Historical Context Flashcards
Animism
Believed mental illness arose from evil spirits taking control of a person and controlling their behaviour.
Evil spirits took the form of animals, ancestors, gods or victims who’s wrongs weren’t redressed.
Treatment: holes in skull to release evil spirit- trepanning.
Situational- madness arising from external source (evil spirit). Individual- spirit may have took control of them due to their actions.
Humourism
Hippocrates claimed the body was made up of the 4 humours: yellow bile, black bile, blood and phlegm. Illnesses occur when there’s too much or too little of a humour.
Sanguine humour- too much blood= changeable or inconsistent
Phlegmatic humour- too much phlegm= sluggish and dull
Choleric humour- too much yellow bile= irritable and aggressive
Melancholic humour- too much black bile= moody and anxious
Restoring balance is done by sexual abstinence, blood letting, sobriety, purgatives.
Individual- how a person experiences mental distress because of imbalance because of the humours (but could be because of external reasons e.g. diet or housing)
Animalism
Disorder explained in terms of person losing their capacity for reason (which is what distinguishes us from animals) so they exhibit unruliness and wildness.
Treatment focuses on restoring reason through fear by treating the person like an animal- bald scalp, chained to cell, whipped, bled and purged.
Individual
Rosenhan- 4 ways of defining abnormality
Statistical infrequency- if a behaviour someone displays isn’t within the societal norm it can be regarded as abnormal/ not the statistical norm for that society.
Failure to function adequately- inability to live a normal life e.g. hold down a job, maintain a relationship, interact effectively in society, look after yourself.
Deviation from social norms- if someone goes against behaviours deemed normal and acceptable by society.
Deviation from ideal mental health- someone can be deemed as abnormal if they don’t have ideal mental health ( positive self image, growth and development, independent thoughts and actions, accurate perception of reality and being able to cope with demands of reality, maintaining interpersonal relationships).
DSM-5
How DSM-5 categorises dysfunctional behaviour.
- chronological lifespan order. Neurodevelopmental disorders e.g. ADHD come first while neurocognitive disorders e.g. Alzheimer’s come last.
- Internalising disorders (depression/ anxiety where distress is caused to individual) or externalising disorders ( substance abuse disorders which cause harm to others).
- 22 categories e.g. obsessive compulsive disorders, sleep-wake disorders, feeding and eating disorders.
- For each disorder, includes details on diagnostic criteria, gender related diagnostic issues, culture related diagnostic issues.
Rosenhan study 1
8 sane people going to 12 different mental hospital admissions saying they all heard a voice of the same sex saying the words ‘hollow’, ‘thud’ and ‘empty’. Once they were admitted they stopped showing symptoms and continued with ward activities while recording the behaviour of staff and patients.
On all occasions the pseudopatients were admitted to hospital with the diagnosis of schizophrenia (once with manic depressive psychosis). All stayed from 7-52 days and once released were labelled as ‘schizophrenic in remission’.
In the hospital, normal behaviours such as writing in the notebook and queueing early for lunch were seen as schizophrenic behaviours.
Hospital staff were reported being abusive to patients and only stopping when approached by other staff. They spent very little time with patients (11.3%) and didn’t notice that they were pretending.
The other patients did: saying things like ‘you’re not sick’, ‘you’re here to check up on the hospital’, ‘you’re a journalist or professor’.
Experiment within rosenhans study
In 4 of the hospitals, the pseudopatient approached a member of staff and asked a simple question e.g. ‘pardon me miss/mr/dr, could you tell me when I will be presented at the staff meeting?’. Responses were recorded: whether they averted their eyes and moved on, stopped and talked, made eye contact, pauses and chats.
This was also done in Stanford university where a young female asked a member of staff who looked busy 6 questions: ‘pardon me, could you direct me to Encina hall?’, ‘how does one apply for admission to the college?’
Another was done at a university medical centre where a young female said ‘I’m looking for a psychiatrist’ or ‘I’m looking for an internist’
More people stopped and talked in university and medical centre.
More people averted eyes in hospital.
However the hospital (1283 nurses) had a much larger sample than in the university and medical centre (14 uni staff)
,
Rosenhan study 2
Rosenhan told a teaching research hospital there would be 1 or more pseudopatients attempting to be admitted into the hospital in the next 3 months. Staff were asked to judge each patient on a 10 point rating scale of how likely they were to be a pseudopatient. Staff were told to treat all patients as if they were real patients so no one would miss out on treatment they needed. No pseudopatients actually attempted to be admitted into the hospital.
Number of patients at least one staff member staff said were definitely pseudopatients: 41
Number of patients at least one psychiatrist said were definitely pseudopatients: 23
Number of patients one psychiatrist and one staff member said were definitely pseudopatients: 19
Conclusions
- Mental hospitals in the USA in the early 1970s were not very good at making valid diagnosis of mental disorders (as in study 1 they failed to detect sanity and in study 2 failed to detect insanity).
- Mental hospitals in the USA in the early 1970s were not very good at making reliable diagnosis of mental disorders as 11 people were diagnosed with schizophrenia but one person was diagnosed with manic depressive psychosis.
- USA mental hospitals in the USA in the 1970s viewed all behaviours as reflecting the given diagnosis of a patient.
- Patients in mental hospitals in the USA in the early 1970s were treated with profound disrespect by attendants (‘come on you mother fucker, out of bed!’
Evaluation of Rosenhan
Reliability- 11times the pseudopatients were diagnosed with schizophrenia but once diagnosed with manic depressive psychosis.
Validity- high in ecological validity because observation done in a real life setting and people weren’t aware of a study. Also low in validity because in study 1, staff failed to detect sanity and in study 2 they failed to detect sanity.
Ethics- no right to withdraw or consent in study 1 as patients and staff weren’t aware their actions were being recorded. Pseudopatients could’ve caused harm by taking up valuable time.
Deception in study 2 because the hospital was told pseudopatients would try to be committed but this didn’t actually happen.
Identity of the hospitals was kept confidential.
Ethnocentrism- only done in hospitals in the USA. Hospitals in Europe may have better staff training e.g. better at diagnosing mental disorders and less abusive.
Usefulness- very useful in highlighting that staff in mental hospitals need more training on how to deal with mentally ill people.
Highlights the need for DSM-11 to be revised - when published in 1980 it had clearer, more quantitative diagnostic criteria for disorders.
Individual/ situational- it was proven by comparison studies that the situation of the location of the mental hospital meant more staff averted and walked away compared to medical facilities and universities where people stopped and talked.
Normal behaviour in the hospital was deemed abnormal e.g. queuing for lunch.
Characteristics of an affective disorder: depression
5+ of these symptoms present during the same 2 week period. At least one of symptoms is depressed mood or loss of interest or pleasure. All occur nearly everyday for most of the day.
- depressed mood
- insomnia or too much sleep
- loss of interest or pleasure in all activities
- more than 5% weight loss not due to diet or change to appetite
- fatigue or loss of energy
- feelings of worthlessness or excessive guilt
- lacks ability to think, concentrate or make decisions
- recurrent thoughts of death or suicide, suicide attempts
Characteristics of a psychotic disorder: schizophrenia
- Hallucinations (auditory or visual)
- Delusions (believing you are being persecuted, believing you are famous or being controlled)
- Word salad (disorganised speech)
- Grossly disorganised or catatonic behaviour (in an unresponsive stupor)
- Negative symptoms e.g. diminished emotional expression (reduction in willingness to talk to others, reduced motivation to do anything).
- Positive symptoms: behaviours experienced in excess of normal behaviours like delusions and hallucinations.
- To be diagnosed person needs at least 2 symptoms for a month and they need to lead to the reduced ability to function.
- Should not be caused by other factors like substance abuse.
Characteristics of an anxiety disorder: phobias
Specific phobia: extreme fear of a specific object or situation (e.g. spiders, water, tight spaces, dogs).
Social phobia: intense and excessive fear of being in a situation where one is exposed to possible scrutiny by others. Fear of acting in a way that would be embarrassing to the self or others. Social phobias include fear of public speaking, fear of interacting with an authority figure and general anxiety in most social situations.
Agoraphobia: the fear of open spaces, fear of being in situations where escape is difficult or help is unavailable.
Disorders evaluation
Reliability: DSM-5 has a specific checklist of criteria a person must be displaying before they can be given a diagnosis of a disorder. All clinicians have the same checklist so are consistent in diagnosing disorders. Overlap in symptoms between disorders makes diagnosing difficult.
Socially sensitive: employers may not want to hire people with a mental disorder like schizophrenia so find other reasons not to employ them. In this way, the diagnosis has a negative impacts.
Ethnocentrism: DSM-5 says assessment of disorganised speech may be made difficult by linguistic differences across cultures- assessment of affect requires sensitivity to differences in styles of emotional expression and body language which vary across cultures. In some cultures or religions, having hallucinations in religious context is normal (e.g. god speaking to them).
Usefulness: receiving a diagnosis means a person can receive treatment for their disorder which can make a positive difference on their life e.g. support services.
Strengths and weaknesses of a patient having to display listed characteristics to receive a diagnosis.
Strengths:
Reliability- helps to ensure clinicians are diagnosing in the same way (controlled).
Validity- ensures only people with the disorder are diagnosed with the disorder assuming the symptoms characterise the disorder.
Weaknesses:
Validity-
Clinician may have bias affecting the accuracy of the diagnosis.
Symptoms depend on self report. Will patients report their moods and thoughts accurately?
Mental disorder may not be the reason for symptoms.
