Mental state exam for youth workers: Perception

Well there are only three more posts left in this series. We have been building an understanding of the core components of a mental state exam so that we can support our young people as best we can. This week I was speaking with a youth worker in one of Victoria’s largest Christian denominations about a mental health conference he was at. I was reminded about how important it is for all youth workers to have a strong understanding of mental health. So far we have discussed how a young persons appearance, behaviour, speech and language, mood and affect and their thought process and content can provide indicators as to their mental state. Today we discuss how a young persons thought content can provide insight into their current mental health status.
Today we look at perception. Perception in the broadest sense of the world is how we sense the world through our five major sense: sight, touch, taste, smell and hearing. The three categories of perceptual disturbance are hallucinations, pseudohallucinations and illusions.

A hallucination is defined as a sensory perception in the absence of any external stimulus, and is experienced objectively by the young person eg. they see it and you don’t. Hallucinations occur in any of the five senses, although auditory (hearing) and visual (sight) hallucinations are the most frequently observed. Auditory hallucinations are typical of psychosis and symptoms such as ‘voices talking about the young person’ and ‘hearing one’s thoughts spoken aloud’ are indicative of schizophrenia, whereas second-person hallucinations such as ‘voices talking to the young person threatening or insulting or telling them to commit suicide’, may be symptomatic of psychotic depression or schizophrenia. Visual hallucinations are more likely suggestive of organic conditions such as epilepsy, drug intoxication or drug withdrawal.

An illusion is defined as a false sensory perception in the presence of an external stimulus, in other words a distortion of a sensory experience, and may be recognized as such by the subject. The best example I can think of is mime artist or the visual illusions of Giuseppe Arcimboldo. The old adage that your eyes play tricks on you is no more true than when we think of illusions. Illusions in themselves are not necessarily an indicator of mental illness but could mean a physical disorder or intoxication.

One of Giuseppe Arcimboldo’s illusions

A pseudohallucination is experienced in an internal or subjective space such as ‘voices in my head’ and is regarded as akin to fantasy. Other sensory abnormalities include a distortion of the young persons sense of time, for example déjà vu, or a distortion of the sense of self (depersonalization) or sense of reality (derealization). These symptoms could be suggestive of dissociative disorders, epilepsy or brain damage.

Aaron Garth

Aaron Garth is the Executive Director of Ultimate Youth Worker. Aaron has worked as a youth worker in a number of settings including local church, street drug and alcohol outreach, family services, residential care, local government and youth homelessness since 2003. Aaron is a regular speaker at camps, retreats, & youth work training events and is a dedicated to seeing a more professional youth sector in Australia. Aaron is a graduate of RMIT University and an alumnus of their youth work program. He lives in Melbourne with his wife Jennifer & their daughters Hope, Zoe, Esther, Niamh and son Ezra.

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