MENTAL HEALTH

It is unfortunate that for many years the mental hygiene movement and public health activities have been quite independent. Now, however, as mental hygiene moves from its traditional concern for the overtly mentally ill to the promotion of positive mental health in the general population, and as public health enters the field of the non communicable diseases, there is a growing interest in applying the time-tested techniques of public health to the problems of mental illness.

The extent of the mental health problem is very great indeed. Half of all the hospital beds in the United States are in mental hospitals; over a million persons each year receive treatment for mental and emotional problems in psychiatric clinics or the offices of private physicians. Suicide and cirrhosis of the liver vie with each other for a place on the list of the ten most common causes of death. If one adds the psychoneuroses and the psychosomatic disorders, the overall problem is staggering.

One should not overlook the emotional problems inherent in chronic disease. The psychological reaction to prolonged illness is a compound of the patient's pre`orbid personality, the precipitating stress, the nature of the disease, and the family's reaction to it. Patients may respond to chronic illness (a) by continuing an existing personality disorder, as in overtly hostile or dependent persons; (b) by reacting acutely with depression or anxiety; or (c) by developing an overt psychosis.

It is not abnormal for a person to react psychologically to an illness, especially if it is disabling or protracted. Sickness is bound to create appre­hension and even fear of death, of disability, of pain, or of the uncertain future. However, an overreaction, with excessive depression, dependency, or hostility, is abnormal. It also is abnormal for the chronic disease patient to react with rationalized denial of his problems and inappropriate affec­tation.

It is of interest that certain chronic diseases tend to occur in persons with characteristic psychological traits. The dependency and repressed hostility of those with rheumatoid arthritis and the aggressive hostility of those with hypertension or peptic ulcer are examples.