reactions towards people and environment
Mastery of one’s environment
It is the ability to adapt, adjust, and behave appropriately in
situations according to approved standards so the
satisfactions are achieved in love, work, play, and
interpersonal relations
Refers to the problem-solving ability of the person
1.
2.
3.
4.
5.
6.
FORENSIC PSYCHIATRY – study of mental health in legal
aspect
HEALTH
INDICATION OF MENTAL HEALTH
Positive attitude towards the individual self
Involves aspects related to person’s self-awareness,
acceptance, confidence, level of self-esteem, sense of
personal identification in relation to role, other people,
gender, vocation, strength and weakness
-
A.
-
1.
2.
Has realistic knowledge of himself
Accepts himself with his strength and weaknesses
Genuinely concerned with others
Is more directed by inner than outer values
Can take care of himself without hurting others
Can tolerate stress and frustration without
personality disorganization
MENTAL DISORDER
A clinically significant behavioral or psychological syndrome
or pattern that occurs in an individual and that is associated
with present distress, increased risk of suffering, death,
disability and loss of freedom.
Loss of ability to respond to environment in ways that are in
accord with oneself and society.
CAUSES OF MENTAL ILLNESS
PREDISPOSING/PRECIPITATING FACTORS
The conditions that make the individuals susceptible to the
effect of the precipitating factors to be more likely to develop
psychosis
INHERITANCE = faulty or defective genes, hereditary
structures, hormonal imbalance
AGE = there are critical periods in life when the individual is
more vulnerable emotionally than others.
e.g. adolescence – role identity, role confusion
middle age – mid-life crisis
old age – ego integrity; acceptance for what life has been.
3.
SEX = male has low frustration tolerance than female. Male
are emotionally weak
4.
MARITAL STATUS = unmarried are more susceptible to
mental illness than the married ones
5.
ENVIRONMENTAL AND SOCIAL FACTORS = a stable,
secure, loving family life assists individuals to develop
attitude about self and others that make it possible to;

Adjust to the pressure of adulthood

To live a satisfying and productive life
6.
OCCUPATION = routinely jobs; jobs with limited or no IPR
7.
PREVIOUS ATTACKS
B. PREFORMATION/PRECIPITATING FACTORS
PHYSICAL

Infections

Intoxication

Exhaustion

Organic conditions

Trauma
III.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
SOCIO-CULTURAL-SPIRITUAL
Age
Sex
Race
Marital status
Occupation
Education
Economic status
Social class
Religious beliefs/values
Migration
Ethnic mores
Isolation/alienation
Overcrowding
Rapid social changes
THE DSM-TR IV: Multi Axis Classification
AXIS I – Major Psychiatric Disorders
AXIS II - Mental Retardation and Personality Disorders
AXIS III – Current Medical Condition
AXIS IV – Psychosocial and Environmental Problems
AXIS V – Global Assessment of Function
NATURE OF PSYCHIATRIC NURSING
Psychiatric Nursing in the Philippines
PSYCHIC

Conflicts

Disappointments

Rejection

Deprivation
Mental Health – state of well-being, where a person can realize
his potential
PROVOCATION
Events that are immediately preceding the occurrence
of mental illness is critical. It only needs a very little
space to go back once there’s a highly emotional and
critical situation such as;

Loss of a loved one

Rape

Conflict

Disappointments

Rejection

Inferiority
Mental Hygiene – science which deals with measures
employed to promote mental health
FACTORS RELATED TO MENTAL ILLNESS
I.
a.
b.
c.
d.
e.
f.
PHYSIOLOGICAL
Defective genes
Disturbance in neurotransmitters
Hormonal imbalance
Malnutrition
Sensory deprivation
Sleep deprivation
II.
a.
b.
c.
d.
e.
f.
g.
PSYCHOLOGICAL
Lack of maternal attachment/deprivation
Sibling position
Parental behavior and child rearing practices
Double bind process of communication
Conflict
Stress
Ineffective coping styles
Mental III Health – disturbance of thought, feelings and
behavior
Mental Disorder – medically diagnosable illness
BASIC PRINCIPLES IN PSYCHIATRIC NURSING
1. acceptance – worth and dignity (holistic being)
2. patients need to be allowed to express both positive and
negative feelings.
Focus on strength and assets nor on his weakness and
liabilities
3. patient needs the opportunity to set his own pace in working
with his problems
The nurse needs to accept the client as a human being
who has the value and worth, exactly as he is.
4. nursing care should center on the patient’s care and treatment
not on the control of his symptoms
Patient’s behavior = designed to meet a need or to
communicate
5. understanding – the nurse has the potential for establishing a
relationship with most if not all clients
6. consistency – attitudes, schedules should be consistent so
that results are predictable; this will evoke security
Quality of interaction which the nurse engaged with the
client will be the major determinant of the degree to
which the client will be able to alter his behavior
towards more satisfying IPR
7. setting limits – the patient does not know what they are doing
is harmful or not
The nurse need to view the client’s behavior as the best
possible adaptation he is capable of making at the time
Avoid using force, instead provide a substitute to
deviate his behavior
8. reassurance – giving the patient the attention to do things for
him without waiting anything in return
-
UNIT II PSYCHIATRIC NURSING PRACTICE
Theoretical Foundations

Mental
health-Psychiatric treatment
integrates
concepts and strategies from theories.

Theoretical Models are used as guides for treatments

These theories attempt to explain human behavior,
health and mental illness
Theoretical frameworks

allow the systematic organization of knowledge

guide data collection

provide explanations for assessed behaviors

guide care plan development

provides rationales for interventions and

determine evaluation criteria

Guide research by providing assumptions to be tested.
PsychosexualPsychoanalytical Theory
Psychosocial theory
Cognitive theory
Interpersonal theory
Moral theory
Spiritual theory
Behavioral theories
Humanistic theories
Psychobiology theory
Sigmund Freud
Erik Erikson
Jean Piaget
Harry Stack Sullivan
Kohlberg
Fowler
Pavlov and Skinner
Maslow and Carl Rogers
Neuro-anatomy
and
physiology
A. Theories of Personality development

Freud’s Psychoanalytic theory

Erikson’s Psychosocial theory

Sullivan’s interpersonal theory

Piaget’s Cognitive theory

Fowler’s Spiritual theory

Kohlberg’s Moral theory
FORMATION OF PERSONALITY
TEMPERAMENT:

Biological-genetic template interacts with our environment

a set of in-built dispositions we are born with

mostly unalterable

our nature
CHARACTER:

The outcome of the process of socialization the acts and
imprints of our environment and nurture on our psyche
during the formative years (0-6 years and in adolescence)

The set of all acquired characteristics we possess, often
judged in a cultural-social context

Sometimes the interplay of all these factors results in an
abnormal personality
Psychosexual Theory

Was based on his therapy with troubled adults.


He emphasized that a child's personality is formed by the
ways which his parents managed his sexual and aggressive
drives.
By Sigmund Freud
Psychosexual/Psychoanalytical

This theory supports the notion that EVERY human
behavior is caused and can be explained

Freud believes that “repressed” sexual urges, desires,
impulses or drives motivated much human behavior
Components of Personality
1. ID - pleasure principle
2. EGO - reality principle
3. SUPEREGO - moral principle
ID dominates:
Mania
Narcissistic
Anti – social behaviors
Delinquents
EGO dominates
Self – centeredness
Selfishness
Schizophrenia
Psychosis
Anti-social PD
SUPEREGO dominates
Strict super ego: lead to rigid, compulsive, unhappy person
Weak super ego: may permit a person to express hostile & anti
– social behaviors without anxiety or feelings of guilt
Personality Stages and Functional Awareness
1. Conscious – perceptions, thoughts and emotion that exist
in the person’s awareness
2. Pre-conscious/Subconscious – thoughts and emotions
not currently in awareness but can be recalled with effort
3. Unconscious – thoughts, drives and emotions totally a
person is Unaware
According to this theory, much of our behavior is motivated by
our SUBCONSCIOUS thoughts or feelings.
FIVE STAGES OF PSYCHOSEXUAL DEVELOPMENT
PHASE
AGE
FOCUS
Major task: weaning
Oral
0-18 months
Major
task:
toilet
Anal
1 ½ -3 years
training
Major task: oedipal
Phallic
3-5 years
and electra complex
Major task: school
Latency
6-12 years
activities
Major task: sexual
Genital
12 & above
intimacy
1. ORAL
a. 0-18 months
b. Pleasure and gratification through mouth
c. Behaviors: dependency, eating, crying, biting
d. Distinguishes between self and mother
e. Develops body image, aggressive drives
Fixation:


narcissism, pleasure seeking thru eating, suckling.
Individual tends to become dependent, talkative, nail
chewer, self-centered, taking but not giving, fantasy of
gustatory pleasure, smokers.
2. ANAL
a. 18 months - 3 years
b. Pleasure through elimination or retention of feces
c. Behaviors: control of holding on or letting go
d. Develops concept of power, punishment, ambivalence,
concern with cleanliness or being dirty
Fixation:

Child may show temper tantrums, ambivalence,
guilt/shame & stress laden.

The individual may become stingy, miser, bossy, selfish,
meticulously clean or untidiness. Deals anxiety through
reaction formation.
CLUES FOR TOILET TRAINING:
A. walk alone
B. stand steadily
C. be dry for at least 2 hours
D. demonstrate awareness of voiding & defecating
E. use words & gestures regarding toilet need & training
3. PHALLIC/OEDIPAL
a. 3 - 6 years
b. Pleasure through genitals
c. Behaviors: touching of genitals, erotic attachment to parent of
opposite sex
d. Develops fear of punishment by parent of same sex, guilt,
sexual identity
Fixation

Sexual role confusion

Sexual identity confusion

Failure to resolve complexes is one of the sources of guilt
among neurotic people.
4. LATENCY
a. 6 - 12 years
b. Energy used to gain new skills in social relationships and
knowledge
c. Behaviors: sense of industry and mastery
d. Learns control over aggressive, destructive impulses
e. Acquires friends
Fixation:

Obsessiveness

Compulsion

Role identity confusion
5. GENITAL
a. 12 - 20 years
b. Sexual pleasure through genitals
c. Behaviors: becomes independent of parents, responsible for
self
d. Develops sexual identity, ability to love and work
Fixation:

Role confusion

Identity confusion

Exhibits delinquency

Anti – social behaviors
Ego Defense Mechanisms
= are specific, unconscious, intrapsychic, adjustive efforts
utilized to resolve emotional conflict & free the individual
from anxiety.
Coping Mechanisms
= conscious efforts
1st level:
considered normal and involves conscious efforts at
maintaining control over anxiety by changing the
environment or one’s perspective:

Suppression,

substitution,

rationalization,

fantasy
2nd level:
involves character changes and manipulation of
relationships with others.
May lead to personality disorders if prolonged or
exaggerated and to difficulties in the interpersonal
areas of work, marriage and parenting:
identification, introjection /internalization, restitution
3rd level:
comprises the repressive defenses which involve
changes in the intra- psychic process:
compensation,
reaction-formation,
sublimation,
displacement,
projection,
symbolization,
conversion,
repression,
undoing
4th level:
seen in the use of the regressive defenses and involves
a return to a state of helplessness and withdrawal from
reality:

denial,

dissociation,

regression
1. DENIAL
= Refuses to accept a painful reality, pretending as if it doesn’t
exist.

A man who snorts cocaine daily, is fired for attendance
problems, yet insists he doesn’t have a problem.
2. DISPLACEMENT
= transfer into another situation of an emotion felt in a previous
situation where its expression would not have been socially
acceptable.
= Directing anger toward someone or onto another, less
threatening (safer) substitute.

An older employee is publicly embarrassed by a
younger boss at work and angrily cuts a driver off on
the way home.
3. IDENTIFICATION
=Taking on attributes and characteristics of someone admired.
=Unconscious, wishful adoption of the identity of another
individual which one envies or admires.

A young man joins the police academy to become a
policeman like his father, whom he respects.
4. INTROJECTION
= the symbolic assimilation (taking into one’s self) of a loved or
hated object’s/person’s ideas, tastes, & wishes to become one’s
own.
=Sometimes regarded as a form of identification
5. INTELLECTUALIZATION
= Excessive focus on logic and reason to avoid the feelings
associated with a situation.
= use of intellectual powers of thinking, reasoning, analyzing to
blunt or avoid emotional issues that are too painful/ threatening.

An executive who has cancer, requests all studies and
blood work, and discusses in detail with her doctor, as
if she were speaking about someone else.
6. PROJECTION
= Attributing feelings unacceptable to self onto another
individual.
= unconsciously making another person or situation responsible
for own unacceptable thoughts/actions.

A group therapy client strongly dislikes another
member but claims that it is the member who “dislikes
her.”
7. REACTION FORMATION
= Expressing an opposite feeling from what is actually felt and is
considered undesirable.

John, who despises Jeremy, greets him warmly and
offers him food and beverages and special attention.
8. SUBLIMATION
= Redirecting unacceptable feelings or drives into an acceptable
channel.
= Re-channeling of aggressive energies into socially acceptable
expression.

Excelling in sports to sublimate hostile impulses.

Painting artistically to sublimate sexual impulses.
9. UNDOING / SYMBOLIZATION
= Unconscious ritualistically negating or undoing intolerable
feelings/ thoughts.
= Actions or words designed to cancel some disapproved
thoughts, impulses, or acts in which the person relieves GUILT
by making reparation

A man who has thoughts that his father will die
must step on sidewalk cracks to prevent this and
cannot miss a crack.
10. COMPENSATION
= Conscious/unconscious covering up real or imagined
weaknesses/deficiencies by developing other personal qualities
to counterbalance failure.

A physically small person may become aggressive
& domineering.

A blind person who become proficient in music
11. SUBSTITUTION
=Replacement of a highly valued object by a LESS valuable or
acceptable and available object.
= comparable to displacement

Murderous impulses may be replaced by some
impersonal destructive act such as striking a punch
bag.
12. MINIMIZATION
= Not acknowledging the significance of one’s behavior
13. REGRESSION
= Backward turning to an earlier, more comfortable patterns of
behavior in resolving personal conflicts.
= When faced by a conflict, a mature person’s resulting anxiety
often initiates childish behavior.

Nail biting, thumb sucking, pouting,
14. REPRESSION
= Unconscious, involuntary, automatic banishment of
unacceptable ideas or impulses into the unconscious, but not
forgotten.

Certain thoughts, feelings are forced into
unconsciousness.
15. CONVERSION
= An unconscious mechanism by which an individual converts
an emotional problem into a physical symptom or outlet which
provides a release for the tension & anxiety associated with the
conflict.

A soldier who develops paralysis in his hand when
firing a gun, as a defense against repressed
hostility towards his father who deserted them.
16. SUPPRESSION
= A conscious, deliberate withholding of words or deeds that are
unfavorable to the self.
= put something out of the mind.
= A conscious process, so not considered a true defense
mechanism by many authorities.

A student who wishes to study for an examination
may consciously set aside distracting thoughts &
fantasies.
17. FIXATION
= The arrest of maturation at an earlier level of psychosexual
development.

A child continued attachment to a nursing bottle
beyond the oral period
18. FANTASY
= Non rational mental activity that allows escape from daily
pressures & responsibilities.
= Temporarily breaks through the boundaries of reality that
allows the person to enter a place where he can daydream about
whatever is most pleasurable to them.
19. DISSOCIATION
= The detachment of certain personal activities from normal
consciousness which then function alone.

Sleepwalking (Somnambulism)

Amnesia

Fugue & twilight states

Bruxism (teeth grinding)
20. ISOLATION
= The separation of an acceptable impulse, act or idea from its
memory origin, thereby removing the emotional charge
associated with the original memory.
Transference and Counter-transference
TRANSFERENCE is the clients feeling toward nurse arising
from unconscious experiences with early significant others
COUNTER TRANSFERENCE is the nurse’s feelings toward the
patient arising also form previous experiences

Theory that focuses on developmental task,
focuses on EGO as this develops from social
interaction

The developmental tasks are sequential and
depend on prior successful mastery

An individual who fails to “master” the task at
appropriate age may return to work on mastery



Use of the theory in Nursing
Assessment can be done focusing on the psychosocial
development at specific age
Appropriate interventions can be selected based on task
Nurses can promote healthy behaviors and encourages
hope that re-learning is possible
PSYCHOSOCIAL THEORY BY ERIK ERIKSON

Expanded on Freud's theories.

Believed that development is life-long.

Emphasized that at each stage, the child acquires attitudes
and skills resulting from the successful negotiation of the
psychological conflict.
Identified 8 stages:

Basic trust vs mistrust (birth - 1 year)

Autonomy vs shame and doubt (ages 1-3)

Initiative vs guilt (ages 3-6)

Industry vs inferiority (ages 6-11)

Identity vs identity confusion (adolescence)

Intimacy vs isolation (young adulthood)

Generativity vs stagnation (middle adulthood)

Integrity vs despair (the elderly)
1. TRUST VS MISTRUST
a. 0 - 18 months
b. Learn to trust others and self vs. withdrawal, estrangement
2. AUTONOMY VS. SHAME AND DOUBT
a. 18 months - 3 years
b. Learn self-control and the degree to which one has control
over the environment vs compulsive compliance or defiance
3. INITIATIVE VS GUILT
a. 3 - 5 years
b. Learn to influence environment, evaluate own behavior vs
fear of doing wrong, lack of self-confidence, over restricting
actions
4. INDUSTRY VS INFERIORITY
a. 6 - 12 years
b. Creative; develop sense of competency vs sense of
inadequacy
5. IDENTITY VS ROLE CONFUSION
a. 12 - 20 years
b. Develop sense of self; preparation, planning for adult roles vs
doubts relating to sexual identity, occupational career
6. INTIMACY VS ISOLATION
a. 18 - 25 years
b. Develop intimate relationship with another; commitment to
career vs avoidance of choices in relationships, work, or lifestyle
7. GENERATIVITY VS STAGNATION
a. 21 - 45 years
b. Productive; use of energies to guide next generation vs lack
of interests, concern with own needs
8. Integrity vs despair
a. 45 years to end of life
b. Relationships extended, belief that own life has been
worthwhile vs lack of meaning of one’s life, fear of death
DEVELOPMENTAL ARREST = a term used to describe when
the individual lags or failed to accomplish the developmental
tasks timely and satisfactorily.
Trust vs. Mistrust = HOPE
Adult behaviors showing developmental problems:
Suspiciousness; fear criticism/affection; dissatisfaction/hostility;
projection of feelings; withdrawal from others
OR
Overly trusting to others; naïve/gullible; shares too quickly &
easily
Autonomy vs. Shame & Doubt = WILL
Adult behaviors showing developmental problems:
Self - doubt; dependence on others for approval; feeling of being
exposed; sense of being out of control; obsessive – compulsive
behaviors
OR
Excessive independence; defiance; grandiosity; denial of
problems; unwillingness to ask for help; impulsiveness(inability
to wait); reckless disregard of safety for self & others
Initiative vs. Guilt = PURPOSE
Adult behaviors showing developmental problems:
Excessive guilt/embarrassment passivity/apathy
Avoidance of activities & pleasure; self pity; assuming a role a s
victim; self – punishment; reluctance to show emotions;
underachievement of potential
OR
Lack of follow through on plans; little sense of guilt, excessive
expression
of
emotion,
labile
emotion;
excessive
competitiveness; show off
Industry vs. Inferiority = COMPETENCE
Adult behaviors showing developmental problems:
Feeling unworthy/inadequate; poor work history
(quitting, being fired, lack of promotions, absenteeism, lack of
productivity); inadequate problem solving skills; manipulation of
others; violation of other’s rights; lack of friends of same sex.
OR
Perfectionist, overly high achiever, fear of failing, workaholic
Identity vs. Role diffusion = FIDELITY
Adult behaviors showing developmental problems:
Lack of giving up of goals; feeling of confusion; indecision;
vacillation between dependence & independence; superficial
short term relationships of opposite sex
Gender-related identity disorders= identity crisis= transsexual,
bisexual, sexual perversion
OR
Dramatic over confidence; flamboyant display of sex role
behaviors
Intimacy vs. isolation = LOVE
Adult behaviors showing developmental problems:
Isolation; emotional distance; prejudices against others; lack of
established vocation; many career changes; seek intimacy
through casual sexual encounters.
OR
Possessiveness; jealousy; dependency; abusiveness towards
loved ones; inability to try new things socially & vocationally

Developmental maturational crisis

If all developmental tasks are not fulfilled and
developed, this time all mental disorders and
maladaptive behaviors with all their signs &
symptoms will be manifested= will show & come
out.

Schizophrenia, manic-depressive disorders
Generativity vs. Stagnation = CARE
Adult behaviors showing developmental problems:
Self –centeredness/ self – indulgence; exaggerated concern for
appearance & possession; lack of welfare for others; lack of civic
/prof’l activities; loss of interest in marriage; extra – marital
affairs
OR
Too many prof’l or community activities to the detriment of the
family or self
Integrity vs. Despair = WISDOM
Adult behaviors showing developmental problems:
Sense of helplessness; hopelessness; worthlessness;
usefulness or meaninglessness; withdrawal; regression;
focusing on past mistakes, failures, & dissatisfactions; suicidal
ideations; inability to occupy self in a satisfying activity/hobby
OR
Inability to reduce activities; overtaxing strength & abilities;
feeling indispensable; denial of death as inevitable
INTERPERSONAL THEORY (SULLIVAN)
This concept focuses on interaction between an individual
and his environment
Personality is shaped through “interaction” with significant
others
We internalize approval or disapproval from our parents
Personality has three SELF-SYSTEM:
1. “Good Me” develops in response to behaviors receiving
approval by parents/SO
2. “Bad Me” develops in response to behaviors receiving
disapproval by parents/SO
3. “Not Me” develops in response to behaviors generating
extreme anxiety in parents/SO and this is denied as part of
oneself
Usefulness in Nursing

Nurse and client can participate in and contribute to the
relationship that is therapeutic

This relationship can be used as a corrective interpersonal
experience

Anxiety management
1. Infancy
a. 0 - 18 months
b. Others will satisfy needs
2. Childhood
a. 18 months - 6 years
b. Learn to delay need gratification
3. Juvenile
a. 6 - 9 years
b. Learn to relate to peers
4. Preadolescence
a. 9—12 years
b. Learn to relate to friends of same sex
5. Early adolescence
a. 12—14 years
b. Learn independence and how to relate to opposite
sex
6. Late adolescence
a. 14—21 years
b. Develop intimate relationship with person
of opposite sex
COGNITIVE THEORY (PIAGET)
This theory focuses on the inborn development of
thinking ability from infancy to adulthood
A person is born with a tendency to organize and to
adapt to their environment
Mental illness is not directly discussed
Usefulness of Cognitive theory in Nursing
1. This provides an understanding how an individual think
and communicate. Nurse can provide intervention
accordingly
2. Nursing interventions should be congruent to the agespecific cognitive level
3. Teaching strategies are modified according to cognitive
process
Sensori-motor (birth to 2 )
Pre-operational (2-7)
o Preoperational pre-conceptual (2-4)
o Preoperational intuitive (4-7)
Concrete operational (7-12)
Formal operational (12 to adulthood)
COGNITIVE DEVELOPMENT THEORY

Children "construct" their understanding of the
world through their active involvement and
interactions.

Studied his 3 children to focus not on what they
knew but how they knew it.

Described children's understanding as their
"schemas” and how they use:
 assimilation
 accommodation.
0-2 SENSORIMOTOR
Reflexes
Imitative repetitive behavior
Sense of object permanence and self-separate from
environment
Trial and error results in problem solving
2-7Y PRE-OPERATIONAL
Self-centered, egocentric
Cannot conceptualize other’s view
Animistic thinking
Imaginary playmate – symbolic mental representation
(creativity)
2-4 pre-conceptual (pre-logical)
4-7 intuitive (understanding of roles)
7-12Y CONCRETE OPERATIONAL
Logical concrete thought
-
Inductive
reasoning
(specific
can relate, problem solving ability
Reasoning and self-regulation
to
general)
12-ABOVE: FORMAL OPERATIONAL THOUGHT
Abstract thinking
Separation of fantasy and fact
Reality oriented
Deductive reasoning
Apply scientific method
A. 0 - 2 years: Sensori-motor
-reflexes, repetition of acts
B. 2 - 4 years: preoperational/pre-conceptual
-no cause-and-effect reasoning; egocentrism; use of
symbols; magical thinking
C. 4 - 7 years: intuitive/preoperational
-beginning of causation
D. 7 - 11 years: concrete operations
- uses memory to learn
- aware of reversibility
E. 11 - 15 years: formal operations
-reality, abstract thought
-can deal with the past, present and future
BEHAVIORAL THEORY (PAVLOV) (SKINNER)
This concept describes a person’s function in terms of
identified BEHAVIORS
People learn to be who they are
Behavior can be observed, described and recorded
Behavior is subject to reward or punishment
Behavior can be modified by changing environment
The Classical Conditioning by Pavlov
Learning can occur when a stimulus is paired with an
unconditioned response
Conditioned responses happens when stimulus is present
Acquisition – gain of learned response
Extinction – loss of learned response
The Operant Conditioning by Skinner
Rewards and punishments are utilized
Positive reinforcement- rewards
Negative reinforcementPositive punishment
Negative punishment- withdrawing reward
HUMANISTIC THEORY
Human nature is positive and growth centered and
existence involves search for meaning and truth
Maslow’s theory of Needs are organized in a hierarchy
1.
Application of the theory to Nursing
NCR is based on positive regard, respect and empathy
2. Nurses assess the spiritual aspects of the client
including religion, love and relationships
3. Through reflective listening and emphatic responses,
the nurse helps the client gain self-understanding
KOHLBERG’S STAGES OF MORAL DEVELOPMENT
PRECONVENTIONAL LEVEL:
Stage 1 - Age 2- 3 yrs old
Punishment or obedience (heteronymous morality)
A child does the right things because a parent tells him
or her to avoid punishment
Stage 2 - Age 4-7 yrs old
Individualism
Child carries out actions to satisfy own needs rather
than society’s.
The child does something for another if that person
does something for him in return
Stage 3 - Age 7-10 yrs old
Orientation to interpersonal relations of mutuality
A child follows rules because of a need to be a good
person in own eyes and in the eyes of others
Stage 4 - Age 10-12 yrs old
Maintenance of social order, fixed rules and authority
Child follows rules of authority figures as well as
parents to keep the system working
Stage 5 - Age older than 12
social contract, utilitarian law making perspective
child follows standards of society for the good of all
people
Stage 6 - Age older than 12
universal ethical principle orientation
child follows internalized standards of conduct
-
OTHER THEORIES OF PERSONALITY DEVELOPMENT
1. INDIVIDUAL PSYCHOLOGY – ALFRED ADLER
Emphasize EGO rather than sexuality.
Conceive personality as beginning from feeling of
inferiority & striving throughout life toward superiority.
Supported that all behaviors are goal – directed.
Coined the term INFERIORITY COMPLEX
2. ANALYTIC PSYCHOLOGY – CARL JUNG
Believed that LIBIDO was broadly derived from all life
energy (not just from sex)
Described PERSONA & ANIMA aspects of personality
PERSONA – social façade assumed by the individual
ANIMA – the true inner self or the soul
ANIMA – the female component of a male personality
ANIMUS – the masculine component of a female
personality
3. ADAPTATION PROCESS – KAREN HORNEY
Developed the school of thought that utilizes the
process of adaptation to life situations as an
explanation for personality development.
Attributed to man the inherent desire & ability to
change, to grow, & to expand, not merely to avoid pain
& suffering
4. BIRTH TRAUMA = OTTO RANK
Claims that the process of birth – the sudden, violent
change from the security of intra - uterine existence to
the uncertainties of the outside world, produces
PRIMAL ANXIETY
As the child becomes conscious of himself as separate
from his mother, he develops conflict.
The central focus is the relief of guilt feelings generated
by the desire for separation.
5. GROWTH & SELF – REALIZATION = ERICK FROMM
Focused upon the healthy potential for growth & self –
realization of man as a central idea in personality
development.
-
Believed that the major need of man is to find meaning
in life through the use of his own powers.
From productive work & loving relationship with others
are derived fulfillment and the meaning of life.
6. PSYCHOBIOLOGY – HOLISM = ADOLF MEYER
Emphasized the importance of considering the total
individual from all points of view – biologically;
psychologically; socially
(holism)
Holistic approach – understands that the individual
personality is based on the interplay of his inherited
structures; his uniqueness and the cultural patterns in
which he lives.
7. ECLECTIC APPROACH
Concepts from more than one school of thought have
been used in developing a usable theory in personality
development.
Personality is the sum total of all internal & external
patterns of adjustment to life.
Personality is part determined by ones genetically
transmitted organic endowment and in part by one’s life
experiences.
HAVIGHURST’S DEVELOPMENTAL TASKS
Baby to early childhood – right from wrong and conscience
Late childhood – physical skills, wholesome attitude, social
roles
Conscience morality and values
Fundamental skills in academics
Personal independence
Adolescence – sexual social roles
Relationships
Independence and ideology
Early adulthood – career
Selecting a mate
Finding civic or social responsibility
Middle age – achieving civic or social responsibility
Adjusting to changes
Satisfactory career performance
Adjusting to aging parents
Adjusting parental roles
Old age – adjusting to changes
Establishing satisfactory living arrangements and
affiliations
KOHLBERG’S MORAL
DEVELOPMENT/THINKING/JUDGEMENT
PRE-CONVENTIONAL (0-6)
Punishment and obedience
Obedience to rules to avoid punishment
CONVENTIONAL (6-12)
Mutual interpersonal expectations, relationships and
conformity
Social system and conscience maintenance
Being good is important and self-respect or conscience
POST-CONVENTIONAL (12-18)
Prior right or social contract
Universal ethical principle
Abide for common good
Rational person-validity of principles and become
committed to them
-
Inner control of behavior; understanding the equality of
human rights and dignity of human beings as
individuals
HARRY STACK SULLIVAN’S INTERPERSONAL THEORY
INFANCY – need for security-infant learns to rely on others
gratify needs and satisfy wishes, develops a sense of basic trust,
security and self-worth when this occurs
TODDLERHOOD/EARLY CHILDHOOD – child learns to
communicate needs through use of words and acceptance of
delayed gratification and interference of wish fulfillment
PRE-SCHOOL – development of body image and selfperception
Organizes and uses experiences in terms of approval
and disapproval received
Begins using selective inattention and disassociates
those experiences that cause physical or emotional
discomfort and pain
SCHOOL AGE – the period of learning to form relationships with
peers-uses competition, compromise and cooperation
The pre-adolescent learns to relate to peers of the
same sex
ADOLESCENCE – learns independence and how to establish
satisfactory relationships with members of the opposite sex
YOUNG ADULTHOOD – becomes economically, intellectually
and emotionally self sufficient
LATER ADULTHOOD – learns to be interdependent and
assumes responsibility for others
SENESCENCE – develops an acceptance of responsibility for
what life is and was of its place in the flow of history
B. Theories / Roots of Psychopathology
A. Psychodynamic/ psychoanalytic
framework
B. Behavioral framework
C. Interpersonal/ psychosocial framework
D. Cognitive framework
E. Humanistic/ existential framework
F. Biomedical/ psychobiologic framework
G. Eclectic framework
A. PSYCHODYNAMIC/PSYCHOANALYTIC FRAMEWORK
A. FOCUS: INTRAPSYCHIC PROCESS
1. Conflicts
2. Anxiety
3. Defenses
4. Impulses
Level of awareness: conscious, preconscious, unconscious
Personality structure: Id, Ego, Superego
Psychic determinism:
1. All behaviors have meaning, although meaning may be
on unconscious level
2. Search for meaning / cause of events

Psychodynamic: Psychic energy (Cathexis) force
required for mental functioning;

Instincts (drives); anxiety; defense mechanisms
B. PSYCHODYNAMIC VIEW OF MENTAL ILLNESS
Abnormal behavior is traced back to unresolved
problem occurring in earlier developmental stages.
This framework applies mainly to non-psychotic
conditions
PSYCHOSEXUAL/PSYCHOANALYTICAL
The Freudian View of Mental Illness
All behavior has meaning
Mental illness and manifestations are caused by
unconscious INTERNAL conflict arising from
unresolved issues in early childhood
Ego defenses are utilized to relieve inner tension
C. PSYCHODYNAMIC TREATMENT
1. Focuses on conflicts, anxiety, defenses, sexual &
aggressive drives
2. Seek to alter thought & behavior by examining &
resolving earlier conflicts
3. Makes repressed thought conscious through: Free
association, Dream analysis, Transference analysis (
analysis of person’s feelings about therapist),
Catharsis (uncovering & relieving traumatic events)
D. NURSING IMPLICATION
1. A nurse typically does not conduct psychodynamic
therapy unless trained.
2. Principle of psychodynamic often prove useful in
interpreting a patient’s behavior.
3. Attention is given to the person’s anxiety & defensive
behaviors.
4. A nurse commonly performs developmental
assessment.
B. BEHAVIORAL FRAMEWORK
A. FOCUS: LEARNED BEHAVIOR
1. Persons are shaped by their environment.
2. Various behavior are subject to reward or punishment.
3. Experiment can determine what environmental aspects
affect behavior.
4. Certain behavior can be changed if environment is
changed.
Beliefs about behavior
1. People learn to be who they are by environmental
shaping
2. Behaviors can be observed, described, & recorded
3. Behaviors are subject to reward & punishment
4. behaviors can be modified if environment is changed.
B. BASIC CONCEPTS
1. Classical conditioning (Pavlov)
a. Conditioning response: pairing of stimulus with
response
b. Acquisition: gain of a learned behavioral response
c. Extinction: loss of a learned response
2. Operant conditioning (Skinner)
a. Positive reinforcer: reward for a behavior will help
continue the behavior
b. Negative reinforcer: punishment for a behavior that
will discourage the behavior
C. BEHAVIORAL VIEW OF MENTAL ILLNESS
1. Maladaptive behaviors are learned through classical &
operant conditioning.
2. Maladaptive behaviors are maintained through
reinforcement.
3. Maladaptive behaviors can be modified by changing
the environment.
4. The environment can be changed by altering original
stimuli & using positive or negative reinforcement.
5.
This framework applies mainly to anxiety disorders,
phobias, & behavioral problems
D. BEHAVIOR MODIFICATION THERAPY
Process:
1. Targeting maladaptive behavior by specifically defining
it.
2. Identifying reinforcers that help maintain maladaptive
behavior.
3. Identifying maladaptive behavior to replace adaptive
behavior.
4. Identifying reinforcers that will discourage undesirable
behavior & encourage desirable behavior
5. Substituting one’s stimulus with another
NURSING IMPLICATION
1. The nurse applies the behavioral principles in inpatient
psychiatric care.
2. Techniques for limit setting are based on behavioral
principles
3. The nurse & the patient collaborate in identifying target
behaviors for modification
4. Privileges such as phone use, off – unit movement are
used as reinforcers
5. The patient practices new behavior with the nurse’s
help.
C. INTERPERSONAL FRAMEWORK
A. FOCUS: INTERPERSONAL RELATIONSHIPS
1. Personality development results from interaction with
significant other/s.
2. The child internalizes approval & disapproval by
significant others, creating of his self – concept (or self
– system )
B. BASIC CONCEPTS
1. Human beings have 2 basic drives
a. Satisfaction of basic needs.
b. Security from culturally defined need for conformity,
similarity of values.
2. A person’s degree of satisfaction & security reflects positive
or negative relationships.
3. Anxiety plays a critical role in personality development & later
coping; Anxiety is related to disapproval.
4. Verbal sharing in a relationship clarifies thinking & reduce
anxiety.
C. INTERPERSONAL VIEW OF MENTAL ILLNESS
1. Three personification of “me” can evolve through relationships
with significant others.
a. “Good me”- result from positive approval, leading to
good feelings about the self.
b. “Bad me”- result from experiences related to
disapproval leading to anxiety states.
c. “Not me” – result from very disapproving messages
leading to overwhelming anxiety.
2. Security operation becomes part of coping to relieve anxiety.
3. If anxiety is great, the person is unable to evaluate self
objectively.
4. If the anxiety is great, the person also can’t operate in a
mature mode of experiencing.
Mental Health is Viewed as:
1. Related to conflict or problematic interpersonal
relationships
Past relationships, inappropriate communication and
current relationship crisis are etiologic factors of mental
illness
a.
D. INTERPERSONAL TREATMENT
1. A trusting, therapeutic relationship is the basis for a
corrective experience
2. The patient is encouraged to share anxieties & feelings
with the therapist
3. The therapist assists the patient in developing close
relationship
c.
2.
E. NURSING IMPLICATION
1. The nurse focuses on nurse – patient relationship, the vehicle
through which the patient becomes healthy.
2. Nurse counsels the patient by developing therapeutic
relationship.
3. Counseling tends to focus on “here & now” interpersonal
concerns.
4. Anxiety interventions are important nursing roles.
5. Nurses assists psychiatric patients with effective problem
solving related to interpersonal issues
D. COGNITIVE FRAMEWORK
A. FOCUS: COGNITIVE PROCESSES
1. Cognitive processes include expectations, beliefs,
memory, & thinking patterns.
2. Thinking influences behavior.
B. BASIC CONCEPTS
1. Cognitive processes can be altered or restructured.
2. Appraisals are the automatic thoughts a person uses to
evaluate his situation
3. Attributions refer to a person’s conception of why an event is
happening.
4. Beliefs are long - held ideas that shape thoughts, feelings &
behavior.
C. COGNITIVE VIEW OF MENTAL ILLNESS
1. This framework is applicable to depression & other
mental disorders.
2. Distorted thinking (irrational, illogical beliefs, unrealistic
self-appraisal & rigid attributions )
3. Thought processes that are identified as misperception:
a. Arbitrary inference – holding beliefs in absence of
supporting evidence.
b. Selective abstraction – concentrating on a single detail while
ignoring others.
c. Overgeneralization – making global assumptions based on
an isolated incident.
d. Magnification – greatly exaggerating a situation.
e. Minimization – belittling personal ability, action or response
f. Dichotomous thinking – all or nothing patterns of thought
D. COGNITIVE TREATMENT
1.Process:
a. Identifying negative processes by listening to the
patient.
b. Making the patient aware of cognitive processes.
c. Disputing
cognitive
processes
that
underlie
maladaptive feelings & behaviors.
d. Encouraging the patient to practice alternative thought
patterns
2. Types of Cognitive treatment
b.
Rational – Emotive therapy – disputes underlying
irrational beliefs.
Multi – modal therapy – separate disorders into
different levels & applies various techniques.
Cognitive therapy – teaches the patient new cognitive
structures (cognitive restructuring =)
E. NURSING IMPLICATION
1. Nurses assess patient’s thought (cognitive patterns )
2. Nurses participate in cognitive restructuring as part of
a team approach
3. Cognitive therapy can’t be done if the nurse is not
trained.
E. HUMANISTIC /EXISTENTIAL FRAMEWORK
A. FOCUS: CONSCIOUS HUMAN EXPERIENCES OF THE
“HERE & NOW”
1. Human beings have the potential to grow.
2. Human being can exercise freedom of choice
3. Freedom to choose among alternatives, gives meaning
to a person’s life
4. Human beings are responsible for their own behavior
B. BASIC CONCEPTS
1. Human experience is a search for meaning,
authenticity, & realization of potential.
2. Human needs are organized in a hierarchy.
3. As the person’s basic needs are gratified higher level
of needs emerge.
4. If the lower needs are not satisfied, insecurity &
regression occur.
5. When the basic needs are met, the individual becomes
growth oriented.
C. HUMANISTIC VIEW OF MENTAL ILLNESS
1. Mental illness is an alienation from self that hinders
freedom of choice, responsibility & growth.
2. Lack of self – awareness & unmet needs interfere with
relationship & with feelings of insecurity.
3. The fundamental human anxiety is the fear of death.
4. Recovery involves heightened awareness of being & of
potential for growth, love & fulfillment
Mental illness in this framework
1. The failure to develop one’s FULL potential leads to
poor coping
2. Lack of self-awareness and unmet needs interfere with
feelings of security
3. Fundamental human anxiety is fear of death which
leads to existential anxiety
D. HUMANISTIC TREATMENT
1. In client – centered therapy:
a. The patient experiences the therapist’s unconditional
positive regard & respect.
b. The therapist attempts to achieve empathic rapport
with the patient.
c. The therapist listens carefully to the patient & reflect
what is understood.
d. The patient develops self – understanding through the
process of being accepted & understood.
e. Recovery involves heightened awareness of being & of
potential for growth, love & fulfillment.
2. In Gestalt therapy
1. The patient is assisted to express feelings directly.
2.
3.
4.
Various techniques, such as role playing, are used to
act out past experiences & feelings.
Confronting feelings lead to acceptance of self.
Acceptance of self lead to a more mature behavior.
E. NURSING IMPLICATION
1. Basic nurse – patient interaction are based on
humanistic principles such as : positive regard,
empathy, respect.
2. Nurse – patient interactions are client – centered in
which:
a. The patient is encouraged to express topics of concern.
b. The nurse listens carefully to the patient.
c. The nurse uses reflective listening approaches to help
the client gain self – understanding.
d. The nurse helps the client select alternative choices.
F. BIOMEDICAL FRAMEWORK
A. FOCUS: DISEASE APPROACH
1. Identification of syndromes (sy & sx occurring together)
2. Establishment of diagnosis
3. Search for etiologies (bacterial / viral infections, genetic
transmission, biochemistry)
B. BASIC CONCEPTS:
1. Physiologic factors cause or predispose to mental
illness.
2. Mental illness have certain signs & symptoms that can
be classified & treated.
3. The mentally ill patient assumes a sick role.
4. Evidence supporting the biomedical approach to
mental illness includes:
a. Presence of genetic transmission patterns in
Schizophrenia & Affective disorders
b. Reduction of symptoms through pharmaceutical
agents. Etc.
C. BIOMEDICAL VIEW OF MENTAL ILLNESS
1. Mental illness is a disorder of the body.
2. Mental illness can be classified as in DSM
3. Labeling of mental disorder as an illness helps patient
& families focus on treatment & recovery
Biological Aspects of Mental Illness
René Descartes (17th C) espoused the theory of the
mind-body dualism (Cartesian dualism), wherein the
mind (soul) was said to be completely separate from
the body.
Current research and approaches show the connection
between mind and body and that newer treatments will
develop from a better understanding of both the
biological and psychological. (Hunt 1994)
The US Congress stated that the 1990s would be “The
Decade of the Brain,” with increased focus and
research in the areas of:

neurobiology,

genetics,

and biological markers.
Research on relationships between Psychobiology &
mental illness
1. Hypotheses related to DOPAMINE (neurotransmitter);
MONOAMINE OXIDASE (brain enzyme); TRANMETHYLATION
( transfer of molecule from one compound to another) have all
been implicated in Schizophrenia.
2. Abnormalities
in
neurotransmitters
(SEROTONIN,
EPINEPHRINE, NOREPINEPHRINE) have been associated
with mood disorders of Depression & Mania.
3. Endocrine dysfunction (THYROID & ADRENAL CORTEX)
can contribute to Depression & Mania.
4. Relative deficiency in ACETYLCHOLINE (neurotransmitter)
can be associated with Alzheimer’s disease.
5. Genetic marker for mental illness like (Huntington’s Chorea,
Bipolar disorder, & familial Alzheimer’s disease).
6. Alterations in biorhythms have been implicated to Mood
disorders, & abnormal sleep patterns.
D. BIOMEDICAL TREATMENT
1. Diagnostic work ups include detailed history, laboratory
tests, as well as careful observation of current
behavior.
2. Pharmacotherapy is a common treatment.
3. The client – therapist relationship is fostered to
engender trust & compliance with the treatment
regimen.
4. Psychotherapy has become part of the biomedical
model
E. NURSING IMPLICATION
1. Nurses work in biomedically oriented settings.
2. Nursing is one of the core psychiatric disciplines.
3. Nurses observe & assess patient’s behavior as well as
facilitate physical well – being.
4. Nurses administer treatments & foster patient’s compliance.
5. Nurses teach their patient about their illness including
recognition of symptoms, mgt of illness, prevention of relapse.
6. Nurses coordinate diverse aspect of care.
G. FAMILY SYSTEMS THEORY
Believed that dysfunctional family may lead to mental illness due
to:

Low level of differentiation – the self in his family is
diffused so there’s little sense of separation in the
family. No separate identities

Role confusion/diffusion -of children to what
behavior is expected – domineering mother & a
passive father

Double bind communication – a message with 2
opposing & conflicting meaning both of which must be
obeyed, however since this is impossible, the child is in
a dilemma up to which one is to respond first.
All these result to inconsistency which result to anxiety that lead
to confusion which then lead to inability to establish successful
IPR
H. PSYCHOPATHOLOGY & PHILIPPINE CULTURE
1. SIR – being agreeable even under difficult circumstances &
keeping out of sight in the presence of troubles / problems to
avoid conflict, disagreements.
- use “pakikisama”; euphemism; use of go between
Because of these, IPR are characterized by superficial aura of
good will.
2. AMOR PROPIO
= High degree of sensitivity
= One takes slighted easily & very intolerant of criticism.
= indication of low self esteem
3. FILIPINO CHILD REARING PRACTICES
a. Over protection; Over controlling; Parental intrusiveness may
lead to dependent children, and difficulty in adjustment
b. Authoritarian parental attitude
c. Parents know best
d. Parents who ridicule underachiever children
e. Parents who limit children to socialize
f. Attitude of parents that children are seen & not heard
g. Favoritism among children
= all of which result to passive, less assertive and shy children.
4. High concept of self esteem
MALES are more assertive, develop superiority who
tends to dominate women.
May lead towards abuse or violence among women.