There has been a lot of school of thoughts when it comes to defining what mental health is. Scott (1958) defined mental health as schizophrenia, suicide, being unhappy, a disruptive child and embracing an insufferable environment (p.29). However, the World health organization (2004) defines mental health as a state where an individual can identify his or her potentials, withstand common stresses in life, be progenitive and effective in their work and be instrumental in their community or environment (p.12). This definition by the WHO removes all forms of diagnosis and labels and provides a different perspective on mental health other than a disease or illness. Mental health has become a trending topic particularly since the COVID -19 pandemic which tested the mental health of people worldwide. The restrictions and social isolation due to the pandemic escalated mental health concerns. While mental health is debated openly in the western world in contrast, it remains a contentious topic in Africa especially Ghana. It is important to note that it is mostly related to disease and illness. As a result, it is almost a taboo to mention having a mental health crisis as it is likely to create stigmatization for an individual and their family. This reflection will dive into four articles that focus on experimental analysis of individual differences and personality, behavioural treatment given to people with acquired brain injury who are compulsive gamblers, eating disorder symptoms liked to Pavlovian disgust and employing modified bedtime pass intervention to aim at co-sleeping in children with anxiety disorders.
According to Harzem (1984), individuals are moulded according to their environment (p.385). This statement is relatable as growing up in Ghana has shaped my life morally. In Ghana, it is important to greet those older than you when you meet them. It does not matter if they met you or the other way round. This helps children to acknowledge and be more respectful. Also, it is disrespectful to give an item to anyone with the left hand because the left hand is seen as unclean as it is the hand used to wipe after using the bathroom. Another notable example is that as a young woman you need to cover up and it is frowned upon if you wear clothing that expose your breast, stomach, waist and inner thighs. This act is considered indecent. This is imperative as a young woman in Twi is” aketesia” which translates as a young woman is covered up. Furthermore, young boys who pull their pants down below their waistline is also frowned upon as it is expected for pants to be on the waist with a belt. Another vital point raised in the article was that past experiences can influence behaviour (p.388). Past experiences direct our approach to the same experience in the future. If you went for a walk in your neighbourhood on a cloudy day without an umbrella and you came home wet because it rained, you are likely to pick an umbrella whenever it is cloudy. This will serve as reinforcement as you may want to avoid getting wet again.
Guercio, Johnson and Dixon (2012) explained how aversive interventions have been used in treatment of pathological gambling (p.485). I was wondering how electric shock could be used to stop someone when they think about gambling as thoughts cannot be seen or read. In other words, unless an individual tells you what they are thinking, you cannot determine their thoughts. It feels it was a cruel way to deal with pathological gambling and I doubt it was even effective. Similarly, I am horrified the intervention which requires the use of medication to induce vomiting when these chronic gamblers engage in gambling. Reflecting on this, apart from vomiting, this medication has other side effects such as hallucinations, confusion, anxiety, drowsiness etc. Imagine someone that has already been diagnosed with schizophrenia and has a gambling issue and they are given this medication, this would escalate behaviour in a negative way. The article highlighted chronic gambling is an impulse control affliction. It is even worse in people with brain injury who are at high risk of engaging in impulsive behaviours. In my opinion, anyone can graduate to be a chronic gambler. As humans sometimes we like to challenge ourselves on how far we can go and take risks. Back in university, a friend became a chronic gambler by the time we graduated. It started from sports betting where predicting the winning team gave some form of incentive then it graduated to board games. I remember prompting him to stop when he started using his school fees and accommodation fees to bet but he was too invested and had been winning huge incentives. This was his motivation to press on. By the time of graduation, he ended up selling his new 2018 Honda CRV graduation gift from parents to fund his betting scheme and lost the money in the process. It has so bad now to the point he begs friends for money to just to fund the bets and is in financial crisis.
Olatunji (2020) elaborated on the role disgust plays in eating disorders. The paper acknowledged that it is not only fear of gaining weight that causes some eating disorders, but some people are disgusted by the sight food itself (p.178). From my perspective, the Pavlovian theory to link disgust and food may be subjective because some professionals would not be disgusted by someone vomiting. In other words, I am just imagining a nurse who has anorexia nervosa seeing someone vomiting. He or she might react because he or she sees it daily at work, so the mind is conditioned to the point where it is no longer a disgusting thing to see. Moreover, I am also of the view that eating disorders are influenced by culture. Growing up in Ghana being overweight or obese means wealth and being thin is associated with illness. When you have a baby and throughout childhood if the baby is not chubby, people assume your child is ill, so children are overfed to become chubby. By the time these children become adults, they develop binge eating habits to be accepted in their society. In contrast, the western world promotes a thin body imagine to fit into society.
Ravid et al. (2021) talks about modified bedtime pass used in controlling co-sleeping in children with anxiety. The concept of co-sleeping is a topic that resonates with me especially because I have a toddler. Co-sleeping has its pros of building a bond between parents and their children by making children feel protected. However, it also comes with parents not having any privacy as well as removing intimacy from marriages. This can take a toll on marriages if one party feels no attention is given to him or her when the kids are around. Children sometimes have a wild imagination so I can only imagine how those with anxiety would feel. As a child, I believed there were ghosts in the darkness, so I always slept with the lights on. The article spoke about the use of fluvoxamine which made children with separation anxiety and GAD to be less resistant when sleeping alone (p.299). This might be because of the medication side effect which includes drowsiness. This may make these children too tired to fight so they comply to sleeping alone. Additionally, the article explained extinction-based interventions and non-compliance of some parents (p.300). This is understandable and should have been expected. Imagine as a parent having to work the next day at 8am and you must camp out until your child sleeps. Your child does not sleep throughout the night and sleeps at 5am. This means you would only have 3 hours of sleep. If your workplace is an hour away, it will mean less than the 2 hours of sleep which would leave you tired. This situation will promote non-compliance. Also, the article highlighted the fact that one of the participants of the intervention (Liam) went back to co-sleeping with parents after a 2-week vacation. Even though parents stated they slept in the same room during the vacation, I believe two weeks should not have affected the intervention of sleeping alone if the intervention was that effective. Moreover, throughout the article at no point where parents advise they would have to continue independent sleeping regardless of where they go. This might explain why parents chose to sleep in the same room during their vacation. Even though Liam was able to sleep alone after starting therapy again, I am a bit worried he would return to co sleeping again as soon there is another vacation and therapy also stops.
The criticisms I have on Harzem (1984) are the definitions of individual differences and personality was unclear after reading the article. The other three articles discussed the gaps in their research and the need for further research.
In conclusion, mental health is a broad topic not just limited to diagnosis and disease. Furthermore, it is an essential part of health which should be invest in as it does not just affect individuals. it causes an unseen domino effect on communities as well as world economies.
References
Scott, W. A. (1958). Research definitions of mental health and mental illness. Psychological Bulletin, 55(1), 29–45. https://doi.org/10.1037/h0042457
World Health Organization. (2004). Promoting mental health: concepts, emerging, evidence, practice (Summary report).
Guercio, J.M., Johnson, T., & Dixon, M.R. (2012). Behavioral treatment for
pathological gambling in persons with acquired brain injury. Journal of Applied Behavior
Analysis,45(3), 485-495.
Harzem, P. (1984). Experimental analysis of individual differences and personality.
Journal of the Experimental Analysis of Behavior, 42(3), 385-395.
Olatunji, B.O. (2020). Linking Pavlovian disgust conditioning and eating disorder
symptoms: An analogue study. Behavior Therapy, 51, 178-189.
Ravid, A., Lagbas, E., Johnson, M., & Osborne, T.L. (2021). Targeting co-sleeping in
children with anxiety disorders using a modified bedtime pass intervention: A case
series using a changing criterion design. Behavior Therapy, 52, 298-312
Nice piece! Very insightful