An Exploration of Mental Health Nursing Philosophies and Theories

This essay delves into the philosophy of mental health nursing, exploring various theories and their practical applications. It begins by outlining the core philosophies, including the philosophical underpinnings of mental health, the historical context of alienists and Freud's contributions, and the evolution of diagnostic models like the DSM. The essay then examines key psychological theories, such as psychoanalytic theory, Sullivan's interpersonal theory, Kohlberg's theory of moral development, and object relation theory, as well as GAS theory of stress. A detailed case study of a 30-year-old patient with schizophrenia is presented, illustrating how these theories are applied in a clinical setting, from initial assessment to treatment strategies. The case study integrates the bio-psycho-social model to understand the patient's condition and determine appropriate interventions. The essay concludes by highlighting the importance of responsibility and autonomy in mental health care.

PHILOSOPHY AND THEORIES
OF MENTAL HEALTH
NURSING
4/27/2019

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INTRODUCTION
Mental health nursing have some differences than the other branches of the healthcare
systems. While treating the mentally ill person, not only the physical abnormalities I them have
to be judged, but also many ethical and moral issues arise which should also be considered
while dealing with the mentally ill person. There are various theories and philosophies which
were developed by the psychologists and mental health experts which helps in addressing the
problems related to the mental health nursing. Some of the theories and philosophies are
discussed in this assignment.

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PHILOSOPHY OF MENTAL HEALTH NURSING
Philosophy of the mental health nursing is based on the combined views and methods from the
philosophy of mind, psychological aspects, neurosciences and moral philosophy and providing
the treatment to the patient who is suffering from mental illness. These philosophies are
generated for fining the solutions of the issues which may arise due the variations in the
conception of mental illness.
Three questions arise while talking about the philosophies of mental health nursing. The first
and main question is regardless of whether psychological sicknesses ought to be
comprehended as a type of distinctly mental dysfunction, and whether dysfunctional behaviors
are best distinguished as discrete mental elements with clear incorporation/prohibition criteria
or as focuses along a continuum between the typical and the evil (Thomas, 2018). On this,
philosophers often argue that they disguise the traditional or pre existing ways of categorizing
the mental illness through this. Another issue is about the relationship between the diagnostic
methods and the mental illness. The last question is surrounding the relationship between the
normativity and the mental illness.
Conceptions of mental illness
Alienisms and Freud
There are records of the cases of the mad from the ancient time also. In the middle of the 19th
century, separate asylums were constructed for treatment of the persons who were considered

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to be psychotics. All those who were thought to be suffering from any type of the brain
disorders were considered to be psychotics. All those practitioners who were assigned to
provide treatment to these people were known as Alienists. People who were facing from any
sort of stress were also supposed to visit these asylums as the person was considered to be
psychotic (Tanaka, Hasegawa, Nagayama & Oe, 2018).
Sigmond Freud was an alienist who worked for the development of new theories for the
distinctions between the person who is mentally ill and the person who is in real normal from
psychological aspects. He also came up with the theories which tell about the psychological
mechanisms as the normal process of life. This led to the development of many new models
and theories in this field.
DSM I – II
The models of the DSM played very important roles in changing the concepts for the treatment
of the mentally ill person. It also come up with the theories in which the persons who were
looking very normal from the outside but having some additional changes were also considered
to be the mentally ill person who needs eh treatment. Classification of the diagnoses methods
for the different disorders was also included in these models.
Bio- psycho-social model
It is the most recent model of the series DSM. In this model, diagnostic criteria of more than
400 disorders have been included (Felton, Repper & Avis, 2018). Another upgrade in this model

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is that it presented the concept of the mental illness as biological, psychological and social
dysfunctions in an individual.
Szasz’s Myth of mental illness
As per Szasz, the proper understanding of the medical sciences can be done by asking some
law-like deterministic. In this domain, all the knowledge can be concentrated to and can be
explained as physicalism. As medicines are also the part of the treatment, they are also
included in this model for the mental disorders treatments. When using these models, the
mental health is just confined to the narrow region of the neurological or neurochemical
disorders.
Neurodiversity
The abilities in the field of cognitions and physical functions are different for different people.
However, most of the people lie in the range of the normalcy. . Types of perception as of now
observed as useless, sick, or cluttered are better comprehended as speaking to different
methods for seeing and understanding the space of reasons (Stacey et al., 2016). Advocates of
neurodiversity guarantee that operators on the chemical imbalance range, those with identity
issue, consideration deficiency and hyperactivity issue, dyslexia, and maybe even those with
psychopathic qualities ought not to experience the ill effects of the disgrace related with the
disease mark. People to whom these name apply frequently show significant abilities

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(imaginative, science, and logical) that are indistinguishable from the condition basic their
ailment name.
Motivation
When anybody is labeled as a mentally ill person, this results in the long term effect on the
person. Along with this, people’s behavior towards them also changes. This different class of
mentally ill people s created without the consultation of the people who is going to be involved
in that group. The impacts that being named mentally sick or disarranged have on people are
wide-running and sufficiently strong to warrant alert; those in the neurodiversity development
contend, from different points of view, that clinicians keep on mixing up various types of
comprehension with psychological instability on account of the supposition, which advocates
contend is mixed up, that deviation from factually ordinary neural-advancement and capacity
establishes clutter.
Autism and psychopathy
Autism spectrum disorder is the clinical diagnosis for the person who is unable to cop-up with
the social understanding and also has communication problem while talking with others. The
symptoms for this disorder can be diagnosed in earlier stages also. On the other side,
psychopathy is a controversial model. This can be diagnosed by the psychopathy checklist.
Psychopathy, particularly the impacts that psychopathy has on passionate and moral ability has
raised difficulties to conventional speculations of good obligation.

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Responsibility and autonomy
Handling the cases of mental illness is totally attached with the responsibility. After any crime
also, questions about the suspects’ mental illness is asked and the people responsible of the
caring of the people who are mentally ill can be charged for the crime committed by the
mentally ill person. The reason behind this can be that the mentally ill person is more likely to
adopt the sick behavior and therefore, the person will be the passive victim of the condition. An
increasingly cautious investigation of the connection between psychological instability and
speculations of good duty demonstrates that few elements are regularly thought to issue with
regards to holding an individual with a dysfunctional behavior in charge of what s/he has done.

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PSYCHOLOGICAL THEORIES OF MENTAL HEALTH NURSING
Psychoanalytic theory
This theory was developed by Freud. This theory was actually comprised of four separate
theories, namely structural, libido, topographical and theory of Narcissism. Structural theory
states that the main reasons for the conflicts include Id, ego and superego. Id is first to develop
and is ruled by pleasure principle, while ego may develop for the defense against the anxiety
and also provides reality testing. Superego develops at the end and it is self-criticism against
moral value. In superego, most f the functions are unconscious.
In libido theory, it is explained that the main forces for the mental activity in the life are due to
the sexual stimulation. This also plays a major role in the neuroses (Isobel & Edwards, 2017).
Topographical theory explains that the consciousness of thought can be related to three
regions of mental functioning. The three regions are conscious, preconscious and unconscious.
Narcissism is the self admiration of the self-love and it is erotic pleasure derived contemplation.
Sullivan’s interpersonal theory
This theory was developed by Sullivan in 2013. According to this theory, change in the behavior
of the person is due to the interpersonal relations and the experiences which mould their
personality. This theory can be used while treating the patients of schizophrenia and the person
who are suffering from depression (Gottlieb & Gottlieb, 2017). The theory also states that the

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reason of the development of the stress is due to the personal experiences and particularly,
interpersonal losses.
Kohlberg theory of moral development
Moral values are the one’s decisions about the things and practices that whether they are
wrong or correct. Kohlberg’s theory states that there are three stages when development of
the reasoning skills and 6 stages involved in the development of the moral values. The three
stages of the reasoning are the preconvention, conventional and postconventonal. The 6 stages
of the moral development are
1. Obedience and Punishment Orientation
2. Individualism and Exchange
3. Good Interpersonal Relationships
4. Maintaining the Social Order
5. Social Contract and Individual Rights
6. Universal Principles
The theory of Kohlberg combined the moral values with the philosophical and psychological
aspects.

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Object relation theory
It tells about the impacts of the environmental factors in the development of the mind. This
theory mainly focuses on the impacts of the family members on the development of the mind
of the person. In the treatment of the mentally ill person, this theory helps in the determination
of the behavior f the patients and it also helps in the study of the psychodynamic family.
GAS theory of stress
According to this theory, it stated that the stress is related with the functions of the hormones
like pituitary hormones, hypothalamic hormones and adrenalines. The theory also tells about
the local adaptations for the inflammatory responses and the repairing processes (Holmberg,
Caro & Sobis, 2018).

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CASE STUDY
While practicing in the community care clinic, a patient who was aged 30 years old was
admitted in the clinic. He was suffering from schizophrenia. The first step towards the
treatment is to know about the complete information about the patient and his diseases from
which he is suffering from. After looking at the reports, I got to know that the person was
suffering from the schizophrenia from last eight months and he was already under the
treatment of some psychiatrist. Reports were showing that the person was having recurrent
strokes of aggressive behavior and therefore it can be said that the case was of severe
schizophrenia.
From the philosophy of the Alienisms and Freud, any person who is having some mental
disorders should be kept in the asylums until they become normal again. In the case of patient
having schizophrenia, the diseases were not only dangerous for him but it was also dangerous
for other people. When looking at the patient for the first time, he was looking very normal like
all other people. For the distinction of the patient if he was having any disorder or not, I used
DSM I model as well as DSM-II model. In these models, which were developed by Freud, there
were some set of questions which were developed for the distinction of normal people from
the patients who are actually looking normal (McCoy, 2018).
Schizophrenia is a disorder which can occur from multiple reasons, that means it has multiple
causes. To find the solution for the treatment of the schizophrenia, the first requirement was to
find the exact cause of the disease (Hunter, Weber, Shattell & Harris, 2015). For the diagnosis of
the causes of the disease, I used the concept of Bio-Psycho-social model. In this model, the

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diagnosis methods of more than 400 diseases are mentioned amongst which, the diagnostic
methods of the schizophrenia is also included. On clinical tests and other findings of this case
revealed that the person was already victim of the neurological disorder. He was having some
neurological disturbances in his frontal lobe. Along with this, he was an unemployed person
from past few months and also he was divorced due to some family reasons. In this case, the
person was biologically ill due to some problems in his frontal lobe, he was also psychologically
ill as he was recently divorced and maybe there were some bad memories of his married life
and then he was socially ill as he was unemployed also.
For the treatment of the patient, psychoanalytic theory was also considered in which
mentioned that libido can also leads to the psychological disorders. As the patient was divorced
before some time, maybe his libido is also the reason behind the schizophreniatic disorders.
For this reason, he should be provided with the talk treatment, which would also help in curing
of the stress which was caused by the social factors like unemployment. When following the
Sullivan’s theory the changes and incidents in the person’s life can also lead to the mental
illness. Sullivan’s interpersonal theory can be best used for the treatment of the patients who
are suffering from schizophrenia. Again, the losses which the patient had undergone in his life
were the reason for his schizophrenia. This can be concluded from the Sullivan’s interpersonal
theory (Brunero, Jeon & Foster, 2015).
As the patient was mentally not fit, his responsibility during the treatment and the safety of the
other patients were also my responsibility. Philosophically, there was one dilemmatic situation
in front of me. For the treatment of the patient, I decided to give him ECT along with the talk