Alternatives to the Medical Model Flashcards
The Behaviourist Explanation of Mental Illness?
Behaviourist perspectives follow the belief that mental health issues are learned. Using those behavioral theories, could you attempt to describe how they could explain the development of depression?
Treatments:
Aversion therapy:
This is used to produce and unpleasant association, such as sickness with alcohol addiction. This could be used in relation to depression by using electric shocks every time the person exhibits depressive symptoms. The effectiveness of this approach can be largely questioned!
Positive reinforcement:
This is effective if people around the depressed person removes positive reinforcement of depressive symptoms and only rewards the person when they show non-depressive symptoms. Lewinsohn found that training parents to reinforce non-depressive symptoms, along with cognitive therapy to their children, there depressive symptoms significantly reduced.
Classical Conditioning
Classical conditioning:
Classical conditioning proposes depression is learned through associating certain stimuli with negative emotional states. For example, someone going to work everyday and feeling really down, may associate work with depressive moods. They then might avoid going to work and become further isolated – leading to further depression.
Operant Conditioning
This is the idea that people learn behaviours through positive and negative reinforcement. Both types of reinforcement work by encouraging a behaviour.
Operant conditioning states that depression is caused by the removal of positive reinforcement from the environment. Certain events, such as losing your job, induce depression because they reduce positive reinforcement from others (e.g. being around people who like you).
The Cognitive Explanation of Mental Illness?
This theory states that errors in cognitive processes can explain mental health. Cognitive psychology assumes that all mental health issues derive from faulty thought processes. Depressed people tend to have irrational cognition and distorted thoughts and judgements. Therefore, it is the way in which individuals perceive and think about situations that causes the depression, rather than the situation itself.
Over-generalisation: Viewing one unfortunate event as part of a never ending defeat or struggle e.g. ‘everything always goes wrong for me’
Filtering: Giving greater consideration and focus to negative aspects, while ignoring positive ones e.g. ‘it doesn’t matter that i passed the test because I got that silly question wrong and I’ve let myself down’
Catastrophisation: Making a mountain out of a mole hill – feeling that a situation is or will be far worse than it actually is e.g. ‘I got the customers order wrong, I’m bound to get fired now’
Cognitive - Behavioural Therapy for Depression
The therapist consistently teaches cognitive and emotional-regulation skills, so that the patient becomes their own therapist. The skills are usually taught over 6-12 sessions so that the patient can use these skills independently
The therapist identifies irrationality of the faulty beliefs and then tries to reconstruct more rational thoughts. For example, rather than thinking that the future is hopeless, the therapist may explore options for the client that are possible, showing the illogical thinking behind their belief that there is no future. The aims of CBT are as follows:
To re-establish previous levels of activity
To re-establish a social life
To challenge patterns of negative thinking
To learn to spot the early signs of recurring depression
The Psychodynamic Explanation of Mental Illness?
The key principle of the psychodynamic approach is the idea that the unconscious mind and early trauma has a key influence on mental health issues.
Freud believed that emotion (which he termed, psychic energy) has the same properties as physical energy i.e. that it can be stored, transformed or discharged, but not destroyed. A build up of negative psychic energy results in repressed emotions and then forms into mental health issues.
Freud believed that depression could be linked to traumatic events such as the loss of a parent or feeling rejected by a parent. There is a constant unconscious battle between anger towards the parent, and love for the parent. This conflict of emotions leads to repression causing guilt and low self-esteem – symptoms commonly displayed in people who suffer with depression. Freud believed that the key influence in depression was ‘self-hatred’. He believed that during childhood, you repress emotions such as anger, as you fear punishment or guilt if you express them. this anger then manifests into self-hatred where the child constantly feels that they are not good enough.
Psychodynamic Therapies for Depression
Psychoanalysis is a very intensive therapy, taking place 4-5 times per week and lasting for several years. Usually the person would lie down and face away from the therapist
Psychotherapy is less intensive, typically 1-3 times per week and can last between 1-5 years. Usually the therapist and patient would be facing each other.
In both types of therapy the emphasis is on exploring the patients past and linking it to their current symptoms. Early experiences of loss and rejection are particularly important in depression.
Psychotherapy works by helping the patient to vividly recall experiences (known as abreaction) and then discharge the associated emotion (known as catharsis). This helps the patient to release the anger and understand how it relates to their feelings of guilt and low self-esteem
Key Research?
Szasz (2011) - The myth of mental ilness
Aim?
Szasz revisits his famous essay ‘The myth of mental illness’. He considers the current medicalisation of abnormal behaviour in the light of his earlier arguments.
Method?
Szasz paper is an essay on psychiatry and how it affect those who experience mental health issues. As such it is not a study and does not involve participants or specific procedures.
Findings?
He believed that people with mental illnesses should not be treated in the medical sense. This essay aimed to look at his initial research on mental illness in the 1960’s and then reconsider how his points may or may not be valid.
1960’s:
- Health care for mental health consisted of mental hospitals and private professionals
- Mental patients are treated no better than prisoners. Patients have few rights – e.g. held against their will with no chance to appeal that decision
- Mental illness is not the same as physical illness
- Mental illness doesn’t exist, so it is foolish to look for causes or cures
Reconsiderations in 2010:
- All mental health care is provided by the NHS and the aim is to prevent danger to patients and others
- A false belief that is apparent in research is that mental illness can be diagnosed accurately and treated successfully
- Mental illness is seen as being a disorder of the brain, despite there being no scientific evidence that mental illness is caused solely by the brain
- Mental disorders are labels given to people with undesirable behaviours
- Doctors don’t see people as inherently bad, but if they perform negative behaviours, it is a result of their mental illness
- Consent for treating mental illness does not happen
- Medical treatments should not be used to treat mental illness. People need to be helped to overcome obstacles and treated with respect
Conclusion?
- The medicalisation and politicisation of psychiatry over the past 50 years has led to a dehumanised model of care.
- Mental illness should be regarded as a metaphor; a fiction.
- Szasz rejects the moral legitimacy of psychiatry as it violates human liberty.
