25 Alternative approaches to individual psychopathology

Question 1

What was the criticism of the DSM-5 made by the British Psychological Society?

Answer 1

It disregards social and environmental factors. By regarding all problems as intrapsychic, it leaves the individual out of context.

Question 2

What was the criticism of the DSM-5 made by the National Institute of Mental Health?

Answer 2

It’s not biological enough. Diagnoses should be linked to neurological functioning.

Question 3

What does the bio-psycho-social model of mental illness risk becoming?

Answer 3

A bio-bio-bio model that relegates human despair to physiological functioning.

Question 4

What is a risk of giving a diagnoses to children or adolescents?

Answer 4

They may self-label, referring to their illness as an organic part of themselves. E.g. I am ADHD, Asperger’s

Question 5

Describe a successful multisystemic therapy?

Answer 5

Henggeller’s (2010) Multisystemic Therapy for juvenile offenders. It involves the family and the community, addressing all environmental systems that impact chronic and violent juvenile offenders.

Question 6

When was homosexuality removed from the DSM as a disorder?

Answer 6

In DSM-III in 1980.

Question 7

What was part 1 of the experiment that formed the basis of Rosenhan’s ‘On Being Sane in Insane Places’ (1973)?

Answer 7

Part 1

• Healthy associates report to psychiatric hospitals claiming to hear voices. After admission, they ceased all symptoms.
• Average time spent in hospital was 19 days.
• All were forced to admit they had a mental illness and forced to take antipsychotic drugs as a condition of their release.
• All but one diagnosed with schizophrenia ‘in remission’

Question 8

What was part 2 of the experiment that formed the basis of Rosenhan’s ‘On Being Sane in Insane Places’ (1973)?

Answer 8

Part 2

• An offended hospital administration challenged Rosenhan to send pseudopatients to its facility. Rosenhan agreed.
• In the following weeks staff identified 41 of 193 as potential pseudopatients. 19 were suspected by at least 1 psychiatrist and 1 other staff member.
• No pseudopatients had been sent.

Question 9

What changes were suggested in the aftermath of the ‘On Being Sane in Insane Places’ (1973) experiment?

Answer 9

Psychiatric labels and incarceration might not be a solution. In fact, the facilities themselves might create mental illness. Switch to community health facilities.

Question 10

What two types of therapeutic knowledge does Epston (1999) identify?

Answer 10

1. Outsider (global) knowledge –used by practitioners

2. Insider (local) knowledge –based on the experience of people living with and having overcome problems

Question 11

What is the recovery movement?

Answer 11

Movements such as AA, run by non-professionals relying primarily on insider knowledge. Sharing stories etc.

Question 12

What’s the difference between the consumer/survivor approach to mental illness and the medical model?

Answer 12

Medical model focuses on mental health problems as illnesses –diagnosis of pathology, treatment, symptom resolution and a return to former state of functioning.

Recovery paradigm focuses on the person, not simply the symptoms, and emphasises empowerment and self-management across the lifespan. Idea that mental illness and recovery can transform you. Don’t have to get rid of symptoms (e.g., hearing voices).

Question 13

What did Rhodes report about having families with AN sufferer talk to survivor family pre-treatment?

Answer 13

Increased efficacy of treatment by 2%.

Question 14

Does the recovery movement advocate giving up medication?

Answer 14

No, says Roberts and Wolfson (2004).

Question 15

What are Arthur W. Frank’s 3 typologies of illness narrative?

Answer 15

1. Restitution –illness is transitory. Expect reversion to previous functioning.
2. Chaos –despair, lack of control, overwhelmed by illness.
3. Quest –illness accepted and incorporated as part of life story.

Question 16

What are Arthur W. Frank’s 3 kinds of Quest illness narrative?

Answer 16

1. Quest memoir –accept illness stoically. No insight gained from experience.
2. Quest manifesto –demands for social reform or action. Insight gained.
3. Quest automythology –change of character, rebirth, transformation

Question 17

What is Kenneth Gergen’s idea of the ‘relational self’ (2009)?

Answer 17

There is no such thing as an autonomous, isolated self. What is commonly viewed as the individual subject is the common intersection of multiple relationships. (Relational Being)

Question 18

What is Gergen’s riff on Descartes’ cogito?

Answer 18

I am linked therefore I am.

Question 19

What is the Hearing Voices movement?

Answer 19

A consumer/recovery movement for psychotics, which normalises hearing voices, interpreting them as a manifestation of solvable emotional problems.

Question 20

What are the three phases of recovery in the Hearing Voices movement suggested by Romme and Escher (1993)?

Answer 20

1. Startling –shock, trying to push the voices away
2. Organisation –employing strategies to deal with the voices, placing boundaries…
3. Stabilisation –integrating the voices into life, recognise them as ‘part of me’

Question 21

How is anti-psychotic medication regarded in the Hearing Voices movement?

Answer 21

As a form of repression –silencing the voices, rather than making sense of them. Individuals should be taught to lean in to the voices rather than lean away.

Question 22

What two recovery typologies were revealed by Dejager, Rhodes et al. (2014)?

Answer 22

After a period of despair/exhaustion…

1) turning toward/empowerment: normalising voices, integration into daily life, transformation of identity
2) turning away/protective hibernation: harnessing all available resources to survive the experience, with importance of medication emphasised.

Question 23

Why is it important for voice hearers to understand where the voices come from?

Answer 23

Unless meaning is attributed to voices, hard to establish relationship with them and feel in control.

Question 24

What do the voices of psychotics express, according to Rhodes?

Answer 24

Voices express what the voice hearers are feeling or thinking –e.g. fear, aggression. The feelings are important, not the voices.

Question 25

What is Open Dialogue or Network Therapy for psychosis? (Seikkula, 2006)

Answer 25

Upon first presentation of psychosis, intensive engagement with the client and whole community. Hold meetings where focus on polyphonic dialogue, including the heard voices of the psychotic.

Question 26

Why is Conduct Disorder a dodgy diagnosis?

Answer 26

It’s just a description of behaviour (it doesn’t suggest any internal dysfunction).

Question 27

How is Judith Herman’s beef with Borderline Personality Disorder, and how should it be more accurately named?

Answer 27

BPD sufferers are people whose trust has been so broken – through various kinds of trauma – that they don’t feel safe in relationships. Judith Herman claims Complex PTSD is a more valid description.

Question 28

What are the treatment results for Open Dialogue therapy?

Answer 28

At 5-year follow-up, 80% of those who experienced acute psychosis for the first time had experienced functional recovery. I.e. they were working, studying or looking for a job and not on disability. Roughly 80% of these were asymptomatic and not on medication.