mental hygiene

mental hygiene, the science of promoting mental health and preventing mental illness through the application of psychiatry and psychology. A more commonly used term today is mental health. In 1908, the modern mental hygiene movement took root as a result of public reaction to Clifford Beers's autobiography, A Mind That Found Itself, which described his experiences in institutions for the insane. Beers adopted the name “mental hygiene” (suggested by Adolf Meyer) to describe his ideas, and founded the Connecticut Society for Mental Hygiene (1908) and the National Committee for Mental Hygiene (1909), the group which organized the National Association for Mental Health in 1950. Each of these groups sought to improve the quality of care for the mentally ill, to prevent mental illness where possible, and to ensure that accurate information regarding mental health was widely available. The National Institute of Mental Health has been responsible, since 1949, for the major portion of U.S. research in mental illness. The mental hygiene movement has accomplished, among other advances, wide reforms in institutional care, the establishment of child-guidance clinics, and public education concerning mental hygiene.


mental retardation

mental retardation, below average level of intellectual functioning, usually defined by an IQ of below 70 to 75, combined with limitations in the skills necessary for daily living. Daily living skills include such things as communication, the ability to care for oneself, and the ability to work. The definition of mental retardation has evolved over the years. Prior categorizations of mental retardation, defined solely by IQ, have largely been abandoned in favor of an approach that looks at how much support the retarded person needs in various areas of his or her life at any given time. Such support can range from intermittent help in such things as finding housing or a job, to pervasive, daily, lifelong help in all areas.


Causes

There are several hundred possible causes of mental retardation. They include genetic conditions (e.g., Down syndrome, fragile X syndrome); prenatal problems (e.g., fetal alcohol syndrome, rubella, malnutrition); problems apparent at birth (e.g., low birth weight and prematurity); and problems that occur after birth (e.g., injuries and childhood diseases like measles that can lead to meningitis and encephalitis). The most commonly identified causes of mental retardation are Down syndrome, fragile X syndrome, and fetal alcohol syndrome. In many cases the cause is never known.


memory

memory, in psychology, the storing of learned information, and the ability to recall that which has been stored. It has been hypothesized that three processes occur in remembering: perception and registering of a stimulus; temporary maintenance of the perception, or short-term memory; and lasting storage of the perception, or long-term memory. Two major recognized types of long-term memory are procedural memory, involving the recall of learned skills, and declarative memory, the remembrance of specific stimuli. For long-term memory to occur, there must be a period of information consolidation.

The process of forgetting was first studied scientifically by Hermann Ebbinghaus, a German experimental psychologist, who performed memory tests with groups of nonsense syllables (disconnected syllables without associative connection). Ebbinghaus showed that the rate of forgetting is greatest at first, gradually diminishing until a relatively constant level of retained information is reached. Theories to explain forgetting include the concept of disuse, which proposes that forgetting occurs because stored information is not used, and that of interference, which suggests that old information interferes with information learned later and new information interferes with previously learned information.

In some instances, memory loss is an organic, physiological process. Retrograde amnesia, i.e., the failure to remember events preceding a head injury, is evidence of interrupted consolidation of memory. In anterograde amnesia, events occurring after brain damage—e.g., in head injury or alcoholism—may be forgotten. Memory loss may also result from brain cell deterioration following a series of strokes, cardiovascular disease, or Alzheimer's disease (see dementia).

Physiologically, learning involves modification of neural pathways. PET scans and related studies have shown certain parts of the brain, such as the frontal lobe of the cerebral cortex and a structure called the hippocampus, to be particularly active in recall. Computer models of brain memory are called neural networks. In a study using genetic manipulation, a mouse with enhanced memory capabilities has been produced.



motivation

motivation, in psychology, the intention of achieving a goal, leading to goal-directed behavior. Some human activity seems to be best explained by postulating an inner directing drive. While a drive is often considered to be an innate biological mechanism that determines the organism's activity, a motive is defined as an innate mechanism modified by learning. In this view human drives serve to satisfy biological needs, such as hunger, while motives serve to satisfy needs that are not directly tied to the body requirements, such as companionship. Learned motives are sometimes linked with drives; e.g., the motivation to achieve social status is often viewed as a derivitive of the sex drive. Motives are sometimes classed as deficiency motives, such as the need to remove the physiological deficiency of hunger or thirst, or abundancy motives, i.e., motives to attain greater satisfaction and stimulation. American psychologist Abraham Maslow has classified motives into five developmental levels, with the satisfaction of physiological needs most important and esteem and self-actualization needs least important. According to Maslow, the most basic needs must be satisfied before successively higher needs can emerge. Cognitive psychologists such as Albert Bandura have suggested that individual mental processes, such as beliefs, play an important role in motivation, through the expectation of certain reinforcements for certain behaviors. Studies have shown that humans and other animals are likely to seek sensory stimulation, even where there may be no foreseeable goal. In recent years, the use of various tools for brain scanning has worked toward the discovery of a neurological basis for motivation.



multiple personality

multiple personality, a very rare psychological disorder in which a person has two or more distinct personalities, each with its own thoughts, feelings, and patterns of behavior. The personalities often are direct opposites and dominate at different times, with abrupt transitions triggered by distressful events or memories. Each may be entirely unaware of the other but aware of unexplained gaps in remembered time. In psychiatry the condition is known as dissociative identity disorder. The term “split personality,” denoting schizophrenia, refers to an unrelated disorder in which the split (separation) is between thought and feeling.

Multiple personality was first recognized and described by the French physician Pierre Janet in the late 19th cent. Public awareness of the disorder increased in contemporary times after a case was the subject of The Three Faces of Eve (1957). In the 1980s and early 90s, such factors as recognition of child abuse, public interest in memories recovered from childhood (whether of actual or imagined events), allegations of so-called satanic ritual abuse, and the willingness of many psychotherapists to assume a more directive role in their patients' treatment, led to what came to be regarded as a rash of overdiagnoses of multiple personality.

The cause of multiple personality is not clearly understood, but the condition seems almost invariably to be associated with severe physical abuse and neglect in childhood. It is believed that amnesia, the key to formation of the separate personalities, occurs as a psychological barrier to seal off unbearably painful experiences from consciousness. The disorder often occurs in childhood but may not be recognized until much later. Social and psychological impairment ranges from mild to severe. The primary treatment is psychotherapy to help the individual integrate the separate personalities.



narcissism

In psychoanalysis, narcissism is considered a normal stage in the development of children. It is known as secondary narcissism when it occurs after puberty, and is said to indicate a libidinal energy directed exclusively toward oneself. A degree of narcissism is considered normal, where an individual has a healthy self-regard and realistic aspirations. The condition becomes pathological, and diagnosable as a personality disorder, when it significantly impairs social functioning. An individual with narcissistic personality disorder tends to harbor an exaggerated sense of his own self-importance and uniqueness. He is often excessively occupied with fantasies about his own attributes and potential for success, and usually depends upon others for reinforcement of his self-image. A narcissist tends to have difficulties maintaining healthy interpersonal relationships, stemming largely from a lack of empathy and a propensity for taking advantage of others in the interest of self-aggrandizement. It is often found in combination with antisocial personality disorder.



narcosis

state of stupor induced by drugs. The use of narcotics as a therapeutic aid in psychiatry is believed to have a history dating back to the use of opium for mental disorders by the early Egyptians. Prolonged narcosis was employed at the beginning of the 20th cent.; its chief value was the reduction of excitement and tension in the psychotic patient. J. S. Horsley introduced (1936) the term narcoanalysis for the use of narcotics to induce a trancelike state in which the patient talks freely and intensive psychotherapy may be applied. It was used with considerable success in treatment of acute combat psychoneuroses during World War II.



neurasthenia

condition characterized by general lassitude, irritability, lack of concentration, worry, and hypochondria. The term was introduced into psychiatry in 1869 by G. M. Beard, an American neurologist. Used by Freud to describe a fundamental disorder in mental functioning, the term was incorrectly applied to almost any psychoneurosis and has been largely abandoned.


neurosis

neurosis, in psychiatry, a broad category of psychological disturbance, encompassing various mild forms of mental disorder. Until fairly recently, the term neurosis was broadly employed in contrast with psychosis, which denoted much more severe, debilitating mental disturbances. The two terms were used regularly until 1980, when the American Psychiatric Association released a precise listing of known mental disorders excluding the two broad categories of “mild” and “serious” mental disorders.

Neurosis, according to Sigmund Freud, arose from inner conflicts and could lead to anxiety. In his formulation, the causal factors could be found roughly in the first six years of life, when the personality, or ego, is weak and afraid of censure. He attributed neurosis to the frustration of infantile sexual drives, as when severe eating and toilet habits and other restrictions are parentally imposed (see Oedipus complex), which appear in adulthood as neurotic symptoms (see psychoanalysis). Other authorities have emphasized constitutional and organic factors. Among the psychoanalysts, Alfred Adler and H. S. Sullivan stressed social determinants of personal adjustment, and Karen Horney emphasized insecurity in childhood as causes of neurosis.

Until 1980, neuroses included anxiety disorders as well as a number of other mild mental illnesses, such as hysteria and hypochondria. Anxiety disorders are fairly common, and generally involve a feeling of apprehension with no obvious, immediate cause. Such intense fears of various situations may be severe enough to prevent individuals from conducting routine activities. Phobias, the most common type of anxiety disorder, involve specific situations which cause irrational anxiety attacks. For instance, an individual with agoraphobia (fear of open spaces) may be too anxious to leave their house. Obsessive-compulsive disorder occurs when an individual relentlessly pursues a thought or action in order to relieve anxiety. Panic disorder is characterized by anxiety in the form of panic attacks, while generalized anxiety disorder occurs when an individual experiences chronic anxiety with no apparent explanations for the anxiety. Post-traumatic stress disorder, occurring in the wake of a particularly traumatic event, can lead to severe flashbacks and a lack of responsiveness to stimuli. Anxiety disorders are usually accompanied by a variety of defense mechanisms, which are employed in an attempt to overcome anxiety. Hypochondriasis and hysteria (now generally known as conversion disorder) are classified today as somatoform disorders, and involve physical symptoms of psychological distress. The hypochondriac fears that minor bodily disturbances indicate serious, often terminal, disease, while the individual suffering from conversion disorder experiences a bodily disturbance—such as paralysis of a limb, blindness, or deafness—with no clear biological origin. Treatment of neurosis may include behavior therapy to condition an individual to change neurotic habits, psychotherapy, and group psychotherapy. Various drugs may also be employed to alleviate symptoms.



Oedipus complex

Oedipus complex, Freudian term, drawn from the myth of Oedipus, designating attraction on the part of the child toward the parent of the opposite sex and rivalry and hostility toward the parent of its own. It occurs during the phallic stage of the psycho-sexual development of the personality, approximately years three to five. Resolution of the Oedipus complex is believed to occur by identification with the parent of the same sex and by the renunciation of sexual interest in the parent of the opposite sex. Freud considered this complex the cornerstone of the superego and the nucleus of all human relationships. Many psychiatrists, while acknowledging the significance of the Oedipal relationships to personality development in our culture, ascribe love and attraction toward one parent and hatred and antagonism toward the other not necessarily to sexual rivalry but to resentment of parental authoritarian power.



paranoia

in psychology, a term denoting persistent, unalterable, systematized, logically reasoned delusions, or false beliefs, usually of persecution or grandeur. In the former case the paranoiac creates a complex delusional system that purports to show that people want to hurt him; in the latter, he sees himself as an exalted person with a mission of great importance. Other types of delusions include somatic delusions, as in the case of hypochondria, and jealous delusions. The term paranoia was first used by German psychiatrist Karl L. Kahlbaum in 1863. The condition, often known as delusional disorder, is found among individuals suffering from paranoid schizophrenia, paranoid personality disorder, and any of several paranoid disorders. Minor instances of paranoia are also commonly found among older people. Most individuals who suffer from some form of paranoia tend to be suspicious of the motives of others, leading them to be hypersensitive, tense, and argumentative. Jealousy and vengeful emotions are also common, and can lead to violent confrontation in the most severe cases. In most paranoid delusions, the individual believes that there is a pattern to random events which is somehow connected to him. Individuals with paranoid schizophrenia often suffer from delusions in conjunction with more severe symptoms, such as hallucinations.



parapsychology

parapsychology, study of mental phenomena not explainable by accepted principles of science. The organized, scientific investigation of paranormal phenomena began with the foundation (1882) of the Society for Psychical Research in London. Such early efforts attempted to dissociate psychical phenomena from spiritualism and superstition, and particularly to investigate mediums and their claims of evoking spirits or apparitions. The society also studied automatic writing, levitation, and ectoplasmic and poltergeist activities. One of its principal founders, Frederic William Henry Myers, summed up the society's early efforts in Human Personality and Its Survival of Bodily Death (1903). An American Society for Psychical Research was also founded, with James Hervey Hyslop as its leading spokesman. Considerable experimentation has been conducted, perhaps the best-known being that of Joseph Banks Rhine at Duke Univ. The Foundation for Research on the Nature of Man, created in the early 1960s, has since replaced the Duke program. In Great Britain the work of Whately Carington and Samuel George Soal paralleled that of Rhine. The great majority of parapsychological studies have focused on the area called extrasensory perception (ESP), which includes telepathy, clairvoyance, and precognition. The popular press often reports stories that are parapsychological in nature. Many scientists criticize the claims made by parapsychologists, arguing in particular that there can be no proof of such phenomena.



perception

perception, in psychology, mental organization and interpretation of sensory information. The Gestalt psychologists studied extensively the ways in which people organize and select from the vast array of stimuli that are presented to them, concentrating particularly on visual stimuli. Perception is influenced by a variety of factors, including the intensity and physical dimensions of the stimulus; such activities of the sense organs as effects of preceding stimulation; the subject's past experience; attention factors such as readiness to respond to a stimulus; and motivation and emotional state of the subject. Stimulus elements in visual organization form perceived patterns according to their nearness to each other, their similarity, the tendency for the subject to perceive complete figures, and the ability of the subject to distinguish important figures from background. Perceptual constancy is the tendency of a subject to interpret one object in the same manner, regardless of such variations as distance, angle of sight, or brightness. Through selective attention, the subject focuses on a limited number of stimuli, and ignores those that are considered less important. Depth perception, considered to be innate in most animals, is produced by a variety of visual cues indicating perspective, and by a slight disparity in the images of an object on the two retinas. An absolute threshold is the minimal physical intensity of a stimulus that a subject can normally perceive, whereas a difference threshold is the minimal amount of change in a stimulus that can be consciously detected by the subject. Recent studies have shown that stimuli are actually perceived in the brain, while sensory organs merely gather the signals. William Dobelle's research, for instance, has offered significant hope for the blind.



personality

personality, in psychology, the patterns of behavior, thought, and emotion unique to an individual, and the ways they interact to help or hinder the adjustment of a person to other people and situations. A number of theories have attempted to explain human personality. In his psychoanalytic interpretation, Sigmund Freud asserted that the human mind could be divided into three significant components—the id, the ego, and the superego—which work together (or come into conflict) to shape personality. Psychoanalysis emphasizes unconscious motivations and the conflicts between primal urges and learned social mores, stressing the importance of early childhood experiences in determining mature personality. Exponents of behaviorism, such as B. F. Skinner, suggest that an individual's personality is developed through external stimuli. In the behaviorist model, personality can change significantly with a shift to a new environment. Social-learning theorists, notably Albert Bandura, also emphasized environmental influences but pointed out that these work in conjunction with forces such as memory and feelings to determine personality.

Trait theories have arisen in recent years, with the object of determining aspects of personality that compel an individual to respond in a certain way to a given situation. Gordon Allport delineated three kinds of traits with varying degrees of intensity: cardinal traits, central traits, and secondary traits. Raymond Cattell used a group of obvious, surface personality traits to derive a small group of source traits, which he argued were central to personality. Objections to trait theories point out that behavior is largely situation dependent, and that such traits as “honesty” are not especially helpful in characterizing personality and behavior. Despite such objections, trait theories have been popular models for quantifying personality. Paul Costa has postulated five basic dimensions of personality—introverson-extroversion, friendly compliance–hostile noncompliance, will, neuroticism, and openness to experience—and has developed a test to measure these traits.

Abraham Maslow and Carl Rogers supported a humanistic approach to personality, pointing out that other approaches do not factor in people's basic goodness and the motivational factors that push them toward higher levels of functioning. Researchers offering biological approaches to personality have focused on the action of specific genes and neurotransmitters as determinants.

Psychologists may use psychological tests to determine personality. Well-known personality tests include the Rorschach test, in which an individual is asked to look at ink blots and tell what they bring to mind; the Minnesota Multiphasic Personality Inventory, which uses a true-false questionnaire to delineate normal personality types from variants; and the Thematic Apperception Test, which employs cards featuring provocative but ambiguous scenes, asking the viewer their meaning. The American Psychiatric Association has sought to delineate personality disorders in its periodically revised and updated Diagnostic and Statistical Manual of Mental Disorders.



phrenology

phrenology, study of the shape of the human skull in order to draw conclusions about particular character traits and mental faculties. The theory was developed about 1800 by the German physiologist Franz Joseph Gall and popularized in the United States by Orson Fowler and Lorenzo Fowler through their publication the Phrenological Almanac and other publications. Modern neurology and physical anthropology have refuted the theory and consider its use a form of quackery.


post-traumatic stress disorder

post-traumatic stress disorder (PTSD), mental disorder that follows an occurrence of extreme psychological stress, such as that encountered in war or resulting from violence, childhood abuse, sexual abuse, or serious accident. The stressful event is usually followed by a period of emotional numbness and denial that can last for months or years. After that period, symptoms such as recurring nightmares, “flashbacks,” short-term memory problems, insomnia, or heightened sensitivity to sudden noises may begin. In some cases outbursts of violent behavior have been observed. The usual treatment for PTSD is individual psychotherapy, including anxiety management, or group psychotherapy with others who have the disorder. Some antianxiety and antidepressant drugs are being studied for their effectiveness.

Certain traits (a history of depression, shyness, impulsivity) appear to heighten a person's risk of experiencing PTSD after a traumatic event. In those who do experience it, there is growing evidence that actual physical changes occur in the brain. The hippocampus, a structure that lies deep in the brain and that is associated with memory, has been found to be smaller in PTSD victims. It has been hypothesized that excesses of cortisol, a steroid hormone released during periods of extreme stress, may damage nerve fibers in the area or actually kill the nerve cells. However, the role of cortisol is not completely understood; studies of concentration camp survivors found abnormally low levels of cortisol rather than abnormally high levels.

Post-traumatic stress disorder was referred to as “shell shock” after World War I and as “battle fatigue” after World War II and was traditionally thought of as a condition of war veterans. Studies of Vietnam veterans and Nazi concentration camp survivors have added greatly to the knowledge of PTSD. The National Vietnam Veterans Readjustment Study (1988) estimated that 31% of the males and 27% of the females who served in the Vietnam War had symptoms of PTSD. Estimates of civilian populations put the rate of PTSD at 10% (women) and 5% (men) in the 15 to 54 age group. Childhood sexual abuse, sexual abuse, and assault are common causes of PTSD in both military and nonmilitary women. In 1989 the U.S. Congress created the National Center for Post-Traumatic Stress Disorder for the study and treatment of PTSD.



psychiatry

branch of medicine that concerns the diagnosis and treatment of mental, emotional, and behavioral disorders, including major depression, schizophrenia, and anxiety. Although the Greeks recognized the significance of emotions in mental disorders, medieval thought emphasized demonic influence. From the Middle Ages until the time of the French physician Philippe Pinel (1745–1826), who instituted humanitarian reforms in the care of the mentally ill, there was no organized attempt to study or treat mental abnormalities or to provide decent institutional conditions for the mentally ill. Such 19th-century reformers as Dorothea Dix fought for improved conditions in asylums. The early 20th cent. saw the organization of the mental hygiene movement, dedicated to the prevention of mental disease through guidance clinics and education. Scientists of the period sought underlying causes of mental and nervous disorders. The German psychiatrist Emil Kraepelin was the first to divide psychosis into the two general classifications of manic-depressive psychosis (see bipolar disorder) and schizophrenia. Gradually, some psychiatrists, led by Sigmund Freud, turned to the behavior and emotional history of the patient as clues to the nature of psychoneurosis and psychosis.

Today, a wide variety of treatment strategies are used in psychiatry, to combat many different psychological disorders. Psychiatry may involve physiological or psychological treatment, or a combination of the two. Physiological treatment generally involves the use of drugs influencing neurotransmitter functions in the brain, or electroconvulsive treatment (see electroconvulsive therapy). Psychiatrists are licensed physicians, specially trained to treat patients with mental disorders and to prescribe drugs. In recent years, psychological difficulties have lost much of the stigma they once had, and many people have sought psychiatric help who might have been reluctant to do so in the past.



psychoanalysis

psychoanalysis, name given by Sigmund Freud to a system of interpretation and therapeutic treatment of psychological disorders. Psychoanalysis began after Freud studied (1885–86) with the French neurologist J. M. Charcot in Paris and became convinced that hysteria was caused not by organic symptoms in the nervous system but by emotional disturbance. Later, in collaboration with Viennese physician Josef Breuer, Freud wrote two papers on hysteria (1893, 1895) that were the precursors of his vast body of psychoanalytic theory. Freud used his psychoanalytic method primarily to treat clients suffering from a variety of mild mental disorders classified until recently as neuroses . Freud was joined by an increasing number of students and physicians, among whom were C. G. Jung and Alfred Adler. Both made significant contributions, but by 1913 ceased to be identified with the main body of psychoanalysts because of theoretical disagreements with Freud's strong emphasis on sexual motivation. Other analysts, including Melanie Klein and Jacques Lacan, also have contributed greatly to the field. Psychoanalysis and its theoretical underpinnings have had an enormous influence on modern psychology and psychiatry and in fields as diverse as literary theory, anthropology, and film criticism.


psychosis

a broad category of mental disorder encompassing the most serious emotional disturbances, often rendering the individual incapable of staying in contact with reality. Until recently, the term was used in contrast with neurosis, which denoted the “mild” mental disorders which did not interfere significantly with the ability to function normally, or severely impair the individual's conception of reality. In 1980, the American Psychiatric Association made sweeping changes in its classificatory system for psychological disorders, and the opposition between neurosis and psychosis became obsolete. The former classification included functional psychoses including schizophrenia, paranoia, bipolar disorder, and involutional psychotic reactions, where no brain change was detectable with available tools. Today, there are separate categories for schizophrenic disorders, mood disorders (which include bipolar disorder and major depression), and other serious mental disturbances such as delusional disorder. Symptoms of these disorders may include hallucinations and delusions; severe deviations of mood (depression and mania); lack of, or inappropriateness of, emotional response; and severe impairment of judgment. Another type of psychosis involves brief episodes, characterized by an acute onset lasting no longer than a month, usually resulting from situational circumstances such as an earthquake or flood. Nonspecified psychotic disorders include psychotic symptoms, e.g., delusions, hallucinations, or disorganized behavior, that cannot be classified in any other disorder. Drug therapy and electroconvulsive therapy have been successful in the treatment of many patients with serious psychological disorders. Organic psychoses, so called because of the structural deterioration of the brain, include senile dementia and Alzheimer's disease. Occurring in middle to old age, these disorders involve progressive, nonreversible brain damage. Organic brain damage may also result from toxic reactions to such substances as alcohol, PCP, amphetamines, and crack cocaine. In criminal law, the term insanity can be applied to most forms of psychoses, although defenses based on insanity have been relatively rare.




to be continued

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