Learn

Mental Health

According to the World Health Organization (WHO), mental health is “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 is able to make a contribution to his or her community.”

Good Mental Health

Teens with good mental health exhibit the following characteristics.

  • They are generally happy and positive about life and the future.
  • They establish meaningful, healthy relationships with family and friends.
  • They pursue activities they enjoy.
  • They have positive values.
  • They have a sense of purpose.
  • They have a sense of personal identity and positive self-esteem. Because they know who they are and what they believe, they make choices that are consistent with their values and they avoid activities that go against their values.
  • They practice self-care by eating nutritious food, getting adequate rest, exercising, and valuing personal well-being.
  • They recognize and accept their strengths and weaknesses.

Influences

Who we are, including our mental health, is a product of the influences of heredity and environment. As you have already learned, heredity has to do with the genes we inherit from our parents. Environment has to do with the people and places where we live and work. If we live in a home and neighborhood that is pleasant and calm, we are more able to focus on academics and preparing for the future. If we are not sure we will have something to eat, or are afraid of being harmed at home, in the neighborhood, or at school, it is more difficult to focus on learning and developing skills for the future.

Maslow’s Hierarchy of Needs

Everyone has needs that motivate how we act and who we become. A psychologist named Maslow believed some of our needs are more basic than others. He also believed if our most basic needs are not met, we are not able to progress to meet our higher needs. His ideas are illustrated in the diagram below, called Maslow’s Hierarchy of Needs.

Maslow's hierarchy of needs

What Maslow’s hierarchy is showing us is that people’s physical needs for things such as food, clothing, shelter, and safety have to be met before they can invest in relationships, self-esteem, and reaching their potential. This theory explains why it is difficult for people who experience trauma to focus on academics, work, and planning for a successful future.

Factors Affecting Mental Health

Managing Emotions

Experiencing a wide range of emotions is part of being human. Recognizing, experiencing, and managing the our emotions is essential to healthy living. Think about times in the past 24 hours when you felt mad, sad, glad, and afraid. What caused you to feel those feelings? How did you manage your emotions? There is nothing wrong with feeling any emotion. Emotions are not right or wrong, they are just part of who we are. How we respond to those emotions can be healthy or unhealthy.

Healthy Response

For example, when we are mad, it is unhealthy to yell, belittle, or hit others. Using that energy to do something productive, such as clean out a closet or mop the floor, can be a healthy response. Using the communication skills you learned earlier can help. Stating “I feel ________ because ________,” can help in managing all of our emotions.

Denying Emotions

Denying our emotions can turn our normal emotions into something unhealthy. For instance, if we bury our anger we can become depressed. If we pretend we are not sad, we can develop a stomachache or headache. Fear can turn into anger and cause us to lash out at someone. It is an important life skill to recognize our emotions and practice responding to them in healthy ways.

Healthy Boundaries

Personal boundaries are limits we set to protect ourselves from manipulation by others. Boundaries communicate to others that we value ourselves and have high self-esteem. They protect us from being used and manipulated in relationships. Healthy boundaries must be clearly communicated and respected by both partners in the relationship.

Establishing Boundaries

We can establish boundaries early by stating clearly what we can and cannot do. The decisions for the boundaries we set depend on what we value and how we want to spend the time we have. For example, “I am glad to give you a ride, but you cannot drive my car,” makes what you will and will not do clear.

Setting boundaries involves the following:

  • open, honest communication,
  • respect for differences,
  • healthy friendships outside the relationship,
  • keeping commitments,
  • taking responsibility for one’s actions, and
  • accepting the end of a relationship.

Poor boundaries are characterized by the following:

  • manipulation,
  • game-playing,
  • jealousy,
  • feeling incomplete without your partner, and
  • depending on your partner for happiness.

Maintaining Boundaries

Maintaining boundaries can be challenging, because saying no to people is difficult. Boundaries are a good strategy for maintaining control of our lives and our time. They also help us live with self-respect and manage how others treat us. For more information about healthy boundaries, read Love is Respect: What are My Boundaries?.

Challenges

Just as healthy people get sick, people who are mentally and emotionally well have seasons when emotional health is impaired. Sometimes those seasons are short, and sometimes they last a very long time. Many different types of stressors can challenge our mental and emotional well-being. Recovering from experiences of trauma and loss throughout life can require support and care from family, friends, and professionals.

Trauma

Those who experience loss and trauma during their formative years can develop responses that affect their lives and relationships throughout adulthood. Trauma can occur when a child’s safety is threatened, or when that child witnesses or hears of a threat to a loved one. These threats can result from a single traumatic event or from neglect or abuse over a long period of time. Events that traumatize a child can be from outside the family, such as violence in the neighborhood, an accident, or a natural disaster. Domestic abuse, sexual abuse, or neglect within the family also cause childhood trauma. Children living in traumatic circumstances often have to live with someone other than their parents, which can require changing schools. Moving can bring relief from the traumatic environment, but interrupting significant relationships can cause additional distress. The child often moves from one difficult home environment to another unhealthy home.

Trauma Effects

Children who have experienced trauma often develop patterns of behavior that affect their lives long after the traumatic events are over. Reminders of the trauma can cause unpleasant physical and emotional responses. Children might become depressed, anxious, and prone to engage in risky behaviors. Children who have experienced trauma have often learned poor relationship patterns and, as a result, have difficulty establishing healthy relationships. The severity and frequency of the trauma, the responses of those around the child, and family and community characteristics all influence the child’s long-term responses.

Watch these two videos to learn more about how trauma can affect people.

Open Trauma and Toxic Stress: One Man's Story in a new tab

Open What is Trauma? in a new tab

 

Addressing the Effects of Trauma

Recognizing childhood trauma and taking steps to learn healthy ways to relate to others can help children grow into healthy adults. When children experience loss, abuse, or neglect, they need help from family members, close friends, and sometimes mental health professionals. Supportive adults can help a child understand their experiences from a healthy perspective. Those who are traumatized and do not have help developing healthy coping strategies are more likely to develop mental illness (Source: National Child Traumatic Stress Network).

Grief

Loss can challenge our mental health. We all experience loss at times, and grief is a normal response to loss. There is not a right or wrong way to grieve. Grief is individual, and does not occur in a neat sequence or on a particular timetable. Dr. Elizabeth Kubler-Ross identified stages of grief people typically experience, although not everyone goes through every stage, and not always in the same order.

  • The first stage of grief is shock and denial. This is illustrated when someone learns of a sudden loss, and responds, “No!” or “I cannot believe it!” This phase helps shield us from the impact of a sudden, devastating loss to give us time to absorb the news.
  • As the news begins to sink in, anger protects us from the pain of loss. Blaming someone or something for what is happening can help us keep pain at a distance. People might say, “He will regret what he did.”
  • When we experience loss, we often want to bargain with God or a higher power. We find ourselves saying, “What if” or “If only.” Guilt is a common emotion during this stage.
  • When the reality of loss becomes more real, people often experience depression. At this stage people say things like, “I don’t know how to go on.” The support of family, friends, counselors, and others experiencing similar losses can help a person move through this difficult stage.
  • Acceptance does not mean the pain is over. It means you acknowledge the changes in your life and understand how it impacts your life. People might say, “I will find a new path,” when they reach this stage.

Recognizing these stages are a normal part of grieving can help us progress through the seasons of life. Support from family, friends, and others who have experienced similar types of grief can help us reach acceptance and live in our new reality.

Mental Illness

Mental illness can happen to anyone. It touches people of all cultures, socioeconomic levels, genders and races. Symptoms often begin in the late teens and young adulthood years, but can occur earlier or later. Some symptoms are common to several illnesses, so diagnoses can be difficult. There are no lab tests that tell doctors what mental illness a person has. Diagnoses are based on observations and reports of a person’s behaviors and experiences over time. We will discuss some of the most common mental illnesses.

Anxiety

The American Psychological Association defines anxiety as, “an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.” It is normal to be anxious in response to a specific event or situation.

According to the American Psychological Association, anxious feelings can be managed by practicing good self-care with adequate sleep, a nutritious diet, exercise, and positive self-talk. If anxiety levels make life difficult, a physician or counselor can assess the need for professional help. Anxiety disorders can often be managed through talk therapy (counseling) and medication. Your personal doctor or school counselor can advise you about next steps.

Anxiety Disorders

When anxiety becomes high enough to cause a person to avoid situations because they are worried, it could indicate an anxiety disorder. People with anxiety disorders often have intrusive thoughts or concerns. They often experience physical symptoms such as a rapid heart rate, high blood pressure, dizziness, sweating, and trembling. These symptoms can occur in response to an event, troubling circumstances, the anniversary of a traumatic experience, or with no known trigger. There are various types of anxiety disorders, including panic attacks, phobias, and obsessive-compulsive disorder (OCD).

Panic Attacks

Panic attacks cause sudden terror in the absence of danger or threat. Panic attacks can happen any time under any circumstances without warning. They typically begin during young adulthood, and can affect anyone, but are more common in women. They cause a sudden rise in heart rate, difficulty breathing, weakness, dizziness, or sweating.

Phobias

Phobias are anxiety disorders in which the person experiences irrational fear of a variety of triggers that are not especially dangerous. People often have phobias of things such as leaving their homes to go to public places (agoraphobia), closed spaces (claustrophobia), and spiders (arachnophobia). People with phobias experience the physical symptoms of anxiety disorders and also have a strong desire to get away from whatever they fear.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is characterized by uncontrollable, recurring thoughts and repetitive behaviors. Those with OCD often check things over and over, or repeat behaviors such as hand-washing. Unwanted, intrusive thoughts of violence or aggression can also be symptoms of OCD, as can physical or vocal tics.

Depression

People who are depressed lose interest in activities they once enjoyed. Fatigue, sadness, difficulty concentrating, changes in appetite and sleep patterns, and difficulty managing daily responsibilities are common signs of depression. Depression often causes people to avoid social contact, do poorly in school or at work, and not pay attention to personal hygiene. Many people experiencing depression have thoughts of suicide.

A diagnosis of depression is considered if symptoms last more than two weeks. Depression is more common in those with low self-esteem and people living in a home characterized by violence, neglect, or poverty. It tends to run in families and is characterized by differences in chemicals in the brain. Some illnesses and medications make depression more likely. It can be treated with talk therapy (psychotherapy) with a counselor and with medications prescribed by a doctor (Source: American Psychiatric Association).

To hear the story of one teen who has learned to manage depression, watch this video.

Open Depression: One Teen’s Story in a new tab

Postpartum Depression

There are several types of depression. Each type has different triggers and is managed differently.

One notable type, postpartum depression, often occurs in a mother after the birth of a baby when hormones are changing rapidly. New mothers should speak openly with their doctors if they are experiencing symptoms of depression. The doctor can evaluate symptoms, prescribe treatment, and refer the patient to a specialist if indicated.

Seasonal Affective Disorder

People who live in environments where there is little light sometimes experience seasonal affective disorder (SAD). This type of depression occurs during times of the year when the days are short and there is little exposure to light. In addition to typical treatments for depression, therapy for SAD includes exposure to a very bright light for at least 20 minutes a day.

Bipolar Disorder

Bipolar disorder, previously called manic depression, is characterized by alternating cycles of extreme sadness and happy, energetic highs. During the low periods, people exhibit signs typical of depression. The happy, or manic, periods are characterized by reckless, dangerous behavior, spending huge sums of money, and not sleeping for prolonged periods of time. During episodes of mania, people might participate in risky behaviors that go against their values. They feel powerful, happy, and important. Bipolar disorder requires lifelong treatment. Psychotherapy and medication can be effective in managing symptoms and enabling people to live normal lives.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) often occurs after experiencing or witnessing a traumatic event, such as an act of violence, a natural disaster, a serious accident, or military combat. This condition is characterized by disturbing thoughts, flashbacks, nightmares, difficulty sleeping, anger, sadness, or self-destructive behavior. People with PTSD sometimes become detached from people and avoid situations that remind them of distressing events. Loud, sudden noises can be particularly disturbing to many who have experienced military combat. Many people manage PTSD with support from family, friends, and others who have had similar experiences. When additional help is needed, doctors and counselors can provide talk therapy and medication as needed for each individual.

Schizophrenia

Schizophrenia is a chronic, serious mental disorder that affects a person’s view of reality. Symptoms usually begin during the late teens and twenties and require lifelong treatment.

People suffering with schizophrenia typically have hallucinations, seeing or hearing things that are not present. Thinking and daily functioning are impaired, which can be disabling. Schizophrenia can cause irritability, depression, poor sleep, lack of motivation, withdrawal from loved ones, and poor school performance. Hallucinations can be distracting, making it difficult for those with the disease to comprehend information and make decisions.

Early treatment is important to prevent complications and provide the best long-term outcome. Your physician can provide referrals for appropriate treatment.

Narcissistic Personality Disorder

Self-centeredness is typical of everyone, and is normal throughout childhood and adolescence. When that self-centeredness becomes extreme as a person reaches adulthood, it can be termed narcissistic. People with narcissistic personality disorder have an exaggerated sense of self-importance and need to be admired by others. They are preoccupied with power and success, take advantage of others, and expect compliance with their wishes. They are not empathetic, and are unwilling or unable to recognize the needs of others. Criticism is not received well, and problems are viewed as someone else’s fault.

In relationships, people with narcissistic personality disorder often isolate their significant others from those they find supportive, such as family members and close friends. They are particularly suspicious of people who are critical of them. They are often charming in social settings, but have troubled close relationships.

While the cause of narcissism is unknown, one influence appears to be early experiences of either excessive criticism or excessive pampering. Treatment for narcissism is challenging because the person has difficulty seeing anything wrong with their behavior. Successful treatment centers on long-term psychotherapy focusing on understanding emotions and learning skills to improve relationships.

Eating Disorders

Eating disorders are serious, life-threatening conditions characterized by an obsessive concern about food, body shape, and weight. While the physical symptoms are visible and often are the stimulus for seeking help, the roots of the condition are psychological. Media messages that promote unrealistic standards of beauty and thinness can create unhealthy goals, particularly for adolescents. Those affected have often been teased repeatedly about their bodies, or participate in sports or activities that emphasize low weight. Eating disorders can also be a reaction to trauma such as rape, abuse, or a distressing loss.

Eating disorders can happen to anyone at any time in life, but are most common in teens and young adults, with females affected more often than males. These conditions keep your body from getting proper nutrients, which can damage all body organs.

There are three primary types of eating disorders: anorexia nervosa, bulimia nervosa, and binge eating disorder.

Anorexia Nervosa

People with anorexia nervosa are often perfectionists with high personal standards. The illness is characterized by an extreme restriction of food intake, excessive exercise, and/or overuse of laxatives. While people with anorexia are underweight, they have an intense fear of being overweight and check their weight constantly. Anorexia often causes osteoporosis, brittle and thinning hair, absence of menstrual cycles, infertility, anemia, constipation, and damage to the heart and brain. According to the National Institute of Health, more people die of anorexia nervosa than from any other mental illness. The American Psychological Association states that teens with anorexia are 18 times more likely to die than teens with no eating disorder, but only 13 percent of those affected receive treatment.

Bulimia Nervosa

Bulimia nervosa is a condition in which people eat large amounts of food, then purge themselves of what they've eaten using "compensatory behaviors" such as making themselves vomit, overusing laxatives, or over-exercising. In those who purge by vomiting, the acid from the stomach causes erosion of tissue in the esophagus and mouth. Purging can also cause dehydration and electrolyte imbalance, which can lead to problems with muscle and nerve function. People with bulimia can be underweight, overweight, or of normal weight. This is the primary diagnostic difference between anorexia nervosa and bulimia nervosa, since the criteria for diagnosing anorexia require that the patient be underweight.

Binge Eating Disorder

People with binge eating disorder eat large amounts of food over a short period of time, but they do not purge after bingeing. They continue to eat even if they are uncomfortably full. They might be of normal weight, overweight, or obese. People with this disorder often develop physical problems associated with obesity, such as diabetes and cardiovascular disease.

Treatment of Eating Disorders

Eating disorders negatively impact physical, emotional, and social health. It is often difficult to identify the problem because those afflicted hide their behaviors from family and friends. The earlier treatment begins, the more successful it is likely to be.

Treatment requires a team approach addressing physical, psychological, family, and social issues. The goal is to replace destructive thoughts and behaviors with a focus on healthy living. The focus should not be on weight, but on physical, emotional, mental, social, and spiritual health.

Information and support is available from:

Mental Health Treatment

Family History

A family history of mental illness and childhood trauma make people more likely to develop mental illness. However, a person’s family and past does not dictate the future. Facing the past with support and guidance from mental health professionals can help us grow from our experiences and make good choices in pursuing our goals for the future.

Barriers to Treatment

The most important factor in addressing mental illness is recognizing, diagnosing, and treating the disease early and appropriately. There are some important barriers to treatment for mental illness. The norms of society, peers, and family members influence how willing a person is to seek treatment. Mental illness is often viewed as an embarrassment or failure, causing people to deny symptoms and avoid treatment. Many people do not have insurance to cover the cost of treatment. There are also not enough facilities and programs to treat all those who need help. The result for those experiencing these barriers to treatment is poor management of their illness. Inadequate treatment results in a poor quality of life for those who are ill and their families.

Seeking Help

No one is always physically well. When we are physically ill, we seek help from a doctor. Similarly, when we have psychological challenges, there are psychologists, psychiatrists, and counselors who are trained to help us identify our problems and find ways to address them. It is important to advocate for loved ones and community members to receive the needed treatment.

Physical Exam

A person who shows signs of mental illness should begin an assessment with a physical exam. Many symptoms are caused by chemicals that are out of balance, which can be treated by a doctor. There are also some physical illnesses that can produce symptoms similar to the symptoms of mental illness. The doctor can work with people who specialize in treating mental illness to address all factors that could be causing symptoms.

Resources

For help with issues related to mental illness in yourself or someone close to you, talk with your parents, school counselor, doctor, or another trusted adult.

In Alabama, additional resources are available at:

National resources are available at: