alternatives to the medical model

Question 1

behaviourist explanation base principle?

Answer 1

we are born as a tabula rasa

all behaviour (including mental illness symptoms) is learnt

Question 2

types of conditioning/learning and what they are?

Answer 2

classical conditioning - pavlov - association

operant conditioning - b.f. skinner - reinforcement

social learning - bandura - imitation

Question 3

classical conditioning creating a phobia?

Answer 3

watson & rayner

used little alberts unconditioned response to a fear of loud noises (crying) to make the neutral stimulus (a white rat) a phobic stimulus

Question 4

operant conditioning creating a phobia?

Answer 4

learning through the reinforcement or punishment of a behaviour

if a child retreats to their parents bed during a storm and is allowed to stay, the behaviour is positively reinforced, so they will remain afraid of storms

Question 5

social learning creating a phobia?

Answer 5

learn through observation and imitation

blood-injection-injury phobias common in first degree relatives

if parent is worried about their child getting immunized then the child will pick up on this

vicarious transmission of a conditioned emotional response

Question 6

behaviourist explanation: application?

Answer 6

systematic desensitisation for specific phobias

three step: teach relaxation techniques, create fear hierarchy, work up hierarchy until agreed upon therapeutic goal is reached

mcgrath: successfully used this with a nine yo girl who was afraid of loud noises. her fear rating went of party poppers went from 9/10 to 3/10 after ten sessions

Question 7

systematic desensitization: step one?

Answer 7

relaxation techniques taught

meditation, controlled breathing, muscle detensioning

reciprocal inhibition as fear incompatible with relaxation

Question 8

systematic desensitization: step two?

Answer 8

creation of a fear hierarchy

patient lists and rates feared stimulus from least to most provoking fears

Question 9

systematic desensitization: step three?

Answer 9

patient works up fear hierarchy along with the relaxation techniques

when comfortable with one stimulus, they move onto the next

therapy finished when agreed therapeutic goals are met

Question 10

quick behaviourist cure?

Answer 10

flooding

patient directly exposed to phobic stimulus

fear response will eventually pass, which should associate the stimulus with calm

if successful will lead to the extinction of the fear, but if unsuccessful, will make it worse

Question 11

behaviourist explanation strengths?

Answer 11

considerable scientific support for it as an explanation of anxiety disorders

basis in nurture provides general hope for treatment

provides effective therapy for phobias

Question 12

behaviourist explanation weaknesses?

Answer 12

not effective explanation for many disorders

deterministic

treatment can be distressing, take time and needs significant patient input

Question 13

cognitive explanation base principle?

Answer 13

behaviour is the product of mental processing of information

if something is wrong with how we attend, perceive or store it then behaviour will be abnormal

Question 14

cognitive distortions?

Answer 14

irrational thinking that can make an individual’s worldview negative or disturbed

distortions include: black & white thinking, overgeneralization, mental filter, disqualifying the positive, jumping to conclusions, magnification, minimization, emotional reasoning, labelling, personalization and should/must/ought

these form in childhood but can resurface with mental disorders, trauma and stress

Question 15

cognitive explanation for depression?

Answer 15

beck described triad of beliefs that are seen in people with depression: negative self, world and future view

formed in early life but can be triggered later by adverse life events

from these, all information is processed with a negative bias, resulting in emotional, cognitive and behavioural symptoms of depression

Question 16

cognitive explanation: application?

Answer 16

cognitive behavioural therapy

therapist and patient agree on what needs to be changed

the patients negative beliefs are talked through, the therapist explaining links between thinking, behaviour and emotions and provides rational alternatives

patients are tasked with strategies, like reality checks, to perform in their everyday life, and to keep a diary which should provide evidence to challenge cognitive distortions

sessions to happen once a week/fortnight and targets should be achieved by 5-20 sessions

Question 17

beck et al?

Answer 17

compared effectiveness of drug therapy and cbt

two groups: one given 100 imipramine tablets over 12 weeks, the other given 2x 1 hour cbt sessions a week over same period

cbt group showed 79% decrease in symptoms compared to 20% decrease for drug therapy (self-report and observer based ratings). however, for those with chronic depression there was little difference

drop out rates: 5% for cbt, 32% for imipramine

Question 18

cognitive explanation strengths?

Answer 18

considers the individuals thoughts, feelings and beliefs

well-suited to explaining affective disorders

optimistic in that patients can change their behaviour

basis of highly effective treatments

therapies like cbt aim to treat the cause not just the symptoms of a disorder

Question 19

cognitive explanation weaknesses?

Answer 19

could be seen as implying patients are responsible for their symptoms

reductionist in disregard for biological factors

therapies long and need a lot of patient input, also a considerable delay between therapy and relief from symptoms

effective in explaining social phobias, but not specific (patients know they’re irrational)

Question 20

szasz background?

Answer 20

response to his essay from the 60s

challenged the concept of mental illness as medical, claiming that psychiatry stands on a conceptual error. this is that it interprets unwanted or undesirable behaviours as symptoms of mental illness

Question 21

szasz four headings?

Answer 21

50 years of change in US mental health care

mental illness: a medical or legal concept

‘mental illness’ is a metaphor

revisiting ‘the myth of mental illness’

Question 22

50 years of change in mental health care?

Answer 22

distinction between mental and medical hospitals has disappeared

most mental health care is responsibility of government, public money; legally responsible for preventing patients being a threat to themselves or others

argues there is no legally valid non-medical approach to mental illness, just as there is none to measles

Question 23

mental illness: a medical or legal concept?

Answer 23

politicians now claim mental illness to be like physical illness, diagnosed and treated as accurately

this turns these false beliefs into lying facts

this isn’t based off of scientific research and is a revival of the humoural theory

mental hospitals are like prisons: involuntary hospitalisation and coercion

Question 24

‘mental illness’ is a metaphor?

Answer 24

accepts physical causes for some mental illnesses but argues this means they were never mental illnesses, but undiagnosed physical illnesses

eg. historically, illnesses such as syphilis have manifested in ways interpreted as ‘madness’

the term refers to judgements of others behaviours, creating an ever expanding list of conditions

the principle ‘do no harm’ is discarded and replaced with preventing the patient from harming themselves or others, discarding liberty

Question 25

revisiting ‘the myth of mental illness’?

Answer 25

the book was ABOUT psychiatry not ON psychiatry, an effort to recast mental health from a medical problem to a linguistic rhetorical phenomenon

one of the worst assumptions in psychiatry is that mentally ill people are sick patients who need treatment regardless of whether it’s wanted

psychiatry refers to two things: healing via conversation and controlling people by force with government backing

people accept medical justifications just as they used to religious ones, viewing mental health systems as morally and medically legitimate

Question 26

szasz conclusions?

Answer 26

mental illness = myth/metaphor

patients are just using whatever coping mechanisms they can to deal with the world and are not passive players to biological forces

medicalisation and politicisation of psychiatry has led to dehumanised system of care, with people deprived of freedom to behave as they would normally

Question 27

szasz suggestions?

Answer 27

psychosis & neurosis to be viewed simple as behaviours that disturb others/self; patients shouldn’t be seen as helpless victims; withdraw from coercive psychiatric practices

accept that the ‘mentally ill’ have reasons for their actions that should be understood, they cannot be treated or cured but being treated with respect may help them overcome their obstacles