Mental Illness

Its beginning often evident early in life has resulted in persistent vulnerability to experience fear or anxiety when facing every day problems. In these cases ordinary methods of coping, including the “normal” use of ego-defense mechanisms, have proven inadequate and an individual either experiences disabling anxiety or increasingly relies on more defensive reactions. Although these defenses may help ward off acute feelings of threat, they exact a high price in ineffective and self-defeating behavior.

The term neurosis was coined by Englishman William Cullen and first used in his System of Nosology, published in 1769, to refer to disorder sensation of nervous system. It reflected the long-held belief that neurological malfunction must be involved in neurotic behavior. This belief endured until the time of Freud, who postulated that neurosis stems from intrapsychic conflict rather than a physically disordered nervous system. Freud held that inner conflict involving an unbearable wish (approach tendency of the id) and ego’s and superego’s prohibitions against its expression (avoidance tendency).

Anxiety is a feeling of fear and apprehension.


Normal Anxiety
Everyone experiences anxiety. It is characterized as a diffuse, unpleasant, vague sense of apprehension, often accompanied by autonomic symptoms such as headache, perspiration, palpitations, tightness of chest, mild stomach discomfort and restlessness, indicated by inability to sit or stand still for long.

Fear versus Anxiety
Fear is a response to a known external, definite, or nonconflictual threat; anxiety is a response to threat that is unknown, internal, vague or conflictual.



Symptoms of Anxiety
Anxiety has two components: the awareness of physiological sensations (e.g. palpitations and sweating) and the awareness of being nervous or frightened

Panic Disorder
This is episode of acute anxiety. The episode is sudden in onset, lasting for a few minutes and is characterized by very severe anxiety. Classically the symptoms begins unexpectedly or ‘out-of-blue’. Usually there is no apparent precipitating factor.

DSM-IV-TR emphasizes that at least the first attacks must be unexpected. Clinicians should attempt to ascertain any habit or situation that commonly precedes a patient’s panic attacks. Such activities may include the use of caffeine, alcohol, nicotine, or other substances; unusual pattern of sleeping or eating; and specific environmental settings, such as harsh lightening at work.
The attack often begins with in 10-minute period of rapidly increasing symptoms. The major mental symptoms are extreme fear and a sense of impending death and doom. Patients usually cannot name the source of their fear; they may feel confused and have trouble concentrating. The physical signs often include tachycardia, palpitation, dyspnoea, and sweating. The attack generally lasts 20 to 30 minutes and rarely more than an hour. The symptoms can disappear quickly or gradually. Between attacks, patients may have anticipatory anxiety about having another attack.
Somatic concern of death from cardiac or respiratory problem may be major focus of patient’s attention during panic attacks. Patient may believe that the palpitations and chest pain indicate that they are about to die.

Agoraphobia
This is an example of irrational fear of situations. It is characterized by an irrational fear of being in places away from the familiar setting of home. Although it was earlier thought to be a fear of open spaces only, now it includes fear of open spaces, public places, crowded places, and any other place from where there is no easy escape from public view.

In fact the patient is afraid of all the places or situations from where escape may be difficult or help may not be available. As the agoraphobia increases in severity there is gradual restriction in normal day-to-day activities that person become self-imprisoned at home. One or two persons (usually close relations) may be relied upon with whom the patient can leave home. Hence the patient becomes severely dependent on these phobic companions.