Alternatives to medical model

Question 1

Describe the behaviourist explanation of mental illness [4]

Answer 1

the behaviourist explanation would explain specific phobias as being caused by associations made in the environment

Mowrer put forward a two-process model to explain how phobias are learned through classical conditioning and maintained through operant conditioning

Phobias learnt though association of an object (NS) with fear to be manipulated into a controlled response (fear of NS)

These are maintained through consequences eg. negative reinforcement of avoidance (reduces anxiety) or positive reinforcement (attention/sympathy)

Can also learn a phobia through observing and imitating a model who shows fear of situation/object, eg. dads scared so your scared

Question 2

Evidence in behaviourist explanation

Answer 2

Study found little albert could be classically conditioned to be scared of a rat he wasn’t originally afraid of

+ supports idea phobias can be acquired through classical conditioning
- phobias created in lab doesn’t reflect real life

Study where children were shown images of unfamiliar animals paired with happy or sad adult faces
Found children’s reactions eg. fear towards animals were similar to adult face (social learning theory)

Question 3

Strengths and weaknesses of behaviourist explanation

Answer 3

+ successful treatments for phobias based on classical conditioning eg. systematic desensitisation and flooding

• reductionist - not just classical conditioning + social learning theory
  > phobias may result of irrational thinking, not just learning
  > phobias may be instinctive to aid survival

Question 4

Treatment related to behaviourist explanation

Answer 4

Systematic desensitisation for phobias
= changes associations related to phobia eg. fear>relaxation

= gradually exposes to their phobia using an anxiety hierarchy from last anxiety-provoking situation to most

= client moves up hierarchy at own pace + taught how to stay calm so they can change associations

= relaxation training also a part, teaches deep breathing, body scan and visualising being in a peaceful place

Question 5

Evaluation of systematic desensitisation

Answer 5

Study compared group of people with snake phobias who did and didn’t to systematic desensitisation
found those who did it showed less avoidance of snakes and reported fewer phobic behaviours
> shows its an effective treatment of phobias

Positive effects and lasts longer than other therapies

Ethical as patient has a lot of control over the treatment > only progresses when feel confident enough

Takes longer + costly than other classical conditioning technique for phobias called flooding
> exposed to their phobic object and not allowed to escape)

Question 6

Describe the cognitive explanation of mental illness

Answer 6

says the root cause of mental illness is irrational thinking

for example, may believe everyone dislikes them > lead to negative feelings about self + depression

Beck’s negative triad > depression
1. Pessimistic views about self “I am useless”
2. Pessimistic views of world / cant cope with environment “this job is too much”
3. Pessimistic views of future - thinks wont change “I will never do well”

Negative beliefs lead to negative schemas (mental representations of world
Negative schemas lead to cognitive bias in thinking (illogical thinking about things)
For example, individuals overgeneralise, draw sweeping conclusions regarding self-worth based on one small piece of negative feedback

Question 7

Evaluation of cognitive explanation

Answer 7

Numerous clinical reports that people with depression have irrational thoughts so supports explanation

> study found depressed people were more likely to show distorted thoughts eg. I’m worthless than control group

> Meta-analyses found significant improvements in patients who had undergone cognitive therapy > irrational thoughts are basis of depression > supporting cognitive explanation

Question 8

Explain cognitive behavioural therapy

Answer 8

the therapist help clients to recognise the negative thoughts and errors in logic that cause them to be depressed

they guide clients to challenge their dysfunctional thoughts and try new interpretations/ways of thinking in daily lives

Question 9

Evaluation of CBT

Answer 9

Meta analyses investigated the effectiveness of Beck’s cognitive therapy + 80% benefited from therapy

CBT is more effective than drug therapy and leads to lower relapse rates

Supports view that depression is linked to negative unrealistic thoughts

Question 10

Describe how cognitive explanation can be used to explain schizophrenia

Answer 10

1) schizophrenics have problems with processing information eg. distorted belief

2) metarepresentation problems - can’t recognise own thoughts eg. thought insertion (think someone else is putting thoughts in head as cant distinguish own thoughts and someone else’s speech)

3)disorganised speech (can’t process info properly)

4) sensory overload - more consciously aware of all cognitive processes that take place

Question 11

Evidence of cognitive explanation to explain schizophrenia

Answer 11

Study asked schizophrenics to move hand a certain way. Found those with delusions and hallucinations couldn’t tell difference between own hand ant someone else’s o a TV screen
> can’t distinguish between own actions and others action (metarepresentation problem)

Study found schizophrenics with negative symptoms did worse on verbal fluency tasks
> they have difficulties in info processing

The cognitive explanation of schizophrenia can’t explain the causes, but biological explanations can explain causes (high levels of dopamine + enlarged ventricles)

Question 12

Describe psychodynamic explanation of mental illness

Answer 12

says mental illness is caused by unconscious conflicts and early childhood experiences

eg. specific phobias may be caused by unconscious anxieties being displaced onto neutral objects eg. Little Han’s fear of father displaced onto fear of horses

Freud suggests rejecting parenting can lead to mental illness eg. depression
eg. a child may feel angry towards parents but can’t express this out of fear of punishment, so leads to unconscious conflicts + mental illness

Question 13

Describe ego defence mechanisms

Answer 13

The ego is under constant attack from id and superego

Repression = push away disturbing thoughts, feelings and memories into unconscious mind

Displacement = unconscious feelings to one thing is shifted to another with less harmful consequences

Regression = adopting childlike behaviours in order to cope with difficult emotions

Question 14

Psychodynamic explanation of phobias

Answer 14

phobias are caused by unconscious anxieties that threaten the ego

so displace it onto a neutral object/situation

Freud said little han’s displaced his fear of his father onto horses

HOWEVER
= subjective interpretation
= could’ve been classically conditioned (behaviourist explanation) as saw horse collapse which scared him then associated this fear with all horses

Question 15

Psychodynamic explanation of depression

Answer 15

A person experiences depression due to unresolved/unconscious conflicts stemming from childhood

psychic energy builds up inside (due to defence mechanisms) and leaves them with lack of energy + depression

Freud suggested a loss/rejection of parent leads to depression. Feel anger towards them, can’t express this out of fear of punishment, so anger is repressed.

The anger becomes self hatred and leads to low mood

Question 16

Evaluation of psychodynamic explanation for depression

Answer 16

Another longitudinal study found strongest predictor of adult depression was loss of a parent between 5-8yrs

> however any earlier was not associated with depression

> provides partial support for explanation but doesn’t say if depression is caused by self-directed anger

Question 17

Psychodynamic explanation of schizophrenia

Answer 17

Freud thought adults with schizophrenia experienced harsh enviro at childhood, they cope with trauma by regressing

Freud believed regression can be detected in symptoms eg. delusions of grandeur

This is due to ego tries to regain contact with reality and leads to auditory hallucinations

Question 18

Evaluation of psychodynamic explanation for schizophrenia

Answer 18

Study conducted interviews on schizophrenics and found strong relationship between childhood sexual abuse and schizophrenia

Supports idea that schizophrenia is the outcome of childhood trauma

Doesn’t establish that schizophrenia as a result of specific psychodynamic processes such as regression

Question 19

Describe how psychoanalysis can be used to treat depression

Answer 19

Psychoanalysis is based on idea depression is linked to repressed memories of loss and anger in childhood

The therapist attempts to trace unconscious memories in childhood. The patient lies on couch facing away from therapist

Free association - patient encouraged to talk freely about everything that comes to mind, then therapist will draw association between similar themes to uncover conflicts + resolve them

Dream analysis - patient asked to recall dreams. Ego defence mechanisms are more relaced when we dream so gives insight into our unconscious mind
The content in out dream is symbolic for the real meaning (latent content)
The therapist will interpret dreams in context of patients desires and fears

Question 20

Evaluation of psychoanalysis

Answer 20

Study randomly allocated patients with depression to one of two therapy groups - psychoanalysis or standard (meds + CBT)

found psychoanalysis showed decrease in symptoms in 2 yrs, control group (meds+CBT) had no decrease ins symptoms

Question 21

Szaz’s argument overview

Answer 21

challenge peoples views of mental illness and how it should be treated

Szasz argued that disturbed behaviour began to be seen as a biological disease requiring medical treatment but he disagrees with this medical model of mental illness

Question 22

Why did szasz think mental illness was a metaphor

if ask to evaluate a view, first explain it then in second para say why its socially sensitive

Answer 22

he said mental illness is a figure of speech for disturbed behaviour and that if it has a physical basis it should be classed as a physical disease

he mentioned how people say their mental illness are bodily diseases, but he says this is because when mental illness turns out to be physical, it was not a mental illness

For example, schizophrenia does have a physical basis so should be classed as a mental illness
Personality disorders don’t have a physical basis so shouldn’t be viewed as a mental illness but disturbed behaviour that is caused by environmental factors

Also argued disturbed behaviour should be explained psychologically and not biological treatments eg. drug therapy

Question 23

How does Szasz explain changing perspectives on human life and illness

Answer 23

supports argument that mental disorders (those that don’t have a physical basis) don’t exists by showing how perceptions of mental disorder have changed overtime.

Homosexuality was seen as mental disorder in 1961 but isn’t now

ADHD didn’t exist as mental illness in 1961 but is now one

Szasz argues that if mental disorders were real they wouldn’t change over time!!!

Question 24

Describe what Szasz meant by ‘medicalisation of disturbing behaviour” and how it can be seen as a problem

Answer 24

says people diagnosed with mental disorders are too readily given medication eg. anti-depressants + rejects medical model.
- mental illness with physical basis is a physical illness, and those which don’t shouldn’t be treated with medication

problem is people labelled as mentally ill are too readily given medication, behaviours which don’t fit societal norms are given biological treatments - control people in society

not a problem as treatments eg. anti-depressants do help the individual with their symptoms + reassure them their experience isn’t unusual

viewing disturbances in behaviour as equivalent to physical illness can improve access to funding for support services

Question 25

Szasz and how ‘having a illness doesn’t turn an individual into a patient”

Answer 25

argued psychiatric treatments are for society’s benefit rather than person with ‘abnormal’ behaviours - they don’t need it,
- pharmaceutical companies make more money

as a result of disturbed behaviour labelled as diseases, people are sectioned and put in psychiatric hospital and this violates human rights

Question 26

How has szasz show the change in US mental healthcare

Answer 26

made comparisons between mental illness in 1960s vs 2011

50yrs ago, people with mental illness were considered incurable and had few rights eg. held against will+ no chance to appeal decision

in 2011, there are still false belief’s about mental illness eg. diagnosed accurately + treated successfully despite no scientific evidence mental illness is solely due to the brain

Western mental health clinicians think metal disorder implies a distinction between ‘mental’ disorders and ‘physical’ disorders that is a reductionist (umbrella term when its not)

Question 27

Methodological issues in Szasz

Answer 27

VALIDITY
- based on his own opinions about mental illness
- reduces validity as no objective evidence to support views

ETHNOCENTRISM
- focused on how mental illness is described in western societies
- non-western societies are more likely to refer to healing, which applies to healthy people too

Question 28

Discuss how Szasz is socially sensitive

Answer 28

those who suffer with mental illness is extremely distressing for someone to describe it as a ‘myth’ when they experience real symptoms and effective treatment

lead to people distrusting psychiatrists when they or there to offer help

however, he highlighted how psychiatrists should not be coercive when treating patients and that medical treatments eg. drug therapy may not be best option for psychological disorders eg. CBT, psychoanalysis

Question 29

Szasz relating to
Nature/Nurture Debate
Reductionism/Holism Debate

Answer 29

Nature/Nurture -
Nurture - says disturbed behaviour is a result of environmental factors
Nature - rejects medical model and states that disturbed behaviour is not caused by biological factors (nurture)

Reductionism/Holism
holistic - argues mental illness isn’t just a biological disease but disturbed behaviour related to multiple environmental factors eg. family, society, culture

Question 30

Szasz relating to
Free will/Determinism Debate
Psychology as a science debate

Answer 30

Free Will/Determinism
deterministic - people are defined by psychiatrists diagnosis and this determines how people are related (treatments) based on diagnosis)
free will - patients exert free will by taking control of their therapy and making own decisions about how to get better

Psychology as a science
seeing mental illness shouldn’t be scientific - rejects medical model (which is scientific)
he argues disturbed behaviours should be understood in terms of family issues, society, environment rather than labelled according to list of (less scientific)

Question 31

Nature Nurture debate in relation to alternatives to medical model

Answer 31

BEHAVIOURIST - nurture
= mental illness is learnt from the environment
= eg. phobia learnt through classical conditioning

PSYCHODYNAMIC - nurture & nature
= experiences in childhood are sources of mental illness eg. loss of parent increases chance of depression
= born with unconscious conflicts (ego defence mechanisms

COGNITIVE - nurture
= Beck argues negative cognitive schemas stem from rejection in early in life (environment)

Question 32

Free will/Determinism in relation to alternatives to medical model

Answer 32

All support determinism

BEHAVIOURIST
= mental illness determined by enviro, eg. classical conditioning, can’t control associations
= rewards and punishment in enviro outside of our control

PSYCHODYNAMIC
= mental illness determined by unconscious processes eg. Hans

COGNITIVE
= negative schemas + irrational thoughts are related to childhood, which is outside of out control

ALL FREE WILL IF CHOOSE TO DO TREATMENTS

Question 33

Reductionism/Holism in relation to alternatives to medical model

Answer 33

all explanations are reductionist

BEHAVIOURIST
- mental illness stems from our environment (conditioning or social learning) doesn’t consider other explanations

PSYCHODYNAMIC
- unconscious process and early childhood
- less reductionist as two explanations

COGNITIVE
- negative schema and irrational thoughts as only cause

DIATHESIS STRESS MODEL - more holistic
- biology as well as stressors in enviro cause mental illness

Question 34

Psychology as a science in relation to alternatives to medical model

Answer 34

BEHAVIOURIST - scientific
= falsifiable theories eg. classical/operant/ social
= Watson & Rayner classically conditioned Little Albert under controlled conditions + established cause+effect

PSYCHODYNAMIC - unscientific
= unfalsifiable theories
= difficult to conduct empirical research (scientific eg. lab) that tests unconscious fears lead to mental illness

COGNITIVE- less scientific
= hard to test mental processes
= eg. design something but can never fully investigate mental processes