What is Distress?

Introduction

In medicine, distress is an aversive state in which a person is unable to completely adapt to stressors and their resulting stress and shows maladaptive behaviours.

It can be evident in the presence of various phenomena, such as inappropriate social interaction (e.g., aggression, passivity, or withdrawal).

Distress is the opposite of eustress, a positive stress that motivates people.

Risk Factors

Stress can be created by influences such as work, school, peers or co-workers, family and death. Other influences vary by age.

People under constant distress are more likely to become sick, mentally or physically. There is a clear response association between psychological distress and major causes of mortality across the full range of distress.

Higher education has been linked to a reduction in psychological distress in both men and women, and these effects persist throughout the aging process, not just immediately after receiving education. However, this link does lessen with age. The major mechanism by which higher education plays a role on reducing stress in men is more so related to labour-market resources rather than social resources as in women.

In the clinic, distress is a patient reported outcome that has a huge impact on patient’s quality of life. To assess patient distress, a Hospital Anxiety and Depression Scale (HADS) questionnaire is most commonly used. The score from the HADS questionnaire guides a clinician to recommend lifestyle modifications or further assessment for mental disorders like depression.

Management

People often find ways of dealing with distress, in both negative and positive ways. Examples of positive ways are listening to music, calming exercises, colouring, sports and similar healthy distractions. Negative ways can include but are not limited to use of drugs including alcohol, and expression of anger, which are likely to lead to complicated social interactions, thus causing increased distress.

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Who was Hans Selye?

Introduction

János Hugo Bruno “Hans” Selye CC (Hungarian: Selye János; 26 January 1907 to 16 October 1982) was a pioneering Hungarian-Canadian endocrinologist who conducted important scientific work on the hypothetical non-specific response of an organism to stressors.

Although he did not recognise all of the many aspects of glucocorticoids, Selye was aware of their role in the stress response. Charlotte Gerson considers him the first to demonstrate the existence of biological stress.

Hans Selye in the 1970s
Hans Selye in the 1970s.

Biography

Selye was born in Vienna, Austria-Hungary on 26 January 1907 and grew up in Komárom (the town with Hungarian majority in present day Slovakia was cut by the Treaty of Trianon in 1920). Selye’s father was a doctor of Hungarian ethnicity and his mother was Austrian. He became a Doctor of Medicine and Chemistry in Prague in 1929 and went on to do pioneering work in stress and endocrinology at Johns Hopkins University, McGill University, and the Université de Montréal. He was nominated for the Nobel Prize in Physiology or Medicine for the first time in 1949. Although he received a total of 17 nominations in his career, he never won the prize.

Selye died on 16 October 1982 in Montreal, Quebec, Canada. He often returned to visit Hungary, giving lectures as well as interviews in Hungarian television programs. He conducted a lecture in 1973 at the Hungarian Scientific Academy in Hungarian and observers noted that he had no accent, despite spending many years abroad. His book The Stress of Life appeared in Hungarian as Az Életünk és a stressz in 1964 and became a bestseller. Selye János University, the only Hungarian-language university in Slovakia, was named after him. Selye’s mother was killed by gunfire during Hungary’s anti-Communist revolt of 1956.

Stress Research

Selye’s interest in stress began when he was in medical school; he had observed that patients with various chronic illnesses like tuberculosis and cancer appeared to display a common set of symptoms that he attributed to what is now commonly called stress. After completing his medical degree and a doctorate degree in organic chemistry at the German University of Prague, he received a Rockefeller Foundation fellowship to study at Johns Hopkins in Baltimore and later moved to the Department of Biochemistry at McGill University in Montreal where he studied under the sponsorship of James Bertram Collip. While working with laboratory animals, Selye observed a phenomenon that he thought resembled what he had previously seen in chronic patients. Rats exposed to cold, drugs, or surgical injury exhibited a common pattern of responses to these stressors (A stressor is a chemical or biological agent, environmental condition, external stimulus or an event seen as causing stress to an organism).

Selye initially (circa 1940s) called this the “general adaptation syndrome” (at the time it was also called “Selye’s syndrome”), but he later rebaptised it with the simpler term “stress response”. According to Selye the general adaptation syndrome is triphasic, involving an initial alarm phase followed by a stage of resistance or adaptation and, finally, a stage of exhaustion and death (these phases were established largely on the basis of glandular states). Working with doctoral student Thomas McKeown (1912-1988), Selye published a report that used the word “stress” to describe these responses to adverse events.

His last inspiration for general adaptation syndrome came from an experiment in which he injected mice with extracts of various organs. He at first believed he had discovered a new hormone, but was proved wrong when every irritating substance he injected produced the same symptoms (swelling of the adrenal cortex, atrophy of the thymus, gastric and duodenal ulcers). This, paired with his observation that people with different diseases exhibit similar symptoms, led to his description of the effects of “noxious agents” as he at first called it. He later coined the term “stress”, which has been accepted into the lexicon of most other languages.

Selye argued that stress differs from other physical responses in that it is identical whether the provoking impulse is positive or negative. He called negative stress “distress” and positive stress “eustress“.

The system whereby the body copes with stress, the hypothalamic-pituitary-adrenal axis (HPA axis) system, was also first described by Selye.

Selye has acknowledged the influence of Claude Bernard (who developed the idea of milieu intérieur) and Walter Cannon’s “homeostasis”. Selye conceptualised the physiology of stress as having two components: a set of responses which he called the “general adaptation syndrome”, and the development of a pathological state from ongoing, unrelieved stress.

While the work attracted continued support from advocates of psychosomatic medicine, many in experimental physiology concluded that his concepts were too vague and unmeasurable. During the 1950s, Selye turned away from the laboratory to promote his concept through popular books and lecture tours. He wrote for both non-academic physicians and, in an international bestseller entitled The Stress of Life (1956). From the late 1960s, academic psychologists started to adopt Selye’s concept of stress, and he followed The Stress of Life with two other books for the general public, From Dream to Discovery: On Being a Scientist (1964) and Stress without Distress (1974).

He worked as a professor and director of the Institute of Experimental Medicine and Surgery at the Université de Montréal. In 1975 he created the International Institute of Stress, and in 1979, Selye and Arthur Antille started the Hans Selye Foundation. Later Selye and eight Nobel laureates founded the Canadian Institute of Stress.

In 1968 he was made a Companion of the Order of Canada. In 1976, he was awarded the Loyola Medal by Concordia University.

Controversy and Involvement with the Tobacco Industry

Although it was not widely known at the time, Selye began consulting for the tobacco industry starting in 1958; he had previously sought funding from the industry, but had been denied. Later, New York attorney Edwin Jacob contacted Selye as he prepared a defence against liability actions brought against tobacco companies. The companies wanted Selye’s help in arguing that the recognized correlation between smoking and cancer was not proof of causality. The firm offered to pay Selye $1000 to make a statement supporting this claim. He agreed but refused to testify. Tobacco industry lawyers reported that Selye was willing to incorporate industry advice when writing about smoking and stress. One lawyer advised him to “comment on the unlikelihood of there being a mechanism by which smoking could cause cardiovascular disease” and to emphasize the “stressful” effect that anti-smoking messages had on the US population.

Publicly, Selye never declared his consultancy work for the tobacco industry. In a 1967 letter to “Medical Opinion and Review”, he argued against government over-regulation of science and public health, implying that his views on smoking were objective: “I purposely avoided any mention of government-supported research because, being too largely dependent upon it, I may not be able to view the subject objectively. However, I do not use … cigarettes so let these examples suffice.” In June 1969, Selye (then director of the Institute of Experimental Pathology, University of Montreal) testified before the Canadian House of Commons Health Committee against anti-smoking legislation, opposing advertising restrictions, health warnings, and restrictions on tar and nicotine. For his testimony Selye was funded $50 000 per year for a 3-year “special project”, by William Thomas Hoyt (executive of Council for Tobacco Research) with another $50,000 a year pledged by the Canadian tobacco industry. His comments on smoking were used worldwide, Philip Morris (Tobacco company) used Selye’s statements on the benefits of smoking to argue against the use of health warnings on tobacco products in Sweden. Similarly, in 1977 the Australian Cigarette Manufacturers quoted Selye extensively in their submission to the Australian Senate Standing Committee on Social Welfare.

In 1999, the United States Department of Justice brought an anti-racketeering case against 7 tobacco companies (British American Tobacco, Brown & Williamson, Philip Morris, Liggett, American Tobacco Company, RJ Reynolds, and Lorillard), the Council for Tobacco Research, and the Tobacco Institute. As a result, the industry’s influence on stress research was revealed.

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What is Eustress?

Introduction

Eustress means beneficial stress – either psychological, physical (e.g. exercise), or biochemical/radiological (hormesis).

The term was coined by endocrinologist Hans Selye, consisting of the Greek prefix eu- meaning “good”, and stress, literally meaning “good stress”.

It is the positive cognitive response to stress that is healthy, or gives one a feeling of fulfillment or other positive feelings. Selye created the term as a subgroup of stress to differentiate the wide variety of stressors and manifestations of stress.

Eustress is not defined by the stress or type, but rather how one perceives that stressors (e.g. a negative threat versus a positive challenge). Eustress refers to a positive response one has to a stressor, which can depend on one’s current feelings of control, desirability, location, and timing of the stressor. Potential indicators of eustress may include responding to a stressor with a sense of meaning, hope, or vigour. Eustress has also been positively correlated with life satisfaction and well-being.

Refer to Distress.

Definition

Eustress occurs when the gap between what one has and what one wants is slightly pushed, but not overwhelmed. The goal is not too far out of reach but is still slightly more than one can handle. This fosters challenge and motivation since the goal is in sight. The function of challenge is to motivate a person toward improvement and a goal. Challenge is an opportunity-related emotion that allows people to achieve unmet goals. Eustress is indicated by hope and active engagement. Eustress has a significantly positive correlation with life satisfaction and hope. It is typically assumed that experiencing chronic stress, either in the form of distress or eustress, is negative. However, eustress can instead fuel physiological thriving by positively influencing the underlying biological processes implicated in physical recovery and immunity.

Measurement

Occupational eustress may be measured on subjective levels such as of quality of life or work life, job pressure, psychological coping resources, complaints, overall stress level, and mental health. Other subjective methodological practices have included interviews with focus groups asking about stressors and stress level. In one study participants were asked to remember a past stressful event and then answer questionnaires on coping skills, job well-being, and appraisal of the situation (viewing the stressful event as a challenge or a threat). Common subjective methodologies were incorporated in a holistic stress model created in 2007 to acknowledge the importance of eustress, particularly in the workplace. This model uses hope, positive affect, meaningfulness, and manageability as a measure of eustress, and negative psychological states, negative affect, anxiety, and anger as a measure of distress. Objective measures have also been used and include blood pressure rate, muscle tension, and absenteeism rates. Further physiological research has looked for neuroendocrine changes as a result of eustress and distress. Research has shown that catecholamines change rapidly to pleasurable stimuli. Studies have demonstrated that eustress and distress produce different responses in the neuroendocrine system, particularly dependent on the amount of personal control one feels over a stressor.

Compared with Distress

Distress is the most commonly referred to type of stress, having negative implications, whereas eustress is usually related to desirable events in a person’s life. Selye first differentiated the two in an article he wrote in 1975. In this article Selye argued that persistent stress that is not resolved through coping or adaptation should be known as distress, and may lead to anxiety, withdrawal, and depressive behaviour. In contrast, if stress enhances one’s functioning it may be considered eustress. Both can be equally taxing on the body, and are cumulative in nature, depending on a person’s way of adapting to the stressor that caused it. The body itself cannot physically discern between distress or eustress. Differentiation between the two is dependent on one’s perception of the stress, but it is believed that the same stressor may cause both eustress and distress. One context that this may occur in is societal trauma (e.g. the black death, World War II) which may cause great distress, but also eustress in the form of hardiness, coping, and fostering a sense of community. The Yerkes–Dodson model demonstrates the optimum balance of stress with a bell curve (shown in the image in the top right).[17] This model is supported by research demonstrating emotional-coping and behavioural-coping strategies are related to changes in perceived stress level on the Yerkes-Dodson Curve. However, the Yerkes-Dodson Curve has become increasingly questioned. A review of the psychological literature pertaining work performance, found that less than 5% of papers supported the inverted U-shaped curve whereas nearly 50% found a “negative linear” relationship (any level of stress inhibits performance).

Occupational

Much of the research on eustress has focused on its presence in the workplace. In the workplace, stress can often be interpreted as a challenge, which generally denotes positive eustress, or as a hindrance, which refers to distress that interferes with one’s ability to accomplish a job or task.

Research has focused on increasing eustress in the workplace, in an effort to promote positive reactions to an inevitably stressful environment. Companies are interested in learning more about eustress and its positive effects to increase productivity. Eustress creates a better environment for employees, which makes them perform better and cost less. Occupational stress costs the United States somewhere in between 200 and 300 billion dollars per year. If this were eustress instead of distress, these companies would retain this money and the US economy could improve as well. Stress has also been linked to the six leading causes of death: “disease, accidents, cancer, liver disease, lung ailments, suicide.” If workers get sick and/or die, there is obviously a cost to the company in sick time and training new employees. It is better to have productive, happy employees. Eustress is necessary for achievement. Eustress is related to well-being and positive attitudes and thus increases work performance.

Techniques such as Stress Management Interventions (SMI) have been employed to increase occupational eustress. SMI’s often incorporate exercise, meditation, and relaxation techniques to decrease distress and increase positive perceptions of stress in the workplace. Rather than decrease stress in the workplace, SMI techniques attempt to increase eustress with positive reactions to stressful stimuli.

Self-Efficacy

Eustress is primarily based on perceptions. It is how you perceive your given situation and how you perceive your given task. It is not what is actually happening, but a person’s perception of what is happening. Eustress is thus related to self-efficacy. Self-efficacy is one’s judgement of how they can carry out a required task, action or role. Some contributing factors are a person’s beliefs about the effectiveness about their options for courses of action and their ability to perform those actions. If a person has low self-efficacy, they will see the demand as more distressful than eustressful because the perceived level of what the person has is lower. When a person has high self-efficacy, they can set goals higher and be motivated to achieve them. The goal then is to increase self-efficacy and skill in order to enable people to increase eustress.

Flow

When an individual appraises a situation as stressful, they add the label for distress or eustress to the issue at hand. If a situation induces eustress, the person may feel motivated and can experience flow. Positive psychologist, Mihaly Csikszentmihalyi, created this concept which is described as the moments when one is completely absorbed into an enjoyable activity with no awareness of surroundings. Flow is an extremely productive state in which an individual experiences their prime performance. The core elements are absorption, enjoyment and intrinsic motivation.

Flow is the “ultimate eustress experience – the epitome of eustress”. Hargrove, Nelson and Cooper described eustress as being focused on a challenge, fully present and exhilarated, which almost exactly mirrors the definition of flow. Flow is considered a peak experience or “the single most joyous, happiest, most blissful moment of your life.”

Factors

There are several factors that may increase or decrease one’s chances of experiencing eustress and, through eustress, experiencing flow:

  • Stress is also influenced by hereditary predispositions and expectations of society. Thus, a person could already be at a certain advantage or disadvantage toward experiencing eustress.
  • If a person enjoys experiencing new things and believes they have importance in the world, they are more likely to experience flow.
  • Flow is negatively related to self-directedness, or an extreme sense of autonomy.
  • Persistence is positively related to flow and closely related to intrinsic motivation.
  • People with an internal locus of control, have an increased chance of flow because they believe they can increase their skill level to match the challenge.
  • Perfectionism, however, is negatively related to flow. A person downplays their skill levels therefore making the gap too big, and they perceive the challenge to be too large to experience flow. On the opposite end of perfectionism, however, there are increased chances of flow.
  • Active procrastination is positively related to flow. By actively delaying work, the person increases the challenge. Then once the challenge is matched with the person’s high skill levels, the person can experience flow. Those who passively procrastinate or do not procrastinate do not have these same experiences. It is only with the purposeful procrastination that a person is able to increase the challenge.
  • Mindset is a significant factor in determining distress versus eustress. Optimistic people and those with high self-esteem contribute to eustress experiences. The positive mindset increases the chances of eustress and a positive response to stressors. Currently, the predominant mindset toward stress is that stress is debilitating. However, mindsets toward stress can be changed.

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What is Ataraxia?

Introduction

Ataraxia (Greek: ἀταραξία, from alpha privative (“a-“, negation) and tarachē “disturbance, trouble”; hence, “unperturbedness”, generally translated as “imperturbability”, “equanimity”, or “tranquility”) is a Greek term first used in Ancient Greek philosophy by Pyrrho and subsequently Epicurus and the Stoics for a lucid state of robust equanimity characterised by ongoing freedom from distress and worry.

In non-philosophical usage, the term was used to describe the ideal mental state for soldiers entering battle.

Achieving ataraxia is a common goal for Pyrrhonism, Epicureanism, and Stoicism, but the role and value of ataraxia within each philosophy varies in accordance with their philosophical theories. The mental disturbances that prevent one from achieving ataraxia vary among the philosophies, and each philosophy has a different understanding as to how to achieve ataraxia.

Pyrrhonism

Ataraxia is the central aim of Pyrrhonist practice. Pyrrhonists view ataraxia as necessary for bringing about eudaimonia (happiness) for a person, representing life’s ultimate purpose. The Pyrrhonist method for achieving ataraxia is through achieving epoché (i.e. suspension of judgment) regarding all matters of dogma (i.e. non-evident belief). The Pyrrhonist philosopher Sextus Empiricus summarized Pyrrhonism as “a disposition to oppose phenomena and noumena to one another in any way whatever, with the result that, owing to the equipollence among the things and statements thus opposed, we are brought first to epoché and then to ataraxia… Epoché is a state of the intellect on account of which we neither deny nor affirm anything. Ataraxia is an untroubled and tranquil condition of the soul.”

Sextus gave this detailed account of ataraxia:

We always say that as regards belief (i.e., dogma) the Pyrrhonist’s goal is ataraxia, and that as regards things that are unavoidable it is having moderate pathē. For when the Pyrrhonist set out to philosophize with the aim of assessing his phantasiai – that is, of determining which are true and which are false so as to achieve ataraxia – he landed in a controversy between positions of equal strength, and, being unable to resolve it, he suspended judgment. But while he was thus suspending judgment there followed by chance the sought-after ataraxia as regards belief. For the person who believes that something is by nature good or bad is constantly upset; when he does not possess the things that seem to be good, he thinks he is being tormented by things that are by nature bad, and he chases after the things he supposes to be good; then, when he gets these, he falls into still more torments because of irrational and immoderate exultation, and, fearing any change, he does absolutely everything in order not to lose the things that seem to him good. But the person who takes no position as to what is by nature good or bad neither avoids nor pursues intensely. As a result, he achieves ataraxia. Indeed, what happened to the Pyrrhonist is just like what is told of Apelles the painter. For it is said that once upon a time, when he was painting a horse and wished to depict the horse’s froth, he failed so completely that he gave up and threw his sponge at the picture – the sponge on which he used to wipe the paints from his brush – and that in striking the picture the sponge produced the desired effect. So, too, the Pyrrhonists were hoping to achieve ataraxia by resolving the anomaly of phenomena and noumena, and, being unable to do this, they suspended judgment. But then, by chance as it were, when they were suspending judgment the ataraxia followed, as a shadow follows the body. We do not suppose, of course, that the Pyrrhonist is wholly untroubled, but we do say that he is troubled only by things unavoidable. For we agree that sometimes he is cold and thirsty and has various feelings like those. But even in such cases, whereas ordinary people are affected by two circumstances – namely by the pathē themselves and not less by its seeming that these conditions are by nature bad – the Pyrrhonist, by eliminating the additional belief that all these things are naturally bad, gets off more moderately here as well. Because of this we say that as regards belief the Pyrrhonist’s goal is ataraxia, but in regard to things unavoidable it is having moderate pathē.

Epicureanism

Ataraxia is a key component of the Epicurean conception of the highest good. Epicureans value ataraxia highly because of how they understand pleasure. Epicureans argue that pleasure is the highest good. They break pleasure down into two categories: the physical and the mental. They consider mental, not physical, pleasures to be the greatest sort of pleasure because physical pleasures exist only in the present; whereas mental pleasures exist in the past, the present, and the future.

Epicureans further separate pleasure into what they call kinetic and katastematic pleasures. Kinetic pleasures are those pleasures which come about through action or change. Such an action could be satisfying a desire or removing a pain, as that very sort of act is pleasurable in itself. Actions that feel good, even if not done to satisfy a desire or remove a pain, such as eating good-tasting food, also fall under the category of kinetic pleasures. Mental pleasures could also be kinetic in nature. Epicurus is said to have described joy as an example of a kinetic mental pleasure.

Katastematic pleasure is pleasure which comes about from the absence of pain or distress. This sort of pleasure can be physical or mental. Physical katastematic pleasure comes in freedom from physical disturbances, such as simply being in the state of not being thirsty. Comparatively, mental katastematic pleasure comes in freedom from mental disturbance. Those who achieved freedom from physical disturbance were said to be in a state of aponia, while those who achieved freedom from mental disturbances were said to be in a state of ataraxia.

Katastematic pleasures were regarded to be better than kinetic pleasures by Epicurus, believing that one could feel no more pleasure than the removal of all pain. Indeed, he is reported to have said:

The magnitude of pleasure reaches its limit in the removal of all pain. When pleasure is present, so long as it is uninterrupted, there is no pain either of body or of mind or of both together.

Being both a mental and katastematic pleasure, ataraxia has a supreme importance in Epicurean ethics and is key to a person’s happiness. In the Epicurean view, a person experiences the highest form of happiness should they ever be both in a state of aponia and ataraxia at the time.

Stoicism

Unlike in Pyrrhonism and Epicureanism, in Stoicism ataraxia is not the ultimate goal of life. Instead, a life of virtue according to nature is the goal of life. However, according to the Stoics, living virtuously in accordance with nature would lead to ataraxia as a byproduct.

An important distinction to be made is the difference in Stoicism between ataraxia and the Stoic idea of apatheia. While closely related to ataraxia, the state of apatheia was the absence of unhealthy passions; a state attained by the ideal Stoic sage. This is not the same as ataraxia. Apatheia describes freedom from the disturbance of emotions, not tranquillity of the mind. However, apatheia is integral for a Stoic sage to reach the stage of ataraxia. Since the Stoic sage does not care about matters outside of himself and is not susceptible to emotion because of his state of apatheia, the Stoic sage would be unable to be disturbed by anything at all, meaning that he was in a stage of mental tranquillity and thus was in the state of ataraxia.

Buddhism

Buddhism, a religion based on the teachings of Siddharta Gautama in the sixth century BC, affirms that the main cause of pain due to anguish is desire (any desire, which, because it is always associated with fear and hope, makes the heart anguish). So the flight or redemption of pain lies in the extinction or nakedness of all desire or disturbing affection, as especially the desire to live.

What is Neurosis?

Introduction

Neurosis is a class of functional mental disorders involving chronic distress, but neither delusions nor hallucinations. The term is no longer used by the professional psychiatric community in the United States, having been eliminated from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980 with the publication of DSM III. However, it is still used in the ICD-10 Chapter V F40-48.

Neurosis should not be mistaken for psychosis, which refers to a loss of touch with reality. Nor should it be mistaken for neuroticism, a fundamental personality trait proposed in the Big Five personality traits theory.

Etymology

The term is derived from the Greek word neuron (νεῦρον, ‘nerve’) and the suffix -osis (-ωσις, ‘diseased’ or ‘abnormal condition’).

The term neurosis was coined by Scottish doctor William Cullen in 1769 to refer to “disorders of sense and motion” caused by a “general affection of the nervous system.” Cullen used the term to describe various nervous disorders and symptoms that could not be explained physiologically. Physical features, however, were almost inevitably present, and physical diagnostic tests, such as exaggerated knee-jerks, loss of the gag reflex and dermatographia, were used into the 20th century. The meaning of the term was redefined by Carl Jung and Sigmund Freud over the early and middle 20th century, and has continued to be used in psychology and philosophy.

The DSM eliminated the neurosis category in 1980, because of a decision by its editors to provide descriptions of behaviour rather than descriptions of hidden psychological mechanisms. This change has been controversial. Likewise, according to the American Heritage Medical Dictionary, neurosis is “no longer used in psychiatric diagnosis.”

Symptoms and Causes

Neurosis may be defined simply as a “poor ability to adapt to one’s environment, an inability to change one’s life patterns, and the inability to develop a richer, more complex, more satisfying personality.” There are many different neuroses, including:

According to C. George Boeree, professor emeritus at Shippensburg University, the symptoms of neurosis may involve:

… anxiety, sadness or depression, anger, irritability, mental confusion, low sense of self-worth, etc., behavioral symptoms such as phobic avoidance, vigilance, impulsive and compulsive acts, lethargy, etc., cognitive problems such as unpleasant or disturbing thoughts, repetition of thoughts and obsession, habitual fantasizing, negativity and cynicism, etc. Interpersonally, neurosis involves dependency, aggressiveness, perfectionism, schizoid isolation, socio-culturally inappropriate behaviors, etc.

Jungian Theory

Carl Jung found his approach particularly effective for patients who are well adjusted by social standards but are troubled by existential questions. Jung claims to have “frequently seen people become neurotic when they content themselves with inadequate or wrong answers to the questions of life”. Accordingly, the majority of his patients “consisted not of believers but of those who had lost their faith”. Contemporary man, according to Jung,

…is blind to the fact that, with all his rationality and efficiency, he is possessed by ‘powers’ that are beyond his control. His gods and demons have not disappeared at all; they have merely got new names. They keep him on the run with restlessness, vague apprehensions, psychological complications, an insatiable need for pills, alcohol, tobacco, food — and, above all, a large array of neuroses.

Jung found that the unconscious finds expression primarily through an individual’s inferior psychological function, whether it is thinking, feeling, sensation, or intuition. The characteristic effects of a neurosis on the dominant and inferior functions are discussed in his Psychological Types. Jung also found collective neuroses in politics: “Our world is, so to speak, dissociated like a neurotic.”

Psychoanalytic Theory

According to psychoanalytic theory, neuroses may be rooted in ego defence mechanisms, though the two concepts are not synonymous. Defence mechanisms are a normal way of developing and maintaining a consistent sense of self (i.e. an ego). However, only those thoughts and behaviours that produce difficulties in one’s life should be called neuroses.

A neurotic person experiences emotional distress and unconscious conflict, which are manifested in various physical or mental illnesses; the definitive symptom being anxiety. Neurotic tendencies are common and may manifest themselves as acute or chronic anxiety, depression, an obsessive compulsive disorder, a phobia, or a personality disorder.

Horney’s Theory

In her final book, Neurosis and Human Growth, Karen Horney lays out a complete theory of the origin and dynamics of neurosis. In her theory, neurosis is a distorted way of looking at the world and at oneself, which is determined by compulsive needs rather than by a genuine interest in the world as it is. Horney proposes that neurosis is transmitted to a child from his or her early environment and that there are many ways in which this can occur:

When summarized, they all boil down to the fact that the people in the environment are too wrapped up in their own neuroses to be able to love the child, or even to conceive of him as the particular individual he is; their attitudes toward him are determined by their own neurotic needs and responses.

The child’s initial reality is then distorted by his or her parents’ needs and pretences. Growing up with neurotic caretakers, the child quickly becomes insecure and develops basic anxiety. To deal with this anxiety, the child’s imagination creates an idealised self-image:

Each person builds up his personal idealized image from the materials of his own special experiences, his earlier fantasies, his particular needs, and also his given faculties. If it were not for the personal character of the image, he would not attain a feeling of identity and unity. He idealizes, to begin with, his particular “solution” of his basic conflict: compliance becomes goodness, love, saintliness; aggressiveness becomes strength, leadership, heroism, omnipotence; aloofness becomes wisdom, self-sufficiency, independence. What—according to his particular solution—appear as shortcomings or flaws are always dimmed out or retouched.

Once he identifies himself with his idealised image, a number of effects follow. He will make claims on others and on life based on the prestige he feels entitled to because of his idealised self-image. He will impose a rigorous set of standards upon himself in order to try to measure up to that image. He will cultivate pride, and with that will come the vulnerabilities associated with pride that lacks any foundation. Finally, he will despise himself for all his limitations. Vicious circles will operate to strengthen all of these effects.

Eventually, as he grows to adulthood, a particular “solution” to all the inner conflicts and vulnerabilities will solidify. He will be either:

  • Expansive, displaying symptoms of narcissism, perfectionism, or vindictiveness;
  • Self-effacing and compulsively compliant, displaying symptoms of neediness or codependence; or
  • Resigned, displaying schizoid tendencies.

In Horney’s view, mild anxiety disorders and full-blown personality disorders all fall under her basic scheme of neurosis as variations in the degree of severity and in the individual dynamics. The opposite of neurosis is a condition Horney calls self-realisation, a state of being in which the person responds to the world with the full depth of his or her spontaneous feelings, rather than with anxiety-driven compulsion. Thus the person grows to actualize his or her inborn potentialities. Horney compares this process to an acorn that grows and becomes a tree: the acorn has had the potential for a tree inside it all along.

Coronavirus: Healthcare Workers & their Mental Health

Research Paper Title

Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019.

Background

Health care workers exposed to coronavirus disease 2019 (COVID-19) could be psychologically stressed.

Objective: To assess the magnitude of mental health outcomes and associated factors among health care workers treating patients exposed to COVID-19 in China.

Methods

This cross-sectional, survey-based, region-stratified study collected demographic data and mental health measurements from 1257 health care workers in 34 hospitals from January 29, 2020, to February 3, 2020, in China. Health care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 were eligible.

The degree of symptoms of depression, anxiety, insomnia, and distress was assessed by the Chinese versions of the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder scale, the 7-item Insomnia Severity Index, and the 22-item Impact of Event Scale-Revised, respectively. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes.

Results

A total of 1,257 of 1,830 contacted individuals completed the survey, with a participation rate of 68.7%. A total of 813 (64.7%) were aged 26 to 40 years, and 964 (76.7%) were women. Of all participants, 764 (60.8%) were nurses, and 493 (39.2%) were physicians; 760 (60.5%) worked in hospitals in Wuhan, and 522 (41.5%) were frontline health care workers.

A considerable proportion of participants reported symptoms of depression (634 [50.4%]), anxiety (560 [44.6%]), insomnia (427 [34.0%]), and distress (899 [71.5%]).

Nurses, women, frontline health care workers, and those working in Wuhan, China, reported more severe degrees of all measurements of mental health symptoms than other health care workers (eg, median [IQR] Patient Health Questionnaire scores among physicians vs nurses: 4.0 [1.0-7.0] vs 5.0 [2.0-8.0]; P = .007; median [interquartile range {IQR}] Generalized Anxiety Disorder scale scores among men vs women: 2.0 [0-6.0] vs 4.0 [1.0-7.0]; P < .001; median [IQR] Insomnia Severity Index scores among frontline vs second-line workers: 6.0 [2.0-11.0] vs 4.0 [1.0-8.0]; P < .001; median [IQR] Impact of Event Scale-Revised scores among those in Wuhan vs those in Hubei outside Wuhan and those outside Hubei: 21.0 [8.5-34.5] vs 18.0 [6.0-28.0] in Hubei outside Wuhan and 15.0 [4.0-26.0] outside Hubei; P < .001).

Multivariable logistic regression analysis showed participants from outside Hubei province were associated with lower risk of experiencing symptoms of distress compared with those in Wuhan (odds ratio [OR], 0.62; 95% CI, 0.43-0.88; P = .008).

Frontline health care workers engaged in direct diagnosis, treatment, and care of patients with COVID-19 were associated with a higher risk of symptoms of depression (OR, 1.52; 95% CI, 1.11-2.09; P = .01), anxiety (OR, 1.57; 95% CI, 1.22-2.02; P < .001), insomnia (OR, 2.97; 95% CI, 1.92-4.60; P < .001), and distress (OR, 1.60; 95% CI, 1.25-2.04; P < .001).

Conclusions

In this survey of heath care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 in Wuhan and other regions in China, participants reported experiencing psychological burden, especially nurses, women, those in Wuhan, and frontline health care workers directly engaged in the diagnosis, treatment, and care for patients with COVID-19.

Reference

Jianbo, Lai., Simeng, Ma., Ying, Wang., Zhongxiang, Cai., Jianbo, Hu., Ning, Wei., Jiang, Wu., Hui, Du., Tingting, Chen., Ruiting, Li., Huawei, Tan., Lijun, Kang., Lihua, Yao., Manli, Huang., Huafen, Wang., Gaohua, Wang., Zhongchun, Liu. & Shaohua, Hu. (2020) Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Network Open. 3(3):e203976. doi: 10.1001/jamanetworkopen.2020.3976.

How to Listen

To listen and communicate non-judgmentally is one of the five basic steps in mental health first aid. It is a term you will find used throughout the website.

This website cannot train you to be a counsellor or a therapist, but you can develop some basic listening skills that will be useful in many situations.

Are You Really Listening?

Most of the time we do not really listen to what others are saying. This is not because we are being rude or uncaring. Usually when we are in conversation with someone else, we find ourselves going off on other trains of thought because something that has been said has reminded us of other things. Other times we are thinking about our reply and only giving the speaker part of our attention.

When we are listening to the other person, part of our mind is thinking about our own reactions to what they are saying. This is a normal response, and in everyday situations it usually works well.

In a situation where a person is distressed or having a mental health crisis, it is very important to pay more attention and put non-judgemental listening skills into practice.

Being An Effective Listener

While you are paying attention to the feelings of the other person, it is important to be aware of your own feelings and thoughts.

Attending to a person who may be distressed may bring up a number of responses, such as fear, irritation, sadness, or a sense of being overwhelmed.

These are normal responses to a difficult situation. However, it is important that the listener continues to be open to listening respectfully, and attempts to avoid reacting to what is being shared.

That means focusing on the distressed person, and understanding how it feels to be in their place.

This may be difficult, depending on the relationship between the listener and the distressed person. Sometimes it is especially difficult if the person is a close friend or relative. If you feel that your relationship is preventing you from being an effective listener, it may be best to get the help of someone else who is not so close to the person. However, in a crisis you may not have this option.

Remember that during a crisis, you are offering the distressed person a place of safety based on respect. acceptance, and understanding – and you may be saving their life.

After the conversation, you may feel unsettled, shocked, confused, or angry. You may wish to share this with someone, to acknowledge your own experience. In doing so, you should maintain the person’s privacy by withholding their name or any details that could identify them. This is not the same as accessing appropriate assistance for the person if they need it (e.g. if they are suicidal) when you will need to reveal their identity.

Always remember that you are human, and that feeling a mixture of emotions is a normal human response.

Is There a Link between News Coverage & Trauma Symptoms?

When something terrible happens in the world, it’s not uncommon to scroll through social media or flip through television channels in search of news coverage. But such media exposure may fuel post-traumatic stress symptoms for years afterwards – and could also drive someone to consume further distressing media.

With high-consequence events where we do not know why they happened, there is a fundamental drive to want to consume information until you get your head around it. Research suggests it may be a function of threat avoidance or wanting to return to some kind of rational understanding of the world around us.

Roxane Silver at the University of California, Irvine, and her colleagues surveyed a representative sample of more than 4400 US residents in the days after the 2013 Boston Marathon bombing. Each person was also asked how many hours of related media coverage they consumed in three follow-up periods:

  • Six months after the bombing;
  • On its second anniversary; and
  • Five days after the 2016 mass shooting in the Pulse nightclub in Florida.

On average, the people surveyed consumed about 6 hours of media a day about the Boston bombing immediately after the event and a little more than 3 hours per day of media about the Pulse shooting.

Those who sought out more media about the bombing – whether or not they had a history of mental health conditions – were more likely to have trauma-related stress symptoms, such as upsetting thoughts, flashbacks and emotional distress, six months later (Thompson et al., 2019).

Two years after the bombing, such people were also more likely to worry about other events of mass violence occurring in the future, and consumed more coverage of the subsequent Pulse shooting.

References

Thompson, R.R., Jones, N.M., Holman, E.A. & Silver, R.C. (2019) Media Exposure to Mass Violence Events can Fuel a Cycle of Distress. Science Advances. 5(4), eaav3502. DOI: 10.1126/sciadv.aav3502.

Whyte, C. (2019) New Coverage Link to Trauma Symptoms. New Scientist. 27 April 2019, pp.16.

What is Mental Health First Aid?

Mental health first aid (MHFA), like any other type of first aid, is the help given to a person before appropriate professional help or treatment can be obtained.

First aid of any type has the following aims:

  • To preserve life;
  • To prevent deterioration of any injury or illness;
  • To promote healing; and
  • To provide comfort to the person who is ill, injured, or distressed.

MHFA is the help given to someone experiencing a mental health problem before other help can be accessed.

The aims of MHFA are:

  • To preserve life;
  • To provide help to prevent the worsening of an existing condition;
  • To promote the recovery of good mental health;
  • To provide comfort to a person experiencing distress; and
  • To promote understanding of mental health issues.

MHFA does not teach people to be therapists. However, it does train people in:

  • How to ask about suicide;
  • How to recognise the signs of mental health problems or distress;
  • How to provide initial help; and
  • How to guide a person towards appropriate professional help.