The World of Mental Health: An Essential Resource for Families, Couples, and Singles

Copyright © 2013 Gabriel G. Feldmar.

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ISBN: 978-1-4497-8784-4 (sc)

ISBN: 978-1-4497-8785-1 (hc)

ISBN: 978-1-4497-8783-7 (e)

Library of Congress Control Number: 2013904508

WestBow Press rev. date: 3/20/2013

SIGMUND FREUD (large image): Austrian physician/psychoanalyst (1856-1939)

CARL GUSTAV JUNG (standing): Swiss physician/psychoanalyst (1875-1961)

IVAN PETROVICH PAVLOV (sitting): Russian physician/physiologist (1849-1936)

OLD VIENNA (background): Illustration by Suzanne Feldmar, graphic artist

Cover page and interior illustrations were designed by Suzanne Feldmar

Contents

PREFACE

CHAPTER ONE:      Children and Adolescents

Section 1.1:      Conception, Pregnancy and Birth

Section 1.2:      Physical Development of the Infant

Section 1.3:      Cognitive Development of the Infant

Section 1.4:      Social and Emotional Development in Infancy

Section 1.5:      Physical Development in Early Childhood

Section 1.6:      Cognitive Development in Early Childhood

Section 1.7:      Social and Emotional Development in Early Childhood

Section 1.8:      Physical Development in Middle Childhood

Section 1.9:      Cognitive Development in Middle Childhood

Section 1.10:      Social and Emotional Development in Middle Childhood

Section 1.11:      Physical Development in Adolescence

Section 1.12:      Cognitive Development in Adolescence

Section 1.13:      Social and Emotional Development in Adolescence

CHAPTER TWO:      Parents and Children

Section 2.1:      Introduction and History

Section 2.2:      Approaches to Child Rearing: General Concepts

Section 2.3:      Parental Care of Infants and Toddlers

Section 2.4:      Parenting Practices for Preschoolers

Section 2.5:      Parenting in the Middle Childhood Years

Section 2.6:      Parenting During the Years of Adolescence

CHAPTER THREE:      The Journey Through Adulthood

Section 3.1:      Early Adulthood

Section 3.2:      Middle Adulthood

Section 3.3:      Late Adulthood

CHAPTER FOUR:      The Effects of Stress

Section 4.1:      Introduction, Definitions, and Basic Concepts

Section 4.2:      Stress, Illnesses, and Coping Mechanisms

CHAPTER FIVE:      Mental Illnesses

Section 5.1:      Introduction

Section 5.2:      The Classification of Mental Illnesses

Section 5.3:      Disorders of Infancy, Childhood and Adolescence

Section 5.4:      Mood Disorders

Section 5.5:      Anxiety Disorders

Section 5.6:      Substance-Related Disorders

Section 5.7:      Psychotic Disorders

Section 5.8:      Eating Disorders

Section 5.9:      Personality Disorders

Section 5.10:      Cognitive Disorders

CHAPTER SIX:      Psychological Testing

Section 6.1:      Introduction and Brief History

Section 6.2:      The Spectrum of Psychological Testing and Measurement

CHAPTER SEVEN:      The Treatment of Psychological Disorders

Section 7.1:      Brief History

Section 7.2:      Outpatient and Inpatient Treatment

Section 7.3:      Providers of Mental Health Services

Section 7.4:      Psychotherapy

Section 7.5:      Psychopharmacological Treatment

Section 7.6:      Miscellaneous Biological Therapies

CHAPTER EIGHT:      Mental Health and the Law

Section 8.1:      Introduction

Section 8.2:      Privacy, Confidentiality, and Testimonial Privilege

Section 8.3:      Civil Commitment

Section 8.4:      Assisted Outpatient Treatment

Section 8.5:      Criminal Law

EPILOGUE

APPENDICES

REFERENCES

About this book…

The material in this book is helpful for readers who need information about the nature of a variety of common psychological and mental health topics. Included are areas related to child development, effective child rearing techniques, adolescent adjustment, adult relationships, mental illnesses in children and adults, description of mental health providers, diagnostic methods, types of medications and psychotherapy, psychiatric hospitalization, and the legal rights of mentally ill individuals.

DEDICATION

To my Parents, Katy, Suzanne, and Monique

ACKNOWLEDGMENT

I wish to thank my mother, Clara Feldmar, and my father, Tibor Feldmar, for encouraging me to write this book. Their continued support and practical ideas gave me the strength to accomplish this work. I am grateful to my colleagues, Marshall Silverstein, Ph.D., Dalit Matatyaho, Ph.D., Howard Sovronsky, L.C.S.W., and Seeth Vivek, M.D., for their most valuable suggestions related to this manuscript. I also appreciate the help of Alyssa Feldman in the preparation of the reference material related to this book.

My special thanks go to Suzanne Feldmar for her creative artistic efforts and illustrations related to this work.

Preface

I have been working in the mental health field for over twenty-five years in a variety of clinical, research, educational settings and capacities. I have interacted with patients of all ages who had many different types of problems and disorders. Over the years of my practice I have made numerous observations and learned a great deal from the patients I treated. I also realized that there are certain fundamental facts, which must be addressed in order to achieve successful treatment outcomes and relapse preventive measures. These facts have to do with information and education about the nature of mental illness, the meaning of normal and abnormal behavior, the elements of interpersonal relationships, psychodevelopmental milestones, and general behavioral dynamics. Patients who possess some knowledge about these topics, and are open and psychologically minded, usually derive more benefit from mental health services than those who have no such understanding. Furthermore, information related to the nature of psychological, psychopharmacological, and substance abuse treatments are also very important for patients to know in order to maximize positive and long-lasting results from therapeutic interventions. It has come to my attention in the course of my work that most individuals who seek mental health services are quite uninformed about the nature of the services available to them.

The purpose of this book is to serve as a resource to better understand concepts related to mental health and mental illness. It is also my intent to educate the public about the nature of current psychological and psychiatric services. Information found in this book is based upon my clinical experience, and results of scientific studies conducted by qualified researchers. It is my hope that reading this material will result in improved appreciation for behavioral abnormalities, mental illnesses, treatment approaches, and the role of providers of mental health services. It is my belief that elimination of misconceptions in these areas will lead to the reduction of stigma related to mental illness, as well as a better understanding of when and where to look for psychological help. Treatment expectations will also become more realistic on the part of the educated consumer of mental health services.

This book is intended to be a reference manual for the general public, a guide, which will equip the reader with tools for the prevention of certain mental irregularities, improvement in the quality of psychological well being, and for conducting a more harmonious family and social life. This book will benefit not only people who are in need of mental health services. The information herein is designed to be beneficial for individuals and families regardless of their mental health status. Parents will be able to track the psychological development of their children, and adjust care-taking requirements accordingly. Appropriate parenting and behavior modifying skills will be learned to deal effectively with ever changing developmental and social needs. Early recognition of learning disabilities and related remediation options will be discussed. Issues related to family dynamics, and techniques needed to maintain a well-balanced marriage will be mentioned. Common, as well as less frequently encountered mental illnesses and substance abuse disorders will be explored. Personality factors related to social behavior will be addressed as well. Topics related to old age and care taking will also be examined. Lastly, in view of the fact that most people are unfamiliar with the law as it relates to psychiatry, I have added some important legal information.

I need to mention that the present volume is not a quick-fix manual for the solution to emergent behavioral problems. There already are an abundance of such manuals on bookstore shelves. In general they offer oversimplified recipes for the solution of complicated and deep-rooted problems. In most cases such methods are of minimal value. This book is a general reference tool for the understanding of basic psychological processes encountered in life. The appreciation of these processes will facilitate insight and a deeper familiarity with the self. Knowledge related to the psychological necessities for a well-adjusted style of life is important. Happiness often resides in our ability to maximize our potentials. Some psychologists call this process self-actualization. Skillful management of daily stressors is also needed for securing optimal mental and physical health. Prompt attention to psychological problems in children, adolescents and adults are necessary to maximize treatment outcome. It is my vision that reading this book will result in a more fundamental understanding of our emotional, intellectual and social processes as we go through the span of life. This understanding will then result in improved adjustment, and a better quality of life. It is also my hope that the reader will have developed the required sensitivity to seek help when needed through the many avenues of available counseling and treatment options.

I organized this book according to related clusters of topic areas. The first three chapters address developmental concepts staring with conception through late adulthood. Basic physical, cognitive, emotional and social domains are described. Parent-child relationships are explored as well. Chapters four, five and six deal with mental health related issues such as stress management, categories of mental illnesses, psychological testing procedures and diagnostic methods used in psychiatry. Chapter seven introduces the various types of mental health providers, as well as the psychological and biological treatment approaches currently in use. Chapter eight, the final chapter, discusses the civil rights of individuals with mental illness. Every effort was made to avoid excessive technical language, and to expose the contents in an interesting albeit professional manner.

Chapter One:

Children and Adolescents

Maturity, one discovers, has everything to do with the acceptance of ‘not knowing’.

Mark Z. Danielewski

Section 1.1:

Conception, Pregnancy and Birth

The following topics are discussed in this section:

How to make decisions related to having children

Awareness about possible chromosomal and genetic abnormalities

Precautions which need to be taken to protect the developing fetus

Precautions related to childbirth

How the physical and emotional status of the newborn is determined

The decision to have a baby needs to be made in a responsible fashion. Many factors need to be addressed; these include health, emotional, and financial. Sound physical health improves the chances for a problem free gestation period. A visit to the family physician or gynecologist for a general pre-pregnancy check up including a genetic history evaluation for both sexes is important. Equally important are emotional issues. Having a baby should be a very happy life event for all individuals involved. The following questions need to be answered by prospective mothers: Is my relationship positive with the man who will be the father of my child? Do I understand the meaning of parenthood? Am I ready to be a mother? Am I willing to change my life style for many years? Prospective fathers need to answer similar questions. In case there are any doubts about the answers to such questions, open and honest communication is crucial between prospective parents. Professional counseling for family planning may be needed to sort out dilemmas and to alleviate insecurities and anxieties.

Unwanted pregnancies need special consideration, and the benefit of responsible counseling may be very advantageous. How to find well-credentialed therapists will be discussed in later chapters. Visiting and talking to friends who already have children often helps in conceptualizing the realities surrounding family life and parenting. Financial and other practical considerations need to be figured out as well. Does the family have sufficient income to support a child? If both parents will need to work, who will take care of the baby during working hours? Are nearby relatives willing to help with baby-sitting? Is there sufficient physical space at home to accommodate the expanding family? While these questions may sound elementary, thinking about them realistically may avert later panic.

Let us now examine some potential biological concerns. Chromosomal and genetic abnormalities are very common. Although approximately fifty percent of all human conceptions have abnormalities of this kind, fortunately many happen to be recessive (not physically expressed). Furthermore, normal genes of one parent often counteract the effects of the defects introduced by the other parent. Genotypic abnormalities, on the other hand, have been detected in about three to four percent of newborns (Ward, 1994). In cases of concern, prospective parents are advised to consult pediatricians about options for genetic counseling. The following is a list of common genetic conditions and diseases. A brief description and associated prognosis is also listed:

Phenylketonuria:      Brain development is inhibited by lack of an enzyme. A restricted diet can prevent severe mental retardation.

Down syndrome:      Chromosomal abnormality resulting in various levels of mental retardation. Special education and/or institutionalization is needed to maximize functional potentials. Many children and adults with Down syndrome can function at high levels and achieve considerable independence.

Turner syndrome:      Secondary sex characteristics fail to develop in females. Treatment is questionable.

Cystic fibrosis:         The lungs and digestive tract become obstructed by mucus. This enzymatic abnormality results in a very short life span, often not reaching adulthood.

Hemophilia:            Abnormality in the blood clotting mechanism may result in dangerous internal bleeding. Frequent transfusions may be needed to stabilize the condition.

Sickle cell anemia:      Severe anemia and circulatory problems are caused by abnormal red blood cells. While the condition is disabling, it is treatable with medication.

Klinefelter syndrome:   Secondary sex characteristics fail to develop in males. Treatment is often not successful.

Thalassemia:         Abnormal red blood cells, resulting in enlarged liver and spleen. Poor motivation, flat affect. Condition may be fatal. Blood transfusions may be effective.

Neurofibromatosis:   Benign tumors on peripheral and optic nerves. Learning disabilities. Surgery may be of help.

Tay-Sachs disease:   Toxins build up in brain tissue as a result of a lack of an enzyme. Early death in childhood as a result of neurological degeneration (Cole et al, 2005; Jorde et al., 1999; Rimoin et al., 1997; Simpson & Golbus, 1993.)

Prenatal development is usually divided into three parts. The germinal period begins at the time of conception when the male and female germ cells are joined. This period ends when the developing organism attaches itself to the wall of the uterus. This process takes about ten days. The embryonic period takes about eight weeks. During this period the major organs begin to develop, and have a primitive shape. The fetal period extends until childbirth. During this period the major organs develop, and the baby is prepared to be able to survive without physiological maternal support (Shaffer, 2002). Prospective mothers need to be cognizant of a variety of conditions that affect the developing fetus. These conditions include general health, various environmental factors, nutrition, her emotional state, stress, and her attitude toward having a baby. Research results tell us that unwanted babies weigh less and need more medical support than babies whose mothers are happy with their pregnancy.

Excessive stress can also be harmful. Elevated levels of cortisol and adrenaline (stress hormones), which cross the placenta, can have long lasting negative emotional effects on children (Relier, 2001). Low birth weight, premature delivery, elevated motor activity and increased aggression have been observed in these children (Lobel, 1994; Susman et.al. 2001). Essential vitamins and minerals and a well balanced diet of 2000 to 2800 calories are recommended (Christian, 2002). In addition, health care providers often advise increased intake of folic acid (vitamin B), iron and calcium. Including small amounts of zinc and magnesium to the mother’s diet can reduce birth complications (Friedman & Polifka, 1996). According to some studies deficient maternal nutrition can lead to miscarriage, low birth weight, premature birth, and a greater risk for the development of stroke, and heart disease later in life (Godfrey & Barker, 2000; Mora & Nestel, 2000).

There are many teratogens (environmental toxic agents), which may cause serious damage to the developing embryo and fetus. Severe structural and physiological birth defects are associated with a variety toxic substances. Abnormal development of internal organs and external body parts are frequently seen. Such damages are irreversible and are often fatal. Susceptibility to teratogenic agents partially depends on genetic vulnerability to such sources. The mother’s physiological state is also a factor. Hormonal balance, maternal nutrition, and age are relevant factors as well. Mothers who are less than twenty and older than forty years old pose most risk to the developing baby. Pollution, ingestion of certain drugs, infection and exposure to radiation are the most common sources for birth defects.

Pollution in industrialized societies is a great concern. Much is said about this problem in the media, and in political circles, but unfortunately too little is being done to eliminate this concern. Herbicides, pesticides, food additives, oil spills in our waterways, industrial waste products such as mercury, and air pollution from petrochemical plants constitute ongoing environmental hazards.

Substance abuse, including alcohol and tobacco is a serious social problem in the United States. Both alcohol and tobacco, including exposure to second-hand cigarette smoke, may harm the developing fetus. Abstinence during pregnancy is therefore strongly advised. Nearly half of the adult population in our country has used an illicit drug at some point in their lives. Approximately one in ten adults in our country engage in substance abuse at some point during their span of life. Many pregnant women take non-prescription pain relievers, and sleep medication. Some also take pills to counteract nausea. While most of these medications are harmless, we have no conclusive research evidence about teratogenic (toxic effect which cause birth defects) effects of all over-the-counter medications; therefore minimal or no use is the safest approach. Many classes of prescription medications have been found to cause abnormalities in the developing fetus. These include artificial hormones, some antipsychotic medications (e.g. Thorazine), anxiolytic medications (e.g. Valium), many antibiotics, anticonvulsants, and anticoagulants (Chavkin, 1995). The following is a list of commonly used illicit drugs and their teratogenic effects:

Heroin:   This drug is a derivative of opium, and is highly addictive. It can be smoked, inhaled as a powder, or injected under the skin or directly into the bloodstream. It has pain-relieving and sleep-inducing properties. Addicted mothers give birth to babies who are addicted as well. Very often these babies are born prematurely, and are underweight. They may be at risk to develop respiratory illnesses (Kaltenbach et. al., 1998). They need to be weaned off heroin under careful medical supervision in order to avoid life threatening withdrawal reactions.

Methadone:         Methadone hydrochloride is a synthetic narcotic which under medical supervision is used to reduce the cravings for heroin. It is available in some drug rehabilitation programs. Babies whose mothers use this drug are born addicted. Upon birth they need to be given methadone in order to avoid often fatal sudden withdrawal effects. These babies often have tremors, are irritable, and have sleep disturbances.

Cocaine:            Cocaine is a natural stimulant found in the leaves of the coca plant. The hardened form of cocaine is called crack. Cocaine can be sniffed, smoked or injected (Nevid, 2013). In some South American countries tea is brewed from coca leaves, and ingested as a beverage. Cocaine users enjoy a feeling of euphoria. Addicted mothers are at risk for depression, psychosis, anxiety, damage to the heart and circulatory system, respiratory arrest and strokes. (Cunningham et al., 2001). Overdose can be fatal. The effects on baby include irritability, poor coordination, learning disabilities and hyper-reactivity to environmental stimulation. (Bendersky & Lewis, 1998). Some residual symptoms may affect cognitive and emotional development for years.

Marijuana:            Marijuana is derived from the leaves and flowering tops of the plant Cannabis sativa (Butcher, et al., 2007). It is considered to be a mild hallucinogen. Smokers of this drug report subjective feelings of relaxation and euphoria. At higher doses it can produce perceptual distortions The effects on the baby is often associated with premature birth and low birth weight.

We often do not think of alcohol as a drug. The reasons behind excessive alcohol use however, is very similar to those which lead people to drug abuse. Mind altering properties of alcohol, which appeal to the user, include a temporary pleasant mood, elevated self-esteem and an escape from the stressful effects of reality. Alcohol addiction may result upon repeated drinking. Chronic alcoholism often has irreversible and fatal physical effects, such as cirrhosis of the liver (irreversible scarring of liver tissue). Alcohol amnestic disorder (alcohol-related psychosis) is another severe side effect, the main symptom of which is profound memory loss especially for recent events. The teratogenic (abnormal malformations) effects of alcohol include serious birth defects such as congenital heart disease, abnormally small head with facial deformities. Brain damage and joint and eye abnormalities also occur. Fetal alcohol syndrome, which includes these anomalies, usually results in retarded physical and mental development. It is essential therefore for pregnant women to refrain from the ingestion of alcohol (Calhoun & Warren, 2007). Tobacco, as mentioned above, may also have serious harmful effects on the fetus. These include stillbirth, miscarriages, and neonatal death (Chan, Keane & Robinson, 2001). Smoking during pregnancy may also lead to disruptive behavior in children (Wakschlag et al., 2006). Lower birth weight results from the adverse effects of nicotine on placental growth (Chertok, et al., 2011). As a result from abnormal growth of the placenta the fetus does not receive sufficient nutrients and oxygen. As stated above, prospective mothers are strongly advised to stop smoking, and to avoid smoky environments.

Excessive caffeine consumption has been linked to increased probability for miscarriage and low birth weight (CARE Study Group, 2008). Consequently, only limited or no intake of coffee, tea, and cola drinks are recommended for pregnant women.

In addition to drugs and other ingestible substances there are other dangers to the embryo, fetus and the newborn, which need to be kept in mind. Pregnant women who suffer from Rubella, or German measles may give birth to babies with mental retardation, congenital heart disease, cataracts and deafness (Bale, 2002). Prospective mothers should receive vaccinations at least six months prior to conception. Medical consultation is recommended.

The following are some additional maternal diseases and conditions, which may affect prenatal development: Genital herpes, Gonorrhea, Syphilis, Chicken pox, Cytomegalovirus, Diabetes, Hepatitis, Hypertension, Influenza, Mumps, Toxemia, and Toxoplasmosis (Jones, Lopez, & Wilson, 2003; Kliegman et al., 2008; Moore & Persaud, 1993; Stevenson, 1977). Babies born to mothers with Acquired Immunodeficiency Syndrome (AIDS) are at risk for developing the disease. The virus may be transmitted through the placental barrier. Also, at the time of delivery the baby may become exposed to the mother’s infected blood (Cole, Cole, & Lightfoot, 2005). The human immunodeficiency virus (HIV) is very aggressive and produces devastating damage to infants. This includes serious brain damage, respiratory illnesses, diarrhea, and death (Devi et. al., 2009). Preconception exposure to HIV/AIDS needs to be determined in order to receive proper medical advice and care prior and during pregnancy. Medications are currently available to reduce the baby’s chances of infection. Rh incompatibility (a characteristic of red blood cells) also needs to be discussed with the treating physician in order to prevent birth defects in future pregnancies (Shaffer, 2002). Exposure to radiation must be minimized during pregnancy in order to avoid serious malformations to the developing fetus (Vorhees & Mollnow, 1987). Pregnant women must alert their physicians and dentists.

Childbirth is a psychologically happy event, but physically painful. Analgesics (pain killers) and sedatives (tranquilizers) are often prescribed to control pain. Unfortunately these medications have undesirable effects on the newborn. Symptoms include irritability, poor muscle tone, reduced attention, and less vigorous sucking responses (Caton et al., 2002). Many pregnant women elect alternative modes of pain control, such as relaxation and breathing exercises. Most hospitals offer educational classes to teach women these self-help skills. Medical interventions such as inducing labor and cesarean section are needed when the mother’s life is in danger or when the baby is in distress during delivery. Sometimes these procedures are recommended unnecessarily and need to be discussed carefully with obstetricians.

The Apgar Scale is often used in delivery rooms to determine the physical condition of the newborn. Heart rate, respiratory effort, muscle tone, reflex responsivity, and color are examined (Apgar, 1953). The Brazelton Neonatal Assessment Scale is used to assess the neurological condition of babies who may be at risk for developmental problems. This test measures muscle tone, reflexes, motor capacities, capacity for responding to environmental stimulation, and attention (Brazelton & Nugent, 1995). Infants who are premature (born before the 37th week of gestational period) and of low