TOPIC: The concept of mental health and disease.

Mental Hygiene and

Psychological Prophylaxis

IMPORTANCE OF THE TOPIC

One of the most important questions in Medical Psychology, both from theoretical
and practical point of view, is: where do "mental norm" and "mental health" end and
"mental pathology" and "mental illness" begin? Without a theoretical solution of this
problem it is impossible to understand the essence of the states that the clinical
psychologist deals with. Proving different criteria for distinction between mental norm
and pathology, we, thus, not only describe different variants of pathological deviations in
mental activity, but also formulate the notion of normative mental activity and the
concept of mental illness itself. Without a practical definition of the boundary between
norm and pathology, it is impossible to justify different forms of intervention, to establish
a point when intervention of a clinical psychologist or a doctor is already necessary, and
at what moment a performed therapy can be considered successfully completed.

LEARNING PURPOSES
GENERAL OBJECTIVE:
To be able to formulate and use in practice various approaches to differentiation
of mental norm and pathology, to plan and to implement measures of Mental
hygiene.

SPECIFIC PURPOSES:
• To be able to apply the knowledge of demarcation criteria between
psychological norm and pathology in doctor’s practical activity;
• To know the merits and limitations of statistical, nosos- and norm-centered
approaches to the understanding of the mental norm;
• To be able to use a functional diagnosis to plan treatment and rehabilitation
measures.
• To know the main tasks facing different sections of Mental hygiene;
• To be able to use in their work factors that have a positive effect on mental
health;

COURSE CONTENT
The first and, perhaps, the most stable conception of psychological norm was
connected with the use of statistical criterion: the "norm" is something that is the most
common and not distinguished from a mass. Naturally, this approach caused sharp
criticism from many scholars. This criticism was as ethical ("On the same day, when
there will be no more semi-normal people, the civilized world will perish. Perish not from
the excess of wisdom, but from the excess of mediocrity"), as scientific (using a
statistical approach with several "normality" criteria makes "absolutely normal" persons
very rare, that is "abnormal") in its nature.
However, even the adoption of the statistical approach does not relieve us from the
necessity for a logical justification of the norm. In particular, we must answer the
question: what variables should have average values in an individual so that he/she could
be considered normal one? Would he/she be «normal» or «abnormal», if only one or two
of these indicators have "abnormal value"? etc.
Significant progress in this area was brought by works of E. Kraepelin, who
abandoned the idea about a rigid boundary between norm and pathology. He believed that
there is a large area of transient ("border") states between health and disease.
An important stage in the development of understanding
mental health was connected with the ideas of V. Kandinsky. This
psychiatrist considered it necessary to have a clear boundary
between diseased and non-diseased disorders. Thus, the norm
and health, pathology and illness could no longer be regarded as
identical concepts («nosos ≠ pathos»).
Another important step in understanding the essence of mental health was a
transition from static to dynamic perspective of «norm». It began to be viewed not as a
rigid ideal, but as a process aimed at adapting to the conditions of existence and the
response to disease-causing effects.
Finally, the only whole abstract concept of the "ideal norm" was replaced by the
idea of some constitutional norms, that is, norms associated with the innate personality
features.
In addition to the above mentioned statistical approach, the following conceptions
could be noted:
• functional approach: "norm" – is a condition that allows you to perform your
functions effectively (a person is healthy if he/she is able to enjoy life, including from
relationships with other people);
• social approach: "norm" – is a state that corresponds to accepted in this culture
behavior, social adaptation;
• ideological approach: "norm" – is a state that corresponds to ideological ideal,
even rarely implemented in a given society;
• subjective approach: "norm" - is a state, that is customary for the individual,
perceived by him as a normal one.
In modern science dealing with the psyche, two basic approaches to the
delineation of norm and pathology can be distinguished: nosos-centered and norm-
centered ones.
 Nosos-centered approach can be reduced to the following statement: norm can
be determined only in relation to pathology; all that can not be attributed to a specific
disease is the norm;
 Norm-centered approach is associated with attempts to find positive criteria for
mental health.

Positive Mental Health Criteria (WHO):

● awareness and sense of continuity and identity of physical and mental self,

● sense of constancy and identity of experiences in the same situations,

● criticality to oneself, own mental products (activities) and their results;

● compliance of mental reactions (adequacy) with the strength and frequency of

environmental influences, social circumstances and situations;
● ability of self-management in accordance with social norms, rules, laws;

● ability to plan own livelihoods and implement these plans;

● ability to change the way of behavior depending on changes in life situations and
circumstances.
In whole, mental health is described by WHO as: «a state of well-being in which
the individual realizes his or her own abilities, can cope with the normal stresses of life,
can work productively and fruitfully, and is able to make a contribution to his or her
community».
Clinical and functional diagnosis.
In order to create a complex of adequate medical, rehab and prophylactic measures
for patients with mental disorders, their multifactorial etiology and various (intrapsychic,
social, somatic) spheres of manifestation must be considered. That is why, some
specialists think it necessary to establish not only a clinical, but also a functional
diagnosis which specifies the psychopathological, psychological, somatic and social
components of the disease (the choice of "therapeutic targets").
Functional diagnosis should include the following components:
1. Nosological form, syndrome, type of an illness flow.
2. "Internal image of disease" type.
3. Type of patient’s adaptive behavior and social integration.
 4. Rehabilitation potential of the patient’s personality.
5. Nosological form, type of flow of a somatic disease (if there is such).

Psychological prophylaxis and Mental hygiene.

The growth of the prevalence of mental and psychosomatic disorders and the
associated socio-economic losses are of particular relevance to the issue of protecting and
strengthening the mental health of the population. Carrying out such work requires
careful study of factors that have both favorable and pathogenic effects on the human
psyche.
Mental hygiene (from "higieinos" – healthy) or Health psychology – a scientific
discipline at the junction of several sciences – Medical psychology, Psychiatry, Hygiene
– which develops knowledge to reduce mental disorders prevalence and maintain mental
health.
There are following sections of Mental hygiene:
1) Age Mental hygiene (children, adolescence, middle and old age);
2) Mental hygiene of labor and education (industrial - in branches, agricultural,
mental labor);
3) Family Mental hygiene (Mental hygiene of everyday life, Mental hygiene of
sexual life).
Psychoprophylaxis is a section of Mental hygiene, which studies the conditions
of mental illnesses’ formation and ways of their preventing. It includes:
 primary psychoprophylaxis (prevention of mental disorders in the general
population, studying the risk factors for mental illnesses and their impact on them); in the
implementation of primary psychoprophylaxis, along with professionals in the field of
mental health (psychiatrists, psychologists, hygienists), social services, education system,
business and other structures, whose work affects the mental health of people, plays an
important role;
 secondary psychoprophylaxis (early recognition and effective treatment of
mental disorders aimed at preventing their recurrence); in the implementation of
secondary psychoprophylaxis, a special role along with psychiatrists and psychologists is
played by general practitioners, whom most patients visit whenever necessary (not
psychiatrists or psychologists!);
 tertiary psychoprophylaxis (prevention of disabilities due to mental disorders);
in the implementation of tertiary psychoprophylaxis special role is played by social
rehabilitation services;
  quaternary psychoprophylaxis (improving social adaptation of mentally ill
patients by reducing the negative reactions of society to these patients, by providing them
with equal opportunities for development and well-being, elimination of discrimination);
in the implementation of quaternary psychoprophylaxis special role is played by central
and local authorities, public organizations, including patients and their relatives
organizations, the media.
Mental hygiene measures suggest not only the elimination or weakening of
pathogenic factors influence on mental health, but also the maximum use of all sanogenic
factors, that is, such factors that strengthen the mental stability of a person. Interest in
these factors is associated with the growing influence of sanogeneous paradigm in
Medical Psychology, which, unlike pathogenic paradigm, raises the question not about
the causes of a disease, but about the etiology of health: why, with constant effects of
adverse factors, many people remain healthy? What resources allow them to bear
stressors and even turn them in their favor?
In Sense of Coherence (SOC) concept by Aaron Antonovsky, three main
components of SOC provide for stress coping and, due to this – psychic health.

1. Comprehensibility – things happen in a predictable way and a person can

understand and predict events in one’s life in the future.
2. Manageability – resources at the disposal of a person (one’s skills or abilities,
one’s external support) are sufficient to meet the requirements to manage the
situation. Individual feels socially competent.
3. Meaningfulness – life is interesting, has its meaning and is a source of satisfaction.
Things are really worthwhile and there is good reason or purpose to care about
what happens.

"Quality of life related to health" (or simply "quality of life", QOL) is a person’s
overall assessment of perceived health status and well-being which includes physical
(somatic well-being), psychological (intrapsychic comfort), and social dimensions. QOL
is largely culturally determined. Improving QOL can be auxiliary or primary goal of
treatment, and in non-curable diseases – even the sole purpose. Therefore, assessment of
 quality of life is increasingly used in treatment methods trials. It has been shown that
evaluation of QOL, performed by a patient himself, may not coincide with his
physician’s assessment, therefore it is necessary to rely on the patient's assessment. It has
a great predictive value for the patient’s survival and his general condition (more than
somatic status).
For standardized quality of life assessment, questionnaires were developed.
Among them there are general (MOS-SF36, EUROQOL, etc.) and special ones (for
certain categories of patients according to the nosology, method of treatment, etc.).

LIST OF PRACTICAL TASKS

Task 1 Understanding pluses and minuses of norm-centered concept.
Analyze list of mental health criteria and justify the possibilities to apply these
criteria, as well as their weak sides.
Task 2 Using functional diagnosis
Suggest a possible functional diagnosis for a patient with neurasthenia.
Task 3 Assessing QOL.
Pass the MOS-SF36 questionnairy. Process the test results and write a conclusion.
Task 4 Assessing Sense of Coherence.
Pass “Orientation to Life” Questionnaire. Process the test results and write a
conclusion.

ASSIGNMENTS FOR THE INDIVIDUAL WORK OF THE STUDENTS

1. Compare the concept of "norm" in Medical psychology and other fields of Medicine.
2. Make a comparative table of norm approaches, highlighting such parameters as: stability-
instability, objectivity-subjectivity of the norm, applicability of the norm to a population
or a specific sample. In your opinion, what are the strengths and weaknesses of this
approaches?
3. Justify the applicability of different approach to understanding psychological norm in Medical
psychology. Can something «typical» be at the same time «abnormal»?
4. Compare the concept of "pathology" in Medical psychology and other fields of Medicine.
5. Draw a diagram of the relationship between the concepts of "disorder" and "pathology."
 RECOMMENDED LITERATURE
Main:
1. Butcher J.N., Hooley J.M., Mineka S. Abnormal Psychology. – London: Pearson
Publishing, 2013. – 816 p. (Chapter 1 «Abnormal psychology: an overview»)
2. Pomerantz A.M. Clinical psychology: Science, practice, and culture. - Thousand
Oaks: SAGE Publications, 2011. – 543 p. (chapter 7 « Diagnosis and Classification
Issues»).
3. Popenya I.S. Medical psychology. Course of lectures for foreign students. –
Grodno: GrSMU, 2008.-140 p. (Lecture 1. «Introducing Medical Psychology.
Psychological Models of Mental Disorders»).
4. Ogden J. Health Psychology. A Textbook. – N.Y: Open University Press, 2007. –
489 p. (Chapter 2. «Health beliefs»).
Additional:
1. Ogden J. Health Psychology. A Textbook. – N.Y: Open University Press, 2007. –
489 p. (Chapter 17. «Measuring health status»).
2. Joyce, C.R.B., O’Boyle, C.A. and McGee, H.M. (eds) Individual Quality of Life.
London: Harwood, 1999.
3. Singh R. Psychological Model of Illness. –Cambridge: Cambridge Scholar
Publishing, 2011. – 183 p.