Mental Health Nursing and Concepts of Behavioral Psychology

This is the instance scenario of a 22 twelvemonth old miss admitted in psychiatric ward with diagnosings of Bipolar Disorder- Mania and question for marginal personality upset. She has two sisters, who are already married. Currently she lives with her female parent. Before her illness patient was co-operative, ambitious and really much affiliated towards her male parent. Her unwellness started 2 old ages back when her male parent died. She was analyzing pharmaceutical class at that clip. After her male parent ‘s decease she fell in love with a cat. When she expressed her feelings of love in forepart of her female parent, she was beaten by her. When confronted with the cat whom she loved, he uttered that he was non at all interested in her. After erstwhile she started wishing another individual who besides rejected her feelings. This resulted in feelings of hatred and suspicion for her household and others. She had the history of physical force towards her female parent and her female parent had besides been physically and verbally opprobrious towards patient. This is her 3rd admittance in psychiatric ward. She had to stop her pharmaceutical class due to her unwellness, presently making B.A and her tests were missed during this admittance which is besides straitening her. Previously she had been admitted for the intervention of bipolar disorder-Depression, but this clip they were surmising Mania. In psychiatric ward, patient had hapless relationships with nursing staff. She had leery attitude towards every individual. She was unable to swear anyone except her adviser. She frequently gave double sentiments for her female parent. At times she says that she is losing her ma and really following minute she gave really negative remarks about her female parent.

The construct which I have extracted from the above instance scenario is ‘Ego Identity ‘ . I have selected this construct because the events from which my patient has gone through, made her individuality questionable and left her in a baffled province and this was the cause of her psychiatric unwellness. Ego individuality poetries Role Confusion is the fifth phase in Erickson ‘s eight phase life span sequence of developmental undertakings but is the first measure for striplings where their childhood individuality begins to reform in a alone form. Identity verses diffusion are the two extreme poles where striplings seek to happen out some declaration. They are free to research assorted grownup functions finally confronting assorted struggles for individuality accomplishment. Erickson calls this procedure as ‘identity crises ‘ . On the other manus, those persons who does non travel through ‘identity crises ‘ they result in individuality diffusion or stop up in function confusion ( a confused and rolling province in which they lack way in life ) in ulterior phases of life. ( Adams and Berzonsky, 2006, p.207 )

Where Erickson talks about individuality poetries diffusion, Marcia elaborated this construct by presenting her Identity position theoretical account ( 1966-1967 ) . Harmonizing to Marcia, the procedure of self-importance individuality formation is divided into two developmental undertakings: ( a ) geographic expedition of occupational, ideological, political and sex function spheres in big life ; and ( B ) committedness of belief or action in each of these countries. Exploration involves active consideration of options and traveling through ideological issues in the above mentioned spheres e.g. what will I make with my life? Whom will I live with? What will my ideals, values and political beliefs are? Whereas, committedness refers to the attainment of a clear sense of ego definition within one or more spheres. Marcia explains four possible results of this procedure. One is identity accomplishment. Adolescents who have reached this position have passed through the individuality crisis and succeeded in doing personal picks about their beliefs and ends. They are happy with their determinations as those determinations are their ain. On the contrary are striplings, who have taken the way of individuality foreclosure, they have prematurely settled on an individuality that others provided for them. They have become what others ( parents ) want them to be without of all time traveling through an geographic expedition procedure. Other striplings are in moratorium sing the pick of an individuality. They are in the procedure of actively researching assorted function options, but they have non yet committed to any of them. Finally, there are teens sing individuality diffusion. Neither they consider function options in any witting manner nor they have any set occupational waies. Many are dissatisfied with this status and are unable to get down a hunt to “ happen themselves ” . ( Yoder, 2000, p.96 ) . Therefore, we can see individuality accomplishment as extremely stable province and individuality diffusion as least stable province for striplings.

In relation to my patient, we will analyse her individuality diffusion procedure in footings of three phases which resulted in psychiatric unwellness. The first event was ‘detachment from her male parent ‘ . Harmonizing to Zimmermann and Becker-Stoll ( 2002 ) , attachment plays a important function in individuality formation. As attachment theory suggests that there is a biologically based security-regulation system taking an person to seek intimacy to the attachment figure and this fond regard provides sense of security and comfort in times of hurt. This fond regard helps the stripling to larn job work outing and societal competency to cover with life issues. Marcia ( 1989 ) proposed that a secure fond regard would advance the development of the ego-identity position accomplishment because an stripling will experience free to research his/her environment and has secure base to discourse ain experiences and attitudes with in household. ( p.107, 111 ) . Therefore, when the clip came when the attachment figure ( male parent ) was most needed to my patient, he expired. In this instance, her individuality reformation procedure was threatened because her individuality struggles could non be resolved due to loss of her male parent which resulted in feeling of insecurity, loss of support and inability to discourse her internal clangs. Therefore, ended up in psychiatric unwellness.

After the withdrawal from her male parent, another stressor which she faced was misgiving from her female parent. Harmonizing to, Beyers and Goossens ( 2008 ) , parents by supplying heat, security, independent and supportive environment at place facilitate in kid ‘s self-importance development. Where male parent plays a function in individuality development, female parent promotes individuality committedness ( p.167 ) . In the instance of my patient, her geographic expedition procedure remained uncomplete due to her male parent ‘s decease. Even than when she tried to do picks sing her life e.g. career/marriage she faced opposition from her female parent. The non supportive attitude of her female parent was the major factor which promoted her individuality diffusion. During individuality reformation, striplings frequently start combating with their parents which does non intend that they do n’t necessitate their parents, so that is call for aid to ease individualization procedure ( separation from parents to seek their single individuality ) . Harmonizing to, Meeus et Al ( 2005 ) , individualization theory suggests that if parental bonding ( connection ) is weak during this procedure, it leads to damaged individualism and self-importance individuality. ( p.90 )

In add-on to withdrawal and misgiving from parents, rejection from her loved 1s besides diffused my patient ‘s individuality. In this instance scenario there is a really critical thing which needs attending that why she fell in love precisely after the decease of her male parent ( to whom she was really much attached ) ? After a critical literature reappraisal I came across the Freud ‘s construct of Electra composite in Phallic phase which suggests that between age 4-6 misss are attached to their male parents. We can presume that it could be her arrested development on phallic phase because the miss might be seeking her male parent ‘s personality in her fellows. In our restrictive society where personal businesss and dirts are considered as tabu, a miss ‘s unfastened credence of her love in forepart of any cat may act upon them to accept her proposal. But in her instance she faced rejection. This can be due to the fact that those cats would hold an apprehension that the miss ‘s outlooks are pretty different. These rejections futher impeded her geographic expedition and committedness procedure.

In Pakistani context, there are multiple issues faced by striplings due to failure to accomplish equal self-importance individuality. Some of these issues are substance maltreatment, self-destructive and anti-social behaviour etc. In the visible radiation of literature, I would wish to discourse these issues. First is high prevalence of substance maltreatment amongst adolescents in Pakistan. Harmonizing to Matri ( 2003 ) , she conducted a study in the flush category of Karachi which shows that about 90 % of the male childs belonging to the elect category every bit immature as 10 old ages old, admitted that they had experimented with drugs and drink. Similarly, Niaz et Al ( 2005 ) , concluded that in a sample of 300 pupils 106 ( 34 % ) reported drug maltreatment and they had common personality features which include self indulgence, aggressiveness, deficient get bying ability, and antisocial behaviours. Whereas, 61 % of non maltreaters reported to hold good techniques to get by with nerve-racking state of affairss ( p.275 ) .

Another issue which is most common in Pakistan is the exposure to perpetrate self-destruction by immature people. Harmonizing to Khan ( 2007 ) , there are no official statistics on self-destruction from Pakistan but evidences suggest that most suicide occurs in immature people under age 30. The most common ground for trying self-destruction are interpersonal jobs and domestic issues ( p.479 ) .

In add-on to substance maltreatment and suicidality amongst immature people in Pakistan, force and anti societal behaviour are besides really common in our adolescents. We frequently hear in intelligence that most of the self-destruction bombers were immature males. Besides this, late in Boltan Market ‘s firing issue all immature people were involved in raising the fire. In any political run, these striplings are found on streets keeping guns and advancing corruptness in the metropolis. The ground for affecting striplings in such activities is really obvious, that it is easy to encephalon wash those whose individualities are still in the procedure of geographic expedition.

By looking at the above state of affairs we can reason that Pakistani striplings can be called as “ Lost Generation ” with diffused individualities. Our striplings are such weak from inside that whenever face stressors they do n’t hold sufficient get bying mechanisms that could forestall them from following maladaptive patterns. These unhealthy attacks can be deadly and we can expect the hereafter of our state.

Therefore, what a nurse can make to be after and prolong an intercession that could use our immature coevals and do them responsible so that they can construct the hereafter of our state. This is non merely the demand of my patient but if the above circumstance would hold been in favour to decide her individuality struggles so she would non hold ended up in psychiatric unwellness. The overall end is to authorise striplings and do them responsible citizens so that they could lend productively towards our state.


For my patient, I encouraged her to verbalise her concerns. I appreciated her for doing even little attempts. Praised sing her personality to hike herself concept. Utilized curative communicating to set up resonance.

A community wellness nurse can play a critical function for advancing mental wellness of striplings in Pakitan. First of all there is a demand to develop understanding among parents about stripling ‘s psychological issues. This will assist them to understand their behaviour and beef up their relationship. As we already studied that strong parenting and connection consequences in individuality accomplishment. This can be done by affecting NGO ‘s for set uping runs for parent instruction. A CHN besides educating parents to set up friendly and swear edifice attitude towards their striplings besides teach them schemes for bound scene. It is besides of import to learn them about communicating barriers and the ways to get the better of them so that stripling could easy turn towards parents at times of hurt instead so utilizing unhealthy attacks for declaration.


Adding to the function of CHN, authorities and non governmental organisations can work to set up ways to advance striplings socialisation. In our state there are really limited installations for this. Particularly pardah detecting misss in assorted parts of our state are non allowed to come out from their places and portion their feelings and concerns. Similarly, due to cultural believes, our work forces are non allowed to shout in forepart of other. In such fortunes when striplings would non be given opportunity to show out their energies and feelings so the ultimate consequence would be homicide/suicidal behaviour or they will be involved in escapist activities. To heighten socialisation, these organisations should be established peculiarly in distant countries to socialise stray and deprived young person. They can advance activities like encampments, skill development plans, boosting, excursions, all right humanistic disciplines, calling seminars etc. Adolescent reding centers/telephone hotlines can be established which are working efficaciously in neighbouring states and besides by some NGO ‘s in Karachi like Aahung. There is a demand to set up more hotlines for striplings reding.


The best establishments to capture adolescent population are schools and colleges. School based intercessions will play a critical function in this respect. A school wellness nurse can place behavioural jobs among teens in coaction with their instructors, learn anger direction and diversional schemes to them, research their avocations to maintain them busy at the clip of emphasis, act as a pupil counsellor, surrogate athleticss activities and prepare pupils for crises direction, self esteem enhancement, development of societal accomplishments, and healthy determination devising. School wellness nurse can besides play a function in forestalling mental unwellness stigma by educating immature people that it is appropriate to seek psychiatric aid at times one feels helpless and unable to decide their stressors. It is besides of import to authorise school instructors to promote pupils for their even minor attempts for the sweetening of their ego regard.


Ideally, youth mental wellness publicity plans should be integrated in primary wellness attention ( PHC ) but due to miss of authorities support, developing PHC staff for showing of high hazard behaviours among striplings seems unrealistic. Possibly, low cost community wellness plans affecting community wellness workers can be good. Therefore, these staff can enter the activities of NGOs, schools and other societal establishments. Besides this, they can place high hazard striplings ( suicidal, felons, aggression, substance maltreaters etc ) and originate early referrals. Government should advance school wellness nursing in Pakistan with a proper occupation description and benefits so that jobs could be identified at grass root degree.

In the terminal, I would wish to portion my acquisition experiences. Overall, this paper was a fruitful acquisition journey for me. I was able to analyse the spread between bing status of young person in Pakistan and the services available for their mental wellness publicity. I was unable to set up equal resonance with my patient due to limited clip and the nature of her psychiatric unwellness and supply intensive intercessions, which was my restriction. But overall I got opportunity to analyze assortment of literature on the footing of which I can reason that the major beginning of mental wellness publicity amongst striplings are their parents. Before turn toing adolescent issues, it is of import to measure their parental attitudes and demand for instruction. The same is applicable for my patient.

In the words of Brown, Larson and Saraswati ( 2002 ) , “ The state that neglects to supply for its young person will see the costs of that disregard in the old ages that follow. The state that equips and energizes it young person is likely to harvest compounded benefits as these young person enter maturity and take over the reigns of society as parents, workers and leaders ” ( p.165 ) .

In the visible radiation of literature which I have gone through, I would propose following model for publicity of stripling ‘s self-importance individuality. In input stage are the protective factors which facilitate self-importance individuality formation. Nursing considerations are the throughputs which farther enhances individuality accomplishment. The end product would be either identity accomplishment or Moratoriums/Foreclosure/Identity diffusion. In instance of subsequently three, there a feedback for re-input.

Nurse Role

Suicide Prevention ( multi-sectoral attack, low cost community mental wellness plans, reference DSH topics

Parent instruction to beef up parent-adolescent relationship.

Address underlying psychosocial issues

Promote stripling ‘s socialisation.

Career seminars

Generative wellness guidance

School based intercessions on crises direction, self esteem enhancement, development of societal accomplishments, and healthy determination devising )

Protective Factors:


Love/ Warmth


Effective parenting

Sense of security

Allows determination devising





Provide mercantile establishment for free geographic expedition

Career picks

Identity Achievement



Identity Diffusion

Input signal


Adams, G.R. & A ; Berzonsky, M.D. ( 2006 ) . Blackwell Handbook of Adolescence. Identity development during adolescence. Blackwell Publishing, USA. p.207

Beyers, W. , & A ; Goossens, L. ( 2008 ) . Dynamicss of sensed parenting and individuality formation in late adolescence. Journal of Adolescence. 31, 165-184

Brown. , B.B, Larson. , R. , & A ; Saraswati. , T.S. ( 2002 ) . The universe ‘s young person: Adolescents in eight parts of the Earth. Adolescents in planetary position: An docket for societal policy. p. 344

Khan, M.M. ( 2007 ) . Suicide Prevention in Pakistan: an impossible challenge? . Journal of Pakistan Medical Association. ( 56 ) , 478-479

Matri, S. The Young and the Restless by – News Line -December 2003. Retrieved on April 1, 2010, from hypertext transfer protocol: //

Niaz, U. , Siddiqui, S.S. , Hassan, S. , Husain, H. , Ahmed, S. , & A ; Akhter, R. ( 2005 ) . A study of psychosocial correlatives of drug maltreatment in immature grownups aged 16-21, in Karachi: Identifying ‘High Risk ‘ Population to Target Intervention Strategies. Pakistan Journal of Medical Science. ( 21 ) , 3, 271-277

Yoder, A.E. ( 2000 ) . Barriers to ego individuality position formation: a contextual making of Marcia ‘s individuality position paradigm. Journal of Adolescence. 23, 95-106

Zimmermann, P. , & A ; Stoll, F.B. ( 2002 ) . Stability of attachment representations during adolescence: the influence of ego-identity position. Journal of Adolescence. 25, 107-124

( Matri )

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