The Meaning of Mental Health from Elderly Women's Perspectives: A Basis for Health Promotion
Hedelin, Birgitta, Strandmark, Margaretha, Perspectives in Psychiatric Care
PROBLEM. To gain a deeper understanding of the meaning of mental health.
METHODS. Qualitative interviews with 16 women between the ages of 71 and 92. The data were collected and analyzed using a phenomenological approach.
FINDINGS. The essence of mental health is the experience of confirmation, trust and confidence in the future, as well as a zest for life, development, and involvement in one's relationship to oneself and to others.
CONCLUSIONS. Creating arenas for encounters confirming the individual's human existence and dignity is an important basis for the psychiatric nurse's health-promotion work.
Search terms: Confirmation, health promotion, life-world, mental health, phenomenology, psychiatric nursing, women
Mental illness is an extensive public health problem. Global estimations of the burden of disease show that mental illness plays a prominent role (Murray & Lopez, 1996). Despite the large extent and serious effects of mental illness, there are few studies focusing on mental health and mental health promotion. In Sweden, the National Board of Health and Welfare (Kompetensbeskrivningar, 1995) has stipulated that psychiatric nurses must be able to initiate and implement measures aimed at promoting mental health in people of all ages, in the population as a whole and at the group and individual levels. In a holistic-existential model for psychiatric nursing (Hummelvoll & Barbosa da Silva, 1994), prominence is given to the nurse's responsibility for mental health promotion. At the individual level, it means assisting clients to have a life in a spirit of social community. On a social level, the nurse has a moral obligation to influence and change conditions that create health problems.
Mental health often is described in negative terms--as the absence of objective signs of mental disease or in terms of "normality" reflecting the prevailing norms in the society. Positive mental health, however, can be regarded as real and existing in itself. A well-known example is Sigmund Freud's observation that a healthy person is a person who is able to work and love. Marie Jahoda's classic work (1958) remains an important and oft-cited contribution on this topic, in reviewing the literature, Jahoda found six different approaches to mental health: the attitudes of an individual toward self; growth, development, or self-actualization; integration; autonomy; perception of reality; and the ability to cope with one's environment. In a philosophical analysis of positive mental health, Tengland (1998) devised the concept of "acceptable mental health," which includes the ability to exercise practical rationality and to cooperate.
This article adopts another point of view: the description of mental health from an "inside perspective." It is fundamental to ask for the inside perspective to understand what nursing actions are appropriate when promoting mental health. How does a person's perspective of well-being, a meaningful life, and community contribute to successful coping and enjoyment of life, especially in later life, when experiencing physical illness and necessary losses? The aim of the study was to gain a deeper understanding of the meaning of mental health by investigating how elderly women perceive their own mental health.
Phenomenology aims to detect and understand rather than to explain, predict, and interpret. Husserl (1989), the founder of the philosophy and method of phenomenology, argued that it is necessary to "return to things themselves" (p. 57) if we want to acquire knowledge about reality. By things he meant phenomena that reveal themselves to a subject. A characteristic of the phenomenological method is to depart from pure descriptions of the "life-world," that is, the subjects' lived experiences of their daily life, the world they live in and take for granted. The overriding aim is to capture the essence of the phenomenon--the characteristic sign, meaning, or innermost being of the phenomenon that emerges through a process of intuition, reflection, and free imaginative variations by the researcher (Husserl; Karlsson, 1995; Merleau-Ponty, 1995). …