Conceptual model in mental Health Nursing

1. Psychoanalytical Model

Psychoanalytical theory was developed by Sigmund Freud in the late nineteenth and early twentieth centuries. It focused on the nature of deviant behavior and proposed a new perspective on human development. Many of Freud’s ideas were controversial, particularly in the Victorian society of that time. Objective observation of human behavior was a great contribution of the psychoanalysts, as was the identification of a mental structure. Such concepts as id, ego, superego and ego defense mechanisms are still widely used. Most people also accept the existence of an unconscious level of mental functioning first introduced by Freud. Freud believed that the personality is formed in early childhood and that knowledge of how an individual’s drives, instincts, psychic energy of libido, and psychosexual attitude are formed during the first 6 years of life is crucial to an understanding off the personality.

Personality processes. The personality consists of three processes, the id, the ego and the superego, that function as a whole to bring about behavior. When these processes function in harmony, the individual experiences stability. When disharmony occurs, the individual is in conflict. The individual is all id at birth, wanting to experience only pleasure. This instinctual drive is known as the pleasure principle. Seeking pleasure involves  primary process thinking, which enables the individual to strive for pleasure through the use of fantasies ang images. The id is compulsive and without morals. The eego controls id is impulses and mediateds between the id and reality.

The ego focuses on the reality principle and strives to meet the demans of the id while maintaining the well-being of the individual by distinguishing fantasy from environmental reality. Secondary process thinking comprises rational, logical thinking and intelligence. The ego is the part of the personality that experiences anxiety and uses defenses mechanisms for protection. Heredity, environmental factors, and maturation influence the formation of the ego.

The superego is concered with right and wrong; that is, the conscience. It provides the ego with an inner control to help cope with the id. The superego is formed from the internalization of what parents teach their children abaut right and wrong throught rewards and punishments. Self-esteem is afeccted by the perception of one’s actions as good or right. Guilt and inferiority are experienced if the individual cannot lived up to parental standards. Inner conflist results when the id, the ego and the superego are striving for different goals.

 

2. Interpersonal Model

The teorist most representative of the interpersonal model is Harry Stack Sullivan, a twentieth-century American therapist. He considered the healty person as a social being with the ability to live effectively in relationships with others. Mental illness was viewed as any degree of lack of awareness of the processes in the interpersonal relationships. Relationships were viewed as the sorce of anxiety, maladaptive behaviors, and personality formation. In addition is given to the interpersonal nursing theory of Hildegard Peplau. Her work represents a milestone in the conceptualization of the psychotherapeutic role of nurse in context of the interpersonal relationship.

 

3. Social Model

The two preceding models focused on the individual and intrapsychic processes and interpersonal experiences.  The social model moves beyond the individual to consider the social environment as it affects the person and the person’s life experience. Psychoanalitycal theory has been repeatedly challenged, particularly by feminists. Some theorists such a Thomas Szasz and Gerald Caplan believe that the culture itself is useful in defining mental illness, prescribing the nature of therapy, and determining the patient’s future. In addition, the community mental health movement is an example of a governmental effort to respond to the philosophy of the social theorists.

 

4. Existential Model

The existential model focuses on the person’s experience in the here andd noow, wih much less attention to the person’s pst than in other theoretical models.

 

5. Supportive therapy Model

Supportive therapy is a relatively new mode of psychotherapy that is widely used in hospital and community based psychiatric treatment settings. It differs from other models in that it is not dependent on any overriding concept or theory. Instead, it uses many psychodynamic theories to understand how people change. The aims of supportive psychotherapy include the following:

-          promote a supportive patient-therapist relationship

-          enhance patient’s strengths, coping skills and ability to use coping resources

-          reduce the patient’s achieve the the greatest independence possible based on yhe specific psychiatris or physical illness

-          foster the greatest amount ot autonomy in treatment decisions with the patient

controlled studies have shown it to be effective in treating schizophrenia, borderline conditions, affective and anxiety disorders, posttraumatic stress disorder, eating and substance abuse disorders, and the psychological component of a variety of physical illnesses.

 

6. Medical Model

The medical model refers to psychiatric care that is based on the traditional physician-patient relationship. It focuses on the diagnosis of a mental illness,and subsequent treatment is based on yhis diagnosis. Sdomatic treatment, including pharmacotherapy and electroconvulsive therapy are important components of the treatment process. The interpersonal aspect of the medical model varies widely, from intensive insight-oriented intervention to brief sessions involving medicall manadement of medications. Much of modern psychiatric care is dominated by the medical model. Other health professionals may be involved in interagency referrals, family assessment, and health teaching, but physicians are viewed asa the leaders of the team when this models is in effect. Elements of other models of care may be used in conjunction with the medical model. For instance, a patient may be diagnosed with schizophrenia and treated with phenothiazine medication. This patient may also bee participating in a token economy program to encourage socially acceptable behavior. A positif contribution of the medical model has been continuous exploration for causes of mental illness using the scientific process. Recently, great strides have been taken in learning about the functioning of the brain and nervous system. This progress had led to a beginning understanding of the probable physiological components of many behavioral disorders and increasingly specific and sophisticated approaches to psychiatric care.