Gavin MHI 1 Flashcards
Stats on increasing MHI
2007: 1/4 adults 16-74, in 2014 half were accessing treatment. In2010: public donates 500 mill to cancer research, less for MH (most is Alzheimer’s)
biological supernatural approach
Stone age/ neolithic 3000BC skulls show trepanning to get rid of mental health disorders by letting out the evil spirits- selling 1940, some were done many times, some larger, some had survived and healed (survival was 40%). Mhi due to displeasure of gods/demons. Possession of spirits - exorcism
Classic Antiquity: Naturalistic approach
Hippocrates 460-377bc. MH had natural causes like imbalance of humours e.g. excess black led to depression so need sobriety, no sex, care over food . Born in kos believed medicine should be scientific discipline, holistic (drugs, diet, exercise) mental and physical related/ healthy mind healthy body, healing the soul via music. Brain organ of consciousness, monks prayed over them
Emperor marcus aurelius: 161-180 AD
Stoicism, cooed W stress of running Roman Empire, kept notebook for + thoughts (meditation), everything is an opinion not a fact (like cbt)
Galen 129-216 AD
Physician to gladiators and Aurelius. Distinguished between physical and mental disorders like brain injury and emotional stressors. Wrote on the passions and errors of the soul, had talk therapy
Middle ages: 578AD: Europe more focused on the supernatural
Bethlam hospital: housing for poor and sick in 1247 Boswell ‘the life of dr johnsn’: went as entertainment
Jane Eyre in Charlotte bronte: the lunatic is both cunning and malignant, she has never failed to take advantage of her guardians temporary lapses, once to secrete the knife with which she stabbed her brother.
Cultural and scientific renaissance 14th-16th C:
Gutenburg 1440:printing press, enabled dissemination of knowledge on a scale never seen.
Copernicus/Galileo 1610: moon orbiting jupiter but persecuted as said didn’t all orbit earth.
Newton:1687 individual liberty and religious tolerance,
Asylums
Pinel (father of modern psychiatry) established better conditions, moral management, seen in a painting, reserved for mainly upper class . York retreat: Hannah mills the Quaker admitted and died there so quakers develop better alternatives (York retreat 1796). Bethlam wakefield another Quaker inspected and saw p James norries who was restrained forever , House of Commons did reforms. Hired other doctor who did sport, music, food and clothes
Examples of bad treatment in asylums
Elizabeth: done for infantacide and epileptic fits, stayed for 10 years then released. Sarah gardener: worthlessness, stigma about working for a man in the home and festered by fiancé, after 2 months was discharged and recovered. Emma riches: PnatalD, out in strong dress (can’t be torn), wouldn’t eat but symptoms passed 1 year, Daniel mcnaighten: Manama and homocide due to delusions (insanity defence), John Payne: ruffianism and homocide, NGRI, after mental hospital took up a trade and cared by sister
Old treatments
The swing: rush 1772, madness due to inflammation of brain, reduced attention to world, tranq chair (reduced sensory input), wet packs (for schizo, could use water baths for hours), insulin shock therapy (given in bigger doses 6/week until coma- sakel, ECT (induce seizure, reduced some depression, no numbing, overused), full frontal lobotomy (moniz broke connection thalamus and frontal, unconscious via ECT, deaths and deficits
Current approaches to defining mental disorders: general criteria and weaknesses
Statistical infrequency, violation of social norms, personal distress, disability, harmful dysfunction. Wakefield 1992, has limitations like socially constructed and there’s exceptions
First know classification by Hippocrates
mania, melancholy, phrenitis, insanity, disobedience, paranoia, panic, epilepsy, hysteria. Need to be handled like physical, sensitivity reached the brain through breathing
The dsm and weaknesses
In ‘52 had 106, dsm 5 has 400 in 2013, more continuous and more valued research. Mezzich- expensive, cultural bias (medicalisation) e.g. Dexedrine/amp sold to tired women, ties to the drug industry and dsm
Icd
Took over by WHO before it was physical, 2022 has hundreds. S: more simple, free W: more qualitative and general, lacks new stuff like BDD
BPS
30% are disorders not otherwise specified, reliability issues when diagnosing freedman 2013, culturally dependent as had homo till 1994, drapetomania for slaves wanting to run away
3 characteristics of any diagnosis
Personal distress tho not all (antisocial don’t feel guilt, not all stress is a disorder like grief), disability and dysfunction (impairment in area of life, not all like bulimia, being blind not included, developmental, physiological and biological dysfunctions), violation of social norms (too broad as criminals break and anxious ppl don’t, vary across culture)
Lunacy trials
From 13th c on, hospitals were secular, mad safe until restored to reason. Trials to determine MH, crown became guardian of estate, memory, habits examined. Strange behaviour due to physical illness or injury, demonic possession, term lunacy from Paracelsus misalignment W moon and stars
Origin of asylums
Until 15th c few and many for leprosy, as it decreased they were converted,. Viewing bedlam options aas entertainment, rush: express boood in the brain, cured by being frightened,
Old bio approaches to MI
Syphilis caused worse mental and physical health, given name paresis. 1860s, pasture created germ theory and 1905 microorganism for syphilis discoursed. Galton study of twins said behaviour hereditary and created eugenics movement , Mesmer: ppl had hysteria and some physical effect s, caused by magnetic fluid in body, used rods to change (hypnosis), Charcot said due to nervous system
Breuer and Freud
Breuer treated hysteria via hypnosis, talked about past (cathartic method), Jung said temporary fix and p used morphine. Fried: unconscious conflicts between I’d ego and superego . Defence mechanisms (denial, projection, displacement, regression, repression, rationalisation
),. Jung collective unconscious (archetypes, happened from working towards goals.
Criteria for DID
Disruption in the normal consciousness, memory, identity, emotion, perception, motor control and behaviour
Criteria A- two or more distinct personality states, some cultures say possession, discontinuity in sense of self and agency
B- recurrent gaps in the recall of everyday events/ traumatic events
First documented case of DID
jeanne fery was a dominican nun in 16thc france described in van der hart 1996, was disturbed had 21 month course treatment care by nuns and exorcists and she also made documents. Range of identities like Mary Magdalene, 7 deadly sins, sanguinnaire. Told by Magdalene that she had to leave the others
Exorcism of anneliese michel
1952, religious family, seizures and depression, intolerant of religious objects , posses by 6 demons, 1-2 exorcisms a week and died from malnutrition and dehydration- no justice and made into a film the exorcism of Emily rose 2005
Dissociation original definition- Pierre Janet
1886 traumatic events lead to extreme dissociation and multiple personalities and hysteria. Simple form is paralysis of a limb, complicated from is DID
Devils demons possess a person -witztum and van der hart 1993
The case of Sybil
Schreiber ‘73- book on analysis of sybil (shohrley manson), 16 personalities brought together to a person called the blonde. Nathan 2011 found no evidence of alters, encouraged to create the,, Manson admitted she was lying. Most diagnosed were women, Wilbur wanted a did case and gave Sybil attention, she was suggestible
The fantasy model - dalenberg
Dissociation propensity, mediators (fantasy proneness, absent minded, executive dysfunction, suggestibility- false memories of trauma (unreliable reports of trauma). Dalenberg: did intrinsic property
Sociocognitive model merckelbach
Tendencies correlate with fantasy process and self reported childhood trauma but dissociation & fantasy link to trauma self reports. Piper and Merksey: the persistence of folly, culture bound due to leading Qs and suggestibility
Trauma model
delenberg : trauma-mediators (genetics, developmental issues, stressors)-dissociation
Marmar: vietnam veterans reported many traumatic dissociative experiences (floating above a scene, not aware of things that happened, blanking out, disconnected from body)
Dissociation and ptsd : carlson, Allen, dalenberg, carlson,
Carlson: relationships between ptsd severity and self reported dissociation. Allen: higher mean score of childhood trauma associated with more dissociation. Dalenberg and carlson- the model and avoidance is trying to reduce stress which can increase it
Neurological studies of did Nicholson, sar, elzinga
Nicholson: those W ptsd and dissociation had enhanced amygdala frontal cortical activity (emotional consciousness and regulation). Sar- increased cerebral blood flow in did patients in frontal regions of host state . Elzinga: did had higher anxiety, less conc and more activity in pfc in working memory task . Due to pattern recognition, reinders could id people 74%. Those w derealisation don’t integrate info the same
Problem and solution for mri studies in did
Reinders: people respond diff but findings can’t say origin and could be due to fantasy proneness . Study compared did vs high fantasy prone in 2 states neural identity (normal) or trauma identity. Did showed larger response to traumatic stim in tis and exaggerated response to neutral story
Treatment -brand
Establish safety, alliance, grounding. 1. Safety, CBT, recalling traumatic events, coping strategies. Some reduced but not cured
Etiology of did renaud and brain regions
When asking ps to wear goggles that distort visual info about where a person is being touched can produce temporary experiences of derealisation (renaud)
Brain regions that process bodily cues e.g. anterior cingulate cortex are underactive when viewing emotionally evocative images
Criticisms of models of did
Child abuse occurring is subjective, abused people seek explanations for symptoms, did increased due to media and therapists (iatrogenic/created W treatment). Treatment reinforces as interview about identities. Boysen 2014: ppl can role play symptoms and produce diff personality tests . Postman 20l3: did performed same as controls in implicit memory but said didn’t remember first test
