Conceptual and historical issues in mental health Flashcards
Mental health disorders in Ancient times
4 points
- Mental disorder attributed to possession by demons or gods
- Could be positive/negative
- Demonic possession treated through exorcism
- Addictions were thought of as sins
Mental health disorders in Greek and Roman thought (400 BC)
4 points
- Mental disorders were not due to demons, but had natural causes and appropriate treatments
- Brain is the central organ of mental activity
- Mental disorders due to brain pathology (imbalanced fluids)
- Treatment consisted of lifestyle (sexual abstinence, sobriety, diet changes, tranquility) and environmental changes
Mental health disorders in Middle ages (500-1500 AD)
2 points
- Greek ideas survive in the Middle East, with Mental Hospitals set up in Baghdad, Aleppo, and Damascus
- In Europe:
- Mass madness
- Exorcism
- Witch hunting
Mental health disorders in Late middle ages/early Renaissance
4 points
- Madness replaces witchcraft
- Move away from religious influence
- 16th century onwards: establishments of asylums
- Confinement of the mentally ill
Bedlam
4 points
- St. Mary of Bethlem, London
- A monastery set up in 1243
- Made into an asylum in 1547
- Hospital for the mentally ill
- Deplorable conditions
- Crude and painful treatments
- Bedlam now mean “a place of wild uproar and confusion”
Humanitarian Reform
Phillipe Pinel
- Phillipe Pinel - La Bicetre Hospital France - 1792
- Removed the chains of inmates and treated them kindly
- Filth and noisiness replaced by order and peace → for high class inmates
What did William Tuke and Benjamin Rush do?
Similar work to Pinel
- Moral management became a feature of the time: Rehabilitation of character, through manual labour and spiritual discussion
What was the mental hygiene movement?
2 points
- improving physical conditions for the mentally ill
- Supported by Dorothea Dix, who was responsible for the establishment of 32 mental hospitals
Mental disorders in The early 19th Century
2 points
- Asylums controlled by laypersons, not doctors
- Moral management was the treatment on offer
Mental disorders in The late 19th Century
2 points
- Psychiatrists have more influence on treatment
- Mental health conditions have vague definitions (’nervous exhaustion’) which are considered treatable
Early 20th century: growth in asylums
2 points
- 1946 onwards: greater attention to care in hospitals due to public concern
- Development of outpatient clinics, inpatient facilities in general hospitals, community consultation
Late 20th century
2 points
- Use of medication like lithium to treat depression
- De-institutionalisation: efforts to close mental hospitals
Grief
Grief is a natural response to the loss of a loved one
→ Symptoms begin to decrease overtime
DSM-5 TR Prolonged Grief Disorder (definintion)
The loss of a loved on had to have occurred at least a year ago for adults, and at least 6 months ago for children and adolescents
DSM-5 TR Prolonged Grief Disorder (symptoms)
- Experienced at least three of the symptoms nearly every day for at least the last month prior to the diagnosis
- Person’s bereavement lasts longer than might be expected based on social, cultural or religious norms
Critics of the DSM
- DSM 5 will dramatically increase the rates of mental disorder
- by reducing thresholds for existing disorders;
- by introducing new high prevalence disorders at the boundary with normality
thinking critically about mental disorder
philosophy & epistemology
- Philosophy of the concept of mental disorder
- How can we define mental disorder
- Philosophy of the concept of psychopathology?
- Rationality, power, biology
- Epistemology of psychiatry
- Natural kinds (e.g. diseases)
60s
The history of madness in the middle ages
- social and physical exclusion of lepers
→ Leprosy disappeared so madness came to occupy this position
The history of madness in the 15th century
ship of fools, sending mad people away in ships
The history of madness in the renaissance
accepted in society, those who push rationality to the boundary are closer to god’s wisdom
The history of madness in the 17th century
the great confinement
The history of madness in the 18th century
madness (vs reason), lost what it is to be human, treated like animals
The history of madness in the 19th century
madness regarded as a curable mental illness (e.g. Pinel, Freud)
Foucault’s Argument: early middle ages
parallel between the medieval isolation of lepers and the modern isolation of madness
Foucault’s Argument: Late Middle Ages and early Renaissance
the mad led an ‘easy wandering life,’ madness having been recognised as part of truth
Foucault’s Argument: Mid-17th century
the age of the Great Confinement & exclusion were distinctive features of the Classical Age’s attitude toward madness
Foucault’s Argument: 19th century
transition to madness as a mental illness, Tuke and Pinel “invented” mental illness
The classical experience of madness (Foucalt)
3 points
- Foucault was not interested in the event of confinement as such
- He was interested in the attitudes toward and perceptions of madness connected with the practice of confinement
- Madness as one division of a wider category “unreason”
Individuals not considered to be following societal norms:
4 points
- Not just those with mental health conditions
- sexual offenders
- those guilty of not following religious practices, blasphemy
- free-thinkers
The classical experience of madness 1st level
confinement as an economic policy
- Meant to deal with problems of poverty
- Getting a large class of idle people off the streets and putting them to work
- hid instead of eliminating poverty
The classical experience of madness 2nd level
Those confined were regarded as moral troublemakers worthy of society’s condemnation and punishment
madness 2nd level +
mad = animal
- behaviour was a deep restructuring of moral categories → mad = animal
- “Madness is assimilated to the broader category of unreason”
- It is detention rather than treatment of the mad that is characteristic of this Classical experience
From morals to science
5 points
- 18th-19th century new scientific views appearing
- “humanisation” of treatment (Pinel, Tuke)
- Madness is a disease of “mind”
- 96000 people came to watch the inmates at Bedlam Hospital in London
The Asylum
2 points
- From the mid-19th century there is a shift in the treatment of madness to the ‘asylum’ and then to psychiatric clinics
- By medicalising madness, we move to moral decision to scientific categories of aetiology, nosology and treatment plans
The Ani-psychiatry movement
2 points
- Psychiatry was founded on a false epistemology: illness diagnosed by conduct but treated biologically
- Challenges the core values of a psychiatry which considers mental illness as a primarily a biological phenomenon, of no social, intellectual or political significance
The Ani-psychiatry movement: Two central contentions
- The specific definitions of current psychiatric diagnoses or disorders are vague. leaving too much room for opinions and interpretations to meet basic scientific standards
- Prevailing psychiatric treatments are ultimately far more damaging than helpful to patients
The Ani-psychiatry movement: Criticisms of psychiatric authority
4 criticisms
- Inappropriate and overuse of medical concepts and tools to understand the mind and society
- Scientifically and/or clinically ill-founded system of categorical diagnoses (e.g., DSM) and stigmatization
- Unexamined abuse or misuse of power over patients who are too often treated against their will
- Compromise of medical and ethical integrity because of psychiatrists’ financial and professional links with pharmaceutical companies and insurance companies
Wakefield: The concept of mental disorder
2 points
- Sexual, racial and sexual orientation biases in diagnosis
- Psychodiagnosis is often used to control, stigmatise socially undesirable behaviour that is not really disordered
Sexual orientation bias 1973
2 points
- American Psychiatric Association removes homosexuality from DSM
- Why? weight of empirical data, coupled with changing social norms and the development of a politically active gay community in USA
Sexual orientation bias 1975
Psychologists removed it and replaced DSM with new diagnosis ego-dystonic homosexuality (DSM II)
Sexual orientation bias 1986
Diagnosis was removed entirely from DSM
Wakefield: The concept of mental disorder, why is it important to understand the concept?
For constructing “conceptually valid” diagnostic criteria that are good discriminators between disorder and non-disorder
Wakefield: The concept of mental disorder, value vs scientific approach
6 points
- The myth of the myth of metal disorder
- Disorder as a pure value concept
- Disorder as whatever professionals treat
- Disorder statistical deviance
- Disorder as biological disadvantage
- Disorder as unacceptable distress or disability
The myth of the myth of mental disorder
3 points
- Szasz “there is no such thing as mental illness”
- Mental disorder is evaluatory label that justifies the use of medical power to intervene in socially disapproved behaviour
- Szasz: physical disorder = physical lesion (deviation in an anatomical structure)
Problem: psychological functioning is not accompanied by any identifiable lesion. Is that true? (Szasz)
Reply: Szasz’s lesion account is inadequate
Why is Szasz’s lesion inadequate?
2 points
- Deviant anatomical structures are not ‘lesions’ per se. It is not the existence of a lesion that defines a disorder
- Not all deviations are lesions: deviation is a ‘lesion’ only if it impairs the ability of the anatomical structure to accomplish the functions
What did Szasz suggest?
Psychological functioning was not accompanied by a lesion but we now have neuroscience methods that enable us to identify alterations in brain structure and functioning
Identification of alterations in brain structuring and functioning has the potential to:
Identify biological markers of mental health conditions
“Disorder is a value concept, and social judgments of disorder are nothing but judgments of desirability according to social norms and ideals”
is there any truth to this statement?
Yes. Disorders are conditions that justify social concern, social values are involved
disorder as a statistical advantage
disorder as a statistical advantage
disease as quantitative deviations from the statistical norm
disorder as unexpectable distress or disability
incorrect classification of greater than average normal responses as disorders. An above the mean reaction to a stressor is a disorder
what is dysfunction? (Wakefield)
dysfunction is the failure of a mechanism to perform its natural function
dennet’s three levels
- physical stance: level of physics and chemistry
- design stance: level of biology and engeneering
- intentional stance: level of software and minds (belief, thinking and intent)
