MENTAL HEALTH AND CLINICAL PSCHIATRY
Course coordinator : Mbundire Farai Happy
UNIT ONE: INTRODUCTION TO MENTAL HEALTH AND PSYCHIATRY
1.1 What is Mental Health?
According to the World Health Organisation (WHO,2022) Mental health is a state of mental
well-being that enables people to cope with the stresses of life, realize their abilities, learn
well and work well, and contribute to their community. It is an integral component of health
and well-being that underpins our individual and collective abilities to make decisions, build
relationships and shape the world we live in and is crucial to personal, community and socio-
economic development.
It is worth noting that Mental health is more than the absence of mental disorders. It exists on a
complex continuum, which is experienced differently from one person to the next, with varying
degrees of difficulty and distress and potentially very different social and clinical outcomes.
As we will see later in this module, Mental health conditions include mental disorders and
psychosocial disabilities as well as other mental states associated with significant distress,
impairment in functioning, or risk of self-harm. People with mental health conditions are more
likely to experience lower levels of mental well-being, but this is not always or necessarily the
case.
1.2 What is psychiatry?
Having outlined what mental health is, let’s term to the concept of Psychiatry.
According to the American Psychiatric Association (APA,2023), Psychiatry is the branch of
medicine focused on the diagnosis, treatment and prevention of mental, emotional and
behavioral disorders.
A psychiatrist Is a medical doctor (an M.D. or D.O.) who specializes in mental health, including
substance use disorders. Psychiatrists are qualified to assess both the mental and physical aspects
of psychological problems.
As we will see later in the module when we start looking at psychiatric signs and symptoms,
people seek psychiatric help for various reasons including sudden problems such as panic attack,
frightening hallucinations, thoughts of suicide, or hearing “voices.” Or they may be more long-
term, such as feelings of sadness, hopelessness, or anxiousness that never seem to lift or problems
functioning, causing everyday life to feel distorted or out of control (APA,2023).
1
,1.3. A Brief History of psychiatry
The term “psychiatry” is a Greek word which literally means “medical treatment of the soul”
and was coined by Dr. Johann Christian Reil in the early 19th century.
Although mental asylums were established during the medieval period, psychiatry as a distinct
medical discipline only started developing from the 18th century.
For the first century of its existence, the field concerned itself with severely disordered individuals
confined to asylums or hospitals. These patients were generally psychotic, severely depressed or
manic, or suffered conditions we would now recognize as medical: dementia, brain tumors,
seizures, hypothyroidism, etc (Reidbord,2014).
The knowledge of psychiatry evolved with description of psychopathologies where doctors
identified syndromes with clusters of symptoms (which sometimes overlapped) of distinctive
mental illnesses. Today, syndromes of mental disorders such as schizophrenia, obsessive
compulsive disorders, personality disorders, ADHD, dementia, major depressive disorder are well
understood by Psychiatrists.
Just over a century ago, Sigmund Freud and other “psychoanalysts” such as Carl Gustav Jung
penned papers on the patients they treated and theorized that mental disorders had an underlying
unconscious etiology. Freud described the patients whose psychoneurotic disorders affected their
daily lives and relationships, he reported that they improved when their unconscious mind were
“psychoanalyzed”. Freud was the first to develop psychoanalytic principles for the treatment of
neurotic patients.
The discovery of medications such as chlorpromazine and thioridaziines in the fifties and sixties
of the 20th century was a major breakthrough for psychiatry. Mental hospitals in Europe and USA
witnessed many patients being released due to the positive healing effects of using psychotherapy
and medicines in combination.
Leading pharmaceutical companies invested billions of dollars and engaged qualified researchers
for conducting R&D that paved the way for the development of highly efficient and safer
antidepressants, antipsychotics, stimulants and relaxants.
The combined used of medicine and psychotherapy together with other adjective treatment
modalities such as art therapy, play therapy have allowed many patients to recover and re-integrate
into society ( Psych Medicine Clinic,2019).
1.4 Concepts of normality and abnormality
The concepts of normality and abnormality are logical opposites in meaning in both everyday
language and even in psychology. Normality is the state of being normal, whereas abnormality is
the state or condition of having abnormal behaviors, including thoughts and emotions, as well as
traits. However, because of the subjectivity of these two terms, behaviors that are not normal are
not always abnormal just as a perceived absence of abnormal behavior is not necessarily called
normal (Brown,2019).Let’s take a close look at these terms
2
, Concept of Normality
Normality is behavior that is consistent in a person’s usual way of behaving. It is conformity
to societal standards as well as thinking and behaving similarly to the majority, and as such is
generally seen as good in this context. Normality is also behavior that is expected and/or
appropriate to the situation. It may also be just being average, as is the case in psychological
statistics. It involves being able to adjust to the surroundings, manage or control emotions, being
able to work satisfactorily as well as build relationships that are fulfilling or at least acceptable
(Brown, 2019).
Concept of Abnormality
Various definitions of abnormal behavior have been proposed though none of these definitions has
won total acceptance. This could be due to the fact that there is no clear dividing line that exists
between normal variations in thoughts, emotions, and behaviors and what would be labeled as
abnormal . Still, most of the definitions have certain features in common, often called the four Ds’:
Deviance, Distress, Dysfunction/maladaptive, and danger. That is, patterns of psychological
abnormality are typically deviant (different, extreme, unusual, perhaps even bizarre), distressing
(unpleasant and upsetting to the individual or to close relations), dysfunctional (interfering with
the person‘s ability to conduct daily activities in a constructive way) and possibly dangerous to
oneself and to others ( Durand & Barlow,2012).
In summary, normality and abnormality are subjective to individual perception and to societal
standards which are further dependent on situation, context, age, or gender. Perceptions of
normality and abnormality also vary by culture. Furthermore, the meanings of these two terms
differ with the changing societal norms, even within a specific culture (Brown, 2019).
1.5 The biopsychosocial model of etiology and management of mental disorders
The biopsychosocial model (BPS) was proposed by George L. Engel in 1977 as a needed medical
model to explain psychiatric disorders.Since then, this model had gained wide acceptability across
the globe. It systematically explained the complex interplay of three major dimensions (biological,
psychological, and social) in the development of psychiatric disorders. It explained that a person
does not suffer as isolated organs but rather as a whole. This provided a holistic approach to
psychiatric illnesses (Tripathi, Das & Kar,2019).
The biological influences on mental health and mental illness are varied, and include
genetics, infections, physical trauma, nutrition, hormones, and toxins.
The psychological component looks for potential psychological explanations for a health
problem, such as lack of self-control, emotional turmoil, or negative thinking.
Social and cultural factors are conceptualized as a particular set of stressful events (being
laid off, for example) that can differentially impact mental health depending on the
individual and his or her social context.
3
Course coordinator : Mbundire Farai Happy
UNIT ONE: INTRODUCTION TO MENTAL HEALTH AND PSYCHIATRY
1.1 What is Mental Health?
According to the World Health Organisation (WHO,2022) Mental health is a state of mental
well-being that enables people to cope with the stresses of life, realize their abilities, learn
well and work well, and contribute to their community. It is an integral component of health
and well-being that underpins our individual and collective abilities to make decisions, build
relationships and shape the world we live in and is crucial to personal, community and socio-
economic development.
It is worth noting that Mental health is more than the absence of mental disorders. It exists on a
complex continuum, which is experienced differently from one person to the next, with varying
degrees of difficulty and distress and potentially very different social and clinical outcomes.
As we will see later in this module, Mental health conditions include mental disorders and
psychosocial disabilities as well as other mental states associated with significant distress,
impairment in functioning, or risk of self-harm. People with mental health conditions are more
likely to experience lower levels of mental well-being, but this is not always or necessarily the
case.
1.2 What is psychiatry?
Having outlined what mental health is, let’s term to the concept of Psychiatry.
According to the American Psychiatric Association (APA,2023), Psychiatry is the branch of
medicine focused on the diagnosis, treatment and prevention of mental, emotional and
behavioral disorders.
A psychiatrist Is a medical doctor (an M.D. or D.O.) who specializes in mental health, including
substance use disorders. Psychiatrists are qualified to assess both the mental and physical aspects
of psychological problems.
As we will see later in the module when we start looking at psychiatric signs and symptoms,
people seek psychiatric help for various reasons including sudden problems such as panic attack,
frightening hallucinations, thoughts of suicide, or hearing “voices.” Or they may be more long-
term, such as feelings of sadness, hopelessness, or anxiousness that never seem to lift or problems
functioning, causing everyday life to feel distorted or out of control (APA,2023).
1
,1.3. A Brief History of psychiatry
The term “psychiatry” is a Greek word which literally means “medical treatment of the soul”
and was coined by Dr. Johann Christian Reil in the early 19th century.
Although mental asylums were established during the medieval period, psychiatry as a distinct
medical discipline only started developing from the 18th century.
For the first century of its existence, the field concerned itself with severely disordered individuals
confined to asylums or hospitals. These patients were generally psychotic, severely depressed or
manic, or suffered conditions we would now recognize as medical: dementia, brain tumors,
seizures, hypothyroidism, etc (Reidbord,2014).
The knowledge of psychiatry evolved with description of psychopathologies where doctors
identified syndromes with clusters of symptoms (which sometimes overlapped) of distinctive
mental illnesses. Today, syndromes of mental disorders such as schizophrenia, obsessive
compulsive disorders, personality disorders, ADHD, dementia, major depressive disorder are well
understood by Psychiatrists.
Just over a century ago, Sigmund Freud and other “psychoanalysts” such as Carl Gustav Jung
penned papers on the patients they treated and theorized that mental disorders had an underlying
unconscious etiology. Freud described the patients whose psychoneurotic disorders affected their
daily lives and relationships, he reported that they improved when their unconscious mind were
“psychoanalyzed”. Freud was the first to develop psychoanalytic principles for the treatment of
neurotic patients.
The discovery of medications such as chlorpromazine and thioridaziines in the fifties and sixties
of the 20th century was a major breakthrough for psychiatry. Mental hospitals in Europe and USA
witnessed many patients being released due to the positive healing effects of using psychotherapy
and medicines in combination.
Leading pharmaceutical companies invested billions of dollars and engaged qualified researchers
for conducting R&D that paved the way for the development of highly efficient and safer
antidepressants, antipsychotics, stimulants and relaxants.
The combined used of medicine and psychotherapy together with other adjective treatment
modalities such as art therapy, play therapy have allowed many patients to recover and re-integrate
into society ( Psych Medicine Clinic,2019).
1.4 Concepts of normality and abnormality
The concepts of normality and abnormality are logical opposites in meaning in both everyday
language and even in psychology. Normality is the state of being normal, whereas abnormality is
the state or condition of having abnormal behaviors, including thoughts and emotions, as well as
traits. However, because of the subjectivity of these two terms, behaviors that are not normal are
not always abnormal just as a perceived absence of abnormal behavior is not necessarily called
normal (Brown,2019).Let’s take a close look at these terms
2
, Concept of Normality
Normality is behavior that is consistent in a person’s usual way of behaving. It is conformity
to societal standards as well as thinking and behaving similarly to the majority, and as such is
generally seen as good in this context. Normality is also behavior that is expected and/or
appropriate to the situation. It may also be just being average, as is the case in psychological
statistics. It involves being able to adjust to the surroundings, manage or control emotions, being
able to work satisfactorily as well as build relationships that are fulfilling or at least acceptable
(Brown, 2019).
Concept of Abnormality
Various definitions of abnormal behavior have been proposed though none of these definitions has
won total acceptance. This could be due to the fact that there is no clear dividing line that exists
between normal variations in thoughts, emotions, and behaviors and what would be labeled as
abnormal . Still, most of the definitions have certain features in common, often called the four Ds’:
Deviance, Distress, Dysfunction/maladaptive, and danger. That is, patterns of psychological
abnormality are typically deviant (different, extreme, unusual, perhaps even bizarre), distressing
(unpleasant and upsetting to the individual or to close relations), dysfunctional (interfering with
the person‘s ability to conduct daily activities in a constructive way) and possibly dangerous to
oneself and to others ( Durand & Barlow,2012).
In summary, normality and abnormality are subjective to individual perception and to societal
standards which are further dependent on situation, context, age, or gender. Perceptions of
normality and abnormality also vary by culture. Furthermore, the meanings of these two terms
differ with the changing societal norms, even within a specific culture (Brown, 2019).
1.5 The biopsychosocial model of etiology and management of mental disorders
The biopsychosocial model (BPS) was proposed by George L. Engel in 1977 as a needed medical
model to explain psychiatric disorders.Since then, this model had gained wide acceptability across
the globe. It systematically explained the complex interplay of three major dimensions (biological,
psychological, and social) in the development of psychiatric disorders. It explained that a person
does not suffer as isolated organs but rather as a whole. This provided a holistic approach to
psychiatric illnesses (Tripathi, Das & Kar,2019).
The biological influences on mental health and mental illness are varied, and include
genetics, infections, physical trauma, nutrition, hormones, and toxins.
The psychological component looks for potential psychological explanations for a health
problem, such as lack of self-control, emotional turmoil, or negative thinking.
Social and cultural factors are conceptualized as a particular set of stressful events (being
laid off, for example) that can differentially impact mental health depending on the
individual and his or her social context.
3
