Case study — Mental health Essay Example
Ego is identified as one of the significant components governing rational thinking and solving problems in a person (Freud, 1961, p.62). Once the levels of anxiety heightens, the ego strength, is tested, which mobilizes the energy confronting the existing threat. Denial mechanism describes the incapacity of the mind to acknowledge the prevalence of real situations and feeling that are associated with reality (Freud, 1961, p.63). While denial is on operation, it acts as a healthy mechanism since it protects one from the impending reality shock. Once it diminishes, the patient is forced to face the impending harsh reality.
The poor health condition that Peter is experiencing could easily lead to denial mechanism. He has a history of diabetes and is experiencing fatigue and insomnia for the last four months. His blood sugar has been on the increase. Further inquiries reveal Peter’s denial mechanism since his assumes that everything is fine leaving the responsibility of diabetic control to his wife. He has been receiving hypertensive medication for the last five years in a bid to calm his hypertension. Peter has high cholesterol levels.
Peter’s denial of his present poor health condition puts him at a higher risk of contracting other diseases or even death. His denial has led him to adopting unhealthy lifestyles; excessive smoking and drinking of alcohol. It was noted that his HbA1c levels has increased from 8% to 9.2%, which indicates that he has type 2 diabetes. Increase in the HbA1c levels results to: Heart disease, Eye disease, Nerve disease, Kidney disease and Stoke. Excessive consumption of alcohol results in kidney complications. This implies that Peter is bound to suffer from many diseases if his HbA1c remains high for a long duration (American Diabetes Association, 2011, p. 23).
It could be true to state that Peter could be using denial mechanism in order to forget his current economic status. He states that he gets stressed out by the existing downturn present in the construction industry, which has resulted in his poor economic status. He is also experiencing a problem in his marriage. He states that he has a strenuous relationship with his unemployed son, which is causing tension between him and his wife. One of the factors that elaborate that Peter is suffering from denial mechanism is the fact that he avoids eye contact while communicating. This could indicate that he lacks confidence. Lack of confidence could originate from the mere fact that, he is not sure that the things he blames for his problem are the main cause of his problems. Denial could also be characterized by speaking quietly and little display of emotions.
American Diabetes Association. (2011). Standards of medical care in diabetes. Diabetes Care, 35, pp.11-63.
Freud, S. (1961). The Ego and the Id. American Journal of Nursing
, 88 (1), pp.60-65.
Different individuals react differently in response to an existing stressor or a problem. One’s cognitive reaction to an existing situation helps in determining the degree of stress when in a stressful situation. One’s reaction is mainly characterized by the implication and relevance of the event, one’s appraisal of event’s nature. Another significant factor is the person’s ability of coping and efficient management of an event. According to stress theory, there are three significant stages that individual experiences; Alarm reaction, resistance and exhaustion stage.
Peter’s condition indicates that he has gone through the first two phases. According to further inquiries, it is evident that Peter’s condition has been going on for quite some time. Diagnosis carried out on Peter indicates that his blood pressure is high (145/85 mm/Hg). The alarm reaction stage involves the stimulation of the patient’s sympathoadrenal medullary system, which releases catecholamines; norepinephrine and epinephrine. Epinephrine leads to dilation of pupils and bronchi; increasing blood pressure, respiration, alertness and heart rate. Peter’s high blood pressure could have originated from this stage.
In the resistance stage, the individual portrays a reduction, as well as, the alarm reaction is concerned. This happens as the body acquires a full resistance of the established stressor. Further observation of Peter’s behavior displays little spontaneous emotion. Peter’s body mass index is 31, which indicate that he is overweight. This could have resulted from the development of adaptation where the body tissues are forced to intensify their functional characteristic activity as the body reacts to the stressor (Van den Berghe, 2001, p.411). This makes some individuals eat much food, which could lead to the problem overweight. This stage is perceived as a survival mechanism of the body through the utilization of the body’s catatoxic and syntoxic defense mechanism in facilitating the coexistence between the stressor and the organism.
The Allostatic and Allostasis load theories indicate that homeostasis is the control of the body to equilibrium, through a single-point tuning like blood glucose, blood’s level of oxygen, or the blood’s pH (Ganzel, Morris, and Wethington, 2010, p141). The theories suggest that, the central stress mediators in this situation are epinephrine and cortisol. The two elements have both damaging and protective effect on one’s body. Some physiological indicators utilized in the determination of allostatic load; diastolic and systolic blood pressures, total cholesterol, high-density lipoproteins (HDL) and glycosylated hemoglobin (HbA1c) degrees on the metabolism of glucose (Arroll, 2013). The last review on Peter’s medical condition revealed that his HbA1c had increased from 8% to 9.2%. The same occurrence was noted on his high cholesterol level of 5.8mmol/l.
Arroll, M. A. (2013). Allostatic overload in myalgic encephalomyelitis/chronic fatigue syndrome. Medical Hypotheses
, 81 (3), pp.506.
Ganzel,. B., Morris, P. A., and Wethington, E. (2010). Allostasis and the human brain: Integrating models of stress from the social and life sciences. Psychological review
, 117 (1), pp.134-174.
THERAPEUTIC COMMUNICATION TECHNIQUES
In Peter’s statement, he talks of being ‘fed up’. This indicates the degree of his mental status. He feels that he has reached his elastic limit. His health has greatly deteriorated since his blood pressure has considerably shot up, increase in cholesterol level and has type 2 diabetes. He has a sour relationship with a son a fact that is causing tension between him and his wife. He is also experiencing financial problems. All this factors are affecting Peter’s state of mind and is about to give up. The fact that Peter never takes care of his health indicates that, he has already given up and is not concerned of what could become of him.
He also says that he needs to pull himself together. This shows that, despite what his current condition, there is a small ray of hope. The statement that he needs to pull himself together could also indicate his unwillingness to communicate with the doctor. This could have been meant to shut the doctor out of his problem since he is trying to indicate that he knows exactly what to do, in his current condition.
Therapeutic communication is different from the typical communication since it brings about an aspect of empathy in what a patient perceives as being a traumatic experience (Walsh, 2011,p5). Therapeutic communication forms a basis of an interactive relationship between the patient and the nurse. It assists the nurses in establishing a rapport, as well as, understanding their client’s experiences in order to formulate a client-centered intervention. The nurses might choose to use reassuring clichés such as you will be fine, and all will be well.
This could be employed by the nurses to patients who could be experiencing difficulty in choosing what to say. The use of therapeutic communication helps in reducing the anxiety of both the nurse and the patient (Rosenberg & Gallo-Silver, 2011, p.4). Reassuring clichés contradicts the perception of the patient on his current situation. This can efficiently be applied on Peter who claims that he is fed up; reassuring clichés will bring a ray of hope in Peter’s situation.
Rosenberg, S., & Gallo-Silver, L. (2011). Therapeutic communication skills and student nurses in the clinical setting. Teaching and Learning in Nursing
, 6 (1), pp.2-8.
Walsh, J. (2011). Therapeutic Communication with Psychotic Clients. Clinical Social work Journal
, 39 (1), pp.1-8.
ACCEPTANCE AND COMMITMENT THERAPY
Success of treating anxiety disorder varies from one patient to another. Once the patient gets the required professional care, the disorder is treatable. Some patients respond to treatment within a short period while others take a year. The treatment becomes complicated if the patient suffers from numerous anxiety disorders, substance abuse, depression or other related conditions. The diagnosis carried out indicated that, Peter has been suffering from anxiety disorders. This calls for an urgent professional care in order to save Peter’s life.
Peter should start Acceptance and Commitment Therapy (ACT). It is developed from a coherent philosophical and theoretical framework (Twohig, 2012, p.501). ACT is a special psychological intervention, which is empirically based that utilizes mindfulness and acceptance strategies, coupled with change in behavior and commitment. This is meant to improve psychological flexibility (Rector, 2013, p.57). This will help Peter acquire the knowledge to developing clarity concerning his personal values, and necessary commitment required in changing his behavior. ACT psychotherapy will assist Peter in accepting the hardships in his life.
ACT focuses on three significant areas; Acceptance of one’s reaction, choosing a valued direction and taking action. In the acceptance aspect of ACT Peter will have to accept that there is a problem in his marriage. He will have to seek the underlying problem causing the tension between him and his wife rather than blaming his son of his failure. The professional will have the responsibility of helping Peter acknowledge this problem. The nurse will also assist Peter in understanding the need to take care of his poor health, and not leaving the entire responsibility of his health to his wife. Peter should be made to accept that he results to smoking and drinking alcohol as a means to escape his problems, which only worsens his health condition.
The professional employs some acceptance strategies that help the patient in acknowledging his problems. One of the strategies that the profession will utilize on Peter involves letting Peter’s thoughts and feeling happen without an impulse of acting on them. Peter will also be made to observe his weaknesses but taking note of his strengths. Finally, He will be made to realize that he can be in control of his feelings, reaction and thoughts. Acceptance and commitment therapy will assist Peter in seeing the bright side of his problems. This will also help him in taking care of poor health and mend his relationship with his wife and son.
Twohig, M. P. (2012). Acceptance and Commitment Therapy: Introduction. Cognitive and Behavioral Practice
, 19 (4), pp.499-507.
Rector, N. A. (2013). Acceptance and commitment therapy: empirical considerations. Behavior Therapy
, 44 (2), pp.213.
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