Current conceptualisations of mental health Flashcards
Who popularised the term ‘social stigma’ in 1963?
Erving Goffman.
According to his theory, stigma is defined as an attribute, behaviour, or reputation which is socially discrediting. Such discrimination can lead to disadvantages in many life aspects such as personal relationships, eduction, and work. When people internalise stigma, self-esteem can diminish, leading to feelings of shame, alienation, and withdrawal.
When and by who was mental disorder first classified?
In the early 20th C by the Lunacy Commissioners’ coding schemes.
What new classification system was put in place by the Lunacy Commissioners in the early 20th century?
The new Lunacy Commissioners’ coding scheme consisted in:
1. Separated aetiology (causes) from diagnosis
2. Input from psychiatric clinicians and patients was used to identify causes.
3. Sought to establish a patient’s medical record (history).
What classification system followed the Lunacy Commissioners’ coding schemes?
In the late 1940s, British psychiatry moved to use the International Classification of Disease’s framework by WHO.
Explain the ICD-based classification system.
- It moved away from cause & effect dichotomies (things that are represented as being opposed or different)
- Recognized there can be various causes for a mental disorder
- Made efforts to classify new emerging disorders.
What happened in the mid 20th century with the proliferation of psychiatric conditions?
The ICD based-diagnostic system effect:
1. New diagnosis such as depression & anxiety were greeted with confusion
2. Causes were reframed as diagnosis
3. Changes in nomenclature gained resistance
4. There was a call to reinstall older terminology.
What happened with disorder classification in the late 20th century?
According to Darian Leader, ‘commodification of the psyche’ reflected an explosion in diagnoses from 1 to 2 dozen to more than 360.
How did disorder classification changed in the late 20th century?
- Superficial states such as shyness were pathologised as disorders
- Drug companies played a big part on such changes
- DSM-V brought back controversies
- Over diagnosis
Name whose experiment’s questioned the validity of psychiatric diagnosis?
Clinical psychologist David Rosehan (influenced by Laing & Szazs). He and seven more cohorts got admitted into a psychiatric hospital and then started acting normal. Seven of them were diagnosed with schizophrenia. He then published the results in the Journal Science in 1973 which had a big negative response from psychiatric professionals.
What was the response to Rosehan’s experiment in 1973?
The study’s impact was reflected in the DSM-III (1980) by the introduction of more rigorous diagnostic processes.
What can we infer about Rosehan’s study?
The experiment was actually an anthropological study on psychiatric hospitals rather than a test of diagnostic practice. However, it proved that everyday behaviour was misinterpreted and pathologised in line with diagnosis.
What does the term ‘stigma’ encompasses?
- Lack of knowledge (ignorance)
- Negative attitudes (prejudice)
- Discriminative behaviour (discrimination)
What are known imitations of stigma research?
- It is mainly focused on schizophrenia.
- It is based on attitude surveys and media representations of mental disorders.
- There is not much information about effective stigma interventions.
- There are few direct contributions to research by service users.
- Stigma theories have de-emphasised cultural factors and paid little attention to human rights and social structures.
- Only a few intervention studies have been conducted.
- Few connections between academic writings and legislation concerning disability rights policy.
What are the socioeconomic factors associated with stigma?
Poverty and access to health care. They have been long associated with outcomes of mental illness. ‘Rates of anticipated and experienced discrimination are high across countries’.
What can be an effective measure to reduce stigma’s socioeconomic impact?
Disability discrimination laws will only be effective with interventions to improve self-esteem of people with mental illness.
What are effective anti-stigma campaign approaches?
- Improving public knowledge about mental illness.
- Directing education at specific communities and professions.
- Increasing opportunities for social interactions between people with and without mental illness.
- Promoting responsible media reporting on mental health related issues.
- Annual events, celebrity advocates, information in social media platforms, real life testimony, etc.
Name two campaigns that helped long-term reduction in stigma?
Time to change (UK) and Mental Health Europe
What are The hearing Voice Network principles?
- Seeing mental health distress as human.
Seeing symptoms as experiences and using humanistic language when describing these experiences. Start asking: ‘What has happened to you?’ instead of ‘What is wrong with you?’
- Keeping the person in the driving seat.
Giving people freedom to define their own experience and support should be based on need, not diagnosis. Allocating alternatives for people to better understand and manage their experience with mental illness. Providing information about pros and cons of each approach (eg medication).
- Creating supportive communities.
Giving community based options as an alternative to psychiatry. Upscaling awareness of the casual impact of social factors.
Name the social factors associated with stigma.
Poverty, gender, racial inequalities, unemployment, deprivation, abuse.
What are The hearing Voice Network key challenges?
Identifying which interventions will change behaviours and reduce discrimination, refocusing attention on mental health discrimination rather than stigma, and focusing on actual behaviour change rather than intended change.
a. Strengthen evaluation of initiatives
b. Enable people with MH difficulties to receive legal protection, comparable to those with physical disabilities.
Name the main names of the antipsychiatric movement?
Erving Goffman—’the total institution’
R. D. Laing—rejected medical psychiatry
Michel Foucault—mental illness as an 18th
century social construct (Madness and Civilization)
Thomas Szasz—denied the existence of mental illness
Ken Kesey—conceptualised psychiatric patients as nonconformists (One Flew Over the Cuckoo’s Nest)
When did the beginning of deinstitutionalisation start?
The 1960s has been regarded as a critical decade for British psychiatry. There was a cultural and social shift that put psychiatric hospitals under the eye of many, as the discipline was being called fundamentally coercive. Also, overhauls to existing health policies and service organizations. There was a calling for large-scale asylum closures in favour of community-based services.
