1 in 4 people in the UK will experience a mental health issue each year and many will access counselling as a way of getting support for this.

Discuss this statement and demonstrate your understanding of some common mental health problems, as well as considering how counselling can promote positive mental health.

It is said that the Greeks have four different words to describe love. Germans can select from fifteen words to describe anger[1]. Humans are complex beings, created with multiple diverse elements. A problem or difficulty in one element of the self has the potential to have a negative impact on all elements of our being, be it physical, mental, relational or spiritual[2].

According to the World Health Organisation, mental health is defined as a state of wellbeing in which every individual realises their potential, while coping with normal stresses that occur in day-to-day life. The individual can be productive and contribute to their community. Mental health problems affect 1 in 4 people in any given year. This impacts on the psychological, the emotional, the social. How the individual thinks, feels, acts, is affected. If, for any reason, the individual finds they do not have the resilience to overcome difficult circumstances in their life, common mental health problems can develop. Many mental health problems have no set test to diagnose them. Conditions such as Schizophrenia, Bipolar Disorder, Eating Disorders and Personality Disorders will usually be diagnosed during an assessment with a Psychiatrist or a GP will take a view after a consultation. I will briefly take a look at some of these mental health problems below[3].

Clinical depression is best described as a persistent, low mood, lasting for more than two weeks that may or may not be accompanied by the following: lack of interest in doing the things the person did before, reduced energy, disturbed sleep, withdrawal from people, difficulty concentrating, and a change in appetite[4]. Depression can have a clearly identifiable trigger, or the cause can be less clear. If left untreated, some individuals may self-harm or attempt suicide, but not in every case. There is also post-natal depression, which would typically be experienced within the first year of birth, and more rarely post-partum psychosis.

Bipolar disorder, formerly known as manic depression, differs from depression in that the person experiencing it would typically have low mood for a period, followed by a period of elevated mood. These cycles can vary in intensity and duration, and in some circumstances result in a mixed state. It is possible that an individual with bipolar disorder rarely experiences a stable mood but it also possible that the cycles are less frequent and severe and therefore, easier to manage. The elevated mood or ‘mania’ of bipolar disorder and can involve increased energy, delusions, and impulsiveness, making it just as dangerous as low mood due to the decreased concern for risk. The actions taken while cycling through an elevated mood can also cause the sufferer embarrassment once this cycle has ended. The first line preferred treatment for bipolar disorder on the NHS is medication, that can include Lithium, anti-convulsants or anti-psychotics. Many have distressing side effects, with some requiring close monitoring/blood testing (Lithium).

Anxiety is a common mental health problem, and is an overwhelming physiological, cognitive, emotional and behavioural stress response to less threatening situations. The human body is designed to respond a particular way to high stress, threatening situations and in the case of anxiety, this response happens in other situations, too and makes ordinary day-to-day tasks incredibly hard. Symptoms can include fear, dread, inability to concentrate, nervousness, sweating, palpitations, dizziness, shaking, nausea, dry mouth, and impaired sleep. When sudden, overwhelming anxiety is experienced, it can result in panic attacks. When having a panic attack, the boy goes into ‘fight or flight’ mode as a result of the rush of adrenaline. People often feel they are having a heart attack due to the increased and erratic heart rate. A panic attack can also cause shortness of breath, sweating, nausea, trembling, dizziness, and sobbing.

The extreme fear triggered by a situation, place, animal or object, also known as a phobia, can become a very disabling mental health problem requiring long term treatment[5]. With the mental health condition, Obsessive Compulsive Disorder (OCD), the sufferer will typically take an action in an attempt to reduce anxiety. In this instance, obsessive thoughts that cannot be ignored lead to compulsive behaviours, which are typically repeated until the anxiety fades. It can severely impact on day-to-day life. A common example of this would be the process of checking a door is locked a set number of times before the sufferer can move on with their day, and the very real fear that if they fail to complete the task, something bad may happen to a loved one. This can cause problems with both employment and personal relationships.

Eating disorders are a mental health problem that can develop at any stage in life but are often associated with teenage years and young adulthood. They include binge eating disorder (eating a lot in short bursts of time), anorexia nervosa (eating very little resulting in low body weight), bulimia nervosa (eating a lot then trying to purge it from the body). Eating disorders affect both males and females and can be fatal if not addressed[6]. Treatment for eating disorders is very complex and can involve hospital stays, stays in specialist facilities, medication and therapy. Sufferers of eating disorders become adept at hiding the severity of their condition which can cause delays in seeking treatment. In more recent times, a term called orthorexia has been coined to describe people who become fixated on healthy foods. It can be based around “clean” eating but to eat clean in itself is not a mental health problem. It could be rooted in anxiety, particularly health anxiety but can co-occur with anorexia nervosa and other eating disorders. People suffering from eating disorders, and orthorexia, can also become reliant on exercise, to the point where it may become an obsession.

Addictions can cause multiple enduring difficulties in a person’s day-to-day life. Sometimes they are triggered by an underlying mental health problem, and sometimes they are the cause of them. The addiction could be anything from drugs, alcohol, gambling, food, pornography to shopping. The addiction will have a knock-on effect on a person’s thoughts, feeling and behaviours[7]. As relationships, employment and financial stability are affected, it can become more likely to have a dual diagnosis of an addiction and another mental health problem. This can make the addiction more challenging to treat. Many people in recovery from addiction attend programme, either in a rehabilitation setting or in the community, such a Alcoholics Anonymous, that focus on steps. The steps include admitting to the problem, usually in a group setting, and sharing experiences in a safe, boundaried, environment. An often-recommended ideal is to attend 90 meetings in 90 days.

Personality disorders affect the way the person with the condition relate to themselves, and to others. The individual can often feel unhappy or distressed, or become upset with others. Managing and regulating moods and emotions is difficult. This can affect the ability to form and maintain healthy relationships and friendships, and cope with day-to-day stressors and challenges. It can be a very overwhelming condition for someone to live with. Not all personality disorders are the same, and some can elicit a feeling of emptiness and emotional disconnectedness. A common personality disorder is Borderline Personality Disorder, which is categorised by emotional instability, disturbed patterns of thinking or perception, impulsive behaviour, and intense but unstable relationships with others. Most people develop a personality disorder in adolescence, persisting into adulthood[8].

Psychosis may describe an experience of seeing or hearing thing that others may not. There can be differing beliefs. The reality of that person may shift markedly from the people that surround them. The person experiencing psychosis may not understand that is what is happening to them. Schizophrenia is a serious mental health condition that is often thought of when psychosis is described but is not always the cause. Schizophrenia can include hallucinations (visual and/or auditory), delusions, disorganised thinking, lack of motivation and relationship difficulties. It is possible to recover from Schizophrenia but for most people it is a long-term condition that can be managed with support and treatment. It is worth noting that hearing voices, a symptom many associate with Schizophrenia can occur without Schizophrenia being present, and for a number of other reasons, such as severe anxiety. Schizophrenia is typically treated with anti-psychotic medications and cognitive behavioural therapy[9].

Post-traumatic stress disorder (PTSD) is an anxiety disorder that would usually occur when a person witnesses a life-threatening or other traumatic situation, bringing feelings of intense fear, horror and helplessness. The mind suspends normal operation and copes as well a it can in order to survive resulting in repetitive images or feelings, flashbacks and nightmares, and physical sensations such as pain, sweating, shaking, nausea and headaches. PTSD is a very isolating condition and the person experiencing it may also feel irritability and guilt. According to the NHS, any situation that a person finds traumatic can cause PTSD, it can develop immediately after the disturbing event or it can occur years later, with 1 in 3 people who have a traumatic experience affected. It is not yet clear why some people experience PTSD and others do not. Cognitive behavioural therapy and medication are often used to treat the condition[10].

Counselling can promote positive mental health through allowing the client the space and the freedom to look more closely at their experiences, gaining clarity and insight into them. By making sense of what they are experiencing, they can resolve complicated feelings, or find ways to live with them. By recognising unhelpful patterns in the way, they think or act, the client can find their own strategies for change, with the counsellor there working with them in a non-judgemental and empathetic way to enhance their wellbeing. The therapeutic relationship is not about giving advice, because this removes the autonomy[11]. The client is expected to find the solutions and answers within themselves. Freud believed that people should be helped to identify their own conclusions without pressure from a therapist or counsellor[12].

Research has suggested that the school or theoretical model used by the counsellor is less important than the establishing of an appropriately boundaried therapeutic relationship that draws in the core conditions of empathy, congruence and unconditional positive regard. A review by Luborsky et al (1975)[13] concluded that all types of therapy are equally effective. In the case of Smith and Glass (1977)[14], 400 studies were reviewed incorporating many modalities, concluding that all were more effective than no treatment at all.

It may be that the person happens upon the kind of counselling that works for them, but it could also be the case that it does not happen first time. According to Wickelgreen (2012)[15], there is a large body of data that shows mindfulness training helps to reduce stress-related diseases in adults, but this does not work for everyone. Likewise, for cognitive behavioural therapy, which provides strategies and technique that help to reduce uncertainty and to enhance people’s sense of control. Cognitive behavioural therapy does not focus on the why, moving straight to the how. For some people, talking to a trained counsellor about the what and the why I instrumental to what they feel their experience of a talking therapy should be.

It is my view that a one size fits all approach to mental health problems would not be particularly effective and, to take us back to the beginning, just like the Greeks have four different words to describe love, we need to consider that it could take many different therapeutic models in order to promote mentally healthy human beings that all have a differing configuration of self.

[Word Count: 1925]

Bibliography:

Fiona Ballantine Dykes, Traci Postings, Counselling Skills and Studies (2nd Edition), Sage Publications Ltd, 2017

Natasha Devon, A Beginner’s Guide to Being Mental: An A-Z from Anxiety to Zero F**ks Given, Bluebird, 2018

Richard Gross, Psychology: The Science of Mind and Behaviour (Seventh Edition), Hodder Education, 2015

Dawn Holmes with Karen Todd, Freed from Shame — Addressing the stigma of mental illness in the Church, Published by Dawn Holmes, 2018

Margaret Hough, Counselling Skills and Theory (4th Edition), Hodder Education, 2014

Matthew S. Stanford, Grace for the Afflicted — A Clinical and Biblical Perspective on Mental Illness, IVP Books, 2017

[1] Pg 6, “Being Mental, An Introduction” in Natasha Devon, A Beginner’s Guide to Being Mental: An A-Z from Anxiety to Zero F**ks Given, Bluebird, 2018

[2] Pg 8, Matthew S. Stanford, Grace for the Afflicted — A Clinical and Biblical Perspective on Mental Illness, IVP Books, 2017

[3] Source: WHO and Mind [www.who.int and www.mind.org.uk] , as cited in Pg 3–7 “Introduction” of Dawn Holmes with Karen Todd, Freed from Shame — Addressing the stigma of mental illness in the Church, Published by Dawn Holmes, 2018

[4] Pg 15 “Diagnosed mental illnesses” of Dawn Holmes with Karen Todd, Freed from Shame — Addressing the stigma of mental illness in the Church, Published by Dawn Holmes, 2018

[5] Pg 20 “Diagnosed mental illnesses” of Dawn Holmes with Karen Todd, Freed from Shame — Addressing the stigma of mental illness in the Church, Published by Dawn Holmes, 2018

[6] Pg 24 “Diagnosed mental illnesses” of Dawn Holmes with Karen Todd, Freed from Shame — Addressing the stigma of mental illness in the Church, Published by Dawn Holmes, 2018

[7] Pg 25 “Diagnosed mental illnesses” of Dawn Holmes with Karen Todd, Freed from Shame — Addressing the stigma of mental illness in the Church, Published by Dawn Holmes, 2018

[8] Source: NHS Website — https://www.nhs.uk/conditions/personality-disorder/

[9] Source: NHS Website — https://www.nhs.uk/conditions/schizophrenia/

[10] Source: NHS Website — https://www.nhs.uk/conditions/post-traumatic-stress-disorder-ptsd/

[11] May, 1993:117, as cited in Richard Gross, Psychology: The Science of Mind and Behaviour (Seventh Edition), Hodder Education, 2015

[12] Pg 2,18–21, 34, 106, 355, 485, 532, 589–93, 639, 726–30, 779, 787–9, 791, 859, 871–2, as cited in Richard Gross, Psychology: The Science of Mind and Behaviour (Seventh Edition), Hodder Education, 2015

[13] Pg 799, as cited in Richard Gross, Psychology: The Science of Mind and Behaviour (Seventh Edition), Hodder Education, 2015

[14] Pg 799, as cited in Richard Gross, Psychology: The Science of Mind and Behaviour (Seventh Edition), Hodder Education, 2015

[15] Pg 214, 289, 729, as cited in Richard Gross, Psychology: The Science of Mind and Behaviour (Seventh Edition), Hodder Education, 2015

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