A history of 'madness': Deinstitutionalisation to community care

Question 1

What are the different names for mental phenomenon?

Answer 1

1. Mental disorder (legal or administrative construct).
2. Mental illness (medical construct).
3. Mental distress (an alternative or euphemism).
4. Mental health problem (organisational construct eg WHO).

Question 2

When was mental disorder considered a legal construct?

Answer 2

In 1983 with the Mental Health Act .

Question 3

How does the MHA defines mental disorder?

Answer 3

As ‘any disability or disorder of the mind’

Question 4

What is an important factor about the MHA?

Answer 4

It set out criteria to detain and treat a person with a mental disorder against he’s will. If three professionals agree that a mental disorder is present (and other criteria are met) the person can be detained.

Question 5

What is the Code of Practice of MHA?

Answer 5

A list of clinically-recognized disorders that could fall within the Act’s definition of mental disorder (e.g. affective disorders such as depression & anxiety).

Question 6

What are two conditions that do not meet the mental disorder criteria under the MDA?

Answer 6

Alcohol consumption and drug addiction.

Question 7

What is the use of MD as an administrative construct?

Answer 7

1. Identify mental disorder.
2. Calculate the burden of MD.
3. Access specific services or benefits.
4. Diagnostic tool.

Question 8

What are the two main contemporary diagnostic frameworks?

Answer 8

The Diagnostic Statistical Manual from the APA (DSM-5) & the International Classification of Diseases from the WHO (ICD-10)

Question 9

Name an uncontroversial disorder:

Answer 9

Depression

Question 10

Name a ‘fashionable’ disorder:

Answer 10

Bipolar disorder

Question 11

Name a contested disorder:

Answer 11

Schizophrenia

Question 12

Explain the construct of mental health according to WHO.

Answer 12

Mental Health, according to WHO, is defined as a state of well-being where the individual shows its potential and helps the community. This is an inclusive definition. However, WHO policies focus on increasing services for people with mental illness.

Question 13

Explain the toolkit of ‘positive mental health’ according to UK NHS.

Answer 13

Five steps to mental wellbeing:

1. connect
2. be active
3. keep learning
4. give to others

5 be mindful.

Question 14

What does ‘mental health problem’ terminology conveys?

Answer 14

This is a terminology that:

1. uses careful language
2. implies there is a spectrum within disorders and severity
3. avoid medical language (e.g illness)

Question 15

Explain ‘madness’ according to the Ancient World.

Answer 15

1. a disorder of the brain
2. a reaction to failing or bad moral circumstances
3. spiritual or demonic possession.

Question 16

Name the three psychological constructs of mental disorder.

Answer 16

1. Associationism (John Locke, 18th & 19th C)
2. Psychodynamics (20th C)
3. Cognitive-behavioural approaches (Daniel Freeman—today’s dominant paradigm)

Question 17

Name five key barriers to MH services availability.

Answer 17

1. Lack of integration with primary care.
2. Lack of funding
3. Inadequate human resources for mental health
4. Lack of public leadership.

Question 18

Name a few key points of mental disorder as a brain disease.

Answer 18

1. Degeneration theories in the 29th C which led to sterilisation of people with mental problems or euthanasia as a public policy.
2. General paralisis of the insane (GPI) was viewed as an infection.
3. Alzheimer’s disease was shown as having clear neuropathology.
4. Imaging and functional imaging has remained as research tool.
5. Genetics & Epigenetics as important disciplines for research.

Question 19

Name three main figures in the sociological approaches to mental disorder (mental disorder & society).

Answer 19

1. Durkheim—wrote about suicide and ‘anomie’ (lack of the usual social or ethical standards in an individual or group).
2. Goffman—wrote about the ‘total institution’ eg asylums, prisons, etc. and stigma (1963).
3. Scheff —wrote about the ‘labelling theory’.

Question 20

What is the empirical evidence behind sociological paradigms in mental health?

Answer 20

1. Psychological stressors precipitate illness
2. Childhood adversity & abuse
3. Immigration
4. Family environment
5. Gene-environment interaction (epigenetics)

Question 21

What are the four ‘models’ of mental disorder, according to Peter Tyrer’s book?

Answer 21

1. Disease model
2. Psychodynamic model
3. Social model
4. Cognitive-behavioural model.

Question 22

What would be a multidimensional view on mental disorder?

Answer 22

A bio/psycho/social view.

Question 23

Name two theorists who rejected the idea of mental illness?

Answer 23

Laing and Szasz viewed mental illness as a social construct, and rejected it could be based on a medical condition.